Objective To investigate the serum levels of long non-coding RNA(lncRNA)HOX transcript antisense RNA(HOTAIR)and homeobox A11 antisense RNA(LncRNA HOXA11-AS)in patients with traumatic brain injury(TBI),and their relationship with cognitive function.Methods From January 2022 to December 2023,106 TBI patients who visited Fuling Hospital Affiliated to Chongqing University were regarded as the TBI group.They were separated into a cognitive impairment group(n=44)and a non-cognitive impairment group(n=62)based on whether they experienced cognitive impairment.78 healthy individuals who underwent physical examinations in Fuling Hospital Affiliated to Chongqing University were regarded as the control group.Real-time fluorescence quantitative PCR(qRT-DCR)method was applied to detect serum LncRNA HOTAIR and LncRNA HOXA11-AS levels.Spearman and Pearson methods were used to analyze the correlation between serum LncRNA HOTAIR and LncRNA HOXA11-AS levels,cognitive function,and inflammatory factors in TBI patients.Receiver operating characteristic(ROC)curve was applied to analyze the predictive value of serum LncRNA HOTAIR and LncRNA HOXA11-AS for cognitive impairment in TBI patients.Logistic regression was applied to analyze the impacts of serum LncRNA HOTAIR and LncRNA HOXA11-AS expression on cognitive impairment after TBI.Results Compared with the control group,the expression levels of serum LncRNA HOTAIR(1.75±0.29 vs 1.03±0.15)and LncRNA HOXA11-AS(1.59±0.35 vs 0.99±0.18)in the TBI group were significantly increased,and the differences were statistically significant(t=20.034,13.846,all P<0.05).The cognitively impaired group had significantly higher serum LncRNA HOTAIR,LncRNA HOXA11-AS,tumor necrosis factor-α(TNF-α),interleukin 1β(IL-1β)and interleukin 6(IL-6)levels were significantly higher in the cognitive impairment group than in the group without cognitive impairment(t=3.011～9.615),and Montreal Cognitive Assessment(MoCA)scale was considerably lower than that of the no cognitive impairment group(t=17.633),and the differences were statistical significance(all P<0.05).Spearman correlation analysis showed that the expression levels of serum LncRNA HOTAIR and LncRNA HOXA11-AS in TBI patients were negatively correlated with MoCA scores(r=-0.515,-0.430,all P<0.001),Pearson correlation analysis showed that the expression levels of serum LncRNA HOTAIR and LncRNA HOXA11-AS were positively correlated with TNF-α,IL-1βand IL-6 levels(r=0.423,0.397,0.452,0.437,0.512,0.390,all P<0.001).The AUC(95%CI)of serum LncRNA HOTAIR and LncRNA HOXA11-AS alone and in combination predicted cognitive impairment after TBI was 0.896(0.822～0.947),0.864(0.784～0.923)and 0.960(0.903～0.988),respectively,the combined predictive value of the two was better than that of individual prediction(Z=2.457,2.998,all P<0.05).Logistic regression analysis showed that elevated expression levels of serum LncRNA HOTAIR and LncRNA HOXA11-AS were risk factors for cognitive impairment in TBII patients,while MoCA score was a protective factor(all P<0.05).Conclusion The levels of serum LncRNA HOTAIR and LncRNA HOXA11-AS have certain value in the functional impairment of TBI patients,and they may participate in the occurrence and progression of cognitive impairment in TBI patients by regulating the levels of inflammatory factors in the body.

