Hematoma Size Research Articles

Bioactive Self-Assembled Nanoregulator Enhances Hematoma Resolution and Inhibits Neuroinflammation in the Treatment of Intracerebral Hemorrhage.

Hematoma and secondary neuroinflammation continue to pose a significant challenge in the clinical treatment of intracerebral hemorrhage (ICH). This study describes a nanoregulator formed through the self-assembly of Mg2+ and signal regulatory protein α (SIRPα) DNAzyme (SDz), aimed at enhancing hematoma resolution and inhibiting neuroinflammation in the treatment of ICH. The structure of SDz collapses in response to the acidic endo/lysosomal microenvironment of microglia, releasing Mg2+ and the SIRPα DNAzyme. The Mg2+ then acts as a cofactor to activate the SIRPα DNAzyme. By blocking the CD47-SIRPα signaling pathway, microglia can rapidly and effectively phagocytose red blood cells (RBCs), thereby promoting the clearance of the hematoma. Simultaneously, Mg2+ reset the microglia to the M2 phenotype by inhibiting the MYD88/MAPK/NF-κB signaling pathway, thereby modulating the inflammatory microenvironment of ICH. This co-delivery and synergistic strategy resulted in a significant reduction in hematoma size, decreasing from 11.90 to 5.84mm3, and promoted recovery from ICH with minimal systemic side effects. This simple yet highly effective nanoplatform, which involves complex synergistic mechanisms, proves to be effective for ICH therapy and holds great promise for introducing novel perspectives into clinical and translational approaches for ICH.

Evaluation of incidence and outcomes of compressive extradural haematoma-related infarcts in the paediatric population.

Traumatic extradural haematoma (EDH) is one of the neurosurgical emergencies in the paediatric population. One of the rare complications of extradural haematoma is adjacent parenchymal infarct from the compressive effect of haematoma leading to further morbidity. We aimed to evaluate the incidence and outcomes of this rare complication in paediatric trauma patients. We undertook a retrospective review of all operative extradural haematoma cases in single centre paediatric neurosurgical unit between the years 2008 and 2024. Cases with postoperative imaging were analysed for demographics, age, sex, dimensions of haematoma and underlying infarct, pre-operative GCS and pupillary abnormality and time interval from scan to surgery. Infarct was defined as well-defined parenchymal hypodensity corresponding to vascular territory and not attributable to contusions on postoperative CT head performed at 24-72 h. All patients suspected of stroke had further MRI brain for evaluation. Statistical analysis was then performed comparing groups with and without infarct. Overall, 115 cases of extradural haematoma were identified during the study period. Eighty cases had adequate postoperative imaging to allow assessment for infarcts; 7.5% demonstrated evidence of infarct underlying extradural haematoma. Mean age in the infarct group was 1.8 years (M:F ratio 2:1) with mean EDH dimensions of 77 mm × 31.4 mm × 79.7 mm). Mean age in the non-infarct group was 8.6 years (M:F ratio 2:1) with mean EDH dimensions of (57.5 mm × 19.6 mm × 62.6 mm). Children with infarcts were significantly younger with larger haematoma dimensions and hada higher proportion of pupillary abnormalities. There was no significant difference in pre-operative GCS and scan-to-surgery time-lapse between the groups with and without infarct. Compressive effect of EDH can lead to underlying parenchymal infarct. Children with extradural haematoma-related infarct were younger with larger haematoma size and a higher proportion of pupillary abnormalities.

Leakage sign based on contrast-enhanced CT is a predictive marker for hematoma expansion and poor prognosis in primary brainstem hemorrhage

BackgroundAlthough hematoma expansion is a poor prognostic factor in patients with intracerebral hemorrhage (ICH), its effect on primary brainstem hemorrhage (PBSH) remains unclear. Since we previously observed the “leakage sign” (LS) on computed tomography (CT) to be a significant predictor for hematoma expansion, we herein investigated the effect of LS in PBSH. MethodsBetween January 2013 and August 2023, 515 patients with ICH were admitted to our institute. Thirty-six patients with PBSHs met the inclusion criteria, who were then divided into LS-positive (LS+) and LS-negative (LS-) groups based on the presence of LS. We evaluated hematoma expansion and prognosis at discharge. ResultsPatients in the LS+ group had larger baseline hematoma volume and lower Glasgow Coma Scale scores on admission and significantly poor prognosis at discharge. Subgroup analysis revealed that LS was frequently observed within 100 min after the onset of symptoms in patients with a hematoma size of >10 mm3 on CT; additionally, patients in the LS+ group more frequently experienced hematoma expansion and had poor prognosis at discharge. ConclusionLS is a significant predictive marker for disease severity at admission, hematoma expansion, and poor prognosis at discharge

Factors influencing hematoma expansion in delayed brain CT scans of patients with traumatic Epidural Hematoma.

