Bleeding Volume Research Articles

Quantitative Volumetric Computed Tomography Density Predicts Basal Ganglia Hemorrhage Expansion and Enhances Spot Sign Diagnostic Accuracy.

Identifying patients with basal ganglia intracranial hemorrhage (ICH) at risk of hematoma expansion (HE) may better define selection criteria for early surgical evacuation. The aim of this study was to use automated radiographic feature extraction to improve risk stratification for basal ganglia ICH expansion. A single-center retrospective review was performed to identify patients with basal ganglia ICH between 2013 and 2024. ICH volumes were automatically segmented from the initial noncontrast computed tomography (CT) of the head using a custom-trained convolutional neural network. Features were quantified from the segmented ICH including stereotactic location, normalized volumetric CT density (nv-CTD, measured as mean ICH CT density divided by the background parenchymal CT density), volume, orientation, and border irregularity. HE was defined as an increase in hemorrhage volume of 10 mL or at a rate of 1.7 mL/h. A total of 108 patients (median age 55 years, 62% male) were included. HE occurred in 24 patients (22%) and was associated with shorter duration between symptom onset and initial CT (median 1 vs 3 hours, P = .006), a lower nv-CTD (median 2.0 vs 2.2, P = .011), and a positive spot sign (41% vs 5%, P < .001). nv-CTD was positively associated with time to presentation (R2 = 0.13, P < .001) and was negatively associated with HE in spot-sign-negative patients (median 2.0 vs 2.1, P = .016). Multivariate logistic regression modeling using nv-CTD and spot sign as inputs demonstrated improved diagnostic accuracy compared with that of the spot sign alone (area under the receiver operating characteristic curve 0.80 vs 0.68, P = .008). The area under the receiver operating characteristic curve of nv-CTD alone was 0.67 (95% CI: 0.56-0.78), which was statistically similar to that of the spot sign alone (0.68, 95% CI: 0.54-0.82) (P = .819). nv-CTD is a measure of bgICH acuity and can augment spot-sign bgICH expansion risk stratification.

Hemodynamic Risk Factors for Cerebellar Hemorrhage Presence and Volume in Infants Born Very Preterm.

To examine among infants born very preterm the role of hemodynamic disturbances in the occurrence of cerebellar hemorrhage (CbH) and whether cardiovascular instability is associated with larger CbH volume. Prospective, longitudinal, multisite cohort study. Early-life and/or term-equivalent age (TEA) brain MRIs were performed in 309 very preterm infants admitted to 3 tertiary-level neonatal intensive care units. A cut-off of 4 mm was used to distinguish punctate vs large CbH. CbH volumes were obtained by manual segmentation. As a measure of hemodynamic stability, Score for Neonatal Acute Physiology (SNAP-II), patent ductus arteriosus requiring treatment, and hypotension treated with inotropes were recorded. 60 patients (18.3%) were diagnosed with CbH, classified as punctate in 43 infants (71.3%). Hypotension requiring treatment with inotropes was an independent risk factor for CbH (OR 3.07, 95% CI 1.15 to 8.21, p = 0.02) and was associated with larger CbH volume (0.36 logmm3, 95% CI 0.17 to 0.54, p < 0.001). Hypotension treated with inotropes is shown to be an independent risk factor for the presence of CbH as well as for larger CbH volume. These results reinforce the importance of hemodynamics stability, especially an appropriate management of hypotension to prevent CbH and therefore improve neurodevelopmental outcomes among infants born very preterm.

Abstract TMP61: Ixodes ricinus-Contact Phase Inhibitor (Ir-CPI) reduces neutrophil-mediated injury and promotes recovery following intracerebral hemorrhage in a mouse model

