Deep Hemorrhage Research Articles

TO STUDY RISK FACTORS AND CLINICAL PROFILE OF BRVO AT A TERTIARY CARE CENTRE

Introduction: After diabetic retinopathy, retinal vein occlusion is the second most prevalent retinal vascular condition. BRVO is brought on by blockage of the retinas branch vein, which affects a specific quadrant. The patient will have venous dilatation within the affected sector, superficial and deep retinal hemorrhages, and either macular or retinal edema during ophthalmoscopic examination. Age and systemic vascular diseases are the most well-known risk factors for BRVO. Materials and Methods: Prospective observational study was done for 1 year. Patients more than 25 years of age attending ophthalmology OPD found to have BRVO were evaluated for various risk factors and other clinical findings after taking proper consent. Results: In this Study 24 patients of more than 25 years of age found to have BRVO out of which 14 were male and 10 were female. 15 cases (62.5%) having hypertension, 5 case (20.8 % ) having diabetes, 4( 16.6%) were smokers, 9 (37.5%) were having altered lipid profile, 2 (8.33%) were alcoholics. Conclusion: Modern tools and technology make it simple to diagnose and treat branch retinal vein occlusion. Be cautious of the four Hs: increased age, hypertension, hyperlipidemia, and homocysteinemia. This multifactorial disease affects the eyes of a person with hypertension and other risk factors including aging.

Nanofiber-based Multifunctional Microspheres for Rapid Hemostasis and Microorganism Removal of Water.

Constructing hemostats capable of effectively controlling severe hemorrhage from irregular wounds presents significant challenges and imperatives. In this study, a novel approach is introduced using nanofibrous chitin microspheres (NCM) that are compressed to 60% strain (NCM-60%) to amplify their water-initiated expansion performance. This unique capacity allows NCM-60% to efficiently conform to and fill irregular bleeding cavities, even those of varying depths and curvatures, thereby promoting rapid blood coagulation at deep hemorrhage sites. NCM-60% exhibits effective control of severe femoral artery and "J"-shaped liver hemorrhages in 151 ± 6 s and 68 ± 15 s, respectively, revealing its exceptional hemostatic efficacy. Furthermore, NCM-60% exhibited promising capabilities in removing microbes from water, achieving removal rates of over 96% of bacteria. Blood compatibility assessments and cytotoxicity tests further confirmed the favorable biocompatibility of NCM-60%. Importantly, NCM-60% is found to biodegrade and be absorbed in vivo within 12 weeks. This study represents the first instance of leveraging chitin nanofiber-based biomaterials to design water-initiated expansion micro-hemostat, and integrate hemostatic functions with waterborne microorganism removal, thereby expanding the potential applications of micro-nanostructural materials in emergency first-aid scenarios.

Wearable Single‐Electrode Capacitive Sensor with Large Penetration Depth for Intelligent Deep Tissue and Hemorrhage Monitoring

Wearable Single‐Electrode Capacitive Sensor with Large Penetration Depth for Intelligent Deep Tissue and Hemorrhage Monitoring

PARACENTRAL ACUTE MIDDLE MACULOPATHY AND HENLE FIBER LAYER HEMORRHAGE IN DENGUE FEVER: MULTIMODAL IMAGING AND REVIEW OF THE LITERATURE.

