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Objective To screen the risk factors related to primary trigeminal neuralgia (PTN) based on radiomics. Methods A total of 48 patients with PTN admitted to Guangdong Second Provincial General Hospital from January 2017 to December 2020 were selected. The mean arterial pressure (MAP) of the patients was measured, and the neurovascular compression model was constructed by head MRI examination. Univariate and multivariate Logistic regression analyses were used to screen for risk factors associated with PTN, and the predictive efficacy was evaluated by receiver operating characteristic (ROC) curve according to the risk factors. Results Among 48 patients, 42 patients (87.50%) had unilateral lesions and 6 patients (12.50%) had bilateral lesions. The MAP was 56.89-120.44 mm Hg, with an average of (94.32 ± 11.34) mm Hg. The neurovascular compression model of 54 cases was divided into the affected side (n = 40) and the healthy side (n = 14) according to whether the disease occurred. The neurovascular compression area (Z = -2.823, P = 0.005) and neurovascular pressure (Z = -0.365, P = 0.006) on the affected side were greater than those on the healthy side. Logistic regression analyses showed that high neurovascular pressure (OR = 1.001, 95%CI: 1.0003-1.0022; P = 0.011) was a risk factor for PTN. ROC showed the area under the curve (AUC) of neurovascular compression area for predicting PTN was 0.747 (95%CI: 0.605-0.890, P = 0.006), the sensitivity was 42.50%, the specificity was 100%, and the cut-off value was 25.34 mm². The AUC of neurovascular pressure was 0.755 (95%CI: 0.616-0.895, P = 0.005), the sensitivity was 67.50%, the specificity was 78.60%, and the cut-off value was 1672.99 mm Hg⋅mm². Conclusions The neurovascular compression area and neurovascular pressure are important in the diagnosis of PTN. [ABSTRACT FROM AUTHOR]

Objective To examine the levels of systemic inflammatory response index (SIRI) and serum lipoprotein-associated phospholipase A2 (Lp-PLA2) in patients with acute carbon monoxide poisoning (ACOP), and to explore the predictive value of SIRI, Lp-PLA2 and their combination for delayed encephalopathy after acute carbon monoxide poisoning (DEACMP). Methods Total 265 patients with ACOP diagnosed and treated in Harrison International Peace Hospital of Hebei Medical University, The Second People's Hospital of Hengshui and The No.4 People's Hospital of Hengshui from March 2020 to March 2023 were included. SIRI and serum Lp-PLA2 levels were measured. According to the occurrence of DEACMP, they were divided into DEACMP group (n = 32) and non -DEACMP group (n = 233), while according to the degree of poisoning, they were divided into mild poisoning group (n = 20), moderate poisoning group (n = 107) and severe poisoning group (n = 138). Univariate and multivariate Logistic regression analyses were used to screen the risk factors of DEACMP in patients with ACOP, and the receiver operating characteristic (ROC) curve was drawn to evaluate the predictive efficacy of SIRI, Lp - PLA2 and their combination for DEACMP. Results The levels of SIRI (t = 13.068, P = 0.000) and serum Lp-PLA2 (t = 8.208, P = 0.000) in DEACMP group were higher than those in non-DEACMP group, and their levels gradually increased with the severity of poisoning, the levels of SIRI (t = 8.764, P = 0.000; t = 4.586, P = 0.000) and Lp-PLA2 (t = 3.726, P = 0.000; t = 2.038, P = 0.044) in the severe poisoning group and moderate poisoning group were higher than those in the mild poisoning group, and the levels of SIRI and serum Lp-PLA2 in the severe poisoning group were also higher than those in the moderate poisoning group (t = 10.294, P = 0.000; t = 2.700, P = 0.007). Logistic regression analysis showed the severe poisoning (OR = 11.695, 95%CI: 4.893-39.994; P = 0.000), SIRI increased (OR = 1.600, 95%CI: 1.033-2.476; P = 0.001) and Lp-PLA2 increased (OR = 11.302, 95%CI: 1.486-38.933; P = 0.000) were risk factors of DEACMP in patients with ACOP. ROC curve showed that area under the curve (AUC) predicted by Lp-PLA2, SIRI and their combination were 0.82 (95%CI: 0.754-0.894, P = 0.000), 0.82 (95%CI: 0.739-0.895, P = 0.000) and 0.87 (95%CI: 0.805-0.934, P = 0.000), sensitivity were 0.66, 0.72 and 0.84, specificity were 0.85, 0.88 and 0.90, respectively. The prediction efficiency of Lp-PLA2 combined with SIRI was better than that of Lp- PLA2 (t = 2.198, P = 0.027) or SIRI (t = 2.268, P = 0.023) alone. Conclusions DEACMP is easy to occur when SIRI and serum Lp-PLA2 were high in patients with ACOP. The combined detection of Lp-PLA2 and SIRI can be used for early screening of DEACMP. [ABSTRACT FROM AUTHOR]

Objective To screen factors influencing the neurological prognosis following lumboperitoneal shunt (LPS) in patients with hydrocephalus. Methods Total 136 patients who underwent LPS in Xuanwu Hospital, Capital Medical University from October 2014 to January 2020. The short-term neurological prognosis post-surgery were evaluated by modified Rankin Scale (mRS) at discharge. Univariate and multivariate stepwise Logistic regression analyses were conducted to screen factors affecting neurological prognosis. Results Of the 136 patients, 65 were categorized into the good prognosis group (mRS score ≤ 3), and 71 into the poor prognosis group (mRS score > 3). Logistic regression analysis indicated that an admission Glasgow Coma Scale (GCS) score of 9-12 (OR = 7.800, 95%CI: 7.205-8.443; P = 0.000) and 3-8 (OR = 6.299, 95%CI: 5.744-6.907; P = 0.006), as well as etiologies including traumatic brain injury (OR = 27.681, 95%CI: 24.270-31.572; P = 0.000), cerebral hemorrhage (OR = 13.017, 95%CI: 11.473-14.769; P = 0.005), subarachnoid hemorrhage (OR = 17.682, 95%CI: 15.683-19.935; P = 0.001), and other causes (OR = 5.851, 95%CI: 5.166-6.628; P = 0.050) were risk factors for poor short-term neurological prognosis in patients with hydrocephalus undergoing LPS. Conclusions The neurological prognosis after LPS in patients with hydrocephalus is influenced by multiple factors. Prognoses vary among patients with different admission GCS scores and different etiologies. Personalized treatment plans should be developed based on specific circumstances. [ABSTRACT FROM AUTHOR]

Objective To screen the risk factors of hydrocephalus after decompressive craniectomy in patients with cerebral hernia after traumatic brain injury (TBI), and construct a Bayesian network model based on the risk factors. Methods A total of 77 patients with cerebral hernia after TBI who underwent decompressive craniotomy in Nanjing Tongren Hospital Affiliated to Southeast University from March 2020 to January 2022 were included. They were divided into hydrocephalus group (n = 25) and non - hydrocephalus group (n = 52) according to whether hydrocephalus was complicated after surgery. The risk factors of hydrocephalus after decompressive craniectomy in patients with cerebral hernia after TBI were analyzed by univariate and multivariate Logistic regression analyses. The Bayesian network model was constructed based on the risk factors, and the receiver operating characteristic (ROC) curve and calibration curve were drawn and Hosmer-Lemeshow goodness-of-fit test was conducted. Results In hydrocephalus group, the Glasgow Coma Scale (GCS) score at admission (t = 2.178, P = 0.032), the ratio of cerebrospinal fluid replacement after lumbar puncture (χ² = 8.675, P = 0.003), and the level of β2 -microglobulin after operation (t = 11.146, P = 0.000) were lower than those in non-hydrocephalus group, while subarachnoid hemorrhage (χ² = 5.901, P = 0.015), bilateral operation (χ² = 6.441, P = 0.011), the ratio of dural unstitched during operation (χ² = 9.759, P = 0.002), postoperative intraventricular hemorrhage (χ² = 8.938, P = 0.003), postoperative midline displacement > 10 mm (χ² = 7.589, P = 0.006), and intracranial infection (χ² = 4.519, P = 0.034), as well as postoperative coma time (t = 2.709, P = 0.008) were higher than those in non-hydrocephalus group. Logistic regression analysis showed that subarachnoid hemorrhage (OR = 1.885, 95%CI: 1.432-2.240; P = 0.012), dural unstitched during operation (OR = 1.468, 95%CI: 1.215-1.930; P = 0.006), long postoperative coma time (OR = 1.574, 95%CI: 1.358-1.926; P = 0.007), postoperative intraventricular hemorrhage (OR = 1.550, 95%CI: 1.254-1.768; P = 0.010), the level of β2- microglobulin increased after operation (OR = 1.622, 95%CI: 1.165-1.840; P = 0.004) were risk factors for hydrocephalus after decompressive craniectomy in patients with cerebral hernia after TBI. Based on these 5 factors, the Bayesian network model was constructed, and the area under ROC curve was 0.886 (95%CI: 0.823-0.925, P = 0.000). The calibration curve showed that there was a good consistency between the predicted probability and the actual probability, while the Hosmer-Lemeshow goodness-of-fit test showed no significant difference (χ² = 8.760, P = 0.232), which indicated that the model had good discrimination, calibration and accuracy. Conclusions Subarachnoid hemorrhage, dural unstitched during operation, long postoperative coma time, postoperative intra ventricular hemorrhage, and elevated β2 - microglobulin level are the risk factors for hydrocephalus after decompressive craniectomy in patients with cerebral hernia after TBI. [ABSTRACT FROM AUTHOR]

Objective To explore the factors influencing the severity of acute phase and short-term prognosis of anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis, and search for potential indicators for assessing disease severity and predicting prognosis. Methods A total of 60 patients with anti-NMDAR encephalitis admitted to West China Hospital, Sichuan University from January 2020 to July 2023 were included. According to the modified Rankin Scale (mRS) during the acute phase, they were divided into mild group (mRS ≤ 3 score, n = 25) and severe group (mRS > 3 score, n = 35), as well as good outcome group (mRS ≤ 3 score, n = 32) and poor outcome group (mRS > 3 score, n = 28) based on the mRS score after one month of treatment at our hospital. Univariate and multivariate Logistic regression analyses were used to determine the risk factors of anti-NMDAR encephalitis with severe condition during the acute phase and poor short-term prognosis. Results Logistic regression analysis showed consciousness disorder (OR = 8.975, 95%CI: 2.048-39.327; P = 0.004) and high level of neutrophil percentage-to-albumin ratio (NPAR; OR = 5.004, 95%CI: 1.138-22.011, P = 0.033) were the risk factors of anti-NMDAR encephalitis with severe condition during the acute phase, while high level of serum IgE was the protective factor (OR = 0.994, 95%CI: 0.989-0.999; P = 0.026). Female (OR = 4.380, 95%CI: 1.205-15.929; P = 0.025), consciousness disorder (OR = 5.493, 95%CI: 1.535-19.657; P = 0.009) and high level of NPAR (OR = 2.949, 95%CI: 1.010-8.612; P = 0.048) were the risk factors of anti-NMDAR encephalitis with poor short-term prognosis. Conclusions Consciousness disorder, low serum IgE level and high NPAR are risk factors of anti-NMDAR encephalitis with severe condition during the acute phase, while female, consciousness disorder and high NPAR are risk factors of anti-NMDAR encephalitis with poor short-term prognosis. NPAR is a potential biological indicator for assessing disease severity during the acute phase and predicting short-term prognosis of patients with anti-NMDAR encephalitis. [ABSTRACT FROM AUTHOR]

