Objective:To observe the effect of mirror threshold load training on respiration of persons with respiratory muscle fatigue after a cerebral hemorrhage.Methods:Fifty cerebral hemorrhage patients with respiratory muscle fatigue were randomly divided into an observation group and a control group, each of 25. In addition to routine rehabilitation training, the control group was given threshold load training of the respiratory muscles, while the observation group was provided with mirror threshold load training, twice a day in the morning and afternoon, 5 days a week for 4 weeks. Before the experiment and after 1, 2, 3 and 4 weeks of the treatment, everyone′s maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) was recorded. Before and after the 4 weeks forced expiration volume in the first second (FEV1) was measured along with 25% of the forced expiration volume (FEF25), maximum sound time (MPT) and respiration rate (RR).Results:At each time point the MIP and MEP values of both groups were significantly better than those before the treatment. After 4 weeks the average MIP and MEP values of the observation group were significantly better than those of the control group. And after 4 weeks the FEV1, FEF25, MPT and RR values of both groups had also improved significantly, on average. All of the observation group′s averages except MPT were then significantly better than the control group′s averages.Conclusions:Mirror threshold load training of the respiratory muscles can significantly improve the respiration of persons with respiratory muscle fatigue after a cerebral hemorrhage. It is more effective than respiratory muscle threshold load training.

Objective To investigate the predictive value of early fluid balance combined with daily average fluid intake on the prognosis of patients who received hematoma evacuation for spontaneous intracerebral hemorrhage(sICH).Methods This study retrospectively and consecutively enrolled patients who underwent hematoma evacuation for sICH admitted to the Neurosurgical Intensive Care Unit of North China University of Science and Technology Affiliated Hospital between January 2023 and January 2025.Patients'baseline and clinical data were collected,including gender,age,admission vital signs(body temperature,respiratory rate,heart rate,systolic and diastolic blood pressure),medical history(hypertension,diabetes mellitus,coronary heart disease),admission Glasgow coma scale(GCS)score,admission laboratory parameters(including white blood cell count,red blood cell count,platelet count,urine bacterial levels,urine ketones,urine pH,homocysteine),hemorrhage location,hemorrhage volume,time from ictus to surgery,and hematoma evacuation rate(hematoma evacuation rate[％]=[preoperative hematoma volume-postoperative hematoma volume]/preoperative hematoma volume × 100％).Fluid intake,output,balance,daily average intake,and cumulative fluid balance during the early postoperative period(the first to seventh 24-hour periods)were assessed and recorded.Fluid intake comprised the sum of intravenously administered fluids(crystalloids,hypertonic fluids,colloids,blood products,and parenteral nutrition),enteral nutrition(nasogastric feeding solutions and water),and renal replacement therapy fluids.Fluid output comprised the sum of urine volume,vomitus,drainage fluid,and dialysis fluid losses.Fluid balance was defined as the difference between fluid intake and output.Daily average intake was calculated as the average of the fluid intake over the first seven postoperative 24-hour periods.Cumulative fluid balance was the sum of the fluid balances over the first seven postoperative 24-hour periods.Patient outcomes were assessed at 30 days postoperatively.Discharged patients underwent outpatient review or telephone follow-up,while inpatients were evaluated by neurosurgeons.Prognosis was evaluated using the 30-day modified Rankin scale(mRS)score:mRS scores 0-3 were classified as favorable prognosis,and mRS scores 4-6 as poor prognosis.Patients were subsequently divided into favorable prognosis and poor prognosis groups based on mRS scores.Factors with P＜0.05 in univariate comparisons and without collinearity(multicollinearity was defined by:tolerance＜0.1 and variance inflation factor＞10)were included in multivariate Logistic regression analysis to identify independent risk factors for poor 30-day prognosis after hematoma evacuation in sICH patients.Receiver operating characteristic(ROC)curve analysis was employed to evaluate the predictive value of relevant factors for poor 30-day prognosis after hematoma evacuation in sICH patients.Results A total of 320 patients who underwent hematoma evacuation for sICH were enrolled,including 192 males and 128 females,with an age range of 20-91 years(median age 62[53,68]years).Among them,144 patients were assigned to the favorable prognosis group and 176 to the poor prognosis