Objective:To explore the influencing factors of hematoma enlargement in patients with hypertensive intracerebral hemorrhage and construct a corresponding risk prediction nomogram. The screening effects of the constructed model and different hematoma enlargement risk assessment tools were compared and analyzed.Methods:Two hundred and thirty-two patients with hypertensive intracerebral hemorrhage from the Department of Neurosurgery, Lianyungang First People's Hospital from April 2021 to February 2022 were selected as the research subjects. Multivariate Logistic regression was used to analyze the risk factors of hematoma expansion in patients with hyperhemamic intracerebral hemorrhage, and R software was used to construct a nomo diagram. The receiver operating characteristic curve (ROC) and Hosmer-Lemeshow (H-L) goodness-of-fit were used to evaluate the discrimination and calibration of the model, and the decision curve was used to analyze the clinical validity of the model. The constructed Nomo diagram, nine-point method and BRAIN score were used to assess the risk of hematoma enlargement in the included patients and used them as test variables, and the ROC curve was plotted to compare and analyze the area under the ROC curve, sensitivity and specificity of the constructed Nomo diagram, nine-point method and BRAIN score. The Kappa test was used to analyze the consistency between the Nomo diagram, the nine-point method, and the BRAIN score and the hematoma expansion results.Results:The results of multivariate logistic regression analysis showed that blood pressure was poorly controlled ( OR=13.290, 95% CI: 3.676-48.049), ventricular penetration ( OR=4.825, 95% CI: 1.458-15.975), early neurological deterioration ( OR=27.740, 95% CI: 8.713-88.314), Glasgow Coma Scale(GCS)≤8 points ( OR=25.883, 95% CI: 6.542-102.404) was the main influencing factor for hematoma expansion in patients with hypertensive intracerebral hemorrhage (The P values were <0.001, 0.010, <0.001, and <0.001, respectively). The H-L test results of Nomogram for predicting hematoma enlargement were χ2=3.20, P=0.525, the calibration curve was close to the ideal curve, and the mean absolute error was 0.015, and the decision curve analysis showed that the model had good clinical validity. The ROC results showed that the area under the ROC curve of the constructed Neumo diagram, nine-point method and BRAIN score were 0.971 (95% CI: 0.941-0.989), 0.696 (95% CI: 0.632-0.755), and 0.778 (95% CI: 0.719-0.830)(all P<0.001). The sensitivities were 94.37%, 71.83%, and 84.51%, and the specificities were 90.68%, 58.39%, and 65.84%, respectively. The results of Kappa test showed that the Kappa values of Nuomo diagram, nine-point method and BRAIN score were 0.806 , 0.264 and 0.429 (all P<0.001). Conclusion:The main influencing factors of hematoma enlargement in patients with hypertensive intracerebral hemorrhage were poor blood pressure control, intraventricular hemorrhage, early neurological deterioration, and GCS score. The effect of the constructed Nuomo diagram model in predicting hematoma expansion in patients with hypertensive intracerebral hemorrhage is better than that of the nine-point method and the BRAIN score, which has clinical application value.

Objective:To explore the correlations between the cerebral infarction area and cytokines and immune status in patients with acute ischemic stroke,and to provide the theoretical basis for immunotherapy of the patients with different degrees of cerebral infarction.Methods:Sixty-seven patients with acute ischemic stroke within 72 h of the onset were randomly selected according to the inclusion and exclusion criteria,and were divided into large-area cerebral infarction group(n=34)and non-large-area cerebral infarction group(n=33)on the basis of the biggest infarction area in the sequences of magnetic resonance diffusion-weighted imaging(CDWI).Clinical baseline characteristics such as gender,age,and medical history were collected from the patients in two groups,the serum levels of interleukin(IL)-2,IL-6,IL-10,and IL-17A,tumor necrosis factor-α(TNF-α),and interferon-γ(IFN-γ)were measured using flow cytometry;the absolute values of lymphocytes(LYM#),lymphocyte percentages(LYM％),and neutrophil/lymphocy ratios(NLR)in peripheral blood of the patients caiculated,and the ratios of IFN-γ/IL-4,TNF-α/IL-4,and TNF-α/IL-10 rations were also calculated.The values of National Institutes of Health Stroke Scale(NIHSS)scores of the patients were evaluatd on the basis of the assessment of clinical neurological signs.The correlations of the cerebral infarction area and NIHSS score,cytokines and immune status groups of the patients in two were tested by rank correlation analysis.Results:Compared with non-large-area cerebral infarction group,the serum levels of IL-2,IL-6,IL-10,IL-17A,TNF-α,and IFN-γ as well as the NLR in the peripheral blood of the patients in large-area cerebral infarction group were significantly increased(P＜0.01),while the LYM#,LYM％and TNF-α/IL-4 were significantly decreased(P＜0.01).There was a positive correlation between cerebral infarction area and NIHSS score in the patients in large-area cerebral infarction group(rs=0.521,P＜0.05),and there was a significantly positive correlation between cerebral infarct area and NIHSS score in the patients in non-large-area cerebral infarction group(rs=0.721,P＜0.001).The NIHSS scores were positively correlated with serum IL-6(rs=0.306,P=0.005),IL-4(rs=0.252,P＜0.001),IL-2(rs=0.109,P=0.025),IL-17A(rs=0.405,P＜0.001),and IFN-γ(rs=0.146,P＜0.001)levels in two groups;no correlations were found between NIHSS scores and TNF-α(rs=0.039,P=0.726)and IL-10(rs=0.121,P=0.192)levels.NIHSS scores of the patients in two groups had negative correlatious with the serum level of LYM#(rs=-0.026,P=0.036)and LYM％(rs=-0.008,P=0.002),and had positive correlated with NLR(rs=0.315,P=0.009).Conclusion:The infarction area of the patients with actue cerebral infarction is correlated with the NIHSS score,the inflammatory response,the degree of adaptive immune injury,and the immune status.The have positive correlation with cytokines and immune markers and the overall size of the infarction area.Compared with the patients with non-large-acea cerebral infarction,the immunosuppression of the patients with large-area infarcted areas is more likely to occure.

