Objective:To develop and validate CT radiomics models based on machine learning for predicting recurrence of chronic subdural hematoma (cSDH) after endoscopic treatment.Methods:A retrospective study was performed; 252 patients with cSDH who underwent endoscopic treatment in Department of Neurosurgery, the Second Affiliated Hospital of Soochow University from October 2016 to October 2024 were selected. The clinical and imaging data of these patients were collected, and these patients were divided into a training set ( n=176) and a validation set ( n=76) at a ratio of 7:3. Patients in both sets were further sub-divided into a recurrence group and a non-recurrence group based on whether they had recurrence within 3 months of discharge. (1) Radiomics features of cSDH on initial non-enhanced CT images were extracted using 3D-Slicer software. Optimal features were selected through univariate analysis and least absolute shrinkage and selection operator (LASSO) regression analysis; based on these optimal features, 3 machine learning algorithms (Logistic, support vector machine [SVM], and K-nearest neighbor [KNN]) were used to construct CT radiomics models. Differences in predictive performance of different radiomics models were compared by analyzing indicators such as sensitivity, specificity, and area under receiver operating characteristic (ROC) curve (AUC), and the best model was selected. (2) Based on the initial non-enhanced CT images, cSDH was classified into homogeneous type, laminar type, septated type, and trabecular type according to Nakaguchi classification system; combined these cSDH typing with clinical features (clinical Markwalder's grade and bilateral hematoma), univariate analysis and multivariate Logistic regression analysis were used to screen the independent risk factors for cSDH recurrence. Based on these factors, the 3 machine learning algorithms (Logistic, SVM, KNN) were used to construct hematoma typing-clinical feature models; differences in predictive performance of different hematoma typing-clinical feature models were compared by analyzing indicators such as sensitivity, specificity, and AUC, and the best model was selected. (3) DeLong's test was used to compare the ROC curve differences between the CT radiomics model and hematoma typing-clinical feature model. Decision curve analysis was used to compare the effective scope of the CT radiomics model and hematoma typing-clinical feature model. Results:(1) Seven optimal CT radiomics features based on wavelet transform were obtained after univariate analysis and LASSO regression: one gray-level dependence matrix feature, one first-order energy feature, two gray-level co-occurrence matrix features, two gray level size zone matrix features, and one gray-level run-length matrix feature. The KNN model constructed based on these 7 optimal features had the best performance in predicting cSDH recurrence, with an AUC of 0.845, a sensitivity of 0.833, a specificity of 0.857, a recall rate of 0.833, and an F1 score of 0.476 in patients from the validation set. (2) Three independent risk factors for cSDH recurrence were screened out through univariate analysis and multivariate Logistic regression analysis: hematoma Nakaguchi classification, Markwalder's grade, and bilateral hematoma. Logistic model constructed based on these 3 factors had the best performance in predicting cSDH recurrence, with an AUC of 0.675, a sensitivity of 0.609, a specificity of 0.654, a recall rate of 0.609, and an F1 score of 0.311 in patients from the validation set. (3) DeLong's test showed that the AUC of the CT radiomics model was significantly greater than that of the hematoma typing-clinical feature model in patients from the training set and validation set ( P=0.027 and P=0.035). Decision curve analysis showed that in the CT radiomics model, the net benefit of the model was >0 when the risk threshold was 0.05-0.95; in the hematoma typing-clinical feature model, the net benefit of the model was >0 when the risk threshold was 0.05-0.55. Conclusion:The KNN model based on 7 CT radiomics features in this study can effectively predict the cSDH recurrence in patients after endoscopic treatment, and its performance is obviously better than that of hematoma typing-clinical feature model constructed in this study.