Introduction: Secondary brain injury following intracerebral hemorrhage (ICH) is largely driven by neuroinflammation, which is exacerbated by neutrophil infiltration and their release of neutrophil extracellular traps (NETs). This process disrupts the blood-brain barrier and increases neuronal death. The present study investigates the efficacy of Ir-CPI, an inhibitor of neutrophil-mediated thromboinflammation, in reducing neutrophil-driven damage and promoting functional recovery post-ICH. Methods: ICH was induced in mice via bacterial collagenase injection into the right striatum. Mice were then treated with either PBS, Ir-CPI or enoxaparin. Treatments were administered intravenously immediately after stroke. Cerebral lesion and hemorrhage volumes were assessed up to 14 days by MRI. Neutrophil infiltration, NET release, and neuronal degeneration were evaluated histologically. Functional recovery was assessed using the Corner test and the Bederson’s scale. Results: After ICH induction, Ir-CPI did not increase cerebral lesion or hemorrhage volumes compared to PBS. Ir-CPI resulted in lower hemorrhage volumes than the enoxaparin group on Day 1. By Day 14, the volume of hemorrhage in the Ir-CPI group was significantly reduced in comparison to Day 1. Additionally, Ir-CPI decreased neutrophil infiltration and NETs release in the hemorrhagic area, along with a reduction in neuronal degeneration. In contrast, enoxaparin had no significant impact on reducing neutrophils or neuronal damage. Functional recovery was superior in the Ir-CPI group, with the Corner test showing a significant improvement from Day 1 to Day 5 compared to the PBS and enoxaparin groups. By Day 14, the Ir-CPI group's performance did not significantly differ from baseline, indicating enhanced long-term motor function and spatial awareness. The Bederson’s score also demonstrated a significant improvement in the Ir-CPI group, with lower scores between Day 1 and Day 5 compared to the other groups, thereby highlighting Ir-CPI's effectiveness in reducing neurological deficits. Conclusions: Ir-CPI is a promising therapeutic agent for patients suffering from ICH, exhibiting both safety and efficacy in reducing neutrophil-driven brain damage and enhancing functional recovery. These findings indicate that Ir-CPI may be beneficial in mitigating secondary brain injury and improving patient outcomes following ICH. The potential of Ir-CPI is currently being evaluated in the Phase IIa BIRCH trial (NCT05970224).

Impaired Glymphatic Function in Acute Spontaneous Intracerebral Hemorrhage.

Alterations in glymphatic function during the acute phase of acute spontaneous intracerebral hemorrhage (sICH) remain poorly understood. The aim of this study was to investigate whether, compared to healthy controls (HCs), the glymphatic system is impaired in patients with sICH, and to assess its association with hemorrhage and edema severity and outcome. Fifty-five sICH patients (including 46 supratentorial sICH and 9 ) and 97 age- and sex-matched HCs underwent conventional MRI and diffusion tensor imaging. The diffusion along the perivascular space (DTI-ALPS) index, serving as a marker for glymphatic function, was computed, with supratentorial cases being categorized into ipsilateral and contralateral ALPS. Volumes of hemorrhage and edema were evaluated using susceptibility-weighted imaging (SWI) and T2-weighted magnetic resonance images, and the relative edema ratio was calculated. Clinical outcomes were categorized as favorable or poor based on a modified Rankin scale score of ≤ 2 or > 2 at 90 days. sICH patients showed significantly lower DTI-ALPS values on the ipsilateral side compared to the average in the HC group (1.34 ± 0.24 vs. 1.46 ± 0.22, p = 0.003), whereas contralateral DTI-ALPS values in sICH patients did not differ significantly from HCs (1.48 ± 0.21 vs. 1.46 ± 0.22, p = 0.524). The ipsilateral DTI-ALPS was notably associated with both hemorrhage and relative edema volumes (both p < 0.05). A higher ipsilateral DTI-ALPS was independently associated with a favorable outcome at 90 days (odds ratio = 1.686 per 0.1 increase, p = 0.038). The DTI-ALPS index, which reflects glymphatic functionality, is notably diminished on the ipsilateral side in acute sICH, correlating significantly with increased volumes of hemorrhage and edema. This study suggests that glymphatic dysfunction may contribute to the severity of clinical outcomes, and highlights the potential role of the glymphatic system in the pathophysiology of sICH.

Strontium-based quaternary ammonium salt chitosan particles for ultrafast hemostasis of open fracture.

