Bleeding Volume Research Articles

Postpartum bleeding visual underestimation: A persistent problem.

SynopsisPostpartum bleeding volume calculated by the visual method is lower than the bleeding volume that is objectively quantified.

Fecal microbial transplantation limits neural injury severity and functional deficits in a pediatric piglet traumatic brain injury model.

Pediatric traumatic brain injury (TBI) is a leading cause of death and disability in children. Due to bidirectional communication between the brain and gut microbial population, introduction of key gut bacteria may mitigate critical TBI-induced secondary injury cascades, thus lessening neural damage and improving functional outcomes. The objective of this study was to determine the efficacy of a daily fecal microbial transplant (FMT) to alleviate neural injury severity, prevent gut dysbiosis, and improve functional recovery post TBI in a translational pediatric piglet model. Male piglets at 4-weeks of age were randomly assigned to Sham + saline, TBI + saline, or TBI + FMT treatment groups. A moderate/severe TBI was induced by controlled cortical impact and Sham pigs underwent craniectomy surgery only. FMT or saline were administered by oral gavage daily for 7 days. MRI was performed 1 day (1D) and 7 days (7D) post TBI. Fecal and cecal samples were collected for 16S rRNA gene sequencing. Ipsilateral brain and ileum tissue samples were collected for histological assessment. Gait and behavior testing were conducted at multiple timepoints. MRI showed that FMT treated animals demonstrated decreased lesion volume and hemorrhage volume at 7D post TBI as compared to 1D post TBI. Histological analysis revealed improved neuron and oligodendrocyte survival and restored ileum tissue morphology at 7D post TBI in FMT treated animals. Microbiome analysis indicated decreased dysbiosis in FMT treated animals with an increase in multiple probiotic Lactobacilli species, associated with anti-inflammatory therapeutic effects, in the cecum of the FMT treated animals, while non-treated TBI animals showed an increase in pathogenic bacteria, associated with inflammation and disease such in feces. FMT mediated enhanced cellular and tissue recovery resulted in improved motor function including stride and step length and voluntary motor activity in FMT treated animals. Here we report for the first time in a highly translatable pediatric piglet TBI model, the potential of FMT treatment to significantly limit cellular and tissue damage leading to improved functional outcomes following a TBI.

Radiological features of brain hemorrhage through automated segmentation from computed tomography in stroke and traumatic brain injury.

Radiological assessment is necessary to diagnose spontaneous intracerebral hemorrhage (ICH) and traumatic brain injury intracranial hemorrhage (TBI-bleed). Artificial intelligence (AI) deep learning tools provide a means for decision support. This study evaluates the hemorrhage segmentations produced from three-dimensional deep learning AI model that was developed using non-contrast computed tomography (CT) imaging data external to the current study. Non-contrast CT imaging data from 1263 patients were accessed across seven data sources (referred to as sites) in Norway and Sweden. Patients were included based on ICH, TBI-bleed, or mild TBI diagnosis. Initial non-contrast CT images were available for all participants. Hemorrhage location frequency maps were generated. The number of estimated haematoma clusters was correlated with the total haematoma volume. Ground truth expert annotations were available for one ICH site; hence, a comparison was made with the estimated haematoma volumes. Segmentation volume estimates were used in a receiver operator characteristics (ROC) analysis for all samples (i.e., bleed detected) and then specifically for one site with few TBI-bleed cases. The hemorrhage frequency maps showed spatial patterns of estimated lesions consistent with ICH or TBI-bleed presentations. There was a positive correlation between the estimated number of clusters and total haematoma volume for each site (correlation range: 0.45-0.74; each p-value < 0.01) and evidence of ICH between-site differences. Relative to hand-drawn annotations for one ICH site, the VIOLA-AI segmentation mask achieved a median Dice Similarity Coefficient of 0.82 (interquartile range: 0.78 and 0.83), resulting in a small overestimate in the haematoma volume by a median of 0.47 mL (interquartile range: 0.04 and 1.75 mL). The bleed detection ROC analysis for the whole sample gave a high area-under-the-curve (AUC) of 0.92 (with sensitivity and specificity of 83.28% and 95.41%); however, when considering only the mild head injury site, the TBI-bleed detection gave an AUC of 0.70. An open-source segmentation tool was used to visualize hemorrhage locations across multiple data sources and revealed quantitative hemorrhage site differences. The automated total hemorrhage volume estimate correlated with a per-participant hemorrhage cluster count. ROC results were moderate-to-high. The VIOLA-AI tool had promising results and might be useful for various types of intracranial hemorrhage.