group.The poor prognosis group exhibited significantly higher hemorrhage volume,homocysteine level,fluid intake at the 3rd,5th,6th,and 7th 24-hour periods,fluid balance at the 3rd,5th,6th,and 7th 24-hour periods,daily average intake,and cumulative fluid balance compared to the favorable prognosis group(all P＜0.05).The favorable prognosis group had a significantly higher hematoma evacuation rate,GCS score,proportion of supratentorial hemorrhage and negative urine ketones than the poor prognosis group(all P＜0.05).No significant differences were found in other clinical data(all P＞0.05).Fluid balance over the first seven postoperative 24-hour periods displayed a rise-decline-rise pattern in the poor prognosis group and a rise-decline pattern in the favorable prognosis group.Both groups peaked at the 3rd 24-hour period.Multivariate Logistic regression analysis identified fluid balance at the 3rd 24-hour period(OR,2.013,95％CI 1.386-2.922,P＜0.01)and daily average intake(OR,3.583,95％CI 1.793-7.161,P＜0.01)as independent influencing factors for poor 30-day prognosis after hematoma evacuation in sICH patients.ROC curve analysis revealed that the area under the curve(AUC)for fluid balance at the 3rd 24-hour period and daily average intake in predicting poor 30-day prognosis were 0.699(95％CI 0.642-0.757)and 0.765(95％CI 0.712-0.819),respectively.The combined model of fluid balance at the 3rd 24-hour period and daily average intake achieved an AUC of 0.804(95％CI 0.756-0.853),demonstrating significantly superior predictive performance compared to either variable alone(both P＜0.05).Conclusions The combination of fluid balance at the 3rd 24-hour period and daily average intake demonstrates modest predictive value for poor 30-day prognosis after hematoma evacuation in sICH patients.These findings require validation through multicenter,large-scale,prospective studies.

Objective To compare and analyze the predictive value of a variety of novel blood inflammation composite indicators in spontaneous intracerebral hemorrhage(sICH)patients'prognosis.Methods This retrospective study consecutively enrolled 329 sICH patients admitted to the Neurosurgical Intensive Care Unit of North China University of Science and Technology Affiliated Hospital between September 2022 and December 2024.Patients were categorized into favorable(with modified Rankin scale[mRS]score ≤2)or unfavorable(mRS score ≥ 3)prognosis groups based on 90-day post-onset assessments.Baseline and imaging data,included age,gender,smoking history,alcohol consumption history,admission systolic/diastolic blood pressure,medical history(diabetes,coronary heart disease,stroke),24-hour laboratory parameters after admission(albumin,hemoglobin,blood glucose,potassium,platelets,lymphocytes,monocytes,neutrophils,homocysteine,red cell distribution width[RDW]),site of hemorrhage(basil ganglia,lobes,cerebellum,brain stem),hemorrhage volume,the National Institutes of Health stroke scale(NIHSS)score.Systemic complications during hospitalization(pulmonary/urinary tract/bloodstream infections)were recorded.Head CT and CT angiography(CTA)were performed at 24 h after admission to measure hematoma volume.Calculate and analyze the comprised inflammatory indices including systemic immune-inflammation index(SII;platelets × neutrophils/lymphocytes),platelet-to-lymphocyte ratio(PLR),RDW to albumin ratio(RAR;RDW/albumin),hemoglobin to RDW ratio(HRR,hemoglobin/RDW),systemic inflammation response index(SIRI;neutrophils × monocytes/lymphocytes),lymphocyte-neutrophil-albumin ratio(LANR;lymphocytes × albumin/neutrophils),neutrophil-to-albumin ratio(NPAR;neutrophil％/albumin),glucose-to-lymphocyte ratio(GLR;glucose/lymphocytes),and glucose-to-potassium ratio(GPR,glucose/potassium).Variables with P＜0.05 in univariate analysis were included in a collinearity analysis(a tolerance＜0.1 or variance inflation factor[VIF]＞10 indicating collinearity).Significant non-collinear variables with P＜0.05 in univariate analysis were included in multivariate Logistic regression to identify factors influencing prognosis in sICH patients.Receiver operating characteristic(ROC)curves was utilized to compare the predictive power of each indictors through net reclassification improvement(NRI)and integrated discrimination improvement(IDI).With NRI/IDI＞0 indicated superiority of new models over the old ones(higher values denote greater improvement).Delong's test was performed to evaluate the area under the curve(AUC)differences.Results Among the 329 sICH patients enrolled(185 males,144 females;mean age[68±6]years,ranged 36-91),138 were categorized into the favorable prognosis group(mRS score≤ 2)and 191 into the unfavorable prognosis group(mRS score ≥ 3),all patients had received a standardized treatment.Significant differences were observed in alcohol consumption history,diabetes,prior stroke,albumin,hemoglobin,blood