The management of open bone defects poses a formidable challenge in clinical practice, primarily due to issues such as profuse bleeding, inflammation, bacterial infections, and compromised bone fracture healing. To tackle these complexities, we have devised a novel hemostatic powder, namely the compound strontium-based chitosan quaternary ammonium salt hemostatic powder (QCS@SrT-TA). This innovative powder leverages the self-assembly of tripolyphosphate and strontium ions, facilitated by a positively charged core cross-linker. Furthermore, its surface has been strategically modified with polyphenol and positively charged macromolecules, imparting unique properties. The mesoporous architecture of QCS@SrT-TA facilitates rapid moisture absorption, enhancing its efficacy. In preclinical studies using rat tail artery amputation and liver bleeding models, QCS@SrT-TA exhibited remarkable performance, significantly reducing both bleeding time and volume (62.39 ± 2.89 mg, 35.33 ± 4.16 s in tail amputation, 63.7 ± 5.19 mg, 62.33 ± 9.61 s in liver bleeding). Notably, the positively charged strontium ions and quaternary ammonium salts within the powder were effective in removing bacteria, minimizing the risk of infection. Beyond hemostasis, QCS@SrT-TA demonstrates additional therapeutic benefits. It polarizes M2 macrophage phenotypes and promotes angiogenesis within bone defect sites, accelerating bone healing processes. Ultimately, a substantially enhanced and notable functional recovery is achieved. In summary, the rapid hemostatic, potent antibacterial, anti-inflammatory, and angiogenesis-promoting characteristics of QCS@SrT-TA hold immense promise as a groundbreaking clinical treatment strategy for open bone defects.

The Effect of Acupoint Sticking Therapy on Serum Estrogen Levels and Endometrial Polyp Tissue Receptor Expression in Postmenopausal Patients With Endometrial Polyps.

Postmenopausal women with endometrial polyps (EPs) often experience hormonal imbalances. Acupoint application, a traditional Chinese medicine (TCM) approach, shows the potential to influence hormonal levels. This study investigated the impact of acupoint application on hormone levels and receptors in postmenopausal women with EP, comparing its efficacy and safety to surgery. We conducted a retrospective analysis of 170 postmenopausal patients with EP. Eighty-four patients received surgery alone, while 86 received surgery combined with acupoint application. Hormone levels, hormone receptor expression, TCM symptom scores, and adverse effects were compared between the two groups. The acupoint application group demonstrated a significantly higher total effective rate than the control group (p <0.05). After treatment, the acupoint application group exhibited a significantly greater reduction in serum progesterone levels and vaginal pH compared to the control group (p <0.05). Additionally, the acupoint application group showed a significant increase in endometrial estrogen receptor expression after treatment (p <0.05). TCM symptom scores related to vaginal bleeding volume, duration, facial complexion, dry mouth, and thirst significantly improved in the acupoint application group post-treatment (p <0.01). Furthermore, the acupoint application group demonstrated a notably lower incidence of adverse effects (including nausea, headache, breast tenderness, and dizziness) compared to the control group (p <0.05). Our study suggests acupoint application, alongside surgery, enhances clinical outcomes, hormonal balance, and symptom relief in postmenopausal women with EPs, compared to surgery alone. Its safety and sustained benefits support its use as a complementary treatment.

Abstract TP187: Automated Assessment of Intracerebral Hemorrhage Volumes using the VIOLA tool Performs Similarly to ABC/2 in Predictive Modelling

Abstract TP187: Automated Assessment of Intracerebral Hemorrhage Volumes using the VIOLA tool Performs Similarly to ABC/2 in Predictive Modelling

Comparative analysis of the parapatellar and subpatellar approaches in reducing peripheral knee pain post-intramedullary tibial fracture surgery