Objective To analyze the risk factors for dismal prognosis in patients with cryptococcal meningitis and construct a prediction scoring system Nomogram model. Methods A total of 100 patients with cryptococcal meningitis who treated with anticryptococcal therapy admitted to Affiliated Hospital of Zunyi Medical University from January 2010 to August 2022 were selected. The patients were divided into favorable prognosis group (n = 19) and dismal prognosis group (n = 81) according to the results of cerebrospinal fluid (CSF) cryptococcal culture during hospitalization and clinical symptoms and signs at the time of discharge. Risk factors were screened by using univariate and multivariate stepwise Logistic regression analyses. A Nomogram model was constructed based on the risk factors, the receiver operating characteristic (ROC) curve and calibration curves of the model were plotted, and Hosmer-Lemeshow goodness-of-fit test was performed. Results The proportion of patients in the dismal prognosis group with Nutritional Risk Screening 2002 (NRS 2002) score (Z =-3.898, P = 0.000), CSF pressure > 250 mm H2O (χ² = 9.512, P = 0.002) and duration of antifungal treatment < 14 d (χ² = 17.847, P = 0.000) on admission were higher than those in the favorable prognosis group, and the blood routine red blood cell count (t =-2.802, P = 0.006) and lymphocyte count (Z =-2.878, P = 0.004), plasma albumin (t =-4.332, P = 0.000), and the proportion of amphotericin B application (χ² = 4.597, P = 0.032) were lower than those in the favorable prognosis group. Logistic regression analysis showed the admission high NRS 2002 score (OR = 3.258, 95%CI: 1.337-7.940; P = 0.009), CBF pressure > 250 mm H2O (OR = 0.108, 95%CI: 0.018-0.659; P = 0.016), and the duration of antifungal treatment < 14 d (OR = 0.092, 95%CI: 0.011-0.742; P = 0.025) were risk factors for dismal prognosis of cryptococcal meningitis. A Nomogram model was constructed based on the above 3 risk factors, and the area under the ROC curve was 0.927 (95%CI: 0.873-0.980, P = 0.000), which predicted a cut-off value of 53.50 points for dismal prognosis in cryptococcal meningitis; the calibration curve (with good consistency), and the Hosmer-Lemeshow goodness-of-fit test (χ² = 2.694, P = 0.912) indicated that the model had good discrimination, calibration and stability. Conclusions Patients with cryptococcal meningitis with a high NRS 2002 score, CSF pressure > 250 mm H2O, and antifungal treatment < 14 d had a dismal prognosis, and the Nomogram model constructed accordingly has a high predictive value of dismal prognostic risk. [ABSTRACT FROM AUTHOR]

Objective To analyze the clinical features and prognostic factors of herpes simplex virus type 1 (HSV-1) encephalitis. Methods A total of 51 patients with HSV-1 encephalitis hospitalized in He'nan Provincial People's Hospital from January 2018 to September 2023 were selected, and their clinical data, laboratory and imaging examination results were recorded. The modified Rankin Scale (mRS) was used to evaluate the prognosis of patients and the recovery of neurological function after brain injury. Univariate and multivariate stepwise Logistic regression analyses were screened for risk factors of adverse prognosis of HSV-1 encephalitis. Results The main symptoms of 51 cases were fever and headache. The serological examination results showed increased white blood cell count (14 cases), increased neutrophil count (14 cases), decreased lymphocyte count (8 cases), and decreased serum sodium level (17 cases). Cerebrospinal fluid (CSF) examination by lumbar puncture showed increased CSF pressure (18 cases), increased white blood cell count (28 cases), increased protein (32 cases), and increased glucose (15 cases). There were 48 patients who underwent head MRI examination, and 43 patients (89.58%) showed obvious brain region involvement on head MRI, among which 35 patients (72.92%) with positive MRI showed typical unilateral or bilateral temporal and frontal lobe involvement, and 8 cases (16.67%) with increased cerebral pia mater enhancement. 66.67% (34/51) of the patients recovered completely within 6 months after discharge, 21.57% (11/51) of the patients had sequelae, and the fatality rate was 11.76% (6/51). There were 34 (66.67%) patients with good prognosis and 17 (33.33%) patients with adverse prognosis. Multivariate Logistic regression analysis showed age increased (OR = 1.090, 95%CI: 1.020-1.200; P = 0.023) and increased CSF glucose level (OR = 23.800, 95%CI: 23.800-1250.000; P = 0.030) were risk factors for adverse prognosis in HSV-1 encephalitis patients. Conclusions Increased aging and CSF glucose level are risk factors for the adverse prognosis in HSV-1 encephalitis patients. In clinical practice, it is necessary to master the clinical characteristics of patients with HSV-1 encephalitis, so as to achieve early detection, diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Objective To explore the relationship between the levels of serum 8-hydroxy deoxyguanosine (8 - OHdG) and malondialdehyde (MDA) and cognitive dysfunction in patients with Parkinson's disease (PD). Methods From February 2021 to February 2022, 126 patients with PD in The Affiliated Hospital of Xuzhou Medical University were divided into normal cognitive function group (PDN group, n = 41), mild cognitive impairment group (PD-MCI group, n = 47) and Parkinson's disease dementia group (PDD group, n = 38), and 50 healthy subjects were selected as control group. Hoehn-Yahr staging was used to evaluate the severity of patients with PD during the "close" period of anti-PD drugs, and the motor function of patients with PD was evaluated by the Unified Parkinson's Disease Rating Scale III (UPDRS III). Montreal Cognitive Assessment (MoCA) was used to evaluate the severity of cognitive dysfunction at rest and in the "on" period of anti-PD drugs, and the serum 8-OHdG and MDA of PD patients and controls were collected. Pearson and partial correlation analyses were used to analyze the correlation between the levels of serum 8-OHdG and MDA and MoCA score in PD patients. Univariate and multivariate Logistic regression analyses were used to analyze the influencing factors of cognitive dysfunction in PD patients. The efficacy analysis of serum 8-OHdG and MDA levels in predicting the risk of cognitive dysfunction in PD patients was carried out by using receiver operating characteristic curve (ROC curve). Results The results of correlation analysis showed that there was a negative correlation between the MoCA score and the duration (r = - 0.241, P = 0.007), Hoehn-Yahr staging (r = - 0.333, P = 0.007), 8-OHdG (r = - 0.310, P = 0.000) and MDA (r = - 0.291, P = 0.004) in PD patients. The results of Logistic regression analysis showed that the elevated levels of 8-OHdG (OR = 1.335, 95%CI: 1.137-1.568; P = 0.000) and MDA (OR = 2.928, 95%CI: 1.676-5.115; P = 0.000) were risk factors for cognitive dysfunction in PD patients. The results of ROC curve showed the areas under the curve of 8-OHdG, MDA and their combination in predicting cognitive dysfunction in PD patients were 0.831 (95%CI: 0.761-0.902, P = 0.000), 0.846 (95%CI: 0.775-0.916, P = 0.000) and 0.922 (95%CI: 0.878-0.966, P = 0.000), respectively. Conclusions The detection of 8-OHdG and MDA in peripheral blood is expected to be a serum marker to evaluate the severity of cognitive dysfunction in patients with PD, and to predict cognitive dysfunction in patients with PD. [ABSTRACT FROM AUTHOR]

Objective To explore the clinical application of quantitative electroencephalography (qEEG) in predicting the early prognosis of acute ischemic stroke after mechanical thrombectomy. Methods A total of 71 patients who underwent acute ischemic stroke mechanical thrombectomy from April 2021 to September 2022 were enrolled in He'nan Provincial People's Hospital, all of them performed qEEG after surgery. Modified Rankin Scale (mRS) was used to evaluate the prognosis on the 90 d after the surgery. Univariate and multivariate backward Logistic regression analyses were used to screen risk factors for prognosis in acute ischemic stroke after mechanical thrombectomy. Receiver operating characteristic (ROC) curve was used to predict the value of qEEG for the prognosis of neural function. Results Patients in dismal prognosis group (mRS score 3-5, n = 28) had higher NIHSS score at admission (t = 2.686, P = 0.009), higher proportion of thrombectomy performed more than 3 times (χ² = 4.201, P = 0.040), higher values of DTABR on the affected side (t = 2.183, P = 0.032), higher ratio of DTABR on affected side/ unaffected side (t = 6.230, P = 0.000), and higher proportion of immediately Thrombolysis in Cerebral Infarction (TICI) < 2b after surgery (χ² = 5.420, P = 0.020) compared to favorable prognosis group (mRS score 0-2, n = 43). Logistic regression analysis showed higher NIHSS score at admission (OR = 1.542, 95%CI: 1.368-1.725; P = 0.012), DTABR on affected side/unaffected side (OR = 3.428, 95%CI: 2.673-7.314; P = 0.008), percent alpha variability (PAV) grade II (OR = 2.983, 95%CI: 2.625-4.682; P = 0.003) and grade III (OR = 4.088, 95%CI: 3.825-5.349; P = 0.002), amplitude electroencephalography (aEEG) grade II (OR = 2.536, 95%CI: 1.942-5.287; P = 0.005) and grade III (OR = 3.924, 95%CI: 2.012-6.378; P = 0.003) were risk factors of dismal prognosis in acute ischemic stroke after mechanical thrombectomy. ROC curve showed the area under the curve (AUC) of NIHSS score was 0.676 (95%CI: 0.554-0.782, P = 0.000), DTABR on affected side/unaffected side was 0.887 (95%CI: 0.789-0.950, P = 0.000), the PAV was 0.760 (95%CI: 0.643-0.853, P = 0.000), aEEG was 0.778 (95%CI: 0.664-0.868, P = 0.000), and the combined indicators classification was 0.943 (95%CI: 0.861-0.984, P = 0.000). Among them, the predictive power of the combined indicators is higher than that of the NIHSS score at admission (Z = 4.150, P = 0.000), PAV (Z = 4.006, P = 0.000) and aEEG (Z = 3.462, P = 0.001). Conclusions qEEG is an effective method to predict the early prognosis of acute ischemic stroke after mechanical thrombectomy. [ABSTRACT FROM AUTHOR]

Objective To investigate the relationship between triglyceride glucose (TyG) index and the total load of cerebral small vessel disease (CSVD) and its different imaging markers. Methods A total of 202 patients with CSVD admitted to The Third Hospital of Hebei Medical University from January 2020 to May 2022 were selected. The clinical data of all patients were collected and TyG index was calculated. The lacunes, cerebral microbleeds (CMBs), white matter hyperintensity (WMH) and enlarged perivascular space (EPVS) were evaluated by MRI, and total load of CSVD score was calculated. Results 1) TyG index and total load of CSVD score: Logistic regression analysis showed the male (OR = 2.245, 95%CI: 1.017-4.957; P = 0.045), increase of age (OR = 1.084, 95%CI: 1.046-1.124; P = 0.000), hypertension (OR = 2.457, 95%CI: 1.189-5.078; P = 0.015) and increase of TyG index (OR = 2.657, 95%CI: 1.353-5.216; P = 0.005) were risk factors for moderate and severe total load of CSVD. 2) TyG index and imaging markers of CSVD: Logistic regression analysis showed the increase of TyG index was the risk factor of moderate and severe WMH (OR = 2.313, 95%CI: 1.095-4.885; P = 0.028), CMBs (OR = 1.690, 95%CI: 1.011-2.824; P = 0.045), lacunes (OR = 2.087, 95%CI: 1.235-3.525; P = 0.006), moderate and severe EPVS in basal ganglia (OR = 2.005, 95%CI: 1.190-3.378; P = 0.009). Conclusions TyG index is associated with the total load and various imaging markers of CSVD, which can be used as a valuable biomarker to evaluate CSVD and its severity. [ABSTRACT FROM AUTHOR]

Objective To screen the influencing factors for the poor prognosis in patients with ultra- severe traumatic brain injury (TBI). Methods Total 133 patients with ultra-severe TBI [Glasgow Coma Scale (GCS) score 3-5] which admitted to the 909th Hospital of Joint Logistic Support Force; Dongnan Hospital of Xiamen University from January 2012 to June 2017 were included. All cases underwent hematoma removal with either standard craniotomy decompression or oversized craniotomy decompression, even combined with internal decompression. Glasgow Outcome Scale (GOS) was used to evaluate prognosis 6 months after surgery. Univariate and multivariate Logistic regression analyses were adopted to screen the influencing factors for poor prognosis in patients with ultra-severe TBI. Results Total 133 patients were divided into favourable prognosis group (GOS score ≥ 4, n = 12) and poor prognosis group (GOS score < 4, n = 121). Logistic regression analysis showed bilateral pupils dilated (OR = 1.779, 95%CI: 1.698-4.531; P = 0.004), postoperative high intracranial pressure (ICP; OR = 12.629, 95%CI: 2.313-68.949, P = 0.007) and volume of secondly cerebral infarction > 75 ml (OR = 2.147, 95%CI: 1.894-5.156; P = 0.009) were the risk factors for poor prognosis, while injury subtyping of isolated epidural hematoma was the protective factor for favourable prognosis (OR = 0.172, 95%CI: 0.032-0.915; P = 0.002). Conclusions GCS score is not reliable in solely predicting the prognosis of patients with ultra -severe TBI. Preoperative bilateral pupil dilation, postoperative high ICP and volume of secondly cerebral infarction > 75 ml were risk factors for poor prognosis of patients with ultra-severe TBI, while injury subtyping of isolated epidural hematoma was the protective factor for favourable prognosis. [ABSTRACT FROM AUTHOR]