Objective:To develop and validate CT radiomics models based on machine learning for predicting recurrence of chronic subdural hematoma (cSDH) after endoscopic treatment.Methods:A retrospective study was performed; 252 patients with cSDH who underwent endoscopic treatment in Department of Neurosurgery, the Second Affiliated Hospital of Soochow University from October 2016 to October 2024 were selected. The clinical and imaging data of these patients were collected, and these patients were divided into a training set ( n=176) and a validation set ( n=76) at a ratio of 7:3. Patients in both sets were further sub-divided into a recurrence group and a non-recurrence group based on whether they had recurrence within 3 months of discharge. (1) Radiomics features of cSDH on initial non-enhanced CT images were extracted using 3D-Slicer software. Optimal features were selected through univariate analysis and least absolute shrinkage and selection operator (LASSO) regression analysis; based on these optimal features, 3 machine learning algorithms (Logistic, support vector machine [SVM], and K-nearest neighbor [KNN]) were used to construct CT radiomics models. Differences in predictive performance of different radiomics models were compared by analyzing indicators such as sensitivity, specificity, and area under receiver operating characteristic (ROC) curve (AUC), and the best model was selected. (2) Based on the initial non-enhanced CT images, cSDH was classified into homogeneous type, laminar type, septated type, and trabecular type according to Nakaguchi classification system; combined these cSDH typing with clinical features (clinical Markwalder's grade and bilateral hematoma), univariate analysis and multivariate Logistic regression analysis were used to screen the independent risk factors for cSDH recurrence. Based on these factors, the 3 machine learning algorithms (Logistic, SVM, KNN) were used to construct hematoma typing-clinical feature models; differences in predictive performance of different hematoma typing-clinical feature models were compared by analyzing indicators such as sensitivity, specificity, and AUC, and the best model was selected. (3) DeLong's test was used to compare the ROC curve differences between the CT radiomics model and hematoma typing-clinical feature model. Decision curve analysis was used to compare the effective scope of the CT radiomics model and hematoma typing-clinical feature model. Results:(1) Seven optimal CT radiomics features based on wavelet transform were obtained after univariate analysis and LASSO regression: one gray-level dependence matrix feature, one first-order energy feature, two gray-level co-occurrence matrix features, two gray level size zone matrix features, and one gray-level run-length matrix feature. The KNN model constructed based on these 7 optimal features had the best performance in predicting cSDH recurrence, with an AUC of 0.845, a sensitivity of 0.833, a specificity of 0.857, a recall rate of 0.833, and an F1 score of 0.476 in patients from the validation set. (2) Three independent risk factors for cSDH recurrence were screened out through univariate analysis and multivariate Logistic regression analysis: hematoma Nakaguchi classification, Markwalder's grade, and bilateral hematoma. Logistic model constructed based on these 3 factors had the best performance in predicting cSDH recurrence, with an AUC of 0.675, a sensitivity of 0.609, a specificity of 0.654, a recall rate of 0.609, and an F1 score of 0.311 in patients from the validation set. (3) DeLong's test showed that the AUC of the CT radiomics model was significantly greater than that of the hematoma typing-clinical feature model in patients from the training set and validation set ( P=0.027 and P=0.035). Decision curve analysis showed that in the CT radiomics model, the net benefit of the model was >0 when the risk threshold was 0.05-0.95; in the hematoma typing-clinical feature model, the net benefit of the model was >0 when the risk threshold was 0.05-0.55. Conclusion:The KNN model based on 7 CT radiomics features in this study can effectively predict the cSDH recurrence in patients after endoscopic treatment, and its performance is obviously better than that of hematoma typing-clinical feature model constructed in this study.