IntroductionIntramedullary tibial nailing is a standard treatment for tibial shaft fractures. Postoperative knee pain significantly impacts functional recovery; however, studies on this issue are limited. This study evaluated the effect of the parapatellar approach for intramedullary nailing on postoperative knee pain.Materials and methodsA total of 29 patients with tibial shaft fractures treated with intramedullary nails from March 2019 to January 2022 were divided into two groups based on the surgical approach: the semi-extended lateral parapatellar approach and the conventional subpatellar ligament split approach. Recorded metrics included operation time, intraoperative fluoroscopy count, intraoperative bleeding volume, Visual Analog Scale (VAS) scores for knee pain at 24 h, 72 h, 1 week, and 1 month postoperatively, fracture healing time and Lysholm knee functional scores at 12 months.ResultsBoth groups completed the operation without significant differences in operation time, intraoperative bleeding, fracture healing time, or intraoperative fluoroscopy (P > 0.05). The parapatellar group showed significantly better VAS scores for knee pain at 24 h, 72 h, and 1 week postoperatively compared to the control group (P < 0.05), with no significant difference at 1 month. After 12 months, Lysholm scores indicated no significant differences in knee support, locking, and swelling (P > 0.05); however, the parapatellar group showed significant improvements in lameness, instability, stair climbing, squatting, and pain (P < 0.05). Overall, the parapatellar group outperformed the control group (P = 0.01). Additionally, long-term follow-up revealed potential advantages of the parapatellar approach in improving long-term functional outcomes.ConclusionsUsing the parapatellar approach for tibial intramedullary nailing avoids splitting the patellar ligament and entering the joint cavity, minimizing knee joint impact and effectively reducing postoperative knee pain, with potential benefits in long-term functional recovery.

Tranexamic acid as an adjunct to resuscitative endovascular balloon occlusion of the aorta does not worsen outcomes in a porcine model of hemorrhage

BackgroundNon-compressible torso hemorrhage (NCTH) represents a leading cause of preventable mortality in trauma. Resuscitative endovascular balloon occlusion of the aorta (REBOA) stabilizes NCTH but may predispose patients to thrombus generation....

10-year experience with single-site laparoscopic-assisted Soave operation for Hirschsprung disease

Background The aim of this study was to investigate the clinical outcomes after a transumbilical single-site laparoscopic-assisted Soave operation (TSLSO) for Hirschsprung disease (HD) in children, with a 10-year follow‑up results assessment. Methods We retrospectively analyzed the clinical data of 165 children with HD from January 2013 to January 2023. The operation method was a TSLSO. The operation time, intraoperative bleeding, postoperative abdominal drainage time, postoperative hospitalization time, and postoperative complications were analyzed. Results All 165 cases were successfully completed using the TSLSO. The median operative time was 160 (120–210) minutes, and the median volume of bleeding was 9 mL (3–15 mL). The median length of the resected intestine was 25 cm (20–32 cm), and the median postoperative peritoneal drainage time was 4.2 days (3–6 days). Postoperative defecation function generally recovered well, there was no recurrence of constipation. There were three cases of anal stenosis, 12 cases of perianal dermatitis, two cases of adhesive intestinal obstruction, 14 cases of soiling, and 18 cases of enterocolitis. Conclusion The TSLSO is a safe and feasible surgical method for the treatment of HD in children. It has the advantages of little bleeding, a good cosmetic effect, and fast postoperative recovery. However, it does require skilled laparoscopic technique by the surgeon.

The effectiveness of ERCP in managing preoperative complications of choledochal cysts in children and its role in facilitating early surgical intervention

IntroductionCurrently, there is no established guideline for the application of ERCP in children with choledochal cyst. This study aimed to investigate the safety and effectiveness of ERCP in managing preoperative complications of choledochal cyst in children, as well as the timing for definitive surgery following ERCP.MethodsWe conducted a retrospective review of medical records for 68 pediatric patients who presented with complications of choledochal cyst, including pancreatitis and biliary obstruction combined with cholangitis. All patients underwent ERCP treatment followed by definitive surgery. The primary outcomes assessed included treatment efficacy, post-ERCP complication, and the impact of ERCP on definitive surgical procedures.ResultsAmong the 68 patients studied, 41 presented with pancreatitis, while the remaining patients had biliary obstruction and cholangitis. Sixty-five patients successfully completed their treatments, with 64 experiencing alleviation of symptoms. Significant improvements were observed in serum amylase levels and liver function tests following ERCP. Post-ERCP complications occurred in three cases, including one case of pancreatitis and two cases of infection. The median interval between ERCP and surgery was 11 days. There was no significant difference in primary outcomes, such as surgical duration, rate of minimally invasive surgery, conversion to open surgery, intraoperative bleeding volume, intraoperative blood transfusion, postoperative complications, or average length of hospital stay, between the early surgery group (≤2 weeks) and the late surgery group (&amp;gt;2 weeks).ConclusionsERCP was proved to be a safe and effective intervention for alleviating preoperative complications in pediatric patients with choledochal cyst. Early definitive surgery following ERCP did not significantly impact the perioperative outcomes of pediatric patients.