To use multimodal imaging to report a case of dengue fever presenting with Henle fiber layer hemorrhage (HH) and acute paracentral acute middle maculopathy (PAMM). Fundus photography and autofluorescence, fluorescein angiography, and optical coherence tomography (OCT) were acquired over a month, and a literature review of dengue fever-associated maculopathy was performed. A 19-year-old man presented with a sudden loss of vision in both eyes 12 days after experiencing initial systemic symptoms suggestive of dengue fever. His best-corrected visual acuity (BCVA) was counting fingers in the right eye (OD) and 20/200 in the left eye (OS). Pupillary light reflex was reduced in both eyes (OU). Dilated fundoscopic examination revealed optic disc swelling and a small deep hemorrhage near the fovea in OU. OCT revealed a petaloid shape hyperreflectivity involving both outer nuclear and plexiform layers in OU and a subtle hyperreflectivity thinning the inner nuclear layer (INL) in OS, findings compatible with HH and PAMM, respectively. Immunoglobin M was positive for dengue fever. Thus, a diagnosis of dengue fever-associated maculopathy was performed and oral steroids were started. After a month, the final BCVA reached 20/25 (OD) and 20/20 (OS), the HH reabsorbed utterly, and a INL thinning in the area of the PAAM was observed. Dengue fever-associated maculopathy can present with PAAM and HH. Multimodal imaging is helpful to characterize the extension of the changes in the retina and to monitor its recovery. In such cases, structural and functional damage may occur despite treatment with oral steroids.

Impact of a deep learning-based brain CT interpretation algorithm on clinical decision-making for intracranial hemorrhage in the emergency department

Intracranial hemorrhage is a critical emergency that requires prompt and accurate diagnosis in the emergency department (ED). Deep learning technology can assist in interpreting non-enhanced brain CT scans, but its real-world impact on clinical decision-making is uncertain. This study assessed a deep learning-based intracranial hemorrhage detection algorithm (DLHD) in a simulated clinical environment with ten emergency medical professionals from a tertiary hospital’s ED. The participants reviewed CT scans with clinical information in two steps: without and with DLHD. Diagnostic performance was measured, including sensitivity, specificity, accuracy, and the area under the receiver operating characteristic curve. Consistency in clinical decision-making was evaluated using the kappa statistic. The results demonstrated that DLHD minimally affected experienced participants’ diagnostic performance and decision-making. In contrast, inexperienced participants exhibited significantly increased sensitivity (59.33–72.67%, p < 0.001) and decreased specificity (65.49–53.73%, p < 0.001) with the algorithm. Clinical decision-making consistency was moderate among inexperienced professionals (k = 0.425) and higher among experienced ones (k = 0.738). Inexperienced participants changed their decisions more frequently, mainly due to the algorithm’s false positives. The study highlights the need for thorough evaluation and careful integration of deep learning tools into clinical workflows, especially for less experienced professionals.

A Small-Molecule NIR-II Probe for the Diagnosis of Hemorrhagic Diseases.

Numerous hemorrhagic disorders, particularly those presenting deep hemorrhage, pose diagnostic challenges, often leading to delayed treatment and severe outcomes. Near-infrared (NIR)-II fluorescence imaging offers advantages such as deep tissue penetration, real-time visualization, and a high signal-to-background ratio, making it highly suitable for diagnosing hemorrhagic diseases. In this study, an NIR-II fluorescent probe LJ-2P carrying carboxylic and phosphoric acid groups is successfully applied for imaging hemorrhagic diseases. LJ-2P demonstrates a strong affinity for fibrinogen and fibrin clots both computationally and experimentally, thus exhibiting increased brightness upon coagulation. As compared to Indocyanine Green, LJ-2P provides a longer imaging window, higher imaging specificity, and signal-to-background ratio, as well as superior photobleaching resistance in three disease models: gastric, pulmonary, and cerebral hemorrhages. These results reveal that LJ-2P demonstrates enhanced imaging capabilities, enabling precise identification of hemorrhagic sites.