Epidural hematoma (EDH) is a type of intracranial hematoma commonly observed in trauma patients. This research aims to evaluate the factors contributing to the expansion of traumatic epidural hematoma (EDH). This retrospective cohort study examined traumatic patients with EDH admitted to Taleqani Hospital, a prominent Western Trauma Center in Iran, from 2018 to 2023. Patients underwent an initial CT scan, and non-surgical patients received a delayed CT scan approximately 5 hours after the initial scan. Data analysis was performed using SPSS version 25 software. The study included 274 brain trauma patients with epidural hematoma. Among these patients, 142 (51.8%) did not undergo surgery, and 121 (85.2%) of the non-surgical patients were male. Motor vehicle accidents (MVAs) were the primary cause of EDH in 127 (46.4%) patients. The mean (±standard deviation) initial hematoma size was 8.86 (±9.71), and the mean (±standard deviation) delayed CT scan size was 8.12 (±8.10). In crude linear regression Two variables, namely Hematoma volume in the initial CT scan (P less than 0.001) and Mixed Density (P=0.007), were found to significantly impact the increase in hematoma size in delayed CT scans of non-surgical patients. But in the adjusted linear regression model, only the Hematoma volume in primary CT scan, was significant (P less 0.001). The R Square values were 0.72. The identification of key variables influencing hematoma volume in delayed CT scans has the potential to guide more effective interventions, thereby improving patient outcomes and reducing trauma-related mortality.

Orbital Hematoma Treatment—A Retrospective Study

Background: Bleeding within the orbit in the form of a subperiosteal or retrobulbar hematoma is a relatively common complication of trauma and surgery. It affects up to 30% of patients fractures involving the orbital bones. Most cases do not require surgical intervention because they do not cause retinal ischemia or optic nerve neuropathy. The above symptoms occur in only 0.5–1% of patients developing Orbital Compartment Syndrome (OCS). Due to the short period (60–100 min) of time in which the optic nerve and retina can tolerate increased intraocular pressure, it seemed reasonable to evaluate and standardize the surgical management protocol for this rare complication. Objective: The aim of this retrospective study was to retrospectively analyze cases of inframammary haematomas with clinically relevant correlations. Methods: Eighteen patients treated at the Department of Maxillofacial Surgery due to OCS, in Lodz and Poznan, Poland, between 2009 and 2022, were included. APTT, INR, systemic diseases, cause, location and size of hematoma, presence and number of fractures, visual disturbances and pupillary response on the day after surgery and one month after, the type of intervention and time between admission to the hospital and surgery were evaluated. Results: Statistically significant correlations were obtained between the size of the hematoma and the patients’ age, the degree of visual disturbance and the weakening of pupillary constriction, severe initial symptoms and poor postoperative outcomes at both postoperative periods studied, immediate and distant poor outcome after decompression surgery and good postoperative outcome persisting one month after. Conclusions: The results obtained in the study and the surgical protocol proposed by the authors are in line with the current state of knowledge regarding orbital hematomas. Some of the correlations described in the literature (such as OCS and anticoagulant treatment) were not demonstrated, but this is probably due to the small study group. Maintaining the 100 min limit as a standard was possible only in early postoperative diagnoses (only 1 of the patients was operated on up to 100 min after the appearance of symptoms). In other cases, the specialized diagnosis took an average of 2785 ± 4020 min or 46 ± 67 h.

Optimal Timeline and Hematoma Size Parameters for Middle Meningeal Artery Embolization in Acute-On-Chronic Subdural Hematomas.