Prevalence of High-Risk CTA-Based Carotid Plaque-RADS Subtypes in Patients With Embolic Stroke of Undetermined Source.

A modified computed tomography angiography (CTA)-based Carotid Plaque Reporting and Data System (Plaque-RADS) classification was applied to a cohort of patients with embolic stroke of undetermined source to test whether high-risk Plaque-RADS subtypes are more prevalent on the ipsilateral side of stroke. With the widespread use of CTA for stroke evaluation, a CTA-based Plaque-RADS would be valuable for generalizability. A retrospective observational cross-sectional study was conducted at a single integrated health system comprised of 3 hospitals with a comprehensive stroke center between October 1, 2015, and April 1, 2017. Patients with unilateral anterior circulation stroke and <50% carotid stenosis on CTA were retrospectively identified. Maximum plaque thickness and ulceration were assessed by a neuroradiologist blinded to the stroke side. A semiautomated segmentation software measured intraplaque hemorrhage volumes. Modified CTA-based Plaque-RADS classification was defined as (1) no plaque, (2) plaque thickness <3 mm, (3) plaque thickness ≥3 mm or ulcerated, and (4) plaque with intraplaque hemorrhage >50 mm3 irrespective of plaque thickness. High-risk plaque subtypes (Plaque-RADS 3 and 4) were compared with low-risk subtypes (Plaque-RADS 1 and 2). Ninety-four patients (55% women; median age, 66 years) were included. CTA-based Plaque-RADS categories for plaques ipsilateral to the stroke side were as follows: (1) 14.9%, (2) 42.6%, (3) 41.5%, and (4) 1.1%. Carotid plaques contralateral to stroke side were Plaque-RADS: (1) 21.3%, (2) 46.8%, (3) 31.9%, and (4) 0%. When compared with the contralateral side, plaques ipsilateral to the stroke side were significantly associated with high-risk Plaque-RADS subtypes in a mixed-effects logistic model adjusting for age and sex (adjusted odds ratio, 2.10 [95% CI, 1.20-3.71]; P=0.01). Carotid plaque ipsilateral to the stroke side was significantly associated with CTA-based high-risk Plaque-RADS subtypes in an embolic stroke of undetermined source cohort. A CTA-based Plaque-RADS classification may be useful for identifying potentially causative carotid plaque phenotypes in patients with embolic stroke of undetermined source.

Single Axillary Incision Versus Triple Lateral Chest Wall Incisions in Endoscopic Mastectomy for Gynecomastia: A Single-Center Retrospective Analysis with Propensity Score Matching.

Endoscopic mastectomy has gradually become an important surgical modality for the treatment of breast diseases, and is the preferred procedure for gynecomastia. However, endoscopic mastectomy presents challenges such as a steep learning curve, prolonged surgical duration, increased hospitalization costs, and high technical difficulty. This study aimed to evaluate the clinical efficacy and patient satisfaction of endoscopic mastectomy using a single axillary incision versus a triple lateral chest wall incision for gynecomastia. Patients were stratified into a single-port group and a three-port group based on the surgical approach. Propensity score matching was used for the nearest neighbor matching, adjusting baseline data differences at a 1:1 ratio, with a caliper value set at 0.2 to ensure comparability between the two groups. Clinical efficacy and patient satisfaction were compared after propensity score matching. A total of 36 pairs of patients were successfully matched after propensity score matching, with no differences in baseline characteristics (P > 0.05). Notably, the three-port group experienced longer surgical durations compared to the single-port group, alongside higher hospitalization costs (P < 0.05). There were no differences in surgical bleeding volume, postoperative drainage volume, extubation time, postoperative hospitalization time , surgical complications, visual analog scale pain scores, and recurrence rate (P > 0.05). After a 6-month follow-up, the vancouver scar scale assessment showed no differences in scar color, thickness, vascularity, softness, and total score (P > 0.05). Based on the BODY-Q questionnaire chest module scores, the single-port group showed better overall satisfaction in appearance (P = 0.038), especially in the smoothness of the chest wall, with significantly higher scores than the three-port group (P = 0.001). No differences were found in nipple symmetry, nipple sensation, and skin redundancy (P > 0.05). The single axillary incision endoscopic mastectomy demonstrated advantages in shorter surgical duration and lower hospitalization costs, while providing a smoother chest wall appearance, thereby enhancing overall patient satisfaction. Consequently, this surgical approach may arise as one of the preferred procedures for gynecomastia. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Single-center experience with ultra-early cranioplasty within 3 weeks after decompressive craniectomy.