Widespread haemorrhages in infants post-shunting (WHIPS): clinical features, risk factors and neuroimaging characteristics of a rare and under-recognised phenomenon

PurposeInfants undergoing CSF shunting procedures face a rare complication which we propose to rename “Widespread Haemorrhages in Infants Post-Shunting” (WHIPS) to better capture this unique phenomenon specific to infants undergoing CSF diversion. Our objective is to analyse the risk factors for WHIPS development and provide a detailed neuroradiological description of these haemorrhages.Materials and methodsA radiology information system (RIS) was searched using the search terms “shunt” and/or “catheter” and/or “drain” and/or “ventriculoperitoneal” and/or “VP” between September 2008 to January 2021 for patients < 12 months of age. Clinical data was compiled for each patient meeting the inclusion criteria. Included cases were reviewed by three radiologists for the presence of WHIPS with calculation of the bifrontal ratio and documenting haemorrhage number, morphology, location and lobar distribution.Results51 patients met inclusion criteria, 8 WHIPS patients and 43 controls. There was a statistically significant correlation between a larger post-op head circumference and WHIPS (p = 0.04). WHIPS was associated with post-haemorrhagic hydrocephalus and post-infectious hydrocephalus (p = 0.009). WHIPS were identified in the cortico-subcortical regions, periventricular white matter, and deep white matter. Haemorrhages were either punctate, ovoid or confluent. Haemorrhages ranged from single to innumerable.ConclusionsWHIPS represent a rare and under-recognised complication of CSF shunting unique to the infantile population. We postulate deep and superficial medullary venous haemorrhage as an underlying mechanism related to disordered intracranial hydrodynamics which are exacerbated in the infantile population due to underdeveloped arachnoid granulations and a compliant skull.

Minimally invasive surgeries for spontaneous hypertensive intracerebral hemorrhage (MISICH): a multicenter randomized controlled trial

BackgroundIntracerebral hemorrhage (ICH) is a common stroke type with high morbidity and mortality. There are mainly three surgical methods for treating ICH. Unfortunately, thus far, no specific surgical method has been proven to be the most effective. We carried out this study to investigate whether minimally invasive surgeries with endoscopic surgery or stereotactic aspiration (frameless navigated aspiration) will improve functional outcomes in patients with supratentorial ICH compared with small-bone flap craniotomy.MethodsIn this parallel-group multicenter randomized controlled trial conducted at 16 centers, patients with supratentorial hypertensive ICH were randomized to receive endoscopic surgery, stereotactic aspiration, or craniotomy at a 1:1:1 ratio from July 2016 to June 2022. The follow-up duration was 6 months. Patients were randomized to receive endoscopic evacuation, stereotactic aspiration, or small-bone flap craniotomy. The primary outcome was favorable functional outcome, defined as the proportion of patients who achieved a modified Rankin scale (mRS) score of 0–2 at the 6-month follow-up.ResultsA total of 733 patients were randomly allocated to three groups: 243 to the endoscopy group, 247 to the aspiration group, and 243 to the craniotomy group. Finally, 721 patients (239 in the endoscopy group, 246 in the aspiration group, and 236 in the craniotomy group) received treatment and were included in the intention-to-treat analysis. Primary efficacy analysis revealed that 73 of 219 (33.3%) in the endoscopy group, 72 of 220 (32.7%) in the aspiration group, and 47 of 212 (22.2%) in the craniotomy group achieved favorable functional outcome at the 6-month follow-up (P = .017). We got similar results in subgroup analysis of deep hemorrhages, while in lobar hemorrhages the prognostic outcome was similar among three groups. Old age, deep hematoma location, large hematoma volume, low preoperative GCS score, craniotomy, and intracranial infection were associated with greater odds of unfavorable outcomes. The mean hospitalization expenses were ¥92,420 in the endoscopy group, ¥77,351 in the aspiration group, and ¥100,947 in the craniotomy group (P = .000).ConclusionsCompared with small bone flap craniotomy, endoscopic surgery and stereotactic aspiration improved the long-term outcome of hypertensive ICH, especially deep hemorrhages.Trial RegistrationClinicalTrials.gov Identifier: NCT02811614.