glucose,platelets,lymphocytes,monocytes,neutrophils,homocysteine,RDW,hematoma volume,lung infection,and NIHSS score between two groups(all P＜0.05).While no significant differences were observed in the rest baseline/imaging data between the two groups(all P＞0.05).The favorable prognosis group exhibited significantly lower GLR(4.67[3.76,5.92]vs.6.67[4.66,10.32]),SIRI(1.92[1.12,3.24]v.s.4.43[2.25,8.33]),PLR(125.11[105.11,156.20]vs.164.46[122.42,232.63]),RAR(0.28[0.27,0.29]vs.0.32[0.30,0.35]),and NPAR(0.18[0.13,0.21]vs.0.22[0.16,0.33];all P＜0.01);and significantly higher SII(1 632.90[882.18,2 429.78]vs.967.93[702.83,1 290.51]),LANR(9.63[7.75,13.10]vs.5.49[3.25,9.77]),and HRR(11.73[10.97,12.62]vs.10.89[10.00,11.82];all P＜0.01).No significant differences were found in GPR(2.15[1.80,2.65]vs.2.28[1.83,3.31])between the favorable and unfavorable prognosis groups(P=0.094).After excluding factors with multicollinearity(including,lymphocytes,platelets,neutrophils,monocytes,albumin,RDW and hemoglobin),the other factors were included in a multivariate analysis,which identified SIRI(OR,1.312,95％CI1.043-1.650,P=0.020),RAR(OR,1.578,95％CI 1.376-1.810,P＜0.01),and HRR(OR,0.641,95％CI 0.480-0.854,P=0.002)as independent predictors of poor 90-day prognosis for sICH patients.ROC analysis showed that the AUC of RAR,SIRI,and HRR were 0.862,0.739 and 0.683 respectively,with RAR demonstrating superior sensitivity(82.20％vs.SIRI 68.06％vs.HRR 51.83％)and specificity(78.26％vs.SIRI 69.57％vs.HRR 76.81％).IDI confirmed RAR's significantly greater predictive ability versus SIRI(IDI=0.210,P＜0.01)and HRR(IDI=0.263,P＜0.01),and SIRI have superior predictive ability over HRR(IDI=0.053,P=0.040).Delong test showed that RAR had significantly greater predictive power than both SIRI and HRR(both P＜0.01),while the predictive power of SIRI and HRR did not differ significantly(P=0.138).Conclusions The three blood inflammatory indicators(RAR,SIRI,HRR)are effective predictors of poor prognosis in sICH patients at 90 d from onset,and among the three composite inflammatory parameters,RAR is significantly more effective than SIRI and HRR indicators.

Objective To longitudinally analyze the changes in perioperative nutritional indicators in elderly patients with spontaneous intracerebral hemorrhage(ICH)and their correlation with the score of modified Rankin scale(mRS)score.Methods A total of 295 elderly ICH patients ad-mitted to the neurosurgery intensive care unit of North China University of Science and Technolo-gy Affiliated Hospital from June 2022 to November 2024 were consecutively enrolled in this study.The levels of relevant nutritional indicators were measured before(T1),and in 1(T2),3(T3),5(T4)and 7 d(T5)after surgery.According to the mRS score in 90 d after onset of the disease,they were divided into a good prognosis group(mRS score≤ 2,114 cases)and a poor prognosis group(mRS score≥3,181 cases).The general data and levels of nutritional indicators at above time points were compared between the two groups.Binary logistic regression analysis was applied to study the relationship between the perioperative nutritional indicator levels and the prognosis in elderly patients with spontaneous ICH.Results The poor prognosis group had significantly higher SBP,larger proportions of stroke history,hemorrhage in the brainstem and midline dis-placement,and increased NIHSS score than the good prognosis group(P＜0.05,P＜0.01).Obvi-ously lower BMI(56.48±9.54 kg vs 66.62±8.12 kg),decreased serum levels of albumin[40.24(39.10,41.16)g/L vs 43.30(40.65,45.50)g/L],prealbumin[203.00(164.00,261.00)mg/L vs 229.00(180.00,282.00)mg/L]and TC[4.68(4.11,5.39)mmol/L vs 4.91(4.47,5.66)mmol/L],reduced lymphocyte count[1.58(0.95,2.03)× 109/L vs 1.77(1.99,1.91)× 109/L],and reduced GCS[7.00(5.00,10.00)vs 9.00(7.00,13.00)]and Barthel[55.00(43.00,64.00)vs 61.00(52.00,69.00)]scores at admission were observed in the poor prognosis group than the good prognosis group(all P＜0.01).At all different time points,the poor prognosis group also got notably higher Controlling Nutritional Status(CONUT)scores(reaching the highest levels at 3 d after opera-tion),and lower Prognostic Nutritional Index(PNI)score and Geriatric Nutritional Risk Index(GNRI)score(both declining the lowest levels at same time)when compared with the poor prog-nosis group(all P＜0.01).Binary logistic regression analysis showed that COUNT scores,PNI scores and GNRI scores before(T1)and at 1(T2),3(T3),5(T4)and 7 d(T5)after operation were independent risk factors for 90-day poor prognosis in elderly patients with spontaneous ICH.Conclusion The fluctuations of 3 nutritional indicators at different time points in the periopera-tive period are closely associated with the 90-day prognosis of elderly ICH patients.Monitoring the changes in the nutritional indicators can quickly and conveniently predict the prognosis of the pa-tients,which has high clinical application value.