Background and objective The biological and molecular characteristics of spread through air spaces (STAS), a newly recognized invasive mode of lung cancer, remain controversial. The aim of this study was to investigate the clinicopathological features and molecular characteristics of STAS in patients with pulmonary adenocar-cinoma. Methods A total of 694 resected invasive non-mucinous lung adenocarcinomas diagnosed by clinicopathology from July 2019 to March 2021 in the First Affiliated Hospital of Guangzhou Medical University were collected, and the relationship between STAS and clinicopathological factors was analyzed. The state of protein expression of anaplastic lymphoma kinase (ALK) was detected by immunohistochemical method. Epidermal growth factor receptor (EGFR) was detected by amplification refractory mutation system-polymerase chain reaction (ARMS-PCR). ROS proto-onco-gene 1-receptor (ROS1) was detected by reverse transcription-PCR (RT-PCR). Results A total of 344 STAS positive cases and 350 STAS negative cases were collected. By univariate analysis, STAS positivity was statistically associated with tumor maximum diameter (P<0.001), pleural invasion (P<0.001), lymphovascular invasion (P<0.001), nerve invasion (P=0.013), lymph node metastasis (P<0.001), clinical stage (P<0.001) and histological type (P<0.001). There was a statistical correlation between STAS and ALK protein expression (P=0.001). Multivariate analysis showed that STAS positive was correlated with pleural invasion (P=0.001), vascular invasion (P<0.001), lymph node metastasis (P=0.005)and ALK protein expression (P=0.032). Conclusion STAS is associated with highly aggressive biological behavior of lung adenocarcinoma, suggesting a poor prognosis. [ABSTRACT FROM AUTHOR]

Objective To summarize the clinical characteristic of stroke in the plateau area with altitude of 4000 m above, and to screen the risk factors of hemorrhagic stroke. Methods The clinical data of 103 stroke patients (including 71 hemorrhagic stroke and 32 ischemic stroke) admitted to Ngari Prefecture People's Hospital of Tibet Autonomous Region from January 2017 to December 2018 were retrospectively analyzed, and the clinical characteristic of hemorrhagic stroke and ischemic stroke were compared. Univariate and multivariate Logistic regression analyses were used to screen the risk factors of hemorrhagic stroke. Results The age of hemorrhagic stroke patients was lower than that of ischemic stroke patients [(57.48 ± 10.81) years vs. (64.03 ± 10.96) years; t = 2.836, P = 0.006], and the systolic blood pressure at admission [(171.92 ± 28.95) mm Hg vs. (141.81 ± 23.24) mm Hg; t = 5.174, P = 0.000], diastolic blood pressure [(107.58 ± 18.76) mm Hg vs. (93.44 ± 14.94) mm Hg; t = 3.757, P = 0.000], hemoglobin [(189.54 ± 28.12) g/L vs. (165.35 ± 25.42) g/L; t = 4.111, P = 0.000] and total cholesterol [(4.60 ± 0.88) mmol/L vs. (4.04 ± 0.82) mmol/L; t = 3.118, P = 0.002] were higher than those of ischemic stroke patients. Logistic regression analysis showed that systolic blood pressure on admission (OR = 1.048, 95%CI: 1.024-1.073; P = 0.000) and hemoglobin (OR = 1.043, 95%CI: 1.015-1.072; P = 0.002) elevation were risk factors of hemorrhagic stroke. Conclusions Hemorrhagic stroke is the main type of stroke in the plateau area with altitude of 4000 m above. Patients with high systolic blood pressure on admission and hemoglobin are more likely to have hemorrhagic stroke. [ABSTRACT FROM AUTHOR]

Objective To screen risk factors related to visual acuity and visual field defects in patients with Cushing's disease, and based on risk factors to analyze health economics. Methods A total of 416 patients with Cushing's disease admitted to Peking Union Medical College Hospital, Chinese Academy of Medical Sciences from August 1994 to December 2019 were included. Objective examination of visual acuity and visual field was used as the dependent variable, while gender, age, duration, blood glucose, blood pressure, hormone level, eye swelling, imaging features, and main complaint of visual acuity and visual field were used as independent variables. Univariate and multivariate Logistic regression analysis was used to screen the risk factors related to visual acuity and visual field defects, and cost-effectiveness ratio (CER) and cost-benefit ratio (CBR) were analyzed based on risk factors. Results Among 416 patients with Cushing's disease, 143 (34.38%) complained of abnormal visual acuity and visual field, including 59 cases of blurred vision, 11 cases of impaired visual field, 41 cases of blurred vision combined with impaired visual field, 13 cases of blurred vision combined with impaired visual field, 3 cases of impaired visual field combined with impaired visual field, and 16 cases of all three symptoms. There were 102 cases (24.52%) with abnormal visual acuity and visual field test, including 44 cases of visual loss, 39 cases of visual field defect, and 19 cases of visual loss combined with visual field defect. Logistic regression analysis showed the increased systolic blood pressure (OR = 1.016, 95%CI: 1.002-1.030; P = 0.025) and abnormal visual acuity and visual field complaints (OR = 14.000, 95%CI: 7.918-24.754; P = 0.000) were risk factors for visual acuity and visual field defects. According to the analysis of health economics, the CER of the whole group was 393 926.53, which was 6.56 times higher than that of the patients with abnormal visual acuity and visual field complaints (60 057.93). The CBR was 4.08, which was 2.25 times higher than that of patients with abnormal visual acuity and visual field complaints (1.81). Conclusions Cushing's disease patients with abnormal visual acuity and visual field complaints are more likely to have abnormal visual acuity and visual field. Therefore, taking abnormal visual acuity and visual field complaints as an indication for visual acuity and visual field test of Cushing's disease patients can improve the detection rate and reduce the waste of health and social resources, which is not only clinically [ABSTRACT FROM AUTHOR]

Background and objective Studies have shown that the incidence and severity of corona virus disease 2019 (COVID-19) in patients with lung cancer are higher than those in healthy people. At present, the main anti-tumor treatments for lung cancer include surgery, immunotherapy, chemotherapy, radiotherapy, targeted therapy and anti-angiogenesis therapy. While the effects of different anti-tumor treatments on the occurrence and severity of COVID-19 pneumonia are not uniform. Therefore, we aimed to describe clinical characteristics and antitumor therapy of patients with lung cancer and COVID-19 pneumonia, and examined risk factors for severity in this population. Methods From December 1, 2022 to February 15, 2023, a retrospective study was conducted in 217 patients diagnosed with COVID-19 and pathologically confirmed lung cancer in the Jinling Hospital. We collected data about patients' clinical features, antitumor treatment regimen within 6 months, and the diagnosis and treatment of COVID-19. Risk factors for occurrence and severity of COVID-19 pneumonia were identified by univariable and multivariable Logistic regression models. Results (1) Among the 217 patients included, 51 (23.5%) developed COVID-19 pneumonia, of which 42 (82.4%) were classified as medium and 9 (17.6%) were classified as severe; (2) Univariate and multivariate analysis revealed overweight (OR=2.405, 95%CI: 1.095-5.286) and intrapulmonary focal radiotherapy (OR=2.977, 95%CI: 1.071-8.274) are risk factors for increasing occurrence of COVID-19 pneumonia, while other therapies are not; (3) Chronic obstructive pulmonary disease (COPD) history (OR=7.600, 95%CI: 1.430-40.387) was more likely to develop severe pneumonia and anti-tumor therapies such as intrapulmonary focal radiotherapy, chemotherapy, targeted therapy and immunotherapy did not increase severity. Conclusion Intrapulmonary focal radiation therapy within 6 months increased the incidence of COVID-19 pneumonia, but did not increase the severity. However, there was no safety concern for chemotherapy, targeted therapy, surgery and immunotherapy. [ABSTRACT FROM AUTHOR]

Objective To screen the risk factors of intracranial infection in patients with severe traumatic brain injury (sTBI) and establish a Nomogram model based on these risk factors. Methods A total of 130 patients with sTBI admitted to The Second Affiliated Hospital of Shandong First Medical University from January 2021 to June 2022 were enrolled. They were divided into a group with intracranial infection (n = 27) and a group without intracranial infection (n = 103) according to whether complicated with intracranial infection. To analyze the risk factors of intracranial infection in patients with sTBI by univariate and multivariate stepwise Logistic regression, and construct a Nomogram model based on the risk factors to draw receiver operating characteristic (ROC) curve and calibration curve of this model and perform Hosmer-Lemeshow goodness of fit test. Results The proportion of diabetes (χ² = 5.356, P = 0.021), open traumatic brain injury (χ² = 4.248, P = 0.039), cerebrospinal fluid (CBF) leakage (adjusted χ² = 4.731, P = 0.030), surgical treatment (χ² = 8.284, P = 0.004), severe infection (adjusted χ² = 6.479, P = 0.011), tracheal intubation (χ² = 6.487, P = 0.011) and tracheotomy (χ² = 4.072, P = 0.044) in intracranial infection group were higher than those in non - intracranial infection group. Logistic regression analysis showed diabetes (OR = 2.748, 95%CI: 1.417-8.654; P = 0.047), CBF leakage (OR = 4.483, 95%CI: 1.852-8.341; P = 0.031), surgical treatment (OR = 1.941, 95%CI: 1.483-8.842; P = 0.031) and severe infection (OR = 1.614, 95%CI: 1.113-5.682; P = 0.041) were risk factors for sTBI complicated with intracranial infection. The area under the curve (AUC) of ROC curve was 0.758 (95%CI: 0.641-0.875, P = 0.001), and the optimal cut-off value for predicting sTBI complicated with intracranial infection was 175. The calibration curve showed good consistency between the predicted probability and the actual probability, while the Hosmer-Lemeshow goodness of fit test showed no statistically significant difference (χ² = 4.613, P = 4.412), indicating the Nomogram model has good differentiation, calibration and stability. Conclusions Diabetes, CBF leakage, surgical treatment and severe infection can increase the risk of sTBI complicated with intracranial infection. The Nomogram model can better predict the risk of sTBI complicated with intracranial infection. [ABSTRACT FROM AUTHOR]

Objective To explore the clinical characteristics of agitated behavior in patients with cognition disorders and screen the related influencing factors based on need-driven dementia-compromised behavior (NDB) in dementia. Methods A total of 402 patients with cognition disorders admitted to Xuanwu Hospital, Capital Medical University from January 2021 to June 2022 were selected. Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were used to evaluate overall cognitive function. Pittsburgh Sleep Quality Index (PSQI) was used to evaluate sleep quality. Barthel Index (BI) was used to evaluate abilities of daily living. Cohen-Mansfield Agitation Inventory (CMAI) was used to evaluate agitated behavior. Univariate and multivariate Logistic regression analyses were used to analyse the influencing factors of agitated behavior in patients with cognition disorders. Results The incidence of agitated behavior in 402 patients was 59.70% (240/402), while mild cognitive impairment (MCI) was 59.38% (19/32) and dementia was 59.73% (221/370), including physical aggressive behavior 23.33% (56/ 240), physical non-aggressive behavior 37.92% (91/240), verbal aggressive behavior 13.75% (33/240) and verbal non-aggressive behavior 83.33% (200/240). Logistic regression analysis showed that divorce or widower (OR = 4.529, 95%CI: 1.416-14.483; P = 0.011), hallucination (OR = 10.483, 95%CI: 4.272-25.722; P = 0.001), delusion (OR = 2.287, 95%CI: 1.140-6.591; P = 0.002), the living environment was unstable (OR = 1.665, 95%CI: 1.024-2.708; P = 0.040), communication difficulties between caregivers and patients (OR = 1.817, 95%CI: 1.047-3.154; P = 0.034), sleep disorders (OR = 2.344, 95%CI: 1.142-4.810; P = 0.020) were risk factors for agitated behavior in patients with cognition disorders; hearing impairment was a protective factor (OR =-1.086, 95%CI: 0.132-0.864; P = 0.024). Conclusions The incidence of agitated behavior is higher in patients with cognition disorders, and the incidence of agitated behavior is more likely in patients with cognition disorders who are divorced or widowed, hallucinations, delusions, unstable living environment, communication difficulties between caregivers and patients, and sleep disorders. [ABSTRACT FROM AUTHOR]