Anemic retinopathy in a patient with abdominal tuberculosis: A case report

Retinal hypoxia caused by anemia can be a cause of retinal nerve fiber infarction and increased transmural pressure. This results in superficial and deep hemorrhages, cotton wool spots, retinal edema, Roth spots, and vessel dilatations. Tuberculosis (TB) may cause anemia due to malabsorption, reduced intake, or due to chronic diseased state. Here, we report a patient of abdominal TB with anemic retinopathy, which was improved after taking proper treatment for anemia.

Injuries in Fatalities of Dismounted Blast: Identification of Four Mechanisms of Head and Spine Injury.

Blast is the most common injury mechanism in conflicts of this century due to the widespread use of explosives, confirmed by recent conflicts such as in Ukraine. Data from conflicts in the last century such as Northern Ireland, the Falklands, and Vietnam up to the present day show that between 16% and 21% of personnel suffered a traumatic brain injury. Typical features of fatal brain injury to those outside of a vehicle (hereafter referred to as dismounted) due to blast include the presence of hemorrhagic brain injury alongside skull fractures rather than isolated penetrating injuries more typical of traditional ballistic head injuries. The heterogeneity of dismounted blast has meant that analysis from databases is limited and therefore a detailed look at the radiological aspects of injury is needed to understand the mechanism and pathology of dismounted blast brain injury. The aim of this study was to identify the head and spinal injuries in fatalities due to dismounted blast. All UK military fatalities from dismounted blast who suffered a head injury from 2007-2013 in the Iraq and Afghanistan conflicts were identified retrospectively. Postmortem computerized tomography images (CTPMs) were interrogated for injuries to the head, neck, and spine. All injuries were documented and classified using a radiology brain injury classification (BIC) tool. Chi-squared (χ2) and Fisher's exact tests were used to investigate correlations between injuries, along with odds ratios for determining the direction of correlation. The correlations were clustered. There were 71 fatalities from dismounted blast with an associated head injury with a CTPM or initial CT available for analysis. The results showed the heterogeneity of injury from dismounted blast but also some potential identifiable injury constellations. These were: intracranial haemorrhage, intracranial deep haemorrhage, spinal injury, and facial injury. These identified injury patterns can now be investigated to consider injury mechanisms and so develop mitigation strategies or clinical treatments. Level of Evidence: Observational. Study type: cohort observational.

Abstract WMP81: Overweight Patients Had Higher Odds of Favorable Outcome After Both Deep and Lobar Intracerebral Hemorrhage

Introduction: Intracerebral Hemorrhage (ICH) leads to high rates of morbidity and mortality. Malnutrition is common in stroke patients and leads to worse outcomes. Body mass index (BMI) is a widely available marker of nutrition status, however studies on BMI and post-ICH outcomes are limited and have conflicting results. We aim to clarify this relationship by examining the relationship between BMI, nutritional lab markers, ICH severity, and functional outcome at discharge stratified by ICH location. Methods: We leveraged data from an ongoing longitudinal ICH study of adults with spontaneous primary ICH. Patients were divided into underweight, normal weight, overweight, and obese according to World Health Organization BMI criteria. Albumin, B12, total bilirubin, cholesterol, CRP, ferritin, iron, folate, hbA1c, HDL, LDL, hemoglobin, MCV, INR, ALT, triglycerides, and vitamin D were abstracted from health records. Associations between BMI, lab markers, ICH volume, and favorable outcome (mRS 0-2) were analyzed using univariate and multivariable logistic regression stratified by deep versus lobar hemorrhage location, with normal weight as the reference. Results: 1,370 patients (719 with deep hemorrhage, 651 with lobar hemorrhage) were included. There was no association between BMI and ICH volume in patients with deep or lobar hemorrhage. Multivariable analyses adjusting for age, education, diabetes mellitus, coronary artery disease, alcohol use, ICH volume, and intraventricular hemorrhage showed that overweight, but not underweight or obese, subjects had higher odds of favorable outcome on discharge in the deep (OR 3.16, 95% CI 1.36-7.34) and lobar (OR 3.15, 95% CI 1.67-5.94) groups. Albumin (OR 2.27, 95% CI 1.05-4.90) and hemoglobin (OR 1.31, 95% CI 1.09-1.59) were the only labs associated with favorable outcome in the deep hemorrhage group while no markers were associated with favorable outcome in the lobar hemorrhage group. Albumin and hemoglobin were not associated with being overweight. Conclusion: Overweight patients had three times higher odds of favorable outcome after both deep and lobar hemorrhages. This was not driven by ICH severity or explained by lab markers. Future biomarker studies are needed to better understand this relationship.