Objective:To explore the influencing factors of hematoma enlargement in patients with hypertensive intracerebral hemorrhage and construct a corresponding risk prediction nomogram. The screening effects of the constructed model and different hematoma enlargement risk assessment tools were compared and analyzed.Methods:Two hundred and thirty-two patients with hypertensive intracerebral hemorrhage from the Department of Neurosurgery, Lianyungang First People's Hospital from April 2021 to February 2022 were selected as the research subjects. Multivariate Logistic regression was used to analyze the risk factors of hematoma expansion in patients with hyperhemamic intracerebral hemorrhage, and R software was used to construct a nomo diagram. The receiver operating characteristic curve (ROC) and Hosmer-Lemeshow (H-L) goodness-of-fit were used to evaluate the discrimination and calibration of the model, and the decision curve was used to analyze the clinical validity of the model. The constructed Nomo diagram, nine-point method and BRAIN score were used to assess the risk of hematoma enlargement in the included patients and used them as test variables, and the ROC curve was plotted to compare and analyze the area under the ROC curve, sensitivity and specificity of the constructed Nomo diagram, nine-point method and BRAIN score. The Kappa test was used to analyze the consistency between the Nomo diagram, the nine-point method, and the BRAIN score and the hematoma expansion results.Results:The results of multivariate logistic regression analysis showed that blood pressure was poorly controlled ( OR=13.290, 95% CI: 3.676-48.049), ventricular penetration ( OR=4.825, 95% CI: 1.458-15.975), early neurological deterioration ( OR=27.740, 95% CI: 8.713-88.314), Glasgow Coma Scale(GCS)≤8 points ( OR=25.883, 95% CI: 6.542-102.404) was the main influencing factor for hematoma expansion in patients with hypertensive intracerebral hemorrhage (The P values were <0.001, 0.010, <0.001, and <0.001, respectively). The H-L test results of Nomogram for predicting hematoma enlargement were χ2=3.20, P=0.525, the calibration curve was close to the ideal curve, and the mean absolute error was 0.015, and the decision curve analysis showed that the model had good clinical validity. The ROC results showed that the area under the ROC curve of the constructed Neumo diagram, nine-point method and BRAIN score were 0.971 (95% CI: 0.941-0.989), 0.696 (95% CI: 0.632-0.755), and 0.778 (95% CI: 0.719-0.830)(all P<0.001). The sensitivities were 94.37%, 71.83%, and 84.51%, and the specificities were 90.68%, 58.39%, and 65.84%, respectively. The results of Kappa test showed that the Kappa values of Nuomo diagram, nine-point method and BRAIN score were 0.806 , 0.264 and 0.429 (all P<0.001). Conclusion:The main influencing factors of hematoma enlargement in patients with hypertensive intracerebral hemorrhage were poor blood pressure control, intraventricular hemorrhage, early neurological deterioration, and GCS score. The effect of the constructed Nuomo diagram model in predicting hematoma expansion in patients with hypertensive intracerebral hemorrhage is better than that of the nine-point method and the BRAIN score, which has clinical application value.

