Determinants of acute and subacute case-fatality in elderly patients with hypertensive intracerebral hemorrhage

Background

Given that limited reports have described the survival and risk factors for elderly patients with hypertensive intracerebral hemorrhage (HICH), we aimed to develop a valid but simple prediction nomogram for the survival of HICH patients.

Methods

All elderly patients ≥65 years old who were diagnosed with HICH between January 2011 and December 2019 were identified. We performed the least absolute shrinkage and selection operator (Lasso) on the Cox regression model with the R package glmnet. A concordance index was performed to calculate the nomogram discrimination; and calibration curves and decision curves were graphically evaluated by depicting the observed rates against the probabilities predicted by the nomogram.

Results

A total of 204 eligible patients were analyzed, and over 20 % of the population was above the age of 80 (65-79 years old, n = 161; 80+ years old, n = 43). A hematoma volume ≥13.64 cm3 was associated with higher 7-day mortality (OR = 6.773, 95 % CI = 2.622-19.481; p < 0.001) and higher 90-day mortality (OR = 3.955, 95 % CI = 1.611-10.090, p = 0.003). A GCS score between 13 and 15 at admission was associated with a 7-day favorable outcome (OR = 0.025, 95 % CI = 0.005-0.086; p < 0.001) and a 90-day favorable outcome (OR = 0.033, 95 % CI = 0.010-0.099; p < 0.001).

Conclusions

Our nomogram models were visualized and accurate. Neurosurgeons could use them to assess the prognostic factors and provide advice to patients and their relatives.

Surgical management and outcome of primary intracranial Rosai-Dorfman disease: a single-institute experience and pooled analysis of individual patient data

Primary intracranial Rosai-Dorfman disease (PIRDD) is considered a nonmalignant nonneoplastic entity, and the outcome is unclear due to its rarity. The study aimed to elaborate the clinic-radiological features, treatment strategies, and progression-free survival (PFS) in patients with PIRDD. Patients with pathologically confirmed PIRDD in our institute were reviewed. Literature of PIRDD, updated until December 2019, was systematically searched in 7 databases (Embase, PubMed, Cochrane database, Web of Science, Wanfang Data Knowledge Service Platform, the VIP Chinese Science and Technology Periodical Database (VIP), and the China National Knowledge Infrastructure (CNKI)). These prior publication data were processed and used according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Clinical-radiological characteristics and adverse factors for PFS were evaluated in the pooled cohort. The pooled cohort of 124 cases (81 male and 43 female), with a mean age of 39.7 years, included 11 cases from our cohort and 113 cases from 80 prior studies. Twenty-nine patients (23.4%) had multiple lesions. Seventy-four patients (59.7%) experienced gross total resection (GTR), 50 patients (40.3%) had non-GTR, 15 patients (12.1%) received postoperative adjuvant radiation, and 23 patients (18.5%) received postoperative steroids. A multivariate Cox regression revealed that GTR (HR = 4.52; 95% CI 1.21-16.86; p = 0.025) significantly improved PFS, and multiple lesions (p = 0.060) tended to increase the hazard of recurrence. Neither radiation (p = 0.258) nor steroids (p = 0.386) were associated with PFS. The overall PFS at 3, 5, and 10 years in the pooled cohort was 88.4%, 79.4%, and 70.6%, respectively. The PFS at 5 and 10 years in patients with GTR was 85.4% and 85.4%, respectively, which was 71.5% and 35.8%, respectively, in patients without GTR. Gross total resection significantly improved PFS and was recommended for PIRDD. Radiation and steroids were sometimes empirically administered for residual, multiple, or recurrent PIRDD, but the effectiveness remained arguable and required further investigation.Systematic review registration number: CRD42020151294.