Chronic subdural hematomas (cSDH) are subdural collection of blood for which the current treatment option remains as surgical evacuation due to recurring focal inflammation and angiogenesis. An adjunctive therapeutic intervention is endovascular embolization of the middle meningeal artery (MMA) to cease the prolific cycle of angiogenesis. Few investigations have been made into the indications of this treatment modality regarding the intervention timeline and hematoma size for non-surgical candidates with acute-on-chronic subdural hematomas. We examined the clinical outcomes of 19 patients with 31 acute-on-chronic SDHs undergone MMA embolization and highlighted preliminary trends in radiological and morbidity outcomes. Primary outcomes identified a 57.6% success rate for MMA embolization of acute-on-chronic SDHs defined as significantly reduced hematoma size (i.e. >50%) without recurring bleeds, peri-procedural complications, post-procedural neurological deficits, and need for post-procedural surgical evacuation. Subgroup analysis demonstrated a success rate of 90.9% in patients undergone embolization after a minimum 3-week delay from initial CT head study compared to 33.3% with early intervention as well as a success rate of 75% in patients presenting with a large (i.e. >10mm) SDH compared to 30% for small SDH. Our preliminary data in this retrospective cohort study demonstrates significantly improved outcomes of MMA embolization in patients presenting with large (>10mm) acute-on-chronic SDHs and in patients undergone embolization after >3 weeks from initial CT head and symptomatic presentation.

Traditional craniotomy versus current minimally invasive surgery for spontaneous supratentorial intracerebral haemorrhage: A propensity-matched analysis.

Minimally invasive surgery (MIS) and craniotomy (CI) are the current treatments for spontaneous supratentorial cerebral haemorrhage (SSTICH). To compare the efficacy and safety of MIS and CI for the treatment of SSTICH. Clinical and imaging data of 557 consecutive patients with SSTICH who underwent MIS or CI between January 2017 and December 2022 were retrospectively analysed. The patients were divided into two subgroups: The MIS group and CI group. Propensity score matching was performed to minimise case selection bias. The primary outcome was a dichotomous prognostic (favourable or unfavourable) outcome based on the modified Rankin Scale (mRS) score at 3 months; an mRS score of 0-2 was considered favourable. In both conventional statistical and binary logistic regression analyses, the MIS group had a better outcome. The outcome of propensity score matching was unexpected (odds ratio: 0.582; 95%CI: 0.281-1.204; P = 0.144), which indicated that, after excluding the interference of each confounder, different surgical modalities were more effective, and there was no significant difference in their prognosis. Deciding between MIS and CI should be made based on the individual patient, considering the hematoma size, degree of midline shift, cerebral swelling, and preoperative Glasgow Coma Scale score.

Quantification of the size of subchorionic hematoma causing pregnancy-related complications: a retrospective cohort study.

This study aimed to establish criteria for defining "large" subchorionic hematoma (SCH) and assess its association with pregnancy complications. This was a retrospective cohort study conducted at our institution between 2019 and 2020. We compared the size of SCH between the pregnancy-related complication and non-complication groups, using two measurement methods. Receiver operating characteristic (ROC) curve analysis determined cutoff values. Additionally, we compared the occurrence of pregnancy complications among three groups: large SCH group (above the cutoff value), non-large SCH group (below the cutoff value), and non-SCH group. Of 1305 singleton pregnancies managed during the study, 80 cases were diagnosed with SCH. Pregnancy complications occurred in 15 patients. The patients with pregnancy complications had significantly larger SCH sizes with both measurement methods. For each method, the cutoff values calculated from the ROC curve analysis were as follows: Method 1, 25% (area under the ROC curve [AUC], 0.662); Method 2, 30% (AUC, 0.624). In Method 1, we found a significantly higher occurrence of preterm delivery in the large SCH group (24.1%) than in the non-large SCH (4.2%) and non-SCH groups (5.3%; all p < 0.01). In Method 2, there was a significantly higher occurrence of preterm delivery in the large SCH group (33.3%) than in the non-large SCH (6.5%) and non-SCH groups (5.3%; all p < 0.01). Large SCHs may indicate a high risk of pregnancy-related complications. Among these, recognizing and managing cases that exceed the aforementioned cutoff value as high-risk cases may be beneficial for reducing pregnancy complications.

In situ implantable DNA hydrogel for diagnosis and therapy of postoperative rehemorrhage following intracerebral hemorrhage surgery.