Clinical Application of Confocal Laser Endomircoscopy Combined with Cryobiopsy in the Diagnosis of Interstitial Lung Disease

Introduction: Confocal laser endomicroscopy (CLE) has the characteristics of high resolution, real-time imaging, and no radiation, which is helpful for the precise and effective implementation of transbronchial cryobiopsy (TBCB). The study aimed to compare the efficacy and safety of TBCB combined with CLE (CLE group) or fluoroscopy (fluoroscopy group) in the diagnosis of interstitial lung disease (ILD). Methods: From a prospective randomized controlled trial, 80 patients with undiagnosed ILD or ILD requiring biopsy between January 2022 and November 2022 were randomly assigned to CLE group and fluoroscopy group. The rate to reach an etiological diagnosis of ILD, maximum cross-sectional area of specimens, operation time, and complications were compared between the two groups. Results: The rate to reach an etiological diagnosis in the CLE group was significantly higher than that in the fluoroscopy group (95.0% vs. 80.0%, p < 0.05), but there was no difference in the maximum cross-sectional area of the specimens (42.1 ± 10.1 mm2 vs. 41.5 ± 10.3 mm2, p > 0.05). In terms of operation time, the CLE group was significantly shorter than the fluoroscopy group (37.6 ± 10.6 min vs. 54.8 ± 24.9 min, p < 0.05). The bleeding volume in the CLE group was significantly lower than that in the fluoroscopy group (4.9 ± 3.6 mL/case vs. 9.0 ± 9.2 mL/case, p < 0.05). Further analysis showed that the incidence of moderate bleeding was also lower in the CLE group (20.0% vs. 75.0%, p < 0.001). In addition, the incidence of pneumothorax in the CLE group was significantly lower than that in the fluoroscopy group (0 vs. 25.0%, p < 0.001). Conclusions: Compared with simple fluoroscopy, the combination of CLE significantly improves the rate of etiological diagnosis, shortens the operation time, and reduces complications such as bleeding and pneumothorax.

Multifactor analysis of the technique in total laparoscopic gastric cancer.

Esophageal gastric anastomosis is a common surgical technique used to treat patients with gastric cancer who undergo total gastrectomy. However, using simple anastomosis techniques alone may not meet the needs of patients in some cases and can lead to complications such as anastomotic stenosis and ulceration. In order to overcome these issues and improve patient prognosis, muscle flap reconstruction technique has emerged. Muscle flap reconstruction is a method of improving gastric-esophageal anastomosis by transplanting muscle tissue. By covering the anastomotic site with muscle tissue, it not only enhances the stability of the anastomosis site but also increases blood supply, promoting healing and recovery of the anastomosis. Therefore, the use of muscle flap reconstruction technique in esophageal gastric anastomosis during total gastrectomy for gastric cancer is increasingly widely applied. To determine the effectiveness of esophagogastric anastomosis using the muscle flap reconstruction technology in total abdominal gastrectomy for gastric cancer and perform follow-up experiments to understand the factors affecting patients' prognosis. The study subjects were 60 patients with gastric cancer who were admitted to our hospital between October 2018 and January 2022. All patients underwent esophagogastric anastomosis using the double muscle flap reconstruction technology in total abdominal gastrectomy. Perioperative indicators were determined, and patients were followed up for 1 year. Furthermore, patient outcomes were observed within 1 year, followed by patient classification based on different outcomes. Moreover, clinicopathological parameters were observed and relevant factors affecting patient prognosis were analyzed. The operation time was 318 ± 43 min, the formation time of esophageal double muscle flap anastomosis was 110 ± 13 min, the number of lymph node dissections was 26 ± 6, the incision length was 3 ± 0.6 cm, intraoperative bleeding volume was 48 ± 15 mL, first anal exhaust time was 5.3 ± 1.8 d, first meal time was 6.0 ± 1.6 d, length of hospital stay was 11.8 ± 2.5, and treatment cost was 5.8 ± 0.7 thousand yuan. The patient experienced three postoperative complications: 2 cases of pulmonary infection and 1 case of respiratory discomfort. During 1-year follow-up, 50 patients survived and 10 died. Univariate analysis revealed that histological types, tumor size, tumor-node-metastasis staging, vascular invasion, and postoperative adjuvant radiotherapy and chemotherapy were the main factors affecting the prognosis of surviving patients. Furthermore, Cox regression analysis revealed that postoperative adjuvant radiotherapy and chemotherapy were the main factors affecting patient prognosis. The survival time of the survival group was significantly higher than that of the death group (P < 0.05). Esophagogastric anastomotic using muscle flap reconstruction exhibits good effects on patients who undergo total abdominal gastrectomy for cancer. Postoperative adjuvant radiotherapy and chemotherapy are the main factors affecting patient prognosis.