The optimal timing of cranioplasty (CP) after decompressive craniectomy (DC) is inconclusive. This article aims to investigate the effect of different timing of CP on the neurologic prognosis of patients, and to explore the feasibility and safety of ultra-early CP (within 3 weeks) following DC. The duration time of surgery, intraoperative bleeding volume, surgery-related complications, and activities of daily living (ADL) scores were retrospectively analyzed in 23 patients underwent ultra-early CP performed within 3 weeks, and compared with 136 patients with non-ultra-early CP performed within the same time period. The mean duration time of surgery in the ultra-early group was significantly shorter than that in the non-ultra-early group. ADL scores were significantly lower in the ultra-early group than in the non-ultra-early group both before and 1 month after CP, but there was no statistically significant difference in ADL scores between the two groups at long-term follow-up. The overall incidence of surgery-related complications was 17.39% (4/23) in the ultra-early group and 14.71% (20/136) in the non-ultra-early group, and there was no statistically significant difference in the comparison between the two groups (p = 0.739). Both ultra-early and non-ultra-early CP can significantly improve the neurological prognosis of patients. Ultra-early CP can significantly shorten the length of surgery and does not increase the incidence of surgery-related complications, which has a certain degree of safety and feasibility, and can be popularized under the premise of strict screening of indications, but further research is still needed.

Real-world evaluation of the accuracy of the Viz.AI automated intracranial hemorrhage volume calculation tool

BackgroundAppropriate management of spontaneous intracerebral hemorrhage (ICH) and intraventricular hemorrhage (IVH) requires rapid, accurate volume estimation. Viz.AI has developed an artificial intelligence (AI)-powered ICH calculation tool that may improve existing...

Efficacy of GnRH antagonists in the treatment of uterine fibroids: a meta-analysis.

Uterine fibroids are the most common pelvic tumors in women, representing the primary indication of hysterectomy. Gonadotropin-releasing hormone (GnRH) antagonists represent a new therapeutic option for premenopausal women. The aim of this review is to evaluate the efficacy and safety of GnRH antagonists in the treatment of uterine fibroids (size reduction and symptom control). A review of studies from electronic databases (PubMed and Cochrane Central) published up to December 2023 was performed. Eleven randomized clinical trials with a total of 4164 patients were included in the review, which evaluated GnRH antagonists (Relugolix, Elagolix, Linzagolix and Cetrorelix) against placebo or GnRH agonists in premenopausal women with uterine fibroids and heavy menstrual bleeding. The results of the measures evaluated to determine the efficacy and safety of GnRH antagonists versus placebo are favorable for the variables of control of uterine bleeding (Relative risk (RR) = 5.09; 95% CI 3.19 to 8.14), percentage reduction of fibroid volume (Mean difference (MD) = -27.36; 95% CI -38.89 to -15.83) and lower reduction of bone density (MD -0.35; 95% CI -0.47 to -0.24). The results do not allow us to conclude whether there are differences between the alternatives compared in the control of vasomotor symptoms. GnRH antagonists represent an effective alternative for uterine fibroids treatment as they allow a superior reduction in menstrual bleeding and uterine fibroid volume compared to the placebo group.