Objective To investigate the prevalence of mild cognitive impairment (MCI) and related influencing factors among elderly population in urban community of Tianjin. Methods The cross-sectional survey and cluster sampling method were used for prevalence survey. Total 3200 elderly people aged ≥ 60 years old who underwent routine physical examination from four communities in Heping District of Tianjin from September 2019 to May 2020 were investigated by questionnaire survey and cognitive screening test, finally 3194 elderly people were recruited. Univariate and multivariate Logistic regression analyses were conducted to explore related influencing factors of MCI. Results Total 340 subjects were diagnosed with MCI among 3194 elderly subjects, with a prevalence rate of 10.64%. Logistic regression analysis showed 70-79 years old (OR = 1.670, 95%CI: 1.275-2.187; P = 0.000), ≥ 80 years old (OR = 3.168, 95%CI: 2.264-4.433; P = 0.000) and body mass index (BMI) < 18.50 kg/m² (OR = 3.602, 95%CI: 1.899-6.833; P = 0.000) were independent risk factors of MCI; and primary school (OR = 0.342, 95%CI: 0.148-0.790; P = 0.012), junior high school (OR = 0.150, 95%CI: 0.066-0.337; P = 0.000), senior high school (OR = 0.131, 95%CI: 0.058-0.294; P = 0.000), college and above (OR = 0.068, 95%CI: 0.030-0.155; P = 0.000) and having exercise habits (OR = 0.786, 95%CI: 0.621-0.995; P = 0.045) were protective factors. Conclusions The prevalence of MCI among elder people ≥ 60 years old is 10.64% in urban community of Tianjin, and mainly influenced by age, body weight, educational level and exercise habits. [ABSTRACT FROM AUTHOR]

Background and objective The incidence and mortality of lung cancer have always been at the forefront of malignant tumors. With the development of lung cancer detection techniques, more peripheral pulmonary lesions (PPLs) have been detected. The diagnostic accuracy of procedures for PPLs keeps controversial. This study aims to systematically evaluate the diagnostic value and the safety of electromagnetic navigation bronchoscopy (ENB) in the diagnosis of PPLs. Methods The relevant literatures in the diagnostic yield of PPLs by ENB were systematically retrieved from Wanfang Data Knowledge Service Platform, China National Knowledge Infrastructure, Embase, PubMed, Cochrane Library and Web of Science. The software of Stata 16.0, RevMan 5.4 and Meta-disc 1.4 were used to conduct the meta-analysis. Results A total of 54 literatures with 55 studies were included in our meta-analysis. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio of ENB in the diagnosis of PPLs were 0.77 (95%CI: 0.73-0.81), 0.97 (95%CI: 0.93-0.99), 24.27 (95%CI: 10.21-57.67), 0.23 (95%CI: 0.19-0.28) and 104.19 (95%CI: 41.85-259.37), respectively. The area under curve (AUC) was 0.90 (95%CI: 0.87-0.92). Meta-regression and subgroup analyses indicated that the potential heterogeneity resulted from study type, additional localization techniques, sample size, lesion size and type of sedation. The use of additional localization techniques and general anesthesia have improved the diagnostic efficiency of ENB in PPLs. The incidence of adverse reactions and complications associated with ENB was very low. Conclusion ENB provides well diagnostic accuracy and safety. [ABSTRACT FROM AUTHOR]

Objective To investigate the influencing factors of hearing preservation after retrosigmoid approach surgery for vestibular schwannoma. Methods A total of 317 patients with vestibular schwannoma treated by retrosigmoid approach surgery in Beijing Tiantan Hospital from January 2018 to January 2021 were included. Tumor size (Koos grade), whether the tumor invaded the bottom of the internal auditory canal, and whether the tumor had cystic changes were evaluated by preoperative imaging examination. Hearing function was evaluated by the American Academy of Otolaryngology-Head and Neck Surgery (AAO - HNS) hearing classification before and after surgery. Univariate and multivariate forward Logistic regression analysis were used to investigate the related risk factors of hearing loss after retrosigmoid approach surgery. Results Among 317 patients, 35 cases (11.04%) had postoperative hearing preservation (AAO-HNS A and B) and all of them had normal preoperative hearing. The rates of age > 45 years old (χ² = 45.648, P = 0.000), Koos grade 3-4 (χ² = 41.692, P = 0.000), invasion the bottom of internal auditory canal (χ² = 30.252, P = 0.000), cystic changes (χ² = 23.888, P = 0.000) and preoperative hearing abnormality (χ² = 78.317, P = 0.000) in hearing loss group were higher than those in hearing preservation group. Logistic regression analysis showed the age > 45 years old (OR = 36.211, 95%CI: 5.006-261.918; P = 0.000), Koos grade 3-4 (OR = 21.215, 95%CI: 2.867-156.963; P = 0.003), invasion the bottom of internal auditory canal (OR = 13.746, 95%CI: 3.005-62.880; P = 0.001) and cystic changes in tumor (OR = 8.336, 95%CI: 1.943- 35.770; P = 0.004) were the risk factors of hearing loss after retrosigmoid approach surgery. Conclusions Retrosigmoid approach surgery is a safe and effective surgical approach for patients with vestibular schwannoma to achieve hearing preservation. Younger patients, with smaller tumors, and without invasion the bottom of internal auditory canal and without cystic changes in tumors are more likely to have postoperative hearing preservation. [ABSTRACT FROM AUTHOR]

Objective To explore the influencing factors of long-term prognosis of patients with spontaneous cerebellar hemorrhage (SCH) after surgery. Methods Total 121 patients with SCH admitted to the Second Affiliated Hospital of Air Force Military Medical University from January 2012 to September 2019 were included. The prognosis was assessed by the modified Rankin Scale (mRS) 12 months after surgery, and the risk factors related to dismal prognosis were screened by univariate and multivariate Logistic regression analysis. Results The age (P = 0.001), proportion of Glasgow Coma Scale (GCS) score ≤ 8 (P = 0.000), activated partial thromboplastin time (P = 0.003), random blood glucose level (P = 0.044) and ventilator assisted ventilation ratio (P = 0.015) of patients with poor prognosis (mRS score 4-6, n = 79) were higher than those of patients with good prognosis (mRS score 0-3, n = 42), while platelet count was lower than those of patients with good prognosis (P = 0.017). There was significant difference in surgery modes between 2 groups (P = 0.001). Logistic regression analysis showed that older age (OR = 1.090, 95%CI: 1.032-1.151; P = 0.002), high serum D-dimer level (OR = 1.339, 95%CI: 1.034-1.735; P = 0.027), craniotomy hematoma removal (OR = 4.949, 95%CI: 1.310-18.691; P = 0.018) and hematoma puncture drainage (OR = 6.789, 95%CI: 1.249-36.912; P = 0.027) were the main risk factors for long-term dismal prognosis after surgery for SCH. Conclusions Older age, high serum D-dimer level and surgery modes are the risk factors for long-term dismal prognosis after surgery for SCH. [ABSTRACT FROM AUTHOR]

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Objective To investigate the risk factors of liver injury in patients with neuromyelitis optica spectrum disorders (NMOSDs) after intravenous methylprednisolone (IVMP). Methods A total of 195 patients with NMOSDs who received IVMP in Beijing Tongren Hospital, Capital Medical University from January 2017 to December 2021 were enrolled. The causal relationship between IVMP and liver injury was evaluated according to Roussel Uclaf Causality Assessment Method (RUCAM). Univariate and multivariate stepwise Logistic regression analysis were used to screen the risk factors of IVMP related liver injury. Results Within 14 d after IVMP therapy, 32.31% (63/195) patients developed liver injury [serum alanine aminotransferase (ALT) > 40 U/L, RUCAM score ≥ 3]. Severe injury (ALT > 120 U/L) accounted for 15.87% (10/63) and mild injury 84.13% (53/63). Logistic regression analysis showed age ≥ 50 years old (OR = 0.969, 95%CI: 0.945-0.993; P = 0.011), previous use of immunosuppressants (OR = 3.543, 95%CI: 1.579-7.949; P = 0.002) and history of IVMP related liver injury (OR = 17.043, 95%CI: 3.400-85.423; P = 0.000) were the main risk factors for IVMP related liver injury. Conclusions The main IVMP related liver injury is mild injury. NMOSDs patients aged ≥ 50 years old, previous use of immunosuppressants and history of IVMP related liver injury are more prone to liver injury when treated with IVMP again. [ABSTRACT FROM AUTHOR]

Objective To investigate the predictive value of the National Institutes of Health Stroke Scale (NIHSS) score combined with serum high -sensitivity C -reactive protein (hs-CRP) on admission to ischemic stroke. Methods A total of 487 patients with acute ischemic stroke admitted to the Department of Neurology of Tangshan Gongren Hospital from May 2018 to December 2019 were selected. The clinical data of patients were collected such as gender, age, hypertension, diabetes, coronary heart disease, previous stroke history, smoking and drinking history, serum low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), triglyceride (TG), hs-CRP, homocysteine (Hcy), fasting blood glucose (FBG). The NIHSS scale was used to evaluate the degree of neurological deficit at admission, and the modified Rankin Scale (mRS) was used to evaluate the prognosis when the patient was discharged. The mRS score ≤ 2 was defined as good prognosis, and the mRS score > 2 was defined as poor prognosis. Univariate and multivariate forward Logistic regression analysis were used to screen risk factors for poor prognosis of ischemic stroke, and the receiver operating characteristic (ROC) curve was used to compare the predictive value of NIHSS and hs-CRP levels at admission alone or in combination for patient prognosis. Results Compared with the good prognosis group, the poor prognosis group had higher proportions of male patients (χ² = 4.729, P = 0.030), previous history of stroke (χ² = 13.665, P = 0.000), and drinking alcohol (χ² = 8.326, P = 0.004). The NIHSS score at admission (Z = -9.316, P = 0.000), serum FBG (Z =-3.234, P = 0.001), Hcy (Z =-3.652, P = 0.000) and hs-CRP (Z =-8.780, P = 0.000) level in poor prognosis group were higher than those in good prognosis group. Logistic regression analysis showed that the NIHSS score increased at admission (OR = 1.316, 95%CI: 1.223-1.417; P = 0.000), and the serum hs-CRP level increased (OR = 1.045, 95%CI: 1.032-1.058; P = 0.000) were risk factors for the prognosis of ischemic stroke. The area under the curve (AUC) predicted by the two combined (AUC = 0.903; 95%CI: 0.873-0.928, P = 0.000) exceeded than that of the NIHSS score at admission alone (AUC = 0.818; 95%CI: 0.781-0.852, P = 0.000) and the serum hs-CRP alone (AUC = 0.806; 95%CI: 0.768-0.840, P = 0.000); pairwise comparison found that the combination of the two was better than the NIHSS score at admission alone (Z = 3.187, P = 0.001) and serum hs-CRP alone (Z = 4.418, P = 0.000). Conclusions NIHSS score and high level of serum hs-CRP at admission are risk factors for poor prognosis of ischemic stroke. Combining NIHSS score and serum hs-CRP can provide an effective reference for clinical prediction of poor prognosis of ischemic stroke. [ABSTRACT FROM AUTHOR]