Postoperative rehemorrhage following intracerebral hemorrhage surgery is intricately associated with a high mortality rate, yet there is now no effective clinical treatment. In this study, we developed a hemoglobin (Hb)-responsive in situ implantable DNA hydrogel comprising Hb aptamers cross-linked with two complementary chains and encapsulating deferoxamine mesylate (DFO). Functionally, the hydrogel generates signals upon postoperative rehemorrhage by capturing Hb, demonstrating a distinctive "self-diagnosis" capability. In addition, the ongoing capture of Hb mediates the gradual disintegration of the hydrogel, enabling the on-demand release of DFO without compromising physiological iron-dependent functions. This process achieves self-treatment by inhibiting the ferroptosis of neurocytes. In a collagenase and autologous blood injection model-induced mimic postoperative rehemorrhage model, the hydrogel exhibited a 5.58-fold increase in iron absorption efficiency, reducing hematoma size significantly (from 8.674 to 4.768 cubic millimeters). This innovative Hb-responsive DNA hydrogel not only offers a therapeutic intervention for postoperative rehemorrhage but also provides self-diagnosis feedback, holding notable promise for enhancing clinical outcomes.

Middle meningeal artery embolization following surgical evacuation of symptomatic chronic subdural hematoma improves outcomes, interim results of a prospective randomized trial

BackgroundOutcomes after surgical treatment of chronic subdural hematoma (cSDH) remain undesirable in a significant proportion of patients. We aimed to show the role of middle meningeal artery (MMA) embolization and to demonstrate its benefits. MethodsThirty-five patients with symptomatic cSDH were enrolled in a prospective randomized trial following evacuation surgery. Participants were randomized to embolization or control group (expectant management following surgical evacuation without embolization). Patients were followed throughout their hospitalization and outpatient follow-ups. The main goals of this planned interim analysis were to assess neurological outcome and resource utilization. ResultsThe groups were comparable in terms of sex, age and follow-up retention rates. Side(s) of intervention(s) and hematoma size were similar. There was no statistical difference in neurological examination improvement at discharge, but at follow-up, we observed a decline in neurologic exam in the control group (p = 0.03). Control group participants required more re-interventions (p = 0.02) and were followed in clinic and during related readmissions for longer (p = 0.02). The number of imaging studies obtained in relation to the disease management was higher in the control group (p = 0.01). ConclusionsOur results suggest a beneficial role for the addition of MMA embolization to surgical intervention in the treatment of symptomatic chronic subdural hematoma. Neurological outcomes were significantly better in the embolization group. This contributed to less need for follow-up, re-interventions, and imaging studies.

Clinical and radiographic predictors for angiography in pelvic trauma: An analysis of 1703 patients

IntroductionPatients who present with hemorrhage from pelvic fractures have an increased risk of mortality with prolonged time to intervention. Identifying risk factors associated with hemorrhage can expedite treatment. In this study we explore clinical and radiographic predictors for angiography in trauma patients with pelvic fractures. MethodRetrospective, single-center review between 2009 and 2019 at a level 1 trauma center of all trauma patients with pelvic fractures. We excluded patients who died prior to arrival or in the trauma bay who did not undergo computed tomography (“CT”). Finalized attending descriptions of CT findings were reviewed, including size of hematomas, and presence of extravasation. Chi-square, Mann-Whitney U and multi-variate regressions were performed. ResultsWe analyzed 1,703 trauma patients with pelvic fractures. Most common mechanisms of injury included MVC (45 %), fall (27 %) and motorcycle accident (12 %). 48 % (819/1703) of patients had pelvic hematomas on CT scan. 17 %(138/819) of patients with a hematoma also had evidence of extravasation. Significant predictors for extravasation on CT included large hematoma on CT, AIS extremity ≥2, binder placement, increased ISS, HR, and decreased GCS and SBP (p < 0.005). Significant predictors for angiography were similar, including AIS extremity ≥2, binder placement, presence of moderate and large hematoma and active extravasation on CT (p < 0.01). Stepwise logistic regression model incorporated ISS, HR, AIS extremity score, binder placement, and contrast extravasation with an AUC = 0.9345. ConclusionIn this large retrospective review of traumatic pelvic fractures, specific clinical and radiographic factors were significantly associated with pelvic hematomas, extravasation and/or need for angiography. Future collaborative work with orthopedics and interventional radiology is planned to better triage pelvic fracture patients and identify those at risk for bleeding that require earlier intervention.