Examining Clinical Application Value of Uterine Compression Suture in the Treatment of Postpartum Hemorrhage

Objective: To observe and explore the clinical effect of uterine compression sutures in treating postpartumhemorrhage. Methods: 56 patients with postpartum hemorrhage were diagnosed and treated from January 2020 to December 2022. According to the coin toss method, they were divided into the conventional group (given routine hemostatic treatment) and the research group (given uterine compression suture), with 28 cases in each group. The hemostatic efficiency, postoperative recovery time, postoperative bleeding volume, and complication rate were compared between the two groups. Results: The hemostatic efficiency of the research group was higher than that of the conventional group (P &lt; 0.05); the hemostasis time, total hospitalization time, lochia excretion promotion time, and time for the menstrual cycle to return to normal in the research group were shorter than those of the conventional group (P &lt; 0.05); the bleeding volume at 2 hours and 24 hours after surgery in the research group was lower than that in the conventional group (P &lt; 0.05); the total incidence of complications such as fever, uterine adhesions, incisional bleeding, and fluid dark areas in the research group was lower than that in the conventional group (P &lt; 0.05). Conclusion: The hemostatic effect of the uterine compression suture is accurate. It stops bleeding quickly and can significantly reduce the amount of perioperative bleeding. It can also reduce postoperative complications and speed up recovery with a specific reference value.

Uterine rupture in first versus second stage of labour—A case‐series study in a tertiary referral centre

AbstractIntroductionTo analyse at what point during delivery, and during what clinical circumstances uterine rupture occurs. Uterine rupture is a rare peripartum complication associated with severe outcome for both mother and child. To date, many studies have characterized potential risk factors to uterine rupture, however, the intrapartum course remains unclear.Material and MethodsA case‐series study based on data collected from patient data records on all women with uterine rupture at a tertiary referral centre between 2008 and 2019. Data were compared on women with uterine rupture during first versus second stage of labour, and women with spontaneous onset versus induced labour.ResultsA total of 109 women were included, whereof 94.5% had one or more previous caesarean deliveries. Uterine rupture occurred during the whole course of labour. Women with uterine rupture during second stage of labour (n = 46) compared to women with uterine rupture during first stage of labour (n = 63), were more exposed to oxytocin (p &lt; 0.0001), tended to use epidural anaesthesia more often during delivery (p = 0.053), had larger mean volume of haemorrhage (p = 0.015), and tended to have a higher occurrence of low Apgar score (p = 0.051) and asphyxia in the infant (p = 0.04). Women with induced labour (n = 42) tended to have shorter time‐to‐uterine‐rupture than women with spontaneous onset (n = 67) (p = 0.055).ConclusionsUterine rupture occur both in first and second stage of labour. Maternal and infant outcomes are worse when uterine rupture occurs in the second stage of labour. These results emphasize the importance of a close monitoring during the whole course of delivery.

Examining the Impact of the Whole-Process Companionship and Responsible Midwifery Model on Delivery Outcomes

Objective: To explore and analyze the impact of the whole-process companionship and responsible midwiferymodel on delivery outcomes. Methods: 200 women who were about to give birth admitted to Lianyungang Maternal and Child Health Hospital’s Obstetrics and Gynecology Department from May 2021 to May 2023 were recruited and divided into whole process and ordinary groups by flipping a coin, with 100 cases in each group. The whole process group implemented the whole process companionship and responsible midwifery model, while the ordinary group implemented the conventional midwifery model. The duration of labor, delivery outcomes, psychological status, postpartum bleeding volume, and incidence of adverse neonatal outcomes were compared between groups. Results: All three stages of labor in the whole process group were significantly shorter than those in the ordinary group (P &lt; 0.05). The natural delivery rate and cesarean section rate in the whole process group were significantly better than those in the ordinary group (P &lt; 0.05). The difference was not statistically significant after comparing the lateral incision rate between the whole process group and the ordinary group (P &gt; 0.05). Before the intervention, the anxiety and depression scores between the groups weresimilar (P &gt; 0.05); after the intervention, the anxiety and depression scores in the whole process group were significantly lower than in the ordinary group (P &lt; 0.05). The amount of postpartum hemorrhage and the incidence of adverse neonatal outcomes in the whole process group were significantly better than those in the ordinary group (P &lt; 0.05). Conclusion: The whole-process companionship and responsible midwifery model has specific positive significance for delivery outcomes, and this midwifery model deserves to be widely used and promoted in clinical practice.