The Screening and Expression of Polysaccharide Deacetylase from Caulobacter crescentus and Its Function Analysis

The bacterium Caulobacter crescentus secretes an adhesive polysaccharide called holdfast which is the known strongest underwater adhesive in nature. The deacetylase encoded by hfs (holdfast synthesis) H gene is a key factor affecting the adhesion of holdfast. Its structure and function are not yet clear, and whether other polysaccharide deacetylases exist in C. crescentus is still unknown. The screening of both HfsH and its structural analogue as well as their purification from the artificial expression products of E. coli. is the first step to clarify these questions. Here, we determined the conserved domains of HfsH via sequence alignment among Carbohydrate Esterase family 4 enzymes and screened out its structural analogue (CC_2574) in C. crescentus. The recombinant HfsH and CC_2574 were effectively expressed in E. coli. Both of them were purified by chromatography from their corresponding productions in E. coli., and were then functionally analyzed. The results indicated that a high deacetylase activity (61.8 U/mg) was observed in recombinant HfsH but not in CC_2574, which suggesting that HfsH might be the irreplaceable gene mediating adhesion of holdfast in C. crescentus. Moreover, the divalent metal ions Zn²⁺ , Mg²⁺ , Mn²⁺ could promote the activity of recombinant HfsH at the concentration from 0.05mM to 1mM, but inhibit its activity when the concentration exceeds 1mM. In sum, our study firstly realized the artificial production of polysaccharide deacetylase HfsH and its structural analogue, and further explored their functions, both of which laid the foundation for the development of new adhesive materials. Expression of polysaccharide deacetylase HfsH promoting the adhesion of holdfast The effects of various metal ions on the deacetylase activity of recombinant HfsH Functional analysis of recombinant polysaccharide deacetylase Screening of functional analogue of HfsH in Caulobacter crescentus based on ts conserved domains This article is protected by copyright. All rights reserved.

[Effect of cotton-moxibustion on chronic eczema and quality of life]

OBJECTIVE

To compare the therapeutic effect between cotton-moxibustion and compound flumetasone ointment, and observe the effect on quality of life in patients with chronic eczema.

METHODS

A total of 66 patients with chronic eczema were randomized into an observation group (33 cases, 2 cases dropped off) and a control group (33 cases, 2 cases dropped off). In the observation group, cotton-moxibustion was adopted on target skin lesion, once a day, 3 cones a time. In the control group, external application of compound flumetasone ointment was given twice a day. The treatment for 3 weeks was required in the both groups. Before treatment and 1,2,3 weeks into treatment, scores of visual analogue scale (VAS), eczema area and severity index (EASI) and dermatology life quality index (DLQI) were observed, and the recurrence rate was evaluated in the follow-up one month after treatment.

RESULTS

Compared before treatment, the VAS scores of 1,2,3 weeks into treatment, the EASI and DLQI scores of 2,3 weeks into treatment were decreased in the both groups (P<0.05), and those in the observation group were lower than the control group (P<0.05). The follow-up recurrence rate in the observation group were lower than the control group (P<0.05).

CONCLUSION

Cotton-moxibustion can effectively improve the pruritus symptom, skin lesion and quality of life in the patients with chronic eczema, the therapeutic effect is superior to the external application of compound flumetasone ointment.

Amplification in the apical turn of the cochlea with negative feedback

The apical turn of the anesthetized guinea pig cochlea was opened to examine the basilar membrane optically through the intact Reissner's membrane. Vibrations of the outer Hensen's cell and the basilar membrane (BM) adjacent to and about 130 microm below the level of the Hensen's cell were measured. Outer Hensen's cell vibration at the characteristic frequency was up to 900 times higher compared to the BM amplitude. After sacrifice BM vibration increased while Hensen's cell vibration decreased. The magnitude and sequence of change after sacrifice can best be explained by the presence of negative feedback between reticular lamina and BM. In other experiments using ototoxic drugs that damage outer hair cells, similar changes in Hensen's cell and BM vibration were observed. These results show that the apical turn behavior is different from that observed by other investigators in the basal turn. The potential benefits of the negative feedback are discussed. The presence of negative feedback would explain the linearity at the fundamental frequency observed in the apical turn of cochlea.