Acute calcitriol treatment mitigates vitamin D deficiency-associated mortality after intracerebral haemorrhage

ObjectiveVitamin D deficiency (VDD) is emerging as a predictor of poor prognosis in various neurological conditions, where clinical outcomes are often worse in stroke patients with VDD. This study aimed to provide experimental evidence on whether and how pre-existing VDD would affect survival and neurofunctional outcomes in intracerebral haemorrhage (ICH), and to evaluate whether acute vitamin D (VD) supplementation would improve post-stroke outcomes. MethodsExperimental ICH models were induced in mice with and without VDD. Haematoma size was measured using T2*-weighted MRI and haemoglobin concentration. Post-ICH mortality, neurofunctional outcomes and the extent of blood–brain barrier (BBB) leakage were assessed to identify their correlations with VD status. Therapeutic benefits of acute VD administration were also evaluated. ResultsMice with VDD exhibited significantly higher acute mortality rates and more severe motor deficits than mice without VDD post-ICH. Marked haematoma expansion and increased Evans blue extravasation were observed in VDD mice, suggesting that VDD was associated outcomes with increased BBB disruption. Acute treatment with a loading dose of VD (calcitriol) significantly improved outcomes in VDD mice. ConclusionThis study provides novel insights into the pathophysiological mechanisms at play in ICH concomitant with VDD and a scientific rationale for acute treatment with VD.

Multilevel Spontaneous Spinal Epidural Hematomas in a Recreational Weight Lifter.

Spontaneous spinal epidural hematoma (SSEH) is a nontraumatic condition that potentially compresses the spinal cord by accumulating blood in the epidural space. We report a case of multilevel SSEH in a 27-year-old male recreational weight lifter, presenting with acute lower back pain and bilateral leg weakness after deadlifts. Initial magnetic resonance imaging (MRI) showed subacute epidural hematomas with distinct signal intensities. The hematomas spanned multiple thoracic and lumbar levels without any predisposing medical conditions. Conservative management, including strict bed rest and pain management, led to marked improvement, with follow-up MRI indicating reduced hematoma size and expanded dural sac dimension. This case highlights the rare possibility of long-extending SSEH from weight lifting in individuals without risk factors and underscores the effectiveness of conservative treatment for multilevel spinal epidural hematomas.

A dispensable role of mural cell-derived laminin-α5 in intracerebral hemorrhage

Although most laminin isoforms are neuroprotective in stroke, mural cell-derived laminin-α5 plays a detrimental role in an ischemia-reperfusion model. To determine whether this deleterious effect is an intrinsic feature of mural cell-derived laminin-α5 or unique to ischemic stroke, we performed loss-of-function studies using middle-aged mice with laminin-α5 deficiency in mural cells (α5-PKO) in an intracerebral hemorrhage (ICH) model. Control and α5-PKO mice exhibited comparable changes in all parameters examined, including hematoma size, neuronal death, neurological function, blood-brain barrier integrity, and reactive gliosis. These findings highlight a minimal role of mural cell-derived laminin-α5 in ICH. Together with the detrimental role of mural cell-derived laminin-α5 in ischemic stroke, these negative results in ICH model suggest that mural cell-derived laminin-α5 may exert distinct functions in different diseases.

Intra‐arterial Selective Bevacizumab Administration in the Middle Meningeal Artery for Chronic Subdural Hematoma: An Early Experience in 12 Hemispheres

Background Chronic subdural hematoma (cSDH) has a rising incidence associated with an increasing burden of disability and mortality worldwide. Vascular endothelial growth factor plays an integral role in the inflammation and formation of subdural membranes responsible for the origin and propagation of cSDH. We report an early experience of intra‐arterial bevacizumab, a vascular endothelial growth factor receptor antagonist, to the middle meningeal artery of 12 hemispheres in 8 patients with cSDH. Methods Eight patients with either unilateral or bilateral cSDH received intra‐arterial infusion of 2 mg/kg bevacizumab into the middle meningeal artery of each treated hemisphere. The primary outcome was hematoma recurrence or reaccumulation requiring surgical drainage or middle meningeal artery embolization within 3 months posttreatment. Results Of 12 hemispheres treated, no treatment‐related complications were reported. Median duration of follow‐up was 5 months (interquartile range 3–7.5). By 3 months posttreatment, no patients experienced hematoma recurrence or reaccumulation. One patient required concurrent evacuation at the time of bevacizumab administration. There were no major strokes or mortality within 3 months. Four hemispheres (33.3%) demonstrated complete radiographic hematoma resolution by 3 months. All hemispheres achieved 50% reduction in hematoma size by 3 months. Conclusion For all hemispheres treated, there was no hematoma recurrence or progression requiring surgical drainage or middle meningeal artery embolization within 3 months except 1 who required concurrent evacuation 24 hours after treatment. Our initial experience supports bevacizumab as a novel, potentially viable agent for cSDH treatment in select patients. Future studies in larger cohorts are necessary to confirm efficacy and safety and appropriate dosing.