Objective:To compare the efficacy of neuroendoscopy-assisted small bone window craniotomy and large bone flap craniotomy for acute subdural hematoma (ASDH) evacuation in elderly patients.Methods:A retrospective cohort study was conducted to analyze the clinical data of 57 elderly patients with ASDH admitted to Chongqing University Fuling Hospital from November 2020 to November 2023, including 27 males and 30 females, aged 65-89 years [(75.0±7.0)years]. The preoperative Glasgow coma scale (GCS) ranged 8-15 points [11.0(11.0, 12.0)points]. Among them, 27 patients were treated with neuroendoscopy-assisted small bone window craniotomy to evacuate ASDH (small bone window group) and 30 received large bone flap craniotomy to evacuate ASDH (large bone flap group). The following parameters were compared between the two groups: surgical duration, intraoperative blood loss, and length of hospital stay; residual subdural hematoma volume before surgery and at 1 day after surgery; GCS before surgery, at 1 and 3 days after surgery; good rate of Glasgow outcome scale (GOS) at 7 days and 6 months after surgery; and postoperative complication rate.Results:All the patients were followed up for 6 months. The surgical duration, intraoperative blood loss, and length of hospital stay were 89.0(85.0, 96.0)minutes, 65.0(55.0, 85.0)ml, and 15.0(14.0, 16.0)days, respectively in the small bone window group, which were shorter or less than 135.0(127.5, 150.0)minutes, 332.0(308.0, 367.5)ml, and 18.5(16.0, 20.0)days in the large bone flap group ( P<0.01). There was no statistically significant difference in the residual subdural hematoma volume between the two groups before surgery and at 1 day after surgery ( P>0.05). No statistically significant difference was found in GCS scores between the two groups before surgery ( P>0.05), while the GCS scores in the small bone window group at 1 and 3 days after surgery [12.0(12.0, 13.0)points and 15.0(14.0, 15.0)points] were higher than 11.5(11.0, 12.0)points and 13.0(12.8, 14.0)points in the large bone flap group ( P<0.01). The good rate of GOS in the small bone window group at 7 days after surgery was 100% (27/27), higher than 77% (23/30) in the large bone flap group ( P<0.05), but no statistically significant difference was found in the good rate of GOS between the two groups at 6 months after surgery ( P>0.05). Two patients in the small bone window group had pulmonary infection after surgery, with a complication rate of 7% (2/27), while in the large bone flap group, four patients had pulmonary infection, two epidural hematoma, one intracranial infection, one delayed wound healing, one subcutaneous fluid accumulation, and one epilepsy after surgery, with a complication rate of 33% (10/30) ( P<0.05). Conclusion:Compared with the conventional large bone flap craniotomy, neuroendoscopy-assisted small bone window craniotomy can shorten the surgical duration and length of hospital stay, reduce the intraoperative bleeding volume, promote early functional recovery, improve prognosis, and reduce the complication rate in elderly patients with ASDH.

Objective To investigate the serum levels of long non-coding RNA(lncRNA)HOX transcript antisense RNA(HOTAIR)and homeobox A11 antisense RNA(LncRNA HOXA11-AS)in patients with traumatic brain injury(TBI),and their relationship with cognitive function.Methods From January 2022 to December 2023,106 TBI patients who visited Fuling Hospital Affiliated to Chongqing University were regarded as the TBI group.They were separated into a cognitive impairment group(n=44)and a non-cognitive impairment group(n=62)based on whether they experienced cognitive impairment.78 healthy individuals who underwent physical examinations in Fuling Hospital Affiliated to Chongqing University were regarded as the control group.Real-time fluorescence quantitative PCR(qRT-DCR)method was applied to detect serum LncRNA HOTAIR and LncRNA HOXA11-AS levels.Spearman and Pearson methods were used to analyze the correlation between serum LncRNA HOTAIR and LncRNA HOXA11-AS levels,cognitive function,and inflammatory factors in TBI patients.Receiver operating characteristic(ROC)curve was applied to analyze the predictive value of serum LncRNA HOTAIR and LncRNA HOXA11-AS for cognitive impairment in TBI patients.Logistic regression was applied to analyze the impacts of serum LncRNA HOTAIR and LncRNA HOXA11-AS expression on cognitive impairment after TBI.Results Compared with the control group,the expression levels of serum LncRNA HOTAIR(1.75±0.29 vs 1.03±0.15)and LncRNA HOXA11-AS(1.59±0.35 vs 0.99±0.18)in the TBI group were significantly increased,and the differences were statistically significant(t=20.034,13.846,all P<0.05).The cognitively impaired group had significantly higher serum