Effect of acrylic bone cement mixed with calcium sulfate combined with percutaneous kyphoplasty in the treatment of osteoporotic fractures

To investigate the clinical efficacy of acrylic cement (PMMA) mixed with calcium sulfate combined with percutaneous kyphoplasty (PKP) in the treatment of osteoporotic fracture (OVCF). The clinical data of 191 patients with OVCF treated with PKP from January 2020 to March 2021 were retrospectively analyzed. Among them, 82 patients with 94 vertebral bodies were treated with PMMA mixed with calcium sulfate as the observation group, and 109 patients with 125 vertebral bodies were treated with pure PMMA as the control group. Among the 82 patients in the observation group, there were 16 males and 66 females, with a mean age of (75.35±11.22) years old, including 36 thoracic vertebrae and 58 lumbar vertebrae. In the control group, there were 109 patients, 22 males and 87 females, with an average age of (74.51±9.21) years old, including 63 thoracic vertebrae and 62 lumbar vertebrae. The visual analog scale (VAS) before operation and 1 day, 3 months and 1 year after operation were calculated. The Oswestry disability index (ODI), Cobb's angle, vertebral body height and the probability of postoperative bone cement leakage were used to analyze the efficacy of the two groups. All the patients were followed up for more than one year. Compared with the control group, there was no significant difference in operation time, bleeding volume and bone cement injection volume between the two groups(P>0.05), while the leakage rate of bone cement was significantly lower in the observation group (P<0.05). In addition, there was no significant difference in VAS, ODI, Cobb angle, and vertebral body height between the two groups before operation, and 1 day, 3 months, and 1 year after operation (P>0.05), but each index was improved compared with that before operation (P<0.05). PMMA mixed with calcium sulfate has equivalent efficacy in treating OVCF than PMMA alone, but can effectively reduce the probability of cement leakage.

Application of body temperature rinse in percutaneous transforaminal endoscopic lumbar discectomy through intervertebral approach

To investigate the effects of two types of temperature rinses on body temperature, inflammatory cytokine levels, and bleeding volume in percutaneous endoscopic lumbar discectomy. Eighty patients underwent percutaneous endoscopic lumbar discectomy from January 2018 to December 2020 were selected and divided into experimental group (40 cases) and control group(40 cases). In experimental group, there were 19 males and 21 females, aged (38.8±9.8) years old;7patients on L4,5 and 33 patients on L5S1;Body msss index(BMI) was (27.8±7.2) kg·m-2. In contral group, there were 18 males and 22 females, aged (41.5±10.9) years old, 5 patients on L4,5 and 35 patients on L5S1;BMI was (26.4±6.2) kg·m-2. The patients in the control group were received normal saline rinse at room temperature, and the patients in the experimental group were received normal saline rinse heated to 37 ℃. Body temperature, chills, nausea, vomiting, and other adverse reactions were recorded. The levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and interleukin-10 (IL-10) in two groups were recorded before and 2 hours after operation. Visual analogue scale (VAS) was used to evaluate the degree of lumbar pain in two groups before and 2 hours after surgery. Fibrinolytic-coagulation indexes with preoperative and 2 hours after surgery, including the D-dimer (DD), fibrinogen degradation products (FDP), activated partial thrombin time (APTT) and prothrombin time (PT) were recorder. Operation time and blood loss in two groups were recorded. The body temperature of both groups showed a downward trend, while the body temperature of the control group was lower than that of the experimental group. The levels of TNF-α, IL-6 and IL-10 in two groups were increased 2 hours after surgery compared with those before surgery(P<0.05), while the levels in experimental group were lower than those in control group(P<0.05). Postoperative VAS in experimental group 2.19±1.13 was significantly lower than that in the control group 3.38±1.35(P<0.05). The levels of DD and FDP at 2 hours after surgery in both groups were higher than those before surgery (P<0.05), while the levels of DD and FDP in the experimental group were higher than those in the control group (P<0.05). There was no significant difference in APTT and PT levels between two groups after operation (P>0.05). The blood loss in the experimental group of (45.2±14.1) ml was lower than that in the control group of (59.52±15.6) ml. The operation time of experimental group (46.7±13.8) min was less than that of control group (58.3±15.2) min(P<0.05). Body temperature rinse can reduce the incidence of adverse reactions, alleviate local inflammatory reactions, reduce intraoperative blood loss and shorten the operation time.