Short-term effectiveness of uni-portal non-coaxial spinal endoscopic surgery via crossing midline approach in treatment of free lumbar disc herniation

To investigate the short-term effectiveness of uni-portal non-coaxial spinal endoscopic surgery (UNSES) via crossing midline approach (CMA) in the treatment of free lumbar disc herniation (FLDH). Between March 2024 and June 2024, 16 patients with FLDH were admitted and treated with UNSES via CMA. There were 9 males and 7 females with an average age of 55.1 years (range, 47-62 years). The disease duration was 8-30 months (mean, 15.6 months). The pathological segments was L 3, 4 in 4 cases, L 4, 5 in 5 cases, and L 5, S 1 in 7 cases. The preoperative pain visual analogue scale (VAS) score was 6.9±0.9 and the Oswestry disability index (ODI) was 57.22%±4.16%. The operation time, intraoperative bleeding volume, postoperative hospital stay, and incidence of complications were recorded. The spinal pain and functional status were evaluated by VAS score and ODI, and effectiveness was evaluated according to the modified MacNab criteria. CT and MRI were used to evaluate the effect of nerve decompression. All 16 patients underwent operation successfully without any complications. The operation time was 63-81 minutes (mean, 71.0 minutes). The intraoperative bleeding volume was 47.3-59.0 mL (mean, 55.0 mL). The length of hospital stay after operation was 3-4 days (mean, 3.5 days). All patients were followed up 1-3 months, with 15 cases followed up for 2 months and 14 cases for 3 months. The VAS score and ODI gradually decreased over time after operation, and there were significant differences between different time points ( P<0.05). At 3 months after operation, the effectiveness was rated as excellent in 12 cases and good in 2 cases according to the modified MacNab criteria, with an excellent and good rate of 100%. CT and MRI during follow-up showed a significant increase in the diameter and cross-sectional area of the spinal canal, indicating effective decompression of the canal. When using UNSES to treat FLDH, choosing CMA for nerve decompression has the advantages of wide decompression range, large operating space, and freedom of operation. It can maximize the preservation of the articular process, avoid fracture and breakage of the isthmus, clearly display the exiting and traversing nerve root, and achieve good short-term effectiveness.

Classification Prediction of Hydrocephalus After Intercerebral Haemorrhage Based on Machine Learning Approach.

In order to construct a clinical classification prediction model for hydrocephalus after intercerebral haemorrhage(ICH) to guide clinical treatment decisions, this paper retrospectively analyses the clinical data of 844 cases of ICH and hydrocephalus inpatients admitted to Yueyang People's Hospital from May 2019 to October 2022, of which 95 cases of hydrocephalus occurred after ICH and no hydrocephalus in 749 cases. The following indicators were compared between the two groups of patients: gender, age, Glasgow Coma Scale(GCS)score, whether the amount of bleeding was greater than 30ml, whether it broke into the ventricle or not, modified Graeb score(MGS), modified Rankin Scale (MRS) score, whether surgery was performed or not, red blood cells, white blood cells, and platelets. After variable screening, the following six variables were selected: GCS score, MGS, MRS score, whether the bleeding volume was greater than 30ml, whether it broke into the ventricle or not, and whether surgery was performed or not were modelled and analysed using logistic regression model and support vector machine model in machine learning. The results showed that under the same conditions, the accuracy of the support vector machine model was 0.89 and F1 was 0.838 ,the value of the AUC of the support vector machine model is 0.888; the accuracy of the logistic regression model was 0.902 and F1 was 0.89, the value of the AUC of the support vector machine model is 0.903. Compared with the group without hydrocephalus, patients in the group with hydrocephalus had bleeding volume greater than 30ml, haemorrhage into the ventricles of the brain, and had undergone surgery in the brain, and the difference was statistically significant (P 0.001). Statistical analysis showed that GCS score ≤ 8.8, modified Graeb score (MGS) ≥ 10 and MRS score ≥ 3 were independent risk factors for the development of hydrocephalus after spontaneous ventricular haemorrhage. Therefore, patients with lower GCS score, higher modified Graeb score, higher MRS score, bleeding volume > 30ml, haemorrhage into the ventricles of the brain, and experience of having undergone surgery in the brain should be operated on early to remove the intraventricular haematoma in order to reduce the incidence of hydrocephalus.