Sonological predictors of complications of percutaneous renal biopsy—a prospective observational study

Percutaneous renal biopsy, although essential for renal disease diagnosis, is associated with a number of post-biopsy complications ranging from gross haematuria to AV fistula to death. In this study, we carried out an active haematoma surveillance and attempted to correlate renal sonological parameters—kidney length, renal parenchymal changes, renal cortical and parenchymal thickness for their potential use in prediction of post-renal biopsy complications.MethodsThis was a prospective study done from April 2022 to April 2023 on all adult patients undergoing native or transplant kidney biopsy. Baseline clinical, laboratory and renal sonological parameters were noted prior to biopsy. USG-guided renal biopsy was done and any haematoma at 0 h, 12 h and 24 h post-biopsy noted. Biopsy complications including need for any interventions were noted.ResultsOut of the 240 patients enrolled in the study, 58.3% experienced post-biopsy complications. Among these, 5% of patients encountered major complications, with 3.33% necessitating medical intervention following renal biopsy procedures. A high percentage, 98.89%, exhibited hematoma formation within 12 h post-biopsy. Furthermore, our analysis revealed that a hematoma size exceeding 1.2 cm at the 12-h mark exhibited a sensitivity of 100% and specificity of 71% in predicting the need for blood transfusion. Renal parenchymal changes were the most reliable sonological parameters for predicting post-biopsy complication on multivariate analysis.ConclusionThe incidence of major complications requiring interventions following renal biopsy is notably low. Our study highlights the significance of renal sonological characteristics, including parenchymal thickness, cortical thickness and parenchymal changes, in predicting these complications. Furthermore, we emphasize the utility of hematoma surveillance immediately post-biopsy and at the 12 h, as a valuable tool for predicting the necessity of post-biopsy interventions. This approach can aid in efficiently triaging patients and determining the need for further observation post-renal biopsy.

Risk factors of prognosis for spontaneous cerebellar hemorrhage: a systematic review and meta-analysis

BackgroundThe most deadly type of spontaneous intracerebral hemorrhage is spontaneous cerebellar hemorrhage (SCH). The purpose of this meta-analysis was to investigate risk factors for prognosis in SCH patients to provide a basis for taking preventive and therapeutic measures.MethodsSeven electronic databases were searched from inception to May 2023 for randomized controlled trial, cohort study, case control study and cross-sectional study on prognosis of spontaneous cerebellar hemorrhage. The quality of the selected studies were assessed by the American Agency for Healthcare Research and Quality (AHRQ). To assess the impact of the included risk factors on the prognosis of spontaneous cerebellar hemorrhage, combined odds ratios (ORs) with matching 95% confidence intervals (CIs) were combined.ResultsEight studies were included, including 539 participants. And a total of 31 potentially associated risk factors were identified. Ultimately, 6 risk factors were included in the meta-analysis after assessing. The factors supported by moderate evidence include the hydrocephalus (OR = 4.3, 95% CI: 2.33 to 7.91) and drug-induced coagulopathy (OR = 2.74, 95% CI: 1.23 to 6.09). The factors supported by limited evidence include the intraventricular bleeding(OR = 1.86, 95% CI: 1.13 to 3.07) and hematoma size>3 cm(OR = 3.18, 95% CI: 1.87 to 5.39). Meta-analysis revealed no association between hypertension, diabetes mellitus and SCH prognosis.ConclusionThe current meta-analysis revealed obvious risk factors for prognosis in spontaneous cerebellar hemorrhage patients, including hydrocephalus, drug-induced coagulopathy, intraventricular bleeding and hematoma size>3 cm.