Comparison of therapeutic effects of arthroscopic popliteal cyst internal drainage and capsular wall resection

To investigate efficacy between arthroscopic popliteal cyst drainage and arthroscopic popliteal cyst resection. From January 2013 to June 2021, 54 patients with popliteal cyst (Rausching-Lindgren gradeⅠto Ⅲ) were treated with arthroscopic surgery. There were 24 males and 30 females. The age ranged from 44 to 72 years old, with a mean of (62.67±6.08) years old. The course of the disease ranged from 1 to 72 months, with a mean of(15±14) months. Twenty-four patients (group A) were underwent arthroscopic internal drainage of popliteal cyst. Thirty patients (group B) were underwent arthroscopic resection of popliteal cyst. Preoperative main symptoms included knee pain, swelling, walking pain, popliteal swelling, popliteal mass and so on. After 1, 3, 6 months and 1, 2 years of surgery, routine outpatient follow-up was conducted to observe and compare the surgical time, bleeding volume, preoperative and postoperative visual analog scale (VAS), knee Lysholm score, and complications between two groups. All incisions healed at one stage after operation. All 54 patients were followed up, and the duration ranged from 6 months to 2 years, with an average of (13.89±4.29) months. There was no intraoperative vascular or nerve injury. Operation time and intraoperative blood loss of the two groups:group A of (62.08±9.55) min and (8.00±1.69) ml, group B of (69.50±6.99) min and (8.70±2.00) ml. Popliteal pain, swelling, limitation of flexion and extension were significantly relieved after operation. VAS before and one month after operation between two groups:group A of 5.38±1.21 and 2.63±0.71, group B of 5.60±1.26 and 2.80±0.81. Lysholm scores of knee joint before and 6 months after operation:group A of 62.59±4.99 and 89.74±2.90, group B of 63.87±3.23 and 89.02±2.35. Knee joint function improved significantly in both groups. In group A, 4 cases had popliteal cyst at 3 months after operation, and 2 cases had small isolated cyst at 1 year after operation. There was no recurrence of cyst in group B. The results between two arthroscopic treatments of popliteal cyst are satisfactory, and there is no significant difference in the amount of blood loss, safety, postoperative pain VAS score and knee function recovery. It is suggested that arthroscopic resection of the cyst wall should be performed when the technique is mature, especially for large cysts and septal cysts.

Blend Sign and Haemorrhage Location and Volume Predict Late Recurrence and Mortality in Intracerebral Haemorrhage Patients.

Studies on risk factors for primary intracerebral haemorrhage (ICH) focus on short-term predictive values of distinct clinical parameters or computed tomography (CT) markers and disregard the others. We, therefore, studied independent predictive values of demographic, clinical, and CT markers regarding ICH expansion, late ICH recurrence, and late mortality. In a retrospective study of 288 patients with primary ICH, ICH localization (158 lobar, 81 deep, and 49 cerebellar), volume, blend sign, spot sign, finger-like projections, and subarachnoid haemorrhages were evaluated. ICH localization-specific differences for demographic (age, sex), clinical parameters (vascular risk factors, antiplatelet, and anticoagulation therapy), and CT markers were evaluated using logistic regression. We applied Cox proportional hazards modelling using these parameters to predict risk factors for ICH expansion, late ICH recurrence, and late mortality. The blend sign in lobar ICH relates to increased risk of ICH expansion (HR2.3), late ICH recurrence (HR2.3), and mortality (HR1.6). Age, conditions requiring antiplatelet medication, deep ICH localization, volume, and blend sign represented the most important independent factors impacting overall mortality. Blend sign at baseline ICH is a manifestation of underlying detrimental vascular processes that signal increased ICH expansion risk, although is also indicative of long-term risks for late recurrent ICH and late mortality.