Abstract 149: Different Response to Blood Pressure Reduction in Lobar and Deep Intracerebral Hemorrhage

Background: Blood pressure (BP) reduction is associated with better neuroimaging and clinical outcomes in patients with spontaneous, non-traumatic intracerebral hemorrhage (ICH). Because this evidence comes from studies that overwhelmingly enrolled deep hemorrhages, the impact of BP reduction in patients with lobar ICH remains understudied. Methods: We re-analyzed data from the pivotal Antihypertensive Treatment of Acute Cerebral Hemorrhage-2 (ATACH-2) study. We included all patients with available neuroimaging data. Participants were randomized to either intensive (systolic BP target 110-139 mmHg) or standard (systolic BP target 140-179 mmHg) acute BP lowering. The main outcome measures were hematoma expansion &gt; 6 mL in the first 24 hours (HE), poor functional outcome (3-month mRS 4-6) and renal adverse events (RAE) until day 7 or hospital discharge. We fitted multivariable logistic regression models to test for association between the intervention and our outcomes of interest. Covariates included sex, age, race and ethnicity, and baseline ICH volume. Results: Among 1,000 patients enrolled in ATACH-2, 875 (87.5%) with complete data were included (88.9% deep hemorrhages and 11.1% lobar hemorrhages). The baseline characteristics of the intensive and standard treatment groups remained balanced as in the original study (all comparisons p &gt;0.05). Multivariable logistic regression showed that intensive BP reduction decreased the risk of HE (OR 0.60, 95%CI 0.39-0.90; p=0.02) and increased the risk of RAE (OR 2.53, 95%CI 1.40-4.77; p=0.003) in patients with deep, but not lobar ICH (HE, OR: 0.89; 95% CI= 0.31 - 2.52; p=0.83 and RAE, OR: 0.46; 95% CI= 0.04 - 5.10; p=0.53). Intensive BP reduction was not associated with improved mRS in either deep (OR: 0.96; 95 % CI= 0.68 - 1.37; p= 0.82) nor lobar (OR: 0.66; 95% CI= 0.16 - 2.42; p= 0.54) ICH. Conclusion: The impact of intensive blood pressure lowering differs in deep and lobar ICH. These results emphasize the need for a better understanding about biologic differences in ICH, which may have therapeutic implications.

Imaging Deep Haemorrhage and Ischaemia in Preterm Infants' Heads with Time-Domain Near-Infrared Optical Tomography: Phantom Study.

The occurrence of brain lesions in preterm infants is common and can result in lasting disabilities. To prevent these and to safeguard the brain through therapeutic measures or neuroprotective treatments, it is important to identify cerebral ischaemia/hypoxia and haemorrhage at an early stage. For this purpose, we have successfully developed a cutting-edge time-domain near-infrared optical tomography (TD-NIROT) system, which offers diagnostic imaging for neonatal brain oxygenation. Our objective is to validate the effectiveness of the TD-NIROT in detecting deep ischaemia/hypoxia and haemorrhages through phantom experiments. Spherical silicone phantoms were fabricated to replicate the head of preterm infant. To simulate the lesions, we made two head phantoms and embedded small inclusions mimicking ischaemia and haemorrhage at the depth of 30 mm. Additionally, a spherical interface was constructed to connect the spherical phantom to the imaging system, allowing us to collect time-domain data. Following the data acquisition, we proceeded with image reconstruction. Dice similarity was used as an indicator of the accuracy and similarity between the reconstructed images and the ground truth. The resulting images exhibited an accurate location of haemorrhage and detected the ischaemia with a slightly shifted position with Dice similarity of 0.47 and 0.27. Our experiment validates the capability of our TD-NIROT system in successfully detecting deep haemorrhages and ischaemia within the phantom model. The achieved results suggest a promising level of accuracy in the imaging process. These findings are encouraging to continue this work to ultimately achieve clinical application of the TD-NIROT system in diagnosing and monitoring neonatal brain injuries.

