Objective To investigate the expression levels of Ubiquitin Carboxy-Terminal Hydrolase-L1(UCH-L1)and Netrin-1 in the serum of patients with spontaneous basal ganglia hemorrhage(ICH)complicated with cerebral edema,and to analyze their impacts on neurological deficits and prognosis.Methods A retrospec-tive analysis was conducted on the clinical data of 173 patients with spontaneous basal ganglia hemorrhage admitted to the Department of Neurosurgery,The First Affiliated Hospital of Bengbu Medical University from September 2023 to January 2025.The serum levels of UCH-L1 and Netrin-1 were measured within 24 hours after the onset.They were divided into three groups according to the size of the cerebral edema volume(CEV):Group A(CEV<10 mL),Group B(CEV 10～30 mL),and Group C(CEV>30 mL).Pearson's correlation analysis was used to analyze the correlation between serum expression levels of UCH-L1 and Netrin-1 with hemorrhage,volume of cere-bral edema,distance of midline shift,Modified Edinburgh-Scandinavian Stroke Scale(MESSS)score,Modified Rankin Scale(mRS)score,and Glasgow Coma Scale(GCS)score.Logistic regression analysis was performed to identify the risk factors for poor prognosis.Receiver operating characteristic(ROC)curve analysis was used to evaluate the predictive value of UCH-L1 and netrin-1 for poor prognosis.Results Significant differences were observed in the serum levels of UCH-L1 and netrin-1 among patients with different volumes of cerebral edema(P<0.05).The larger the volume of cerebral edema,the higher the expression levels of UCH-L1 and netrin-1.The serum levels of UCH-L1 and Netrin-1 were significantly higher in the poor prognosis group compared to the good prognosis group(P<0.05).The serum levels of UCH-L1 and Netrin-1 were positively correlated with MESSS score,hemorrhage volume,cerebral edema volume,distance of midline shift,and mRS score(P<0.05),and negatively correlated with GCS score(P<0.05).Multivariate Logistic regression analysis showed that both UCH-L1 and netrin-1 were independent risk factors for poor neurological prognosis in basal ganglia hemorrhage patients(P<0.05).ROC curve analysis indicated that both markers had important predictive value for poor prognosis.The AUC for serum UCH-L1 level predicting poor prognosis was 0.77[95%confidence interval(CI):0.69～0.85,P<0.01],with a sensitivity of 84.9%and a specificity of 50.6%.The AUC for serum Netrin-1 level predicting poor prognosis was 0.89(95%CI:0.85～0.94,P<0.01),with a sensitivity of 82.1%and a specificity of 68.7%.Conclusions Serum UCH-L1 and Netrin-1 are differentially expressed in patients with spontaneous basal ganglia hemorrhage complicated with different volumes of cerebral edema.They are independent risk factors for poor prog-nosis and are important predictors of neurological function prognosis in these patients.

Objective To investigate the expression levels of Ubiquitin Carboxy-Terminal Hydrolase-L1(UCH-L1)and Netrin-1 in the serum of patients with spontaneous basal ganglia hemorrhage(ICH)complicated with cerebral edema,and to analyze their impacts on neurological deficits and prognosis.Methods A retrospec-tive analysis was conducted on the clinical data of 173 patients with spontaneous basal ganglia hemorrhage admitted to the Department of Neurosurgery,The First Affiliated Hospital of Bengbu Medical University from September 2023 to January 2025.The serum levels of UCH-L1 and Netrin-1 were measured within 24 hours after the onset.They were divided into three groups according to the size of the cerebral edema volume(CEV):Group A(CEV<10 mL),Group B(CEV 10～30 mL),and Group C(CEV>30 mL).Pearson's correlation analysis was used to analyze the correlation between serum expression levels of UCH-L1 and Netrin-1 with hemorrhage,volume of cere-bral edema,distance of midline shift,Modified Edinburgh-Scandinavian Stroke Scale(MESSS)score,Modified Rankin Scale(mRS)score,and Glasgow Coma Scale(GCS)score.Logistic regression analysis was performed to identify the risk factors for poor prognosis.Receiver operating characteristic(ROC)curve analysis was used to evaluate the predictive value of UCH-L1 and netrin-1 for poor prognosis.Results Significant differences were observed in the serum levels of UCH-L1 and netrin-1 among patients with different volumes of cerebral edema(P<0.05).The larger the volume of cerebral edema,the higher the expression levels of UCH-L1 and netrin-1.The serum levels of UCH-L1 and Netrin-1 were significantly higher in the poor prognosis group compared to the good prognosis group(P<0.05).The serum levels of UCH-L1 and Netrin-1 were positively correlated with MESSS score,hemorrhage volume,cerebral edema volume,distance of midline shift,and mRS score(P<0.05),and negatively correlated with GCS score(P<0.05).Multivariate Logistic regression analysis showed that both UCH-L1 and netrin-1 were independent risk factors for poor neurological prognosis in basal ganglia hemorrhage patients(P<0.05).ROC curve analysis indicated that both markers had important predictive value for poor prognosis.The AUC for serum UCH-L1 level predicting poor prognosis was 0.77[95%confidence interval(CI):0.69～0.85,P<0.01],with a sensitivity of 84.9%and a specificity of 50.6%.The AUC for serum Netrin-1 level predicting poor prognosis was 0.89(95%CI:0.85～0.94,P<0.01),with a sensitivity of 82.1%and a specificity of 68.7%.Conclusions Serum UCH-L1 and Netrin-1 are differentially expressed in patients with spontaneous basal ganglia hemorrhage complicated with different volumes of cerebral edema.They are independent risk factors for poor prog-nosis and are important predictors of neurological function prognosis in these patients.