Objective:To investigate the correlation between item d560 of the International Classification of Functioning, Disability and Health (ICF) and the swallowing function of convalescing stroke patients.Methods:A total of 140 convalescent stroke survivors were evaluated for dysphagia using the ICF-d560 and the modified Watian drinking water test. Linear regression was used to analyze the influence of clinical factors when choosing a swallowing function assessment scale. Spearman correlation was computed to explore the correlation between ICF item d560 and the modified Watian drinking water test.Results:According to the ICF-d560 results, 10% of the patients had a mild disorder, with another 37.1% moderate, 29.3% severe and 23.6% completely dysphagic. The corresponding percentages according to the improved Watian drinking water test were 44.3% mild, 31.4% moderate and 24.3% severe. The total correlation coefficient between the two sets of results was 0.86, which was related to the stroke type, age, gender and stroke risk factors. The correlation coefficient of the cerebral infarction group was significantly higher than the cerebral hemorrhage group′s coefficient, and that of the women was slightly higher than that of the men. The strength of the correlation increased with age. The correlation coefficient was 0.84 among both diabetics and hypertension sufferers.Conclusions:Results from the ICF-d560 and the modified Wada drinking water test correlate well, which can provide a screening tool for swallowing function based on the ICF theoretical framework.

Objective To investigate the clinical value of prenatal ultrasound in fetal meningocele and encephalocele.Methods Thirty nine fetuses with meningocele and encephalocele confirmed by prenatal ultrasound and abortion were acquired and their clinical data and sonographic features were retrospectively analyzed.Results Ultrasound screening in 111 620 cases showed 39 fetuses were with meningocele and encephalocele,accounting for 0.35％.Among them,16 cases were diagnosed with meningocele (including 1 case with two bulging parts) and 23 cases with encephalocele.Prenatal ultrasound could clearly detect the location and size fetal skull defect,and bulging features.According to their sonographic features,meningocele or encephalocele was determined.Conclusion Ultrasound could be a reliable prenatal screening method,provide an important basis for clinical intervention and have a significant clinical value in fetal meningocele and encephalocele.

OBJECTIVE:To explore the effects of early treatment with mouse nerve growth factor on the wound healing in aged patients with electric burn. METHODS:78 elderly patients with electric burn were divided into control group and observation group by random number table method,with 39 cases in each group. Control group was given routine method for electric burn, and observation group was additionally given Mouse nerve growth factor for injection 30 μg dissolved in 2 ml 0.9% Sodium chlo-ride injection within 24 h,im,qd,on the basis of control group. Treatment course of 2 groups lasted for 2 weeks. Clinical effica-cies of 2 groups were compared as well as VAS score before treatment,3,5,7 days after treatment. The survival rate of skin flaps and the rate of wound healing 3,5,7 days after treatment,the recovery of wound scar,the value of wound blood perfusion,the time of complete wound healing and the occurrence of ADR were also compared. RESULTS:The total effective rate of observation group(94.9%)was significantly higher than that of control group(66.7%),with statistical significance(P<0.05). 3,5,7 days after treatment,VAS score of observation group was significantly lower than that of control group,and the survival rate of skin flaps and the rate of wound healing were significantly higher than those of control group,with statistical significance(P<0.05). Af-ter treatment,VSS score of observation group was significantly lower than that of control group,while the value of wound blood perfusion was significantly higher than that of control group;the time of complete wound healing was significantly lower than that of control group,with statistical significance (P<0.05). No obvious ADR was found in 2 groups. CONCLUSIONS:Early treat-ment with mouse nerve growth factor for elderly patients with electric burns can effectively lower the VAS and VSS score,improve the survival rate of skin flaps and the rate of wound healing,increase the value of wound blood perfusion and shorten the time of complete wound healing with good clinical efficacy and safety.

Objective To detect the expression of advanced glycation end-products (AGEs) in the sun exposure and non-exposure skin,to observe the elastic protein in the same location,and to explore the relationship between non-enzymatic glycation reactions and,photo-aging skin morphological changes.Methods In the exposure and non-exposure specimens from 30 patients,elastic fibers were stained with Gomori staining,and immunohistochemistry for AGEs was performed.Results AGEs expressed clearly positive in all elastic fibers of degeneration markedly (+ + above) of exposure skin,and appeared line-like in markedly(+ + above)elastic fibers.While in all non-exposure skin,AGEs expressed negative.In the exposure skin with middle or old age,compared with non-exposure skin,AGEs expressed more and elastic fibers were hyperplasia with thickening,curling and irregular distribution.The skin parts of AGEs expressed accorded with where elastic fibers degenerated.Conclusions Ultraviolet radiation can induce denaturation of elastic fibers and non-enzymatic glycation may contribute to the mechanism of skin photo-aging.