Ocular Manifestations of Leukaemia: A Cross-sectional Study from Tertiary Care Hospital of South Gujarat, India

Introduction: Leukaemic ophthalmopathy can be either symptomatic or asymptomatic. Several factors can cause leukaemic ophthalmopathy, including opportunistic infections, direct ocular infiltration by leukaemic cells, indirect ocular involvement from subsequent haematologic alterations, and consequences from different treatment modalities. Patients with leukaemia who develop leukaemic infiltrates must undergo urgent systemic and neurological re-evaluation. Aim: To evaluate the prevalence and spectrum of leukaemic ophthalmopathy among leukaemic patients and to identify and analyse the common ocular manifestations of leukaemia in different age and gender groups. Materials and Methods: A cross-sectional study was conducted at a tertiary care hospital in South Gujarat, India. A total of 48 patients diagnosed with leukaemia were included in the study. Detailed histories regarding their systemic illness, present systemic complaints, ocular complaints, and history of treatment were noted. Detailed ophthalmoscopic examinations like slit lamp examinations, fundoscopic examinations, visual acuity, and intraocular pressure were performed on each participant. Statistical analysis was conducted using descriptive data analysis methods in Microsoft Excel sheets. Results: Out of the total 48 leukaemia patients recruited, 16 (33.33%) had ocular manifestations. Among the 25 acute leukaemia patients and 23 chronic leukaemia patients, 8 (32%) and 8 (34.78%) had ocular manifestations, respectively. Among all ocular manifestations, venous tortuosity was the most common, followed by deep and superficial retinal haemorrhage, dry eye, and Roth’s spot. Conclusion: The prevalence of ocular manifestations in leukaemia was reported to be 33.33%. Although an ophthalmologist's involvement in leukaemia treatment is secondary, it is nonetheless crucial to promptly recognise any ocular signs due to the worse prognosis associated with ocular involvement and to rule out extramedullary disease.

Choroidal neovascularization as first sign of Best's vitelliform dystrophy in a child

Aims/Purpose: To report a case of choroidal neovascularization secondary to Best's vitelliform dystrophy in a child managed by intravitreal aflibercept.Methods: Interventional, case report.Results: A 9‐year‐old boy reported decreased visual acuity (VA) with metamorphopsia in his right eye (RE) for the previous month. VA was RE 20/100 and left eye (LE) 20/20. Funduscopy revealed right‐eye macular oedema with deep macular haemorrhage associated to a bilateral orange‐yellowish deposit. Optical coherence tomography (OCT) showed sub‐ and intraretinal fluid in the foveal area along with a hyperreflective subretinal deposit and a localized retinal pigment epithelium (RPE) elevation. Blue autofluorescence (BAF) imaging disclosed a central hyper autofluorescence area as well as a larger defect corresponding to the haemorrhage and the subretinal deposit. The LE was positive for a central deposit located under the RPE with hyper autofluorescence at BAF. Familiar history was unknown for ocular conditions and the clinical history was irrelevant for fever, inflammation, adenopathy, articular, neurological or respiratory conditions. The condition was diagnosed as choroidal neovascularization (CNV) secondary to Best's vitelliform dystrophy and a single intravitreal injection of aflibercept was performed under general anaesthesia. Genetic study revealed a likely pathogenic mutation c.874G&gt;C (p.Glu292Gln) in the BEST1 gene (missense change, not previously published) affecting a functional dominion. The subretinal bleeding and fluid resolved after one single injection of aflibercept and VA improved to 20/20. No recurrences have been observed during the subsequent five years in either eye.Conclusions: We report a case of CNV as first manifestation of a previously not reported mutation of Best's vitelliform dystrophy in a 9‐year‐old boy that was successfully treated with one single intravitreal injection of aflibercept.