Objective:To investigate the influences of blood pressure fluctuation and biochemical parameters in early cognitive impairment in patients with basal ganglia hypertensive intracerebral hemorrhage (HICH).Methods:A total of 148 patients with basal ganglia HICH, admitted to Department of Neurosurgery, Second Affiliated Hospital of Soochow University from January 2022 to January 2024 were enrolled. Four weeks after onset, these patients accepted Montreal cognitive assessment (MoCA) and were divided into cognitive impairment group (MoCA scores<26, n=62) and non-cognitive impairment group (MoCA scores≥26, n=86) accordingly. Clinical data and average blood pressure on 7 consecutive d (since admission) were collected, and differences of clinical data, mean systolic blood pressure (MSBP), mean diastolic blood pressure (MDBP), and long-term blood pressure variability indexes were compared between the two groups. Multivariate Logistic regression analysis was used to screen the independent influencing factors for cognitive impairment; spearman rank correlation was used to analyze the correlation between independent influencing factors and MoCA score; and receiver operating characteristic (ROC) curve was used to analyze the diagnostic value of independent influencing factors in cognitive impairment. Results:Compared with the non-cognitive impairment group, the cognitive impairment group had significantly longer hypertension duration, statistically higher interleukin-6 (IL-6), MSBP, MDBP and 7 d-duration standard deviation of systolic blood pressure (7dSSD), and significantly lower albumin ( P<0.05). Multivariate Logistic regression analysis showed that hypertension duration ( OR=1.258, 95% CI: 1.134-1.396, P<0.001), MSBP ( OR=1.770, 95% CI: 1.267-2.473, P=0.001), 7dSSD ( OR=1.139, 95% CI: 1.038-1.249, P=0.006), and IL-6 ( OR=1.156, 95% CI: 1.076-1.241, P<0.001) were independent influencing factors for early cognitive impairment in patients with basal ganglia HICH. Spearman rank correlation showed that hypertension duration, MSBP, 7DSSD, and IL-6 were negatively correlated with MoCA score ( rs=-0.271, P=0.001; rs=-0.493, P<0.001; rs=-0.264, P=0.001; rs=-0.412, P<0.001). Area under ROC curve of combined use of MSBP, 7dSSD, hypertension duration and IL-6 in diagnosing early cognitive impairment was 0.932, with sensitivity of 0.855 and specificity of 0.895. Conclusion:MSBP, 7dSSD, hypertension duration and IL-6 might be hemodynamic and serological monitoring indexes for predicting early cognitive impairment in patients with basal ganglia HICH.

Objective:To compare the clinical efficacy and safety of surgeries via frontal keyhole approach assisted by neuro-endoscope and via temporal keyhole approach assisted by microscope in cerebral basal ganglia hemorrhage. Methods:One hundred and five patients with basal ganglia cerebral hemorrhage admitted to our hospital from January 2017 to January 2020 were chosen in our study; 51 patients underwent surgeries via frontal keyhole approach assisted by neuro-endoscope (neuro-endoscopy group) and 54 patients underwent surgeries via temporal keyhole approach assisted by microscope (microscopy group). The clinical data of these patients were retrospectively analyzed; and the differences of hematoma clearance rate, intraoperative blood loss, duration of surgery, length of hospital stays, Glasgow Coma Scale (GCS) scores one week after surgery, incidence of postoperative complications, and activity of daily living (ADL) scores 6 months after surgery were compared between the 2 groups. Results:There were no significant differences in hematoma clearance rate and length of hospital stays between the 2 groups ( P>0.05). As compared with the microscopy group, the neuro-endoscopy group had significantly lower intraoperative blood loss, significantly shorter duration of surgery, and statistically higher GCS scores one week after surgery ( P<0.05). There were no significant differences in incidence of postoperative complications and ADL scores 6 months after surgery between 2 groups ( P>0.05). Conclusion:Both surgeries via frontal keyhole approach assisted by neuro-endoscope and via temporal keyhole approach assisted by microscope can effectively clear the intracranial hematoma in patients with cerebral hemorrhage in the basal ganglia and protect neurological function; however, surgeries via frontal keyhole approach assisted by neuro-endoscope has advantages of shorter duration of surgery and lower intraoperative blood loss, and earlier neurological function recovery.