LncRNA HOTAIR,LncRNA HOXA11-AS,tumor necrosis factor-α(TNF-α),interleukin 1β(IL-1β)and interleukin 6(IL-6)levels were significantly higher in the cognitive impairment group than in the group without cognitive impairment(t=3.011～9.615),and Montreal Cognitive Assessment(MoCA)scale was considerably lower than that of the no cognitive impairment group(t=17.633),and the differences were statistical significance(all P<0.05).Spearman correlation analysis showed that the expression levels of serum LncRNA HOTAIR and LncRNA HOXA11-AS in TBI patients were negatively correlated with MoCA scores(r=-0.515,-0.430,all P<0.001),Pearson correlation analysis showed that the expression levels of serum LncRNA HOTAIR and LncRNA HOXA11-AS were positively correlated with TNF-α,IL-1βand IL-6 levels(r=0.423,0.397,0.452,0.437,0.512,0.390,all P<0.001).The AUC(95%CI)of serum LncRNA HOTAIR and LncRNA HOXA11-AS alone and in combination predicted cognitive impairment after TBI was 0.896(0.822～0.947),0.864(0.784～0.923)and 0.960(0.903～0.988),respectively,the combined predictive value of the two was better than that of individual prediction(Z=2.457,2.998,all P<0.05).Logistic regression analysis showed that elevated expression levels of serum LncRNA HOTAIR and LncRNA HOXA11-AS were risk factors for cognitive impairment in TBII patients,while MoCA score was a protective factor(all P<0.05).Conclusion The levels of serum LncRNA HOTAIR and LncRNA HOXA11-AS have certain value in the functional impairment of TBI patients,and they may participate in the occurrence and progression of cognitive impairment in TBI patients by regulating the levels of inflammatory factors in the body.

Objective:To compare the efficacy of neuroendoscopy-assisted small bone window craniotomy and large bone flap craniotomy for acute subdural hematoma (ASDH) evacuation in elderly patients.Methods:A retrospective cohort study was conducted to analyze the clinical data of 57 elderly patients with ASDH admitted to Chongqing University Fuling Hospital from November 2020 to November 2023, including 27 males and 30 females, aged 65-89 years [(75.0±7.0)years]. The preoperative Glasgow coma scale (GCS) ranged 8-15 points [11.0(11.0, 12.0)points]. Among them, 27 patients were treated with neuroendoscopy-assisted small bone window craniotomy to evacuate ASDH (small bone window group) and 30 received large bone flap craniotomy to evacuate ASDH (large bone flap group). The following parameters were compared between the two groups: surgical duration, intraoperative blood loss, and length of hospital stay; residual subdural hematoma volume before surgery and at 1 day after surgery; GCS before surgery, at 1 and 3 days after surgery; good rate of Glasgow outcome scale (GOS) at 7 days and 6 months after surgery; and postoperative complication rate.Results:All the patients were followed up for 6 months. The surgical duration, intraoperative blood loss, and length of hospital stay were 89.0(85.0, 96.0)minutes, 65.0(55.0, 85.0)ml, and 15.0(14.0, 16.0)days, respectively in the small bone window group, which were shorter or less than 135.0(127.5, 150.0)minutes, 332.0(308.0, 367.5)ml, and 18.5(16.0, 20.0)days in the large bone flap group ( P<0.01). There was no statistically significant difference in the residual subdural hematoma volume between the two groups before surgery and at 1 day after surgery ( P>0.05). No statistically significant difference was found in GCS scores between the two groups before surgery ( P>0.05), while the GCS scores in the small bone window group at 1 and 3 days after surgery [12.0(12.0, 13.0)points and 15.0(14.0, 15.0)points] were higher than 11.5(11.0, 12.0)points and 13.0(12.8, 14.0)points in the large bone flap group ( P<0.01). The good rate of GOS in the small bone window group at 7 days after surgery was 100% (27/27), higher than 77% (23/30) in the large bone flap group ( P<0.05), but no statistically significant difference was found in the good rate of GOS between the two groups at 6 months after surgery ( P>0.05). Two patients in the small bone window group had pulmonary infection after surgery, with a complication rate of 7% (2/27), while in the large bone flap group, four patients had pulmonary infection, two epidural hematoma, one intracranial infection, one delayed wound healing, one subcutaneous fluid accumulation, and one epilepsy after surgery, with a complication rate of 33% (10/30) ( P<0.05). Conclusion:Compared with the conventional large bone flap craniotomy, neuroendoscopy-assisted small bone window craniotomy can shorten the surgical duration and length of hospital stay, reduce the intraoperative bleeding volume, promote early functional recovery, improve prognosis, and reduce the complication rate in elderly patients with ASDH.