CENTRAL BOUQUET HEMORRHAGE: Clinical and Multimodal Imaging Features.

To describe the clinical characteristics, multimodal imaging features, and anatomic basis of a distinctive pattern of deep retinal hemorrhages located in the central fovea, a presentation referred to as "central bouquet hemorrhage." Retrospective, observational, multicenter case series of eyes with central bouquet hemorrhage. Multimodal imaging features were reviewed and analyzed. Ten eyes from 10 patients (4 women and 6 men), with a mean age of 55.6 ± 21.7 years (range 25-84 years) were included. Underlying etiologies were neovascular age-related macular degeneration (40%), lacquer cracks in pathological myopia (30%), macular telangiectasia Type 2 (10%), proliferative diabetic retinopathy (10%), and ocular trauma associated with angioid streaks (10%). On ophthalmoscopy, all eyes with central bouquet hemorrhage displayed a deep retinal hemorrhage with round margins in the central fovea and associated with petaloid hemorrhages radiating in the surrounding Henle fiber layer. Cross-sectional optical coherence tomography showed a well-delineated round hyperreflective lesion involving the central foveal Henle fiber layer/outer nuclear layer in all cases. Accompanying hyperreflective hemorrhages tracking along the obliquely oriented Henle fiber layer were present in all eyes. Resolution occurred in all patients, either spontaneously (30%) or after treatment with intravitreal anti-vascular endothelial growth factor injections (70%), and was associated with partial visual acuity improvement (from 20/113 to 20/36). "Central bouquet hemorrhage" is a novel descriptive term describing a characteristic round pattern of intraretinal blood in the fovea associated with Henle fiber layer hemorrhage and encountered in a spectrum of macular disease.

Chitosan based Janus cryogel with anisotropic wettability, antibacterial activity, and rapid shape memory for effective hemostasis

Excessive bleeding and bacterial infection leading to death is a major concern worldwide, particularly in cases of deep and narrow noncompressible hemorrhage. Herein, a novel Janus cryogel with anisotropic surface wettability, antibacterial activity, and rapid shape recovery was designed by constructing a hydrophilic porous cryogel using chitosan (CS), acacia gum (AG), and quaternized mesoporous bioglass (QMBG), with subsequent surface hydrophobic modification using octadecanol. The asymmetric hydrophobic surface modification of octadecanal endowed OCAQ with outstanding antiblood and antibacterial permeability, effectively preventing blood outflow and the invasion of bacteria to the wound. The hydrophilic parts with interconnected macroporous structure give the cryogel with ultra-high water uptake (5167 ± 182 %) and rapid water-trigged shape recover ability (≈2.1 s). The presence of active CS, AG, and QMBG in cryogel contributes to its exceptional blood clotting ability. Janus cryogel presents outstanding hemostatic performance (0.14 ± 0.03 g) in rat's liver injury model. Moreover, Janus cryogel exhibits excellent antibacterial properties due to the combination of its hydrophobic surface and antimicrobial quaternary amine groups. Meanwhile, the Janus cryogel has favorable hemocompatibility and biocompatibility. A Therefore, the Janus cryogel will become a candidate with great potential for clinical application of noncompressible wound as a multifunctional dressing.

Perihematomal edema after minimally invasive surgery: a matter of concern to neurosurgeons.