The feasibility and short-term safety of single-site hysterectomy: a retrospective cohort study of a novel robotic platform.

Robotic-assisted laparoscopic single-site hysterectomy is popular among patients and surgeons due to good cosmetic outcomes and fast recovery. However, questions remain such as loss of triangulation and instrument collision. Our aim is to test the feasibility and safety of a purpose-designed single-site robotic surgical platform mainly in hysterectomies. We retrospectively collected patients who had undergone hysterectomy by SHURUI (SR-ENS-600) robotic surgical system in the First Affiliated Hospital of Xi'an Jiaotong University. Initial cases as control were also collected including da Vinci single-site (IS4000) and multi-port (IS3000 and IS4000) hysterectomies performed by the same surgical team. The main outcome was surgical feasibility rate (valid surgeries/total cases × 100%). Short-term post-operative outcomes and complications were recorded and compared between three groups. From Dec, 2nd, 2023 to Mar, 1st, 2024, 19 cases of hysterectomies were enrolled, including 6 myomas, 2 adenomyosis, 9 cervical high-grade squamous intraepithelial lesion/stage Ia1 cancers, and 2 stage Ia endometrial cancers. Seventeen cases of da Vinci single-site surgeries and 20 cases of multi-ports surgeries were also included for comparation. Intra-operative bleeding volume was significantly lower in SHURUI group compared with da Vinci single-site and multi-ports groups (40.5mL vs 47.4mL vs 58.5mL, P = 0.046 and 0.028). Post-operative time to flatus was also shorter in SHURUI group compared with da Vinci single-site and multi-port surgeries (22.9h vs. 33.5h vs. 28.6h, P = 0.054 and 0.001). Follow-up for SHURUI group lasted for 3months with no complications. SHURUI robotic surgery was feasible and safe in hysterectomies. It also had comparable outcomes with da Vinci robotic platform and approaches.

Risk Factors for Hypothermia during Laparoscopic or Open Surgery of Colorectal Cancer under General Anesthesia.

Colorectal cancer (CRC) is one of the most prevalent malignancies, which is commonly treated with curative surgical resection, often leading to intraoperative hypothermia. Therefore, this study aimed to compare and analyze the risk factors for intraoperative hypothermia associated with laparoscopic and open CRC resections under general anesthesia. This study included 120 CRC patients admitted between January 2023 and January 2024. Data from these patients were analyzed using logistic regression analysis to investigate the risk factors for hypothermia during CRC surgery. Additionally, surgical indicators such as, intraoperative bleeding volume, number of lymph nodes dissected, and operation time, and serum inflammatory markers like Interleukin-6 (IL-6) and Interleukin-8 (IL-8) were assessed and compared between the two surgical groups. The study group comprised 41 men and 79 women, with a mean age of 52.53 ± 8.90 years and an average body mass index (BMI) of 23.13 ± 3.32 kg/m2. The American Society of Anesthesiologists (ASA) score was measured as 1 for 62 (51.67%) patients and 2 for 58 (48.33%). Among them, 50 patients underwent open surgery, whereas 70 patients were treated with laparoscopic surgery. Gender, laparoscopic surgery, intraoperative fluid infusion volume, prolonged anesthesia, and intraoperative blood transfusion were determined as the independent risk factors for intraoperative hypothermia during CRC surgery under general anesthesia (p < 0.05). The intraoperative bleeding volume was significantly reduced (p < 0.01), with significantly longer operation time (p < 0.05) in patients treated with laparoscopic surgery compared to those with open surgery. However, the two groups had a similar number of lymph nodes dissected. Additionally, the levels of IL-6 and IL-8 in both laparoscopic and open surgery of patients increased significantly after surgery, but the extent of increase in the patients of laparoscopic surgery was significantly lower than that in the patients of open surgery (p < 0.05). In conclusion, gender, surgical approach, intraoperative fluid infusion volume, prolonged anesthesia, and intraoperative blood transfusion are the potential risk factors for hypothermia during laparoscopic radical CRC surgery under general anesthesia.