Objective To predict the value of admission dehydration state combined with fluid accumulation index for post-operative prognosis in elderly patients with intracerebral hemorrhage(ICH).Methods A retrospective study was conducted on 320 elderly ICH patients receiving surgical treatment in Department of Neurosurgery and then admitted to its Intensive Care Unit of the Affiliated Hospital of North China University of Science and Technology from May 2023 to March 2024.According to the survival status at 30 d after onset,they were divided into a survival group(202 cases)and a death group(118 cases).Clinical data such as basic information,admission vital signs,laboratory indicators,and fluid supplementation were compared between the two groups.ROC curve was plotted.Results The death group exhibited significantly advanced age,more bleeding sites,higher 7-day fluid accumulation index,and larger proportions of ventricular rupture,midline displacement and admission dehydration status,but lower uric acid level than the the survival group(P＜0.05,P＜0.01).Binary logistic regression analysis showed that admission dehydration status and 7-day fluid accumulation index were risk factors for 30-day mortality in elderly ICH patients after surgery(P＜0.01).ROC curve analysis showed that the AUC value of admission dehydration status combined with 7-day fluid accumulation index in predicting 30-day death of elderly ICH patients after surgery was 0.774(95％CI:0.722-0.825),and that of the combination was better than that of each indicator alone(P＜0.05).Conclusion Hospital dehydration status combined with 7-day fluid accumulation index has the best effectiveness in predicting 30-day mortality in elderly ICH patients after surgical treatment.

Objective To compare and analyze the predictive value of a variety of novel blood inflammation composite indicators in spontaneous intracerebral hemorrhage(sICH)patients'prognosis.Methods This retrospective study consecutively enrolled 329 sICH patients admitted to the Neurosurgical Intensive Care Unit of North China University of Science and Technology Affiliated Hospital between September 2022 and December 2024.Patients were categorized into favorable(with modified Rankin scale[mRS]score ≤2)or unfavorable(mRS score ≥ 3)prognosis groups based on 90-day post-onset assessments.Baseline and imaging data,included age,gender,smoking history,alcohol consumption history,admission systolic/diastolic blood pressure,medical history(diabetes,coronary heart disease,stroke),24-hour laboratory parameters after admission(albumin,hemoglobin,blood glucose,potassium,platelets,lymphocytes,monocytes,neutrophils,homocysteine,red cell distribution width[RDW]),site of hemorrhage(basil ganglia,lobes,cerebellum,brain stem),hemorrhage volume,the National Institutes of Health stroke scale(NIHSS)score.Systemic complications during hospitalization(pulmonary/urinary tract/bloodstream infections)were recorded.Head CT and CT angiography(CTA)were performed at 24 h after admission to measure hematoma volume.Calculate and analyze the comprised inflammatory indices including systemic immune-inflammation index(SII;platelets × neutrophils/lymphocytes),platelet-to-lymphocyte ratio(PLR),RDW to albumin ratio(RAR;RDW/albumin),hemoglobin to RDW ratio(HRR,hemoglobin/RDW),systemic inflammation response index(SIRI;neutrophils × monocytes/lymphocytes),lymphocyte-neutrophil-albumin ratio(LANR;lymphocytes × albumin/neutrophils),neutrophil-to-albumin ratio(NPAR;neutrophil％/albumin),glucose-to-lymphocyte ratio(GLR;glucose/lymphocytes),and glucose-to-potassium ratio(GPR,glucose/potassium).Variables with P＜0.05 in univariate analysis were included in a collinearity analysis(a tolerance＜0.1 or variance inflation factor[VIF]＞10 indicating collinearity).Significant non-collinear variables with P＜0.05 in univariate analysis were included in multivariate Logistic regression to identify factors influencing prognosis in sICH patients.Receiver operating characteristic(ROC)curves was utilized to compare the predictive power of each indictors through net reclassification improvement(NRI)and integrated discrimination improvement(IDI).With NRI/IDI＞0 indicated superiority of new models over the old ones(higher values denote greater improvement).Delong's test was performed to evaluate the area under the curve(AUC)differences.Results Among the 329 sICH patients enrolled(185 males,144 females;mean age[68±6]years,ranged 36-91),138 were categorized into the favorable prognosis group(mRS score≤ 2)and 191 into the unfavorable prognosis group(mRS score ≥ 3),all patients had received a standardized treatment.Significant differences were observed in alcohol consumption history,diabetes,prior stroke,albumin,hemoglobin,blood glucose,platelets,lymphocytes,monocytes,neutrophils,homocysteine,RDW,hematoma volume,lung infection,and NIHSS score between two groups(all P＜0.05).While no significant differences were observed in the rest baseline/imaging data between the two groups(all P＞0.05).The favorable prognosis group exhibited significantly lower GLR(4.67[3.76,5.92]vs.6.67[4.66,10.32]),SIRI(1.92[1.12,3.24]v.s.4.43[2.25,8.33]),PLR(125.11[105.11,156.20]vs.164.46[122.42,232.63]),RAR(0.28[0.27,0.29]vs.0.32[0.30,0.35]),and NPAR(0.18[0.13,0.21]vs.0.22[0.16,0.33];all P＜0.01);and significantly higher SII(1 632.90[882.18,2 429.78]vs.967.93[702.83,1 290.51]),LANR(9.63[7.75,13.10]vs.5.49[3.25,9.77]),and HRR(11.73[10.97,12.62]vs.10.89[10.00,11.82];all P＜0.01).No significant differences were found in GPR(2.15[1.80,2.65]vs.2.28[1.83,3.31])between the favorable and unfavorable prognosis groups(P=0.094).After excluding factors with multicollinearity(including,lymphocytes,platelets,neutrophils,monocytes,albumin,RDW and hemoglobin),the other factors were included in a multivariate analysis,which identified SIRI(OR,1.312,95％CI1.043-1.650,P=0.020),RAR(OR,1.578,95％CI 1.376-1.810,P＜0.01),and HRR(OR,0.641,95％CI 0.480-0.854,P=0.002)as independent predictors of poor 90-day prognosis for sICH patients.ROC analysis showed that the AUC of RAR,SIRI,and HRR were 0.862,0.739 and 0.683 respectively,with RAR demonstrating superior sensitivity(82.20％vs.SIRI 68.06％vs.HRR 51.83％)and specificity(78.26％vs.SIRI 69.57％vs.HRR 76.81％).IDI confirmed RAR's significantly greater predictive ability versus SIRI(IDI=0.210,P＜0.01)and HRR(IDI=0.263,P＜0.01),and SIRI have superior predictive ability over HRR(IDI=0.053,P=0.040).Delong test showed that RAR had significantly greater predictive power than both SIRI and HRR(both P＜0.01),while the predictive power of SIRI and HRR did not differ significantly(P=0.138).Conclusions The three blood inflammatory indicators(RAR,SIRI,HRR)are effective predictors of poor prognosis in sICH patients at 90 d from onset,and among the three composite inflammatory parameters,RAR is significantly more effective than SIRI and HRR indicators.