The purpose of this study is to explore the evolution of brain edema after minimally invasive surgery in deep spontaneous cerebral hemorrhage (DSICH) treatment and to analyze the differences in edema after different surgical methods. The clinical data of 105 patients with DSICH treated at Renmin Hospital of Wuhan University from January 2020 to June 2022 were analyzed retrospectively. Among them, 54 patients were treated with minimally invasive puncture and drainage surgery (MIPDS group), and 51 were treated with neuroendoscopic surgery (NES group). Continuous computed tomography images of patients in the hospital and 3D Slicer software were used to quantitatively calculate the edematous area to explore the changes in perihematomal edema volume in the two groups after the operation. The peak volume of postoperative edema (37.36±10.51 mL) in the MIPDS group was more extensive than that in the NES group, and its net increase in edema volume was 16.86±10.01 mL more than that in the NES group. The relative edema index (0.86±0.26) was lower in the NES group than in the MIPDS group (P < 0.05). The peak of postoperative edema in the MIPDS group was at 6-8 days after the operation, and that in the NES group was most often at 3-5 days after the operation. There are differences in perihematomal edema of DSICH treated by different minimally invasive methods. Compared with the MIPDS group, the NES group showed earlier peak of cerebral edema and lower degree of cerebral edema. The absolute regression volume of edema in the MIDPs group was greater than that in the NEs group, but there was no difference in the regression rate of edema between the two groups.

Associations of Cerebral Small Vessel Disease on the Features of Hematoma and Hematoma Expansion in Intracerebral Hemorrhage.

Several early noncontrast CT (NCCT) signs of spontaneous intracerebral hemorrhage (ICH) can predict hematoma expansion (HE). However, the associations of underlying cerebral small vessel disease (SVD) on early NCCT signs and HE have been less explored. We conducted an analysis of all patients with spontaneous supratentorial ICH and received follow-up imaging between 2016 and 2020 at a stroke center. The early NCCT signs were categorized as shape or density signs. HE was defined as an increase in hematoma volume ≥6 mL or 33% from baseline. The severity of SVD was assessed by both a 3-point CT-based and a 4-point magnetic resonance imaging (MRI)-based SVD score. Regression models were used to examine the associations between SVD score and hematoma volume, NCCT signs, and HE. A total of 328 patients (median age: 64 years; 38% female) were included. The median baseline ICH volume was 8.6 mL, with 38% of the patients had shape signs and 52% had density signs on the initial NCCT. Higher MRI-SVD scores were associated with smaller ICH volumes (p = 0.0006), fewer shape (p = 0.001), or density signs (p = 0.0003). Overall, 16% of patients experienced HE. A higher MRI-SVD score was inversely associated with HE (adjusted odds ratio 0.71, 95% CI: 0.53-0.96). Subgroup analysis revealed that this association was primarily observed in patients who were younger (&lt;65 years), male, had deep hemorrhage, or did not meet the criteria for cerebral amyloid angiopathy diagnosis. In patients with spontaneous ICH, a more severe SVD was associated with smaller hematoma volume, fewer NCCT signs, and a lower risk of HE. Further research is required to investigate why a higher burden of severely diseased cerebral small blood vessels is associated with less bleeding.

SPONTANEOUS RUPTURED OF RIGHT DEEP BRACHIAL ARTERY PSEUDOANEURYSM WITH UNDERLYING NEUROFIBROMATOSIS TYPE 1

Neurofibromatosis type 1 (NF-1) is known to develop vascular lesions, yet they are uncommon. If missed or ignored, it can be limb-threatening. When a ruptured pseudoaneurysm is clinically identified, rapid surgical intervention is required. We discuss a case of NF-1 that involved a spontaneous rupture of the right deep brachial artery. A 41-year-old woman reported sudden right arm swelling and intensifying pain. She was hemodynamically stable; however, her right arm was enlarged and tense on examination. A radiological test revealed a deep brachial artery haemorrhage. The patient was promptly referred to a vascular surgeon and had endovascular intervention performed. Early detection, emergency angiography, and endovascular treatment for vascular lesions should be initiated immediately.