Objective To summarize the characteristics and changes of traumatic brain injury (TBI) in Tongzhou district of Beijing with the rapid development of social economy, in order to provide the theoretical basis for adjustment of the prevention and treatment strategies in high risk population. Methods The home pages of electronic health record (EHR) of patients with TBI from December 1, 2004 to October 22, 2018 were automatically extracted from the EHR of Beijing Luhe Hospital, Capital Medical University. The clinical characteristics were retrospectively analyzed, and the risk factors related to death at discharge were screened by univariate and multivariate forward Logistic regression analysis. Results A total of 4058 patients with TBI were screened out, of which 3683 cases (90.76%) survived and 375 cases (9.24%) died at discharge. The mortality at discharge was significantly different among different age (χ² = 51.526, P = 0.000), causes of injury (χ² = 82.349, P = 0.000), treatment modalities (χ² = 186.270, P = 0.000) and hospital length (χ² = 9.842, P = 0.000). The mortality of patients aged 45-64, 65-74 and ≥ 75 years was higher than that of patients aged 15-24 and 25-44 years (P < 0.01, for all), and the mortality of patients aged ≥ 75 years was higher than that of patients aged 45-64 years (P = 0.001). The mortality of patients with traffic accident injury was higher than that of fall injury (P = 0.000), and the mortality of patients with traffic accident injury, fall injury and other cases was higher than that of violent injury (P = 0.000, for all). The mortality of patients received neurosurgery and non-neurosurgery was higher than that of conservative treatment (P = 0.000, for all). The mortality of patients with hospital lengh of 1-14 d was higher than that of 15-30 d and > 30 d (P = 0.000, for all). Logistic regression analysis showed that 45-64 years old (OR = 2.285, 95%CI: 1.428-3.657; P = 0.001), 65-74 years old (OR = 4.025, 95%CI: 2.334-6.941; P = 0.000), ≥ 75 years old (OR = 5.757, 95%CI: 3.317-9.991; P = 0.000), hospital admission in year 2007-2010 (OR = 1.856, 95%CI: 1.376-2.504; P = 0.000), treatment with neurosurgery (OR = 6.465, 95%CI: 4.991-8.376; P = 0.000) and non-neurosurgical procedures (OR = 3.389, 95%CI: 1.828 to 6.283; P = 0.000), hospital length 1-14 d (OR = 6.023, 95%CI: 3.822-9.490; P = 0.000) were risk factors for death at discharge of TBI patients, and violent injury was a protective factor for death at discharge (OR = 0.245, 95%CI: 0.112-0.537; P = 0.000). Conclusions The mortality of TBI is still high, patients over 45 years, hospital admission in year 2007-2010, traffic accident injury, treatment with neurosurgery and non-neurosurgery, and hospital length of 1-14 d had a higher mortality at discharge. [ABSTRACT FROM AUTHOR]

Objective To analysis of risk factors for stress ulcers after the surgery of acute cerebral hemorrhage, and use these factors to construct a Nomogram model. Methods In this study, 300 patients with acute cerebral hemorrhage treated in The First Affiliated Hospital of University of Science and Technology of China between January 2015 and November 2020 were recruited and divided into stress ulcers group (53 patients) and non-ulcers group (247 patients) according to whether the postoperative period was complicated by stress ulcers. Univariate and multivariate stepwise Logistic regression were used to assess the risk factors for stress ulcers after the surgery of acute cerebral hemorrhage and the Nomogram model was established. The receiver operating characteristic (ROC) curve and calibration curve of the model were plotted, and Hosmer-Lemeshow goodness of fit test was performed. Results Logistic regression showed that age increased (OR = 1.043, 95%CI: 1.059-1.086; P = 0.042), Glasgow Coma Scale (GCS) score ≤ 8 (OR = 2.809, 95%CI: 1.018-7.740; P = 0.044), the cerebral hemorrhage volume ≥ 30 ml (OR = 3.830, 95%CI: 1.342-10.933; P = 0.012), neutrophil to lymphocyte ratio (NLR) increased (OR = 1.090, 95%CI: 1.032-1.151; P = 0.002), the increase of postoperative systolic blood pressure (OR = 1.031, 95%CI: 1.008-1.055; P = 0.008) and postoperative intracranial infection (OR = 2.809, 95%CI: 1.006-7.847; P = 0.049) were the risk factors for stress ulcers after the surgery of acute cerebral hemorrhage. The Nomogram model was established based on the 6 risk factors, and the area under curve (AUC) of ROC was 0.881 (95%CI: 0.821-0.942, P = 0.001); the best cut-off value for predicting the risk of acute postoperative cerebral hemorrhage complicated by stress ulcers was 137. The calibration curves showed good agreement between the predicted and actual probabilities, and the Hosmer-Lemeshow goodness of fit test showed there was no statistical difference (χ² = 7.891, P = 0.445), indicating that the Nomogram model has good discrimination, calibration and stability. Conclusions Over-age, GCS score ≤ 8, cerebral hemorrhage volume ≥ 30 ml, NLR increase, postoperative systolic blood pressure increase and intracranial infection were the risk factors for stress ulcers after the surgery of acute cerebral hemorrhage. In conclusion, this Nomogram model is able to individually, visually and briefly predict the risk of postoperative complications of stress ulcers in patients after the surgery of acute cerebral hemorrhage. [ABSTRACT FROM AUTHOR]

Objective The clinical characteristics and imaging information of insular glioma patients were collected to predict mutation status of isocitrate dehydrogenase 1 (IDH1). Methods A total of 596 patients with gliomas confirmed by postoperative pathology in The First Affiliated Hospital with Nanjing Medical University from January 2011 to June 2021 were enrolled, including 72 insular gliomas, 213 frontal gliomas, 165 temporal gliomas, 76 parietal gliomas, 28 occipital gliomas, 13 cerebellar gliomas and 29 midline gliomas. All patients were examined by MRI, fifteen glioma-related features were selected from the visually accessible rembrandt images (VASARI), including enhancement quality, enhancement proportion, non-enhancement proportion, necrosis proportion, edema proportion, cyst, thickness of enhanced margin, definition of the enhanced margin, hemorrhage, diffusion, deep white matter involvement, deep ventricle involvement, midline cross, T2-FLAIR mismatch, maximum diameter of tumor. Univariate and multivariate Logistic regression analysis were used to screen the predictive factors related to IDH1-mutant in insular glioma. The receiver operating characteristic (ROC) curve was plotted and area under the curve (AUC), sensitivity and specificity were calculated to evaluate the predictive power of MRI features for IDH1-mutant glioma. Results IDH1 mutation rate was higher in insular and frontal gliomas (P < 0.01, for all). WHO grade II had the highest IDH1 mutation rate (P = 0.008, 0.000), and grade IV had the lowest mutation rate (P = 0.000). The IDH1 mutation rate in low-expression Ki-67 gliomas was higher than that in high-expression gliomas (P = 0.000). Logistic regression analysis showed that weak enhancement (OR = 35.671, 95%CI: 2.805-453.600; P = 0.006), non-enhancement (OR = 75.453, 95%CI: 2.881-1872.759; P = 0.009), unlimited diffusion (OR = 10.573, 95%CI: 1.043-107.175; P = 0.046), no deep ventricle involvement (OR = 187.601, 95%CI: 2.269-15507.607; P = 0.020), T2-FLAIR mismatch (OR = 47.536, 95%CI: 2.838-796.097; P = 0.007) were independent predictive factors for IDH1 mutation in insular glioma. The AUC of enhancement degree, diffusion, deep ventricle involvement and T2-FLAIR mismatch for the diagnosis of IDH1-mutant glioma were 0.846 (95%CI: 0.748-0.944, P = 0.000), 0.730 (95%CI: 0.609-0.850, P = 0.001), 0.708 (95%CI: 0.584-0.833, P = 0.003) and 0.745 (95%CI: 0.627-0.864, P = 0.000). The combination of the 4 groups had the highest diagnostic efficacy, and the AUC was 0.961 (95%CI: 0.923-0.999, P = 0.000). Conclusions Low grade insular glioma has a high IDH1 mutation rate. MRI features of weak enhancement and non-enhancement, unlimited diffusion, non deep ventricle involvement and T2-FLAIR mismatch contribute to noninvasive prediction of IDH1-mutant insular glioma. [ABSTRACT FROM AUTHOR]

Objective To summarize the clinical features of cerebral hyperperfusion syndrome (CHS) after cerebrovascular reconstruction for moyamoya disease (MMD), and to screen its related predictive factors. Methods The clinical data of 50 patients with MMD who underwent cerebrovascular reconstruction in the Second Affiliated Hospital of Nanchang University from June 2017 to December 2018 were collected, including sex, age, history of hypertension, disease type, preoperative Suzuki stage, surgery side, mean arterial pressure (MAP) before and after surgery, time from surgery to onset of CHS, clinical manifestations, duration of symptoms, and postoperative hospital stay. Univariate and multivariate Logistic regression analysis were used to screen the related predictors of CHS after cerebrovascular reconstruction for MM D. Spearman rank correlation analysis to explore the correlation between time from surgery to symptom onset and duration of symptoms. Results Among the 50 patients, 13 patients (26%) developed CHS after surgery. Logistic regression analysis showed that over age (OR = 0.867, 95%CI: 0.790-0.953; P = 0.003) and left-side surgery (OR = 0.158, 95%CI: 0.029-0.863; P = 0.033) was predictor of postoperative CHS in patients with MMD. Spearman rank correlation analysis showed that the time from surgery to symptom onset was negatively correlated with duration of symptom in patients with CHS (rs = -0.925, P = 0.000). Conclusions CHS is a self-limiting complication after cerebrovascular reconstruction for MMD. Higher age and left-sided surgery are clinical predictive factors of postoperative CHS. [ABSTRACT FROM AUTHOR]

Objective To investigate the incidence and risk factors of orthostatic hypotension (OH) in Parkinson's disease (PD) by Active Standing Test (AST) and Head-Up Tilt Test (HUTT). Methods A total of 54 patients with PD were admitted to The First Hospital of Hebei Medical University from February to September 2020. Blood pressure was measured by AST and HUTT, the incidence of OH detected by the two methods was compared. Montreal Cognitive Assessment (MoCA) and Mini -Mental State Examination (MMSE) were used to assess the cognitive function. Hamilton Depression Rating Scale-24 (HAMD-24) was used to evaluate depressive symptoms. Hamilton Anxiety Rating Scale-14 (HAMA-14) was used to evaluate anxiety symptoms. Pittsburgh Sleep Quality Index (PSQI) was used to evaluate the sleep quality. Unified Parkinson's Disease Rating Scale (UPDRS) and its third part were used to assess motor and non - motor symptoms of PD. Modified Hoehn - Yahr staging was assessed for disease severity. Functional gastroenteropathy Rome III diagnostic criteria to assess constipation. KINPAMOR was used to assess olfactory function. Univariate and multivariate forward Logistic regression analyses were used to analyze the risk factors for OH in PD. Results The incidence of OH detected by HUTT was higher than that detected by AST [62.96% (34/54) vs. 24.07% (13/54); χ2 = 19.048, P = 0.000]. Logistic regression analysis showed that the levodopa equivalent daily dose (LEDD) of dopamine receptor agonists increased (OR = 1.029, 95%CI: 1.007-1.051; P = 0.010), constipation (OR = 16.268, 95%CI: 1.213-227.972; P = 0.035), the lower MMSE score (OR = 0.606, 95%CI: 0.418-0.880; P = 0.008), the higher UPDRS total scores (OR = 1.303, 95%CI: 1.034-1.643; P = 0.025) and the higher UPDRSIII score (OR = 1.438, 95%CI: 1.041-1.986; P = 0.027) were risk factors for OH in PD. Conclusions The incidence of OH detected by HUTT was significantly higher than that detected by AST in PD patients. The higher dosage of dopamine receptor agonist LEDD, constipation, the higher total UPDRS score, the higher UPDRSIII score and the lower MMSE score were risk factors for the development of OH in PD patients. [ABSTRACT FROM AUTHOR]