OBJECTIVE：To explore the mec hanism of baicalein plat elet aggregation inhibitiory effect and lung tissue protective effect of baicalein in model rats with acute pulmonary embolism. METHODS ：Totally 36 rats were randomly divided into normal control group （n＝6）and modeling group （n＝30）. The acute pulmonary embolism model was established by autologous thrombus replication in modeling group ，and the sham operation of rats in normal control group was carried out. After modeling ， 30 model rats were randomly divided into model control group ，positive drug group （low molecular weight heparin calcium 0.01 mL/kg，subcutaneous injection ），baicalein low-dose ，middle-dose and high-dose groups （25，50，100 mg/kg，intraperitoneal injection），with 6 rats in each group. Normal control group and model control group were intraperitoneally injected constant volume of normal saline ；administration groups were given relevant medicine ，once a day ，for consecutive 7 d. After medication ， platelet aggregation rates of rats after activated with adenosine diphosphate （ADP） and arachidonic acid （AA） and platelet activation index （RPI）were detected ；lung histopathology was observed by HE staining ；serum platelet activation markers granule membrane（CD62P）and lysosomal membrane glycoprotein （CD63），growth differentiation factor- 15（GDF-15）and N-terminal B-type natriuretic peptide （NT-proBNP）were measured by ELISA. The mRNA expression levels of Notch 2，Notch3 and Notch signaling ligand PLL 1，JAG2 were detected by RT-PCR method. The protein expression levels of Notch 2，Notch3，DLL1 and JAG2 in lung tissue were detected by immunohistochemistry and Western blotting assay. RESULTS ：Compared with normal control group，plasma ADP-activated platelet aggregation rate ，AA-activated platelet aggregation rate ，RPI，serum levels of CD 62P， CD63，GDF-15 and NT-proBNP were increased significantly （P＜0.05）. The lung tissue of rats was in a state of severe inflammatory infiltration. mRNA and protein expression levels of Notch 2，Notch3，DLL1 and JAG 2 in lung tissue decreased significantly（P＜0.05）. Compared with model control group ，changes of above indexes of rats were improved significantly in baicalein groups （P＜0.05）. CONCLUSIONS ：Baicalein can reduce platelet aggregation and improve the pathological state of lung tissue in rats with acute pulmonary embolism. Its mechanism 0270） may be related to activating Notch signal pathway.

Objective To investigate the value of multi-modal neuroendoscopy combined with microscopy in the treatment of solid cystic brain tumors. Methods Fifty patients with cystic solid tumors admitted to Wuzhou Worker′s Hospital(the Seventh Affiliated Hospital of Guangxi Medical University) from February 2016 to February 2019 were enrolled. The patients were divided into two groups by random number table method. The patients in control group (25 cases) received microsurgery, and the patients in observation group (25 cases) received microsurgery combined with neuroendoscopy. All patients underwent CT or MRI. The differences in tumor resection rate between the two groups were observed and compared. The postoperative complications and Glasgow Outcome Scale (GOS) scores were compared between the two groups. All patients were followed up for 12 months after surgery. The tumor recurrence rate and mortality rate of the two groups were compared. Results The total resection rate of the tumor in observation group was 80.00%(20/25), and in control group was 48.00%(12/25), and there was significant difference (P<0.05). The postoperative GOS score of observation group was higher than that of control group: (4.52 ± 1.73) scores vs. (3.65 ± 1.15) scores, t=2.094, P=0.041. The incidence of postoperative complications, tumor recurrence rate and the mortality rate between two groups had no significant difference (P>0.05). Conclusions Multi-modal neuroendoscopy combined with microscopy can significantly improve the total resection rate of cystic brain tumors and improve the prognosis without increasing the risk of surgery.

Objective To observe the curative effect of low molecular heparin for treating secondary high coagulation state in the patients with nephrotic syndrome(NS) .Methods Total 87 cases of NS in our hospital were divided into the conventional treat‐ment group (n=42) and the low molecular heparin treatment group (n=45) .The routine treatment group was given the prednisone treatment and the low molecular heparin treatment group was treated by low molecular heparin combined with prednisone .The re‐lated indicators of blood coagulation before and after treatment were detected and the clinical curative effects in two groups were an‐alyzed .Results The coagulation related indicators in the conventional treatment group had no statistically significant difference be‐tween before and after treatment (P>0 .05) ,the prothrombin time(PT) and activated partial thrombin time(APTT) after treat‐ment in the low molecular heparin treatment group were significantly extended compared with before treatment ,while the concen‐trations of D‐dimer and fibrinogen were significantly decreased and the concentration of antithrombin Ⅲ was markedly increased compared with before treatment ,showing statistically significant differences between the two groups (P<0 .05);the patients of the low molecular heparin group patients had no bleeding after treatment .Conclusion Low molecular heparin combined with predni‐sone can reduce the secondary high condensation state in NS without bleeding and has a significantly clinical effect .