Mechanical nonlinearity in the apical turn of the guinea pig organ of Corti

Confocal microscopy was used to view the sealed apical turn of the cochlea in a living guinea pig, and to identify the cochlear structures through the intact Reissner's membrane. X, Y and Z coordinates for each point of interest were recorded. A confocal laser heterodyne interferometer measured the cellular vibration in response to acoustical signals applied to the ear. Velocity time waveforms were recorded at 32 frequencies between 25 and 2500 Hz at each point of measurement. To characterize the vibration pattern of the organ of Corti, vibrations at multiple locations along a radial track of the reticular lamina were measured before and after sacrificing the animal. Amplitude and phase tuning curves of the fundamental and the second harmonic, velocity time waveforms, and FFTs of time waveforms are compared before and after sacrifice. The results show that a sharply tuned nonlinear part of the response disappears shortly after sacrifice.

Vibrations of the guinea pig organ of Corti in the apical turn

Vibrations of the organ of Corti were measured in response to sound applied to the ear in the apical turn of a living guinea pig. Measurements were made at 29 points on the Reissner's membrane (RM) at 10 micro spacing along a radial track. Measurements also included 22 points on the reticular lamina (RL), Claudius' cells and osseous spiral lamina. Our goal was to characterize the vibration of the RM and the RL with high spatial resolution along a radial axis. The tuning and spatial patterns of the RM are compared in the radial direction with those for the RL at the fundamental frequency and at the second harmonic. The shape of the RM tuning curve changes with radial position, and differ significantly from those observed at the RL. These results support our earlier findings (Hao and Khanna, Hear. Res. 99 (1996) 176-189).

Nonlinearity in the apical turn of living guinea pig cochlea

Mechanical vibrations were measured at the apical turn in living guinea pig cochlea, in response to sinusoidal acoustic stimuli, using heterodyne interferometry. The cochlea was sealed and the vibrations were measured at different cellular locations along a radial track at the level of reticular lamina and one point on the osseous spiral lamina. Averaged time waveforms were recorded at each test frequency. The nonlinearity in the apical turn is demonstrated by the distortion in the time waveforms and the richness of the harmonic components in their Fourier transforms. Tuning curves and input/output curves for the fundamental and harmonics components are shown. The fundamental component is essentially linear below about 90 dB SPL while the harmonics display strong nonlinearity and saturation. Negative feedback in the apical turn of the cochlea linearizes the response at the fundamental frequency.

Reticular lamina vibrations in the apical turn of a living guinea pig cochlea

The reticular lamina of the apical turn of a living guinea pig cochlea was viewed through the intact Reissner's membrane using a slit confocal microscope. Vibrations were measured at selected identified locations with a confocal heterodyne interferometer, in response to tones applied with an acoustic transducer coupled to the ear canal. The position coordinates of each location were recorded. Mechanical tuning curves were measured along a radial track at Hensen's cells, outer hair cells, inner hair cells and at the osseous spiral lamina, over a frequency range of 3 kHz, using five sound pressure levels (100, 90, 80, 70 and 60 dB SPL). The carrier to noise ratio obtained throughout the experiments was high. The response shape at any measuring location was not found to change appreciably with signal level. The response shape also did not change significantly with the radial position on the reticular lamina. However, the response magnitude increased progressively from the inner hair cell to the Hensen's cell. The observed linearity of response at the fundamental frequency is explained by the presence of negative feed back in the apical turn of the cochlea.

Reissner's membrane vibrations in the apical turn of a living guinea pig cochlea

Mechanical tuning curves were recorded at several radial locations on the Reissner's membrane, over a wide range of frequencies, and sound pressure levels. The position coordinates of each location were also recorded. The shape of the tuning curves changed dramatically with the radial location. Near the outer edge of the cochlea the response was broadly tuned, with a maxima near 300 Hz, while near the inner edge the response showed at least three maxima and minima. Responses were also measured at the reticular lamina. The shapes of the frequency responses at the Reissner's membrane are quite different from those measured at the reticular lamina below it.