#1601 Cranial vs. caudal direction technique in percutaneous kidney biopsy: an Italian single-center experience

Abstract Background and Aims The percutaneous kidney biopsy (PKB) is the gold standard for diagnosing kidney pathology. For an appropriate diagnosis, an adequate sample size must be obtained. For most light microscopy assessments, 10 glomeruli are needed to assess the severity and the distribution of lesions adequately. However, the PKB procedure has potential risks such as bleeding, hematuria, hematoma, and the formation of an arterio-venous fistula. The PKB is nowadays a well-known technique with a low number of complications. It consists of an automated biopsy needle directed to the cortex of the inferior pole of the kidney. In clinical practices, the needle direction may have a caudal direction (CD) or a cranial direction (CN). Few small studies have compared the two techniques. Method We report the results of our experience of 107 percutaneous ultrasound (US)-guided native kidney biopsies with the CN technique performed from January 2021 to December 2023. Two core samples were obtained with a 14-G automated needle. After the biopsy, the patient bed-rested in a supine position for 24 hours. Vital signs and blood count controls were monitored after 2 and 4 hours. The post-biopsy kidney ultrasonogram US was done after 48 hours to detect complications. Results We observed 7,5% of complications: one retroperitoneal bleed required blood transfusion and embolization, and 7 perinephric hematoma size ≥ 1 cm. We compared the results of the CN-PKB with a historical cohort of 100 CD-PKB performed from January 2018 to December 2020. These last ones have shown 4% of complications, which resulted in only perinephric hematoma size ≥ 1 cm. The Chi-Square test was performed to compare statistical differences between the groups for categorical variables, showing no statistical significance (p-value &amp;gt;0.05). Samples were always adequate for pathological diagnosis. Conclusion Our results demonstrate that the two PKB techniques performed with the CN and the CD techniques give similar results in terms of adequacy and safety.

Risk Factors Are Not Very Risky Once a Normal Embryonic Heart Rate is Seen in Early Pregnancy.

To assess first-trimester prognosis when an early pregnancy sonogram demonstrates a normal embryonic heart rate and to determine how a number of risk factors affect prognosis. Our study population consisted of 6597 first-trimester scans with gestational age (GA) ≤ 7.0 weeks (all with crown-rump length [CRL] <10 mm), normal embryonic heart, and known first-trimester outcome. We recorded GA; CRL; heart rate; first-trimester outcome; maternal age; presence, absence, and size of subchorionic hematoma; presence or absence of vaginal bleeding; and presence, absence, and size of uterine fibroids. We assessed first-trimester outcome in the study population and subsets based on the above data. First-trimester outcome was successful in 6030 of the 6597 cases (91.4%). The prognosis was somewhat worse with each of the following risk factors: maternal age ≥35 years, large subchorionic hematoma, and large or multiple uterine fibroids (P < .02, chi-squared or Cochran's test for trend, for all of these items). The rate of successful outcome was in the range of 83-88% with each of these risk factors and 93.8% in the absence of any of these factors. The presence of a normal embryonic heart rate on an early first-trimester sonogram is a reassuring finding, indicating a likelihood of good first-trimester outcome of at least 83% even in the presence of risk factors, and of over 90% in the absence of such factors.

Unveiling the Hidden Impact: Hematoma Volumes Unravel Circuit Disruptions in Intracerebral Hemorrhage.

Intracerebral hemorrhage (ICH) imposes a significant burden on patients, and the volume of hematoma plays a crucial role in determining the severity and prognosis of ICH. Although significant recent progress has been made in understanding the cellular and molecular mechanisms of surrounding brain tissue in ICH, our current knowledge regarding the precise impact of hematoma volumes on neural circuit damage remains limited. Here, using a viral tracing technique in a mouse model of striatum ICH, two distinct patterns of injury response were observed in upstream connectivity, characterized by both linear and nonlinear trends in specific brain areas. Notably, even low-volume hematomas had a substantial impact on downstream connectivity. Neurons in the striatum-ICH region exhibited heightened excitability, evidenced by electrophysiological measurements and changes in metabolic markers. Furthermore, a strong linear relationship (R2 = 0.91) was observed between hematoma volumes and NFL damage, suggesting a novel biochemical index for evaluating changes in neural injury. RNA sequencing analysis revealed the activation of the MAPK signaling pathway following hematoma, and the addition of MAPK inhibitor revealed a decrease in neuronal circuit damage, leading to alleviation of motor dysfunction in mice. Taken together, our study highlights the crucial role of hematoma size as a determinant of circuit injury in ICH. These findings have important implications for clinical evaluations and treatment strategies, offering opportunities for precise therapeutic approaches to mitigate the detrimental effects of ICH and improve patient outcomes.