OBJECTIVETo investigate the polymorphism in the promoter region of PCA3 gene and its relationship with risk of prostate cancer (PCa).

METHODSThe promoter region of PCA3 gene of the DNA of peripheral blood mononuclear cells was detected by sequence analysis in the 186 PCa and 141 BPH patients and 135 healthy control individuals. If the samples were detected with polymorphism of insection/deletion, clone sequence analysis was used with pBS-T carrier to verify it.

RESULTSThere were 5 polymorphisms. TAAA repeat times: 4, 5, 6, 7, 8, and 8 genotypes (TAAA 4/5, TAAA 4/6, TAAA 5/5, TAAA 5/6, TAAA 5/7, TAAA 5/8, TAAA 6/6, and TAAA 6/7) were detected in the promoter region of PCA3 gene. The eight genotypes were divided into three groups: ≤10TAAA, 11TAAA, ≥12TAAA. Unconditional logistic regression analysis models were used to analyze the relationship between different genotypes and cancer risks adjusted by sex and age. The type 11TAAA and ≥12TAAA was associated with higher relative risk for prostate cancer than the group ≤10TAAA [OR=1.74, 95% CI=1.06-2.87 (for type 11TAAA); OR=5.63, 95% CI=1.85-17.19 (for type ≥12TAAA)]. In the 186 PCa patients, there was 62.4% allele of PCA3 gene with AG/CA mutation found in the promoter 18-19 bp region of PCA3 gene and it had a close relation with the development of prostate cancer.

CONCLUSIONSShort tandem repeats are found in the promoter region of the PCA3 gene in PCa patients, and the increase of TAAA repeat sequences highly enhance the relative risk of prostate cancer development. The occurrence of such STR might be related to the mutations in their upstream loci.

Antigens, Neoplasm ; genetics ; metabolism ; Base Sequence ; Genes, Neoplasm ; physiology ; Genotype ; Humans ; Leukocytes, Mononuclear ; Male ; Microsatellite Repeats ; Mutation ; Polymorphism, Genetic ; Promoter Regions, Genetic ; Prostatic Neoplasms ; epidemiology ; genetics ; Risk

Objective To study the effects of taking clopidogrel on relevant indicators of platelet aggregation function in 138 cases acute coronary syndrome (ACS) .Methods The platelet function analyzer and flow cytometry were adopted to detect the ADP‐induced platelet aggregation rate ,P selectin and activated GP Ⅱ b/ Ⅲ before medication and on 7 d after taking clopidogrel . Results The platelet aggregation rate after taking clopidogrel for 7 continuous d was decreased significantly (P<0 .01);the P se‐lectin level and activated GP Ⅱ b/ Ⅲ a expressed on platelet surface were significantly reduced (P<0 .01) as well .Conclusion Taking clopidogrel could reduce the platelet aggregation significantly in the patients with ACS and has the effect for inhibiting the platelet aggregation .

Objective To investigate the polymorphism in the promoter region of PCA3 gene and its relationship with risk of prostate cancer ( PCa) . Methods The promoter region of PCA3 gene of the DNA of peripheral blood mononuclear cells was detected by sequence analysis in the 186 PCa and 141 BPH patients and 135 healthy control individuals. If the samples were detected with polymorphism of insection/deletion, clone sequence analysis was used with pBS?T carrier to verify it. Results There were 5 polymorphisms. TAAA repeat times:4, 5, 6, 7, 8, and 8 genotypes (TAAA 4/5, TAAA 4/6, TAAA 5/5, TAAA 5/6, TAAA 5/7, TAAA 5/8, TAAA 6/6, and TAAA 6/7) were detected in the promoter region of PCA3 gene. The eight genotypes were divided into three groups: ≤10TAAA, 11TAAA, ≥12TAAA. Unconditional logistic regression analysis models were used to analyze the relationship between different genotypes and cancer risks adjusted by sex and age. The type 11TAAA and≥12TAAA was associated with higher relative risk for prostate cancer than the group ≤10TAAA [ OR=1. 74, 95%CI=1. 06?2. 87 ( for type 11TAAA);OR=5. 63, 95%CI=1. 85?17. 19 (for type≥12TAAA)]. In the 186 