Objective:To observe the effect of mirror threshold load training on respiration of persons with respiratory muscle fatigue after a cerebral hemorrhage.Methods:Fifty cerebral hemorrhage patients with respiratory muscle fatigue were randomly divided into an observation group and a control group, each of 25. In addition to routine rehabilitation training, the control group was given threshold load training of the respiratory muscles, while the observation group was provided with mirror threshold load training, twice a day in the morning and afternoon, 5 days a week for 4 weeks. Before the experiment and after 1, 2, 3 and 4 weeks of the treatment, everyone′s maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) was recorded. Before and after the 4 weeks forced expiration volume in the first second (FEV1) was measured along with 25% of the forced expiration volume (FEF25), maximum sound time (MPT) and respiration rate (RR).Results:At each time point the MIP and MEP values of both groups were significantly better than those before the treatment. After 4 weeks the average MIP and MEP values of the observation group were significantly better than those of the control group. And after 4 weeks the FEV1, FEF25, MPT and RR values of both groups had also improved significantly, on average. All of the observation group′s averages except MPT were then significantly better than the control group′s averages.Conclusions:Mirror threshold load training of the respiratory muscles can significantly improve the respiration of persons with respiratory muscle fatigue after a cerebral hemorrhage. It is more effective than respiratory muscle threshold load training.

Objective To explore the effect of remote ischemic conditioning(RIC)combined with binaural beat music(BBM)train-ing in patients with cognitive dysfunction after cerebral infarction.Methods From June,2024 to January,2025,200 patients with cognitive dysfunction after cerebral infarction in the Affil-iated Hospital of North China University of Science and Technology were randomly divided into control group(n=50),RIC group(n=50),BBM group(n=50)and combined group(n=50).All the groups received stan-dardized routine training,RIC group received RIC,BBM group received BBM,and the combined group received RIC+BBM,for 14 days.They were assessed with Montreal Cognitive Assessment(MoCA)and Stroke-Specific Quality of Life Scale(SS-QOL)at baseline,day 14,and day 90.Results Two cases in the control group,four in RIC group,three in BBM group and three in the combined group dropped out.For MoCA scores,the inter-group effect,intra-group effect and interaction effect were all significant(F>13.463,P<0.001).After intervention,on both day 14 and day 90,the score of MoCA was higher in each in-tervention group than in the control group(P<0.05),and was higher in the combined group than in both BBM and RIC groups(P<0.05);and on day 90,it was higher in RIC group than in BBM group(P<0.05).For SS-QOL,the score increased with time in all the groups(χ2>75.182,P<0.001).After intervention,there was signif-icant difference at each time point among four groups(H>18.260,P<0.001).On day 14 and day 90,the score of SS-QOL was higher in the combined group than in the control and BBM groups(|Z|>3.149,P<0.05);on day 90,the score was higher in RIC group than in the control group(|Z|=3.590,P<0.05),and it was higher in the combined group than in RIC group(|Z|=3.186,P<0.05).Conclusion RIC,BBM and their combination all improved cognitive function after cerebral infarction.RIC was superior to BBM,and the combined intervention yielded the greatest benefit.Both RIC and the combined intervention im-proved quality of life,with the combined approach being the most effective.

Objective:To understand the current situation and influencing factors of functional constipation among elderly people in nursing homes, and construct a risk prediction model.Methods:Conveniently select 542 elderly people from 8 nursing homes in Tangshan urban area from July to November 2023 as the research subjects, use binary logistic regression analysis to construct a risk prediction model, and conduct internal validation of the model.Results:Among the 542 elderly people who were included in the study, there were 250 males and 292 females with an average age of 78.00 (70.00, 86.00) years. The incidence of functional constipation among elderly people in nursing homes was 54.06%(293/542). The predictive model includes six predictive factors: age, Barthel index, water intake, daily vegetable intake, insomnia, and perianal disease. The model AUC was 0.885 (95% CI 0.858-0.913), the Youden index was 0.628, the best critical value was 0.585, sensitivity was 0.819, specificity was 0.809. The Hosmer-Lemeshow test χ2=6.38, P=0.605. The internal validation results of the Bootstrap method showed that the AUC of the model was 0.876, the calibration curve was close to the standard line, and the Brier score was 0.135. The DCA results showed that the threshold was 0.1-0.9, and the model had good clinical net benefits. Conclusions:The incidence of functional constipation in elderly care institutions is relatively high. The functional constipation risk prediction model constructed in this study has good predictive efficacy and applicability, which can provide reference for nursing home staff.