Comparison of the Clinical Effects of Internal Fixation Combined with Vertebroplasty and Internal Fixation Alone on Patients with Spinal Fractures

Objective: This study aims to explore and analyze the comparison of clinical treatment effects of internal fixation combined with vertebroplasty and internal fixation alone on patients with spinal fractures. Methods: The experimental time was from April 2021 to April 2023. 80 spinal fracture patients treated by spinal surgery in our hospital were used as research objects, and grouped by double-blind method into study group (n = 40) and control group (n = 40). The study group received internal fixation combined with vertebroplasty, and the control group received internal fixation alone. The restoration of spinal structure, treatment, surgical treatment index, and incidence of adverse events were compared between the groups. Results: Before operation, the Cobb angle of the affected vertebra, the degree of spinal canal invasion, and the compression ratio of the prevertebral height of the two groups were compared, and there was no statistically significant difference (P &gt; 0.05). The&#x0D; degree of compression and the compression ratio of the affected prevertebral height in the study group were significantly better than those of the control group, and the difference was statistically significant (P &lt; 0.05). The rating of the treatment situation in the study group was significantly higher than that of the control group, the difference was statistically significant (P &lt; 0.05). The surgical treatment indicators such as tissue bleeding volume, hospitalization time, and intraoperative operation time in the study group were significantly better than those in the control group, and the difference was statistically significant (P &lt; 0.05). The incidence of adverse events in the study group was significantly lower than that in the control group, and the difference was statistically significant (P &lt; 0.05). Conclusion: Internal fixation combined with vertebroplasty is more effective than internal fixation alone in treating spinal fractures.

Targeting the microenvironment in the treatment of arteriovenous malformations

Extracranial arteriovenous malformations (AVMs) are regarded as rare diseases and are prone to complications such as pain, bleeding, relentless growth, and high volume of shunted blood. Due to the high vascular pressure endothelial cells of AVMs are exposed to mechanical stress. To control symptoms and lesion growth pharmacological treatment strategies are urgently needed in addition to surgery and interventional radiology. AVM cells were isolated from three patients and exposed to cyclic mechanical stretching for 24 h. Thalidomide and bevacizumab, both VEGF inhibitors, were tested for their ability to prevent the formation of circular networks and proliferation of CD31+ endothelial AVM cells. Furthermore, the effect of thalidomide and bevacizumab on stretched endothelial AVM cells was evaluated. In response to mechanical stress, VEGF gene and protein expression increased in patient AVM endothelial cells. Thalidomide and bevacizumab reduced endothelial AVM cell proliferation. Bevacizumab inhibited circular network formation of endothelial AVM cells and lowered VEGF gene and protein expression, even though the cells were exposed to mechanical stress. With promising in vitro results, bevacizumab was used to treat three patients with unresectable AVMs or to prevent regrowth after incomplete resection. Bevacizumab controlled bleeding, pulsation, and pain over the follow up of eight months with no patient-reported side effects. Overall, mechanical stress increases VEGF expression in the microenvironment of AVM cells. The monoclonal VEGF antibody bevacizumab alleviates this effect, prevents circular network formation and proliferation of AVM endothelial cells in vitro. The clinical application of bevacizumab in AVM treatment demonstrates effective symptom control with no side effects.Graphical abstractMechanical stress increases VEGF expression in endothelial AVM cells, possibly causing the VEGF upregulation in the microenvironment of AVM cells. The resulting RAS/RAF/MEK/ERK signaling in leads to progression of fast-flow malformations. The monoclonal VEGF-A antibody bevacizumab alleviates this effect, prevents circular network formation and proliferation of AVM endothelial cells in vitro. Sporadically occurring slow-flow malformations (LMs, VMs) have mutations in TEK or PIK3CA. TEK encodes the endothelial receptor tyrosine kinase TIE2. Sporadic extracranial fast-flow malformations (AVMs) show mutations in KRAS, BRAF and MAP2K1, which encodes the dual specificity mitogen-activated protein kinase MEK1. Combined targeting of the molecular causes of the disease could be key to achieve symptom control and reduce lesion growth. Orange: gain-of-function; Blue, circled with orange: enhanced signaling.

Multimodal imaging of the role of hyperglycemia following experimental subarachnoid hemorrhage

Hyperglycemia has been linked to worsening outcomes after subarachnoid hemorrhage (SAH). Nevertheless, the mechanisms involved in the pathogenesis of SAH have been scarcely evaluated so far. The role of hyperglycemia was assessed in an experimental model of SAH by T2 weighted, dynamic contrast-enhanced magnetic resonance imaging (T2W and DCE-MRI), [18F]BR-351 PET imaging and immunohistochemistry. Measures included the volume of bleeding, the extent of cerebral infarction and brain edema, blood brain barrier disruption (BBBd), neutrophil infiltration and matrix metalloprotease (MMP) activation. The neurofunctional outcome, neurodegeneration and myelinization were also investigated. The induction of hyperglycemia increased mortality, the size of the ischemic lesion, brain edema, neurodegeneration and worsened neurological outcome during the first 3 days after SAH in rats. In addition, these results show for the first time the exacerbating effect of hyperglycemia on in vivo MMP activation, Intercellular Adhesion Molecule 1 (ICAM-1) expression and neutrophil infiltration together with increased BBBd, bleeding volume and fibrinogen accumulation at days 1 and 3 after SAH. Notably, these data provide valuable insight into the detrimental effect of hyperglycemia on early BBB damage mediated by neutrophil infiltration and MMP activation that could explain the worse prognosis in SAH.

Catheter Tract Hemorrhages and Intracerebral Hemorrhage Outcomes in the Clot Lysis: Evaluating Accelerated Resolution of Intraventricular Hemorrhage Trial.

Factors associated with external ventricular catheter tract hemorrhage (CTH) are well studied; whether CTH adversely influence outcomes after intracerebral hemorrhage (sICH), however, is poorly understood. We therefore sought to evaluate the association between CTH and sICH outcomes. We performed a post hoc analysis of the Clot Lysis: Evaluating Accelerated Resolution of Intraventricular Hemorrhage trial. The exposure was CTH and evaluated on serial computed tomography scans between admission and randomization (approximately 72 hours). The primary outcomes were a composite of death or major disability (modified Rankin Score >3) and mortality alone, both assessed at 6 months. Secondary outcomes were functional outcomes at 30 days, permanent cerebrospinal fluid (CSF) shunt placement, any infection, and ventriculitis. We performed logistic regression adjusted for demographics, comorbidities, sICH characteristics, and treatment assignment, for all analyses. Of the 500 patients included, the mean age was 59 (SD, ±11) years and 222 (44%) were female. CTH occurred in 112 (22.4%) patients and was more common in minority patients, those on prior antiplatelet therapy, and patients who had more than 1 external ventricular drain placed. The end of treatment intraventricular hemorrhage volume was higher among patients with CTH (11.7 vs 7.9 mL, P = .01), but there were no differences in other sICH characteristics or the total duration of external ventricular drain. In multivariable regression models, CTH was not associated with death or major disability (odds ratio, 0.7; 95% CI: 0.4-1.2) or death alone (odds ratio, 0.8; 95% CI, 0.5-1.4). There were no relationships between CTH and secondary outcomes including 30-day functional outcomes, permanent CSF shunt placement, any infection, or ventriculitis. Among patients with sICH and large intraventricular hemorrhage, CTH was not associated with poor sICH outcomes, permanent CSF shunt placement, or infections. A more detailed cognitive evaluation is needed to inform about the role of CTH in sICH prognosis.

Efficacy of dexmedetomidine in the prevention and treatment of postanesthetic shivering after cesarean section

Purpose: To assess the efficacy of dexmedetomidine in the prevention and treatment of postanesthetic shivering in cesarean section.Methods: A total of 144 pregnant women who underwent anesthesia for cesarean section between March and December 2022 were randomly divided into the study group (n = 72) and control group (n = 72). The pregnant women were given combined spinal-epidural anesthesia. Following childbirth, those in the study group were given dexmedetomidine, while those in the control group were given normalsaline. The dose of spinal anesthesia was administered based on the following criteria: intraoperative infusion, atropine usage, ephedrine usage, intraoperative bleeding, intraoperative dosage, mean arterial pressure, heart rate, blood oxygen saturation, incidence of shivering, and sedation score. Incidence of adverse reactions were recorded and compared between the two groups.Results: Intraoperative infusion volume, bleeding volume, levels of atropine and ephedrine usage, and spinal anesthesia dose were similar between the two groups (p &gt; 0.05). At 10 min post-treatment, the study group had lower mean arterial pressure, heart rate and incidence of postanesthetic shivering, as well as higher postoperative sedation score than the control group. Compared with the control group, the study group had slightly higher incidence of pregnancy-related adverse reactions, but the difference was non-significant.Conclusion: Dexmedetomidine has good efficacy in preventing and treating postanesthetic shivering in cesarean section patients. However, further clinical trials are required prior to its adoption in clinical practice.

Effect of carboprost tromethamine and carbetocin on coagulation factors and prognosis in puerpera with postpartum hemorrhage due to uterine inertia

Purpose: To determine the effect of carboprost tromethamine and carbetocin on coagulation factors and prognosis in puerpera with postpartum hemorrhage due to uterine inertia.Methods: A total of 80 high-risk pregnant women with postpartum hemorrhage due to uterine inertia admitted to Longyan First Hospital Affiliated of Fujian Medical University, Longyan, China from June 2021 to June 2022 were randomly divided into control group (oxytocin + carboprost tromethamine, n = 40) and study group (oxytocin + carboprost tromethamine + carbetocin, n = 40). Vaginal bleeding volume was recorded for both groups at delivery, and 2 and 24 h after delivery. Decrease in hemoglobin level 24 h after delivery, as well as levels of coagulation factors, and adverse drug reactions before and after treatment were assessed.Results: The third stage of labor, postpartum hemorrhage at 2 and 24 h, and decrease in hemoglobin 24 h after delivery in the study group were lower (p &lt; 0.05). Compared with that before treatment, PLT and FIB levels also fell, while APTT and PT levels rose in both groups after treatment for 24 h (p &lt; 0.05). Platelet count and fibrinogen levels in the study group were lower after treatment for 24 h, but APTT and PT levels were higher (p &lt; 0.05). There was no statistically significant difference in the incidence of adverse drug reactions between both groups (15.00 vs 12.50 %; p &gt; 0.05).Conclusion: Co-administration of carboprost tromethamine with carbetocin prevents high-risk postpartum hemorrhage in pregnant women due to uterine inertia. It also reduces the level of bleeding, and promotes recovery of coagulation function. However, further clinical trials on a larger scale are recommended prior to the application of this treatment strategy in clinical practice.

Clinical study on laparoscopic minimally invasive surgery and transumbilical single-port laparoscopic surgery in the treatment of benign ovarian tumours and its influence on ovarian functions.

The objective of this study was to explore the influence of traditional laparoscopic surgery and transumbilical single-port laparoscopic surgery on ovarian function in patients with benign ovarian tumours. Forty-four patients with benign ovarian tumours who were treated in our hospital from January 2020 to June 2021 were selected and randomly divided into two groups, with 22 cases in each group according to random number table. The conventional group was treated with conventional laparoscopic surgery, while the modified group was treated with transumbilical single-port laparoscopic surgery. The measurement method was t -test, and the enumeration method was two tests. The clinical operation-related indicators, ovarian function (follicle-stimulating hormone, E 2 and luteinising hormone), complication incidence, Visual Analogue Scale (VAS) and landscaping satisfaction scores of the two groups were compared. There were no significant differences in complications and operation duration between the two groups ( P > 0.05). After treatment, the ovarian function indexes and beautification satisfaction scores of the modified group were significantly superior to those of the conventional group ( P < 0.05). Besides, the intraoperative bleeding volume, post-operative exhaust time, hospital stay and three-dimensional VAS scores on day 1 and day 3 after surgery of the modified group were lower than those of the conventional group ( P < 0.05). Transumbilical single-port laparoscopic surgery for benign ovarian tumours has a significant clinical effect, which can effectively reduce bleeding during the operation, improve ovarian function, relieve surgical pain, promote rapid post-operative recovery and improve patients' satisfaction with landscaping. It is worthy of clinical application.

Analysis of Programmed Nursing Cooperation During Gastrointestinal Endoscopic Mucosal Dissection

Objective: To analyze the application value of programmed nursing combined with digestive endoscopic mucosal dissection. Methods: A total of 200 patients undergoing endoscopic mucosal dissection from February 2021 to February 2023 were included as samples. Randomized grouping was conducted, with Group A receiving programmed nursing cooperation and Group B receiving routine nursing. Nursing values were then compared. Result: Group A exhibited shorter operation and hospitalization times compared to Group B, with less intraoperative blood loss (P &lt; 0.05). The SF-36 score for Group A was higher than that for Group B, and the postoperative complication rate in Group A was lower than in Group B (P &lt; 0.05). Conclusion: The implementation of a programmed nursing coordination plan in gastrointestinal endoscopic submucosal dissection nursing proved effective in reducing endoscopic surgery bleeding volume, shortening the patient’s disease course, and enhancing the patient’s quality of life. This approach is efficient and feasible.