OBJECTIVETo study the accuracy of pulse contour cardiac output (PCCO) during blood volume change.

METHODSHemorrhagic shock model was made in twenty dogs followed by volume resuscitation. Two PiCCO catheters were placed into each model to monitor the cardiac output (CO). One of catheters was used to calibrate CO by transpulmonary thermodilution technique (COTP) (calibration group), and the other one was used to calibrate PCCO (none-calibration group). In the hemorrhage phase, calibration was carried out each time when the blood volume dropped by 5 percents in the calibration group until the hemorrhage volume reached to 40 percent of the basic blood volume. Continuous monitor was done in the none-calibration group.Volume resuscitation phase started after re-calibration in the two groups. Calibration was carried out each time when the blood equivalent rose by 5 percents in calibration group until the percentage of blood equivalent volume returned back to 100. Continuous monitor was done in none-calibration group. COTP, PCCO, mean arterial pressure (MAP), systemic circulation resistance (SVR), global enddiastolic volume (GEDV) were recorded respectively in each time point.

RESULTS(1) At the baseline, COTP in calibration group showed no statistic difference compared with PCCO in none-calibration group (P >0.05). (2) In the hemorrhage phase, COTP and GEDV in calibration group decreased gradually, and reached to the minimum value (1.06 ± 0.57) L/min, (238 ± 93) ml respectively at TH8. SVR in calibration group increased gradually, and reached to the maximum value (5 074 ± 2 342) dyn · s · cm⁻⁵ at TH6. However, PCCO and SVR in none-calibration group decreased in a fluctuating manner, and reached to the minimum value (2.42 ± 1.37) L/min, (2 285 ± 1 033) dyn · s · cm⁻⁵ respectively at TH8. COTP in the calibration group showed a significant statistic difference compared with PCCO in the none-calibration group at each time point (At TH1-8, t values were respectively -5.218, -5.495, -4.639, -6.588, -6.029, -5.510, -5.763 and -5.755, all P < 0.01). From TH1 to TH8, the difference in percentage increased gradually. There were statistic differences in SVR at each time point between the two groups (At TH1 and TH4, t values were respectively 2.866 and 2.429, both P < 0.05, at TH2 - TH3 and TH5 - TH8, t values were respectively 3.073, 3.590, 6.847, 8.425, 6.910 and 8.799, all P < 0.01). There was no statistic difference in MAP between the two groups (P > 0.05). (3) In the volume resuscitation phase, COTP and GEDV in the calibration group increased gradually. GEDV reached to the maximum value ((394±133) ml) at TR7, and COTP reached to the maximum value (3.15 ± 1.42) L/min at TR8. SVR in the calibration group decreased gradually, and reached to the minimum value (3 284 ± 1 271) dyn · s · cm⁻⁵ at TR8. However, PCCO and SVR in the none-calibration group increased in a fluctuating manner. SVR reached to the maximum value (8 589 ± 4 771) dyn · s · cm⁻⁵ at TR7, and PCCO reached to the maximum value (1.35 ± 0.70) L/min at TR8. COTP in the calibration group showed a significant statistic difference compared with PCCO in the none-calibration group at each time point (At TR1-8, t values were respectively 8.195, 8.703, 7.903, 8.266, 9.600, 8.340, 8.938, 8.332, all P < 0.01). From TR1 to TR8, the difference in percentage increased gradually. There were statistic differences in SVR at each time point between the two groups (At TR1, t value was -2.810, P < 0.05, at TR2-8, t values were respectively -6.026, -6.026, -5.375, -6.008, -5.406, -5.613 and -5.609, all P < 0.05). There was no statistic difference in MAP between the two groups (P > 0.05).

CONCLUSIONPCCO could not reflect the real CO in case of rapid blood volume change, which resulting in the misjudgment of patient's condition. In clinical practice, more frequent calibrations should be done to maintain the accuracy of PCCO in rapid blood volume change cases.

Animals ; Blood Volume ; Calibration ; Cardiac Output ; Disease Models, Animal ; Dogs ; Humans ; Monitoring, Physiologic ; Shock, Hemorrhagic ; diagnosis ; Thermodilution