Role of scalp hypothermia in patients undergoing minimally invasive evacuation of hypertensive cerebral hemorrhage

Prediction of Hematoma Expansion in Hypertensive Intracerebral Hemorrhage by a Radiomics Nomogram

Objective

To develop and validate a radiomics-based nomogram model which aimed to predict hematoma expansion (HE) in hypertensive intracerebral hemorrhage (HICH).

Methods

Patients with HICH (n=187) were included from October 2017 to March 2022 in the Yongchuan Affiliated Hospital of Chongqing Medical University. Patients were randomly divided into a training set (n=130) and a validation set (n=57) in a ratio of 7:3. The radiomic features were extracted from the regions of interest (including main hematoma, the surrounding small hematoma(s) and perihematomal edema) in the first CT scan images. The variance threshold, SelectKBest and LASSO (least absolute shrinkage and selection operator), features were selected and the radiomics signature was built. Multivariate logistic regression was used to establish a nomogram based on clinical risk factors and the Rad-score. A receiver operating characteristic (ROC) curve was used to evaluate the generalization of the models' performance. The calibration curve and the Hosmer-Lemeshow test were used to assess the calibration of the predictive nomogram. And decision curve analysis (DCA) was used to evaluate the prediction model.

Results

Thirteen radiomics features were selected to construct the radiomics signature, which has a robust association with HE. The radiomics model found that blend sign was a predictive factor of HE. The radiomics model ROC in the training set was 0.89 (95%CI 0.82-0.96) and was 0.82 (95%CI 0.60-0.93) in the validation set. The nomogram model was built using the combined prediction model based on radiomics and blend sign, and worked well in both the training set (ROC: 0.90[95%CI 0.83-0.96]) and the validation set (ROC: 0.88[95%CI 0.71-0.93]).

Conclusion

The radiomic signature based on CT of HICH has high accuracy for predicting HE. The combined prediction model of radiomics and blend sign improves the prediction performance.

The effect of butylphthalide injection on the cognitive function and the TLRs/NF-κB pathway in hypertensive intracerebral hemorrhage

OBJECTIVE

This study explored and analyzed the effects of butylphthalide injection on the cognitive function and on the TLRs/NF-κB pathway in hypertensive intracerebral hemorrhage patients.

METHODS

A total of 115 patients admitted to our hospital with hypertensive intracerebral hemorrhages were recruited as the study cohort and randomly placed in the observation group (n=60) or the control group (n=55). In addition to the routine treatment administered in both groups, the control group was additionally administered oral nimodipine tablets, and the observation group was administered intravenous butylphthalide injections. Both groups were treated continuously for 14 days. Subsequently, the changes in the clinical efficacy, the NIHSS scores, the extremity motor function, the Fugl-Meyer scores, the blood-brain barrier (BBB) and the peripheral blood mononuclear cells (PBMCs), the TLR2, TLR9, and the NF-κB mRNA levels in the two groups before and after the treatment were compared, and any adverse reactions were observed.

RESULTS

The total effective rate in the observation group was significantly superior to the total effective rate in the control group (P<0.05). The post-treatment NIHSS scores in the two groups were dramatically lower (P<0.05), and the post-treatment scores in the observation group were significantly lower than they were in the control group (P<0.05). The post-treatment cerebral spinal fluid (CSF) albumin and BBB indexes in the two groups were decreased significantly compared to their pre-treatment levels (P<0.05), and the post-treatment indexes in the observation group were significantly lower than the post-treatment indexes in the control group (P<0.05). The post-treatment relative TLR2, TLR9, and NF-κB mRNA expressions in the two groups were apparently lower than their in pre-treatment levels (P<0.05), and the relative expressions in the observation group after the treatment were clearly lower than they were in the control group (P<0.05).

CONCLUSION

Butylphthalide injection has a high clinical efficacy in treating hypertensive intracerebral hemorrhages. The drug can effectively improve patients' cognitive functions, extremity motor functions, and BBB indexes, and its mechanism may connect with the expressive suppression of the TLRs/NF-κB signaling pathway. The treatment is safe and effective, so it is worthy of clinical promotion.

The risk factors for the postoperative pulmonary infection in patients with hypertensive cerebral hemorrhage: A retrospective analysis

ABSTRACT

The risk factors for the pulmonary infections after hypertensive cerebral hemorrhage remains unclear. We aimed to investigate the potential risk factors for the postoperative pulmonary infection in patients with hypertensive cerebral hemorrhage.Patients with hypertensive cerebral hemorrhage undergone surgery from January 2018 to December 2019 were included. Related personal and medical information were collected. Univariate and multivariate logistic regression analyses were performed to identify the potential risk factors for the postoperative pulmonary infection.A total of 264 patients were included, and the incidence of pulmonary infection for patients with hypertensive cerebral hemorrhage after surgery was 19.70%. Escherichia coli is the most common bacteria of pulmonary infection. Multivariate regression analysis revealed that the preoperative hypoalbuminemia (OR2.89, 1.67∼4.78), tracheotomy (OR5.31, 1.24∼11.79), diabetes (OR4.92, 1.32∼9.80), preoperative GCS (OR5.66, 2.84∼11.21), and the duration of mechanical ventilation (OR2.78, 2.32∼3.61) were the independent risk factors for the pulmonary infection in patients with hypertensive cerebral hemorrhage (all P < .05).Patients with hypertensive intracerebral hemorrhage after surgery have a higher risk of postoperative pulmonary infections, and there are many related risk factors, which should be taken seriously in clinical practice.