Objective To investigate the risk factors of anti - N - methyl - D - aspartate receptor (NMDAR) encephalitis with acute symptomatic seizure (ASS), and establish a Nomogram model based on clinical indicators. Methods A retrospective analysis was performed on 84 patients with anti-NMDAR encephalitis who were diagnosed in Beijing Tiantan Hospital, Capital Medical University from May 2012 to October 2020. Univariate and multivariate Logistic regression analyses were used to determine the risk factors of anti - NMDAR encephalitis with ASS, and a Nomogram model was constructed. The receiver operating characteristic (ROC) curve and calibration curve of the model were plotted, and Hosmer - Lemeshow goodness of fit test was performed. Results In all 84 patients, 63 cases (75%) presented with ASS, and 35 cases (41.67%) had ASS as the initial symptom. Logistic regression analysis showed male (OR = 7.680, 95%CI: 1.811-32.562; P = 0.006), psychosis and abnormal behavior (OR = 6.486, 95%CI: 1.818-23.141; P = 0.004), anti-NMDAR antibody titer in cerebrospinal fluid (CSF) ≥ 1:32 (OR = 9.322, 95%CI: 2.132-40.766; P = 0.003) were the risk factors of anti-NMDAR encephalitis with ASS, older age was the protective factor (OR = 0.942, 95%CI: 0.903-0.983; P = 0.006). A Nomogram model was established based on the 4 risk factors, and the area under curve (AUC) of ROC was 0.862 (95%CI: 0.776-0.949, P = 0.000). Calibration curve showed a good agreement between the predicted probability and the actual probability of ASS occurrence, and Hosmer-Lemeshow test showed there was no statistical difference (χ² = 4.318, P = 0.827). Conclusions Male, young age, psychosis and abnormal behavior, and anti-NMDAR antibody titer in CSF ≥ 1:32 are more likely to have ASS in patients with anti-NMDAR encephalitis. This Nomogram model constructed based on the above 4 indicators may accurately and conveniently predict ASS and provide a reference for clinical diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Background and objective Postoperative complications are an important cause of death after lung resection. At present, the adoption of video assisted thoracoscopic surgery (VATS) for lung cancer in China is increasing every year, but the prediction model of postoperative complications of VATS for lung cancer is still lack of evidence based on large sample database. In this study, Thoracic Mortality and Morbidity (TM&M) classification system was used to comprehensively describe the postoperative complications of VATS major lung resection in our center, and the prediction model of complications was established and verified. The model can provide basis for the prevention and intervention of postoperative complications in such patients, and accelerate the recovery of patients. Methods The clinical data of patients underwent VATS major lung resection in our center from January 2007 to December 2018 were collected retrospectively. Only patients with stage I-III lung cancer were included. The postoperative complications were registered strictly by TM&M classification system. The patients were divided into two groups according to the operation period: the early phase group (From 2007 to 2012) and the late phase group (From 2013 to 2018). The baseline data of the two groups were matched by propensity score matching. After matching, binary logistic regression analysis was used to establish the prediction model of complications, and bootstrap internal sampling was used for internal verification. Results A total of 2,881 patients with lung cancer were included in the study, with an average age of (61.0±10.1) years, including 180 major complications (6.2%). Binary Logistic regression analysis of 1,268 matched patients showed: age (OR=1.04, 95%CI: 1.02-1.06, P<0.001), other period (OR=0.62, 95%CI: 0.49-0.79, P<0.001), pathological type (OR=1.73, 95%CI: 1.24-2.41, P=0.001), blood loss (OR=1.001, 95%CI: 1.000-1.003, P=0.03), dissected lymph nodes (OR=1.022, 95%CI: 1.00-1.04, P=0.005) were independent risk factors for postoperative complications. The ROC curve indicates that the model has good discrimination (C-index=0.699), and the C-index is 0.680 verified by bootstrap internal sampling for 1,000 times. The calibration curve shows a good calibration of the prediction model. Conclusion TM&M system can comprehensively and accurately report the postoperative complications of thoracoscopic lung cancer surgery. Age, operative period, pathological type, intraoperative bleeding and dissected lymph nodes were independent risk factors for postoperative complications of VATS major lung resection for lung cancer. The established complication prediction model has good discrimination and calibration. [ABSTRACT FROM AUTHOR]

Background and objective Segmentectomy has gradually become one of the standard surgical methods for small pulmonary nodules with early lung cancer on imaging. This study aimed to investigate the perioperative outcomes of patients who underwent uniport video-assisted thoracoscopic surgery (VATS) segmentectomy for identifying the intersegmental boundary line (IBL) by the near-infrared fluorescence imaging with intravenous indocyanine green (ICG) method or the modified inflation-deflation (MID) method and assess the feasibility and effectiveness of the ICG fluorescence (ICGF)-based method. Methods We retrospectively analyzed the perioperative data in total 198 consecutive patients who underwent uniport VATS segmentectomy between February 2018 and August 2020. With the guidance of preoperative intelligent/interactive qualitative and quantitative analysis-three dimensional (IQQA-3D), the targeted segment structures could be precisely identified and dissected, and then the IBL was confirmed by ICGF-based method or MID method. Clinical effectiveness and postoperative complications of the two methods were evaluated. Results An IBL was visible in 98% of patients by the ICGF-based group, even with the low-doses of ICG. The ICGF-based group was significantly associated with the shorter IBL clear presentation time [(23.59±4.47) s vs (1,026.80±318.34) s] (P<0.01) and operative time [(89.3±31.6) min vs (112.9±33.3) min] (P<0.01), compared to the MID group. The incidence of postoperative prolonged air leaks was higher in the MID group than in the ICGF-based group (8.0% vs 26.5%, P=0.025). There were no significant differences in bleeding volume, chest tube duration, postoperative hospital stays, surgical margin width and other postoperative complications (P>0.05). Conclusion The ICGF-based method could highly accurately identify the IBL and make anatomical segmentectomy easier and faster, and therefore has the potential to be a feasible and effective technique to facilitate the quality of uniport VATS segmentectomy. [ABSTRACT FROM AUTHOR]

Objective To investigate the incidence and risk factors for impulsive control disorders (ICDs) in Parkinson's disease (PD). Methods A total of 201 patients with PD were included from May 2016 to September 2017. ICDs were assessed by Questionnaire for Impulsive - Compulsive Disorders in Parkinson's Disease (QUIP). Mentation, behavior and mood, activities of daily living, motor function, and complications for therapy were assessed by Unified Parkinson's Disease Rating Scale (UPDRS). Disease severity was assessed by Hoehn -Yahr staging, and depression was assessed by Geriatric Depression Scale (GDS). Univariate and multivariate forward Logistic regression analyses were used to analyze the risk factors for PD patients with ICDs. Results Among 201 PD patients, 41 patients (20.40%) were diagnosed with ICDs, including 17 cases of compulsive medicine use (8.46%), 15 cases of compulsive eating (7.46%), 13 cases of punding (6.46%), 8 cases of compulsive shopping (3.98%), 3 cases of pathological gambing (1.49%) and one case of hypersexuality (0.49%). Logistic regression analysis showed that the longer treatment duration (OR = 1.237, 95%CI: 1.038-1.474; P = 0.018), severe complications for therapy (high UPDRS IV score; OR = 1.389, 95%CI: 1.077-1.790, P = 0.011), depression (OR = 2.417, 95%CI: 0.174- 0.984; P = 0.046) were the risk factors for PD patients with ICDs. Conclusions The incidence of ICDs in PD is high, which is affected by many factors. The risk of ICDs can be evaluated by the QUIP scale to guide medication. [ABSTRACT FROM AUTHOR]

Objective To explore the risk factors related to higher fall risk in patients with cerebral small vessel disease (CSVD) who can walk independently. Methods A total of 226 patients with CSVD treated in Department of Neurorehabilitation, Tianjin Huanhu Hospital from December 2017 to December 2020 were included. Clinical data (including sex, age, height, weight, past medical history, resting blood pressure, fasting blood glucose and glycosylated hemoglobin) were collected. Lacunar infarct (LACI) and white matter hyperintense [deep white matter hyperintense (DWMH) and periventricular white matter hyperintense (PWMH)] were observed by MRI, carotid intima-media thickness (IMT) was measured by color Doppler ultrasound. Postural instability was assessed based on One-Leg Standing Test (OLST). Univariate and multivariate forward Logistic regression analysis were used to screen the risk factors of higher fall risk in patients with CSVD who can walk independently. Results According to OLST time, the patients were divided into high fall risk group (≤ 10 s, 104 cases) and low fall risk group (> 10 s, 122 cases). Univariate and multivariate forward Logistic regression analysis suggested that age (OR = 1.053, 95%CI: 1.006-1.101; P = 0.026), diabetes history (OR = 2.910, 95%CI: 1.288-6.577; P = 0.010), DWMH Fazekas score 1 (OR = 7.329, 95%CI: 1.775-30.272; P = 0.006), Fazekas score 2 (OR = 8.004, 95%CI: 1.905-33.627; P = 0.005) and Fazekas score 3 (OR = 23.884, 95%CI: 4.205-135.657; P = 0.000) were the risk factors of higher fall risk patients with CSVD who can walk independently. Conclusions For patients with CSVD, especially those who appear to have a normal gait and can walk independently, there is still a high risk of falling, which may be independently related to the age, diabetes history and DWMH. [ABSTRACT FROM AUTHOR]

Objective To investigate the association between white matter hyperintensity (WMH), aspirin therapy and cerebral microbleeds (CMBs), and to screen risk factors for CMBs and severity of CMBs. Methods Total 2654 patients with ischemic cerebrovascular disease were admitted to Department of Neurology in Beijing Chao-Yang Hospital, Capital Medical University from June 2016 to February 2021. Systolic blood pressure (SBP), diastolic blood pressure (DBP), aspirin therapy, time of aspirin therapy, high-density lipoprotein cholesterol (HDL - C) and low - density lipoprotein cholesterol (LDL - C) of the serum, glycated hemoglobin (HbA1c), homocysteine (Hcy), fibrinogen (FIB) and D-dimer of plasma were collected within 24 h of admission. MRI was used to evaluate the severity of WMH by Fazekas score and identify the number of CMBs by Microbleed Anatomical Rating Scale (MARS). Univariate and multivariate stepwise Logistic regression analyses were used to screen the related risk factors for CMBs and its severity. Results Total 2654 patients were divided into control group (n = 1315), mild (n = 461), moderate (n = 440) and severe (n = 438) WMH groups by Fazekas score. There was statistically significant difference in age (H = 353.837, P = 0.000), history of hypertension (Χ² = 79.818, P = 0.000), coronary heart disease (Χ² = 56.768, P = 0.000) and diabetes (Χ² = 8.936, P = 0.030), SBP at admission (H = 47.979, P = 0.000), aspirin therapy (Χ² = 161.576, P = 0.000), time of aspirin therapy (H = 4.766, P = 0.000), serum LDL-C (H = 16.533, P = 0.002), plasma HbA1c (H = 22.127, P = 0.000) and Hcy (H = 83.558, P = 0.002), proportion of CMBs (Χ² = 642.054, P = 0.000) among groups. Logistic regression analysis showed that DBP at admission (OR = 1.017, 95%CI: 1.007-1.026, P = 0.001; OR = 1.020, 95%CI: 1.011-1.029, P = 0.000) and Fazekas score (OR = 1.673, 95%CI: 1.590-1.761, P = 0.000; OR = 1.754, 95%CI: 1.669-1.844, P = 0.000) were risk factors for CMBs and its severity. Serum LDL-C was a protective factor for CMBs and its severity (OR = 0.856, 95%CI: 0.765-0.957, P = 0.006; OR = 0.860, 95%CI: 0.774-0.956, P = 0.005). Aspirin therapy and time of aspirin therapy were not significantly correlated with CMBs and its severity. Conclusions Severity of WMH (Fazekas score) was a risk factor for CMBs and its severity. [ABSTRACT FROM AUTHOR]

Background White matter hyperintensity (WMH) is an imaging markers of cerebral small vessel disease (CSVD), which often coexists with recent single subcortical infarct (RSSI). This study aimed to explore the risk factors of poor functional prognosis in patients with RSSI. Methods A total of 432 patients with RSSI from June 2018 to December 2019 in West China Hospital, Sichuan University were analyzed retrospectively. WMH [including paraventricular white matter hyperintensity (PWMH) and deep white matter hyperintensity (DWMH)] was evaluated by MRI. Univariate and multivariate Logistic regression analyses were used to screen for poor prognostic risk factors in patients with RSSI, stratified analyses was used to explore the stability of risk factors associated with poor prognosis in different populations. Results Logistic regression analysis showed that older age (OR = 1.060, 95%CI: 1.028- 1.093; P = 0.000), longer time from onset to admission (OR = 1.005, 95%CI: 1.002-1.008; P = 0.001), higher National Institute of Health Stroke Scale (NIHSS) score at admission (OR = 1.109, 95%CI: 1.047-1.175; P = 0.000), larger direct diameter of infarct (OR = 1.077, 95%CI: 1.028-1.129; P = 0.002) and severe WMH burden (OR = 2.229, 95%CI: 1.082-4.591; P = 0.030) were risk factors for poor prognosis in patients with RSSI. Further stratified analysis showed that the severe WMH burden (Fazekas score 4-6) as a risk factor for poor prognosis in RSSI, which was stable in women (OR = 2.460, 95%CI: 1.120-5.360; P = 0.024), age > 50 years (OR = 1.890, 95%CI: 1.120-3.180; P = 0.017) and hypertension (OR = 3.150, 95%CI: 1.230-8.100; P = 0.017). Conclusions In patients with RSSI, severe WMH burden (Fazekas score 4-6) is a risk factor for 90 d poor prognosis, and it is stable in women, age > 50 years and in people with a history of hypertension. [ABSTRACT FROM AUTHOR]

Objective To explore the preoperative factors affecting the immediate remission of Cushing's disease after transsphenoidal surgery. Methods A total of 420 patients with Cushing's disease (led by Dr. Feng Ming) in the Department of Neurosurgery of Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College from January 2014 to August 2020 were included. Univariate and multivariate Logistic regression analyses were performed to find risk factors for immediate remission after operation of Cushing's disease, and receiver operating characteristic curve (ROC) was used to predict the cut-off value of immediate remission after operation. Results Among 420 patients with Cushing's disease, 318 patients had immediate remission after operation, and the immediate remission rate was 75.71%. Logistic regression analysis showed that non-primary surgery (OR = 3.904, 95%CI: 2.199-6.930; P = 0.000) and high adrenocorticotropic hormone level (OR = 0.995, 95%CI: 0.991-0.999; P = 0.027) were risk factors for immediate remission after operation in patients with Cushing's disease. ROC showed the area under the curve (AUC), sensitivity and specificity of 85.45 pg/ml adrenocorticotropic hormone level (best threshold) for predicting immediate remission after operation were 0.586 (95%CI: 0.524-0.648, P = 0.009), 0.510 and 0.640. Conclusions Preoperative adrenocorticotropic hormone and the first operation are important factors affecting the immediate remission of patients with Cushing's disease after transsphenoidal operation. Endocrinologists and neurosurgeons should pay attention to the factors affecting the prognosis of patients during the preoperative evaluation of patients with Cushing's disease and make good communication between doctors and patients. [ABSTRACT FROM AUTHOR]

Objective To analyze the relevant risk factors for intracranial infection after craniotomy for resection of skull base neoplasms. Methods The clinical data of 159 patients with skull base neoplasms who underwent craniotomy from May 2010 to January 2020 in The Second Affiliated Hospital of Anhui Medical University were analyzed retrospectively. The relevant risk factors for intracranial infection were analyzed by univariate and multivariate forward Logistic regression. Results Postoperative intracranial infection occurred in 81 out of 159 patients, the infection rate was 50.94%. Multivariate forward Logistic regression analysis showed the operation time was ≥5 h (OR = 3.438, 95%CI: 1.371-8.625; P = 0.008), blood loss ≥ 400 ml (OR = 2.308, 95%CI: 1.115-4.777; P = 0.024), frontal sinus or mastoid air chamber breach (OR = 16.817, 95%CI: 3.689-76.658; P = 0.000) were the risk factors for intracranial infection after craniotomy for resection of skull base neoplasms. Conclusions There was a higher risk of intracranial infection after craniotomy for resection of skull base neoplasms in patients who had long operation time, more intraoperative blood loss as well as frontal sinus or mastoid air chamber breach. It is necessary to adopt effective prevention and control measures to reduce the risk of intracranial infection. [ABSTRACT FROM AUTHOR]

Background and objective Lung cancer is the most common malignant tumor in clinic. The prognosis of advanced patients is poor, and the 5-year survival rate is low. Therefore, early diagnosis becomes the key to improve the prognosis of patients. In recent years, with the development of molecular biology technology, aberrant modification of some driver genes, such as methylation, has become an important method for early diagnosis of lung cancer. The purpose of the present work was to quantitatively evaluate the diagnostic value of abnormal hypermethylation in short state homeobox 2 (SHOX2) promoter region in lung cancer by evidence-based medicine. Methods We searched MEDLINE, EMBASE, Ovid, Web of Science and CNKI for literatures related to the relationship between SHOX2 gene promoter hypermethylation and lung cancer. The data of SHOX2 promoter hymethylation in the original study were extracted. The diagnostic sensitivity, specificity and area under receiver operating characteristic (ROC) curve of SHOX2 promoter methylation were calculated. Results Finally, 13 publications were included in this meta-analysis, and due to significant statistical heterogeneity among the studies (P<0.05) the data was pooled by random effect model. The diagnostic sensitivity and specificity of SHOX2 promoter hypermethylation in the diagnosis of lung cancer were 0.75 (95%CI: 0.74-0.77) and 0.89 (95%CI: 0.88-0.91), respectively; The positive likelihood ratio value was 6.75 (4.56-9.99), and the negative predictive value was 0.36 (0.25-0.52); The diagnostic odds ratio was 23.16 (11.34-47.31), and the area under the ROC curve was 0.9. Conclusion SHOX2 gene promoter hypermethylation is high in serum, broncholavage fluid and pleural effusion of lung cancer patients, which can be used as a biomarker for auxiliary diagnosis of lung cancer. [ABSTRACT FROM AUTHOR]

Objective To explore the risk factors for asymptomatic deep venous thrombosis (DVT) in patients with acute ischemic stroke and determine the predictive value of risk indicators. Methods Two hundred thirty-nine acute ischemic stroke patients admitted to Beijing Shijitan Hospital, Capital Medical University from September 2018 to June 2019 met the inclusion criteria. According to the Doppler ultrasound results 7 d after admission, all eligible patients were screened for the presence of asymptomatic DVT. Univariate and multivariate Logistic regression analyses were used to identify risk factors for asymptomatic DVT. The value of risk factors for predicting asymptomatic DVT was analyzed by receiver operating characteristic curve (ROC) analysis. Results Thirty-seven (15.48%) patients with acute ischemic stroke had asymptomatic DVT. The multivariate forward Logistic regression analysis showed elevated D-dimer level on admission was the critical risk factor for asymptomatic DVT (OR = 1.012, 95%CI: 1.011-1.013; P = 0.000). The cut-off value for plasma D-dimer in diagnosing asymptomatic DVT in the acute ischemic stroke patients was 343 ng/ml (sensitivity = 0.784, specificity = 0.901), and the area under the ROC curve was 0.89 ± 0.03 (95%CI: 0.846-0.929, P = 0.000). Conclusions D-dimer is an essential marker of asymptomatic DVT in patients with acute ischemic stroke. Its elevated level is a potential risk factor for asymptomatic DVT. [ABSTRACT FROM AUTHOR]

Objective To investigate the risk factors of vestibular schwannoma without facial nerve functional preservation. Methods Total 95 patients with vestibular schwannoma who underwent surgery via the sigmoid sinus approach bewteen December 2018 to January 2020 were included. Tumor diameter and classification, tumor volume and surface area, tumor property were recorded according to MRI. The course of facial nerve, adhesion degree between tumor and facial nerve, extent of tumor resection and facial nerve anatomic preservation were recorded according to intraoperative observation. Facial nerve function after 8 d was evaluated. Univariate and multivariate Logistic regression analyses were performed to analyze risk factors associated without facial nerve functional preservation. Results Of the 95 patients, 80 patients (84.21%) underwent gross total resection, among which 3 patients had no anatomical preservation of facial nerve. 15 patients (15.79%) underwent near total resection, including 14 cases with thin layer of tumor remaining on the facial nerve, and one case with thin layer of tumor remaining on the brainstem and no anatomical preservation of facial nerve. Logistic regression analysis showed that severe adhesion between tumor and facial nerve was risk factor for functional impairment of facial nerve (OR = 22.349, 95%CI: 1.895-263.599; P = 0.014). Conclusions For severe adhesion, the operation should be more careful. If the tumor might not be completely removed under the premise of preserving the facial nerve function, a small amount of tumor could be left on the facial nerve. [ABSTRACT FROM AUTHOR]

Objective To investigate the risk factors for poor prognosis of patients with Chiari malformation type 1 (CM1) complicated with syringomyelia treated by posterior fossa decompression with duraplasty (PFDD). Methods Forty-seven patients with CM1 complicated with syringomyelia who underwent PFDD at Zhongnan Hospital of Wuhan University from January 2013 to June 2020 were included. The prognosis was evaluated by the traditional evaluation criteria and Chicago Chiari Outcome Scale (CCOS) at 6 months postoperatively, and univariate and multivariate stepwise Logistic regression analyses were performed to screen for risk factors associated with poor outcome. Results Based on whether the CCOS score was greater than 12, 47 patients were divided into the cured group (n = 21) and uncured group (n = 26). Patients in the uncured group had longer disease duration (t = 4.709, P = 0.000) and greater syringomyelia width (t = 3.074, P = 0.004) than the cured group. Multivariable Logistic regression analysis showed that the long duration of disease (≥ 36 months) was an independent risk factor for poor surgical prognosis of patients after PFDD (OR = 21.948, 95%CI: 3.850-125.117; P = 0.001). Conclusions Long duration of disease is an independent risk factor for poor surgical prognosis in patients with CM1 complicated with syringomyelia treated by PFDD, and early surgical treatment is recommended for the patients with symptomatic CM1 complicated with syringomyelia. [ABSTRACT FROM AUTHOR]

Objective To investigate the status of post - traumatic growth of viral encephalitis patients and screen the influencing factors. Methods A total of 110 viral encephalitis patients who were diagnosed and treated in West China Hospital, Sichuan University from July 2017 to July 2019 were investigated. A cross-sectional survey were adopted, including general data questionnaire, Post-traumatic Growth Inventory (PTGI), Family Concern Index Questionnaire (APGAR) and Connor-Davidson Resilience Scale (CD-RISC). Correlation analysis were used to analyze the relationship between PTGI score and age, APGAR score or CD - RISC score, respectively. Logistic regression was used to analyze the influencing factors of post-traumatic growth in patients with viral encephalitis. Results A total of 110 questionnaires were sent out and 105 were effectively received, with an effective recovery rate of 95.45%. The mean total PTGI score was 57.76 ± 15.23, and the score of dimensions of interpersonal relationship, life perception, personal strength, spiritual change and new possibilities was 16.92 ± 3.49, 12.44 ± 3.20, 11.91 ±3.50, 8.82 ± 3.48 and 7.67 ± 3.49, respectively. The partial correlation analysis showed that the total PTGI score was positively correlated with APGAR score (r = 0.331, P = 0.001) and CD-RISC score (r = 0.286, P = 0.003). Logistic regression analysis showed that higher APGAR score (OR = 1.260, 95%CI: 1.051-1.511; P = 0.013) and higher CD-RISC score (OR = 1.093, 95%CI: 1.035-1.153; P = 0.001) could positively affect post- traumatic growth, while complications (OR = 0.029, 95%CI: 0.003 -0.320; P = 0.004) was the opposite. Conclusions The status of post-traumatic growth of viral encephalitis patients is in the lower level. For patients with complications the psychological intervention should be strengthened. At the same time, family care and personality strength have additional effects on post - traumatic growth. We should take targeted measures to encourage such patients to establish better post-traumatic psychological regulation mechanism, and to accelerate the post-traumatic growth. [ABSTRACT FROM AUTHOR]

Objective To screen the risk factors of bacterial meningitis complicated with ischemic stroke and initially construct a risk prediction nomogram model. Methods A retrospective research analysis was performed for baseline data, clinical characteristics, laboratory or imaging examinations about 176 patients with bacterial meningitis diagnosed and treated in Xijing Hospital, Air Force Military Medical University of Chinese PLA from June 2008 to June 2018. Univariate and multivariate Logistic regression screened the risk factors for bacterial meningitis complicated with ischemic stroke. A prediction nomogram model was established by R software, using receiver operating characteristic (ROC) curve and calibration curve to evaluate the discrimination and calibration of the model. Results Fifteen of the 176 patients with bacterial meningitis complicated with ischemic stroke, the incidence was about 8.52%. Logistic regression analysis showed that age ≥ 55 years (OR = 6.350, 95%CI: 1.750-23.046; P = 0.005), seizures (OR = 5.114, 95%CI: 1.363-19.193; P = 0.016), neurological deficit (OR = 10.409, 95%CI: 2.781-39.480; P = 0.001) and cerebrospinal fluid white blood cell count < 1634 X 106/L (OR = 3.538, 95%CI: 1.014-12.345; P = 0.048) were risk factors for patients with bacterial meningitis complicated with ischemic stroke. The risk prediction nomogram model was constructed based on the above four indicators, and the probability of bacterial meningitis complicated with ischemic stroke was 66.8%. The area under the ROC curve was 0.859 (95%CI: 0.749-0.968, P = 0.001), which indicated that the model had excellent performance. The calibration chart showed that the trend of the model curve and the ideal curve was more consistent, which indicated that the model had better prediction performance. Conclusions Prediction of ischemic stroke in patients with bacterial meningitis has an excellent discrimination and calibration based on the currently constructed nomogram model for the risk. This prediction model contributes to the early detection of ischemic stroke in patients with bacterial meningitis, which has clinical significance to make a further study. [ABSTRACT FROM AUTHOR]

Objective To explore the prevalence, influencing factors, and clinical and imaging features of cervicocerebral artery dissection (CAD) in young patients with ischemic stroke. Methods A total of 242 young patients with first ever ischemic stroke were included in this study from October 2016 to September 2020. Thirty-two patients with CAD were included in the CAD group, and 210 patients without CAD were included as controls. We collected the clinical and imaging data of all the patients. Univariate and multivariate Logistic regression analysis were used to screen the influencing factors of young ischemic stroke patients caused by CAD. And we analyzed imaging characteristics of CAD in different locations. Results Among the 242 young patients with ischemic stroke, 32 (13.22%) patients were due to CAD. Compared with the control group, the CAD group had younger onset age (t = -3.480, P = 0.001), more inducible events (infection and neck movement) before the onset of cerebral infarction (t = 8.796, P = 0.003), and higher incidence of headache or neck pain (t = 17.466, P = 0.000) and posterior circulation infarction (t = 22.705, P = 0.000). Multivariate Logistic regression analysis showed that older age (OR = 0.920, 95%CI: 0.853-0.992; P = 0.030), the infarction located in the anterior circulation (OR = 0.145, 95%CI: 0.059-0.356; P = 0.000) were protective factors for ischemic stroke due to CAD, while head and neck pain (OR = 5.428, 95%CI: 1.653-17.824; P = 0.005) was risk factor for ischemic stroke due to CAD. The artery dissection lesions were located in anterior circulation in 11 (34.37%) patients with CAD, including 9 cases of extracranial carotid artery, one case of anterior cerebral artery, and one case of middle cerebral artery, while 21 (65.63%) patients' artery dissection lesions were located in the posterior circulation, including 10 cases of extracranial vertebral artery dissection (2 patients with bilateral lesions), 6 cases of intracranial segment, 4 cases with both intracranial and extracranial segment involvement, and one case with posterior inferior cerebellar artery dissection. After discharge, the follow-up imaging examination of 9 CAD patients showed that 6 patients had varying degrees of recovery of the arterial lumen and the rest 3 patients had no change. Conclusions CAD is a common cause of cerebral infarction in young people, and younger age, posterior circulation infarction and head and neck pain are risk factors for CAD. [ABSTRACT FROM AUTHOR]

Objective To explore the expression of CD4+ effector memory T cells (CD4+TEM) in peripheral blood of acute ischemic stroke patients with pulmonary infection, and to analyze the value of CD4+TEM combined with interleukin-6 (IL-6) and hypersensitive C-reactive protein (hs-CRP) in the diagnosis of pulmonary infection in patients with acute ischemic stroke. Methods Totally 54 confirmed acute ischemic stroke patients with pulmonary infection who were treated in the Department of Neurology at The Affiliated Hospital of Xuzhou Medical University from June 2018 to December 2019 were chosen as the infection group, meanwhile, 55 acute ischemic stroke patients without pulmonary infection were assigned as the control group. The clinical characters and the expression levels of CD4+TEM cells were compared in the 2 groups. Univariate and multivariate Logistic regression analysis were used to screen the risk factors of pulmonary infection in patients with acute ischemic stroke, and receiver operating characteristic (ROC) curve was further conducted to evaluate the diagnostic value of the percentage of CD4+TEM, IL-6, hs-CRP and combined detection in pulmonary infection patients with acute ischemic stroke. Results Multivariate Logistic regression analysis showed that the increased percentage of CD4+TEM cells (OR = 1.153, 95%CI: 1.069-1.244; P = 0.000), IL-6 (OR = 1.351, 95%CI: 1.046-1.747; P = 0.021) and hs-CRP (OR = 1.087, 95%CI: 1.008-1.172; P = 0.021) were important risk factors for pulmonary infection with acute ischemic stroke. When the percentage of CD4+TEM cells, IL-6 and hs-CRP were used as predictors of pulmonary infection with acute ischemic stroke alone, the area under the ROC curve were 0.906 (95%CI: 0.850-0.961), 0.799 (95%CI: 0.714-0.885) and 0.831 (95%CI: 0.754-0.908) respectively. When the percentage of CD4+TEM cells were combined with IL-6 and hs-CRP, the area under the curve increased to 0.943 (95%CI: 0.904-0.982). Conclusions The percentage of CD4+TEM cells combined with IL-6 and hs-CRP has better diagnostic value for pulmonary infection with acute ischemic stroke, and can be used as biomarkers for early prediction of pulmonary infection with acute ischemic stroke. [ABSTRACT FROM AUTHOR]

Objective To explore the imaging data of spontaneous intraparenchymal hemorrhage (sIPH) extracted from the Chinese Intracranial Hemorrhage Imaging Database (CICHID), and analyze the distribution of characteristics and features of hematoma expansion (HE) in patients with more than one non-contrast CT within 24 h. Methods There were 831 patients who received recurrent head CT scans involved the inclusion criteria analyzed from January 2016 to June 2020. The cutoff of HE was defined as 6 ml, and the patients were divided into HE group (≥ 6 ml) and non - HE group (< 6 ml) to explore the characteristics of patients and their imaging. To explore more features, the HE group was subdivided into groups. According to the cutpoints of the expansion volume in hematoma volume, the groups were subdivided into group A (reduce/no change), group B (< 3 ml), group C (3-5.99 ml), group D (6-12.49 ml) and group E (≥ 12.50 ml). According to the expansion rate in hematoma volume, there were group F (< 26%), group G (26%-32%) and group H (≥33%). Results Among 831 patients, there were 155 patients (18.65%) with hematoma expansion. Compared to non - HE group, the patients in HE group had larger initial hematoma volume (t = - 6.148, P = 0.000), higher rate of hematoma breaking into ventricle (χ² = 20.812, P = 0.000) and shorter interval time between CTs (t = 2.306, P = 0.021). When subdivided as 3, 6 and 12.50 ml, there were significant differences among the groups, which including initial hematoma volume (H = 97.129, P = 0.000), rate of hematoma breaking into ventricle (χ² = 50.043, P = 0.000) and interval time between CTs (t = 2.306, P = 0.021), the initial hematoma volume (P = 0.014, 0.005, 0.000) and the rate of hematoma breaking into ventricle (P = 0.000, 0.000, 0.000) in 3-5.99 ml group, 6-12.49 ml group and ≥ 12.50 ml group were higher than < 3 ml group, the interval time between CTs in ≥ 12.50 ml group was shorter than < 3 ml group (P = 0.000). And subdivided as 26% and 33%, only the rate of hematoma breaking into ventricle showed significant difference among groups (χ² = 15.649, P = 0.001). Conclusions In the studies, there was 18.65% sIPH patients occurred HE within 24 h and the risk factors might be initial hematoma volume, rate of hemorrhage breaking into ventricle and interval time between CTs. [ABSTRACT FROM AUTHOR]

Background and objective To compare the clinical efficacy of stereotactic body radiotherapy (SBRT) versus surgery for early-stage non-small cell lung cancer through evidence based medicine analysis. Methods A systematic search was performed in the PubMed, EMBASE, CNKI and Wan Fang databases to find studies published before June 2020. Two authors independently extracted the data and assessed the eligibility. All of the statistical analyses were performed using Stata 13.0. Subgroup analysis were performed according to the score matching study and operation type (lobectomy, seg-mentectomy and thoracoscopic assisted surgery). Results Finally, 14 articles were included, including 15,841 cases in SBRT group and 17,708 cases in operation group. 10 articles used propensity score matching methods for survival analysis. Thirteen were retrospective cohort studies and one was randomized controlled trial. The results of meta-analysis showed that the overall survival rate of the surgery group and the SBRT group was statistically significant. The overall survival rate of the SBRT group (HR=1.51, 95%CI: 1.31-1.74) was inferior to that of the surgery group. In the subgroup analysis of the surgical type, there was no statistical difference between the SBRT group and each surgical type. The difference of overall survival rate between SBRT group and surgery group was statistically significant (HR=1.66, 95%CI: 1.45-1.90) in studies of propensity score matching. There was no statistically significant difference in cancer-specific survival between the surgery and SBRT groups (HR=1.12, 95%CI: 0.83-1.52). Conclusion The overall survival rate of surgical treatment is better than that of SBRT, but it has no obvious advantages in cancer specific survival rate. [ABSTRACT FROM AUTHOR]

Background and objective Immune checkpoint inhibitors (ICIS) have good efficacy on most advanced tumors, which brings new hope to patients with advanced tumors. However, the immune system activated by ICIs may attack human normal tissues and organs, resulting in corresponding immunotoxicity, such as checkpoint inhibitor pneumonitis. This article carried out a meta-analysis on the incidence and risk of programmed cell death protein 1 (PD-1) and programmed cell death protein ligand 1 (PD-L1) inhibitor-associated pneumonia in advanced tumors patients. Methods The computer retrieval of PubMed, Cochrane Library, EMbase and CNKI was performed, and the studies on the occurrence rate of PD-1/PD-L1 inhibitor-associated pneumonia in terminal cancer patients were collected, with the retrieval time limit of January 2000 to January 2020. Statistical analysis was conducted by using Revman 5.3 and R 3.6.2 software to compare the occurrence rate of pneumonia under different circumstances. Results 15 studies were included, involving 8,642 patients, of which those with PD-1/PD-L1 inhibitor were treatment group, and those with chemotherapy were control group. The odds radio of all grades of immune pneumonia was 6.63, and that of high grade was 4.87. The occurrence rate of all grades of pneumonia in the ICI group with non-small cell lung cancer (NSCLC) was 1.658 times than other tumors, and that of high grade was 2.299 times. The occurrence rate of all grades of pneumonia in second-line or more treatment with ICI was 0.489 times than that in first-line, and that of high grade was 0.449 times than that in first-line or more treatment with ICI. Conclusion Compared with chemotherapy, the risk of immune-associated pneumonia is higher in PD-1 and PD-L1 inhibitors, and its occurrence risk is high in the ICI group with NSCLC and the first-line treatment with ICI. This paper provides guidance for clinic treatment of terminal cancers and prevention of complications. [ABSTRACT FROM AUTHOR]