Objective To investigate the predictive value of early fluid balance combined with daily average fluid intake on the prognosis of patients who received hematoma evacuation for spontaneous intracerebral hemorrhage(sICH).Methods This study retrospectively and consecutively enrolled patients who underwent hematoma evacuation for sICH admitted to the Neurosurgical Intensive Care Unit of North China University of Science and Technology Affiliated Hospital between January 2023 and January 2025.Patients'baseline and clinical data were collected,including gender,age,admission vital signs(body temperature,respiratory rate,heart rate,systolic and diastolic blood pressure),medical history(hypertension,diabetes mellitus,coronary heart disease),admission Glasgow coma scale(GCS)score,admission laboratory parameters(including white blood cell count,red blood cell count,platelet count,urine bacterial levels,urine ketones,urine pH,homocysteine),hemorrhage location,hemorrhage volume,time from ictus to surgery,and hematoma evacuation rate(hematoma evacuation rate[％]=[preoperative hematoma volume-postoperative hematoma volume]/preoperative hematoma volume × 100％).Fluid intake,output,balance,daily average intake,and cumulative fluid balance during the early postoperative period(the first to seventh 24-hour periods)were assessed and recorded.Fluid intake comprised the sum of intravenously administered fluids(crystalloids,hypertonic fluids,colloids,blood products,and parenteral nutrition),enteral nutrition(nasogastric feeding solutions and water),and renal replacement therapy fluids.Fluid output comprised the sum of urine volume,vomitus,drainage fluid,and dialysis fluid losses.Fluid balance was defined as the difference between fluid intake and output.Daily average intake was calculated as the average of the fluid intake over the first seven postoperative 24-hour periods.Cumulative fluid balance was the sum of the fluid balances over the first seven postoperative 24-hour periods.Patient outcomes were assessed at 30 days postoperatively.Discharged patients underwent outpatient review or telephone follow-up,while inpatients were evaluated by neurosurgeons.Prognosis was evaluated using the 30-day modified Rankin scale(mRS)score:mRS scores 0-3 were classified as favorable prognosis,and mRS scores 4-6 as poor prognosis.Patients were subsequently divided into favorable prognosis and poor prognosis groups based on mRS scores.Factors with P＜0.05 in univariate comparisons and without collinearity(multicollinearity was defined by:tolerance＜0.1 and variance inflation factor＞10)were included in multivariate Logistic regression analysis to identify independent risk factors for poor 30-day prognosis after hematoma evacuation in sICH patients.Receiver operating characteristic(ROC)curve analysis was employed to evaluate the predictive value of relevant factors for poor 30-day prognosis after hematoma evacuation in sICH patients.Results A total of 320 patients who underwent hematoma evacuation for sICH were enrolled,including 192 males and 128 females,with an age range of 20-91 years(median age 62[53,68]years).Among them,144 patients were assigned to the favorable prognosis group and 176 to the poor prognosis group.The poor prognosis group exhibited significantly higher hemorrhage volume,homocysteine level,fluid intake at the 3rd,5th,6th,and 7th 24-hour periods,fluid balance at the 3rd,5th,6th,and 7th 24-hour periods,daily average intake,and cumulative fluid balance compared to the favorable prognosis group(all P＜0.05).The favorable prognosis group had a significantly higher hematoma evacuation rate,GCS score,proportion of supratentorial hemorrhage and negative urine ketones than the poor prognosis group(all P＜0.05).No significant differences were found in other clinical data(all P＞0.05).Fluid balance over the first seven postoperative 24-hour periods displayed a rise-decline-rise pattern in the poor prognosis group and a rise-decline pattern in the favorable prognosis group.Both groups peaked at the 3rd 24-hour period.Multivariate Logistic regression analysis identified fluid balance at the 3rd 24-hour period(OR,2.013,95％CI 1.386-2.922,P＜0.01)and daily average intake(OR,3.583,95％CI 1.793-7.161,P＜0.01)as independent influencing factors for poor 30-day prognosis after hematoma evacuation in sICH patients.ROC curve analysis revealed that the area under the curve(AUC)for fluid balance at the 3rd 24-hour period and daily average intake in predicting poor 30-day prognosis were 0.699(95％CI 0.642-0.757)and 0.765(95％CI 0.712-0.819),respectively.The combined model of fluid balance at the 3rd 24-hour period and daily average intake achieved an AUC of 0.804(95％CI 0.756-0.853),demonstrating significantly superior predictive performance compared to either variable alone(both P＜0.05).Conclusions The combination of fluid balance at the 3rd 24-hour period and daily average intake demonstrates modest predictive value for poor 30-day prognosis after hematoma evacuation in sICH patients.These findings require validation through multicenter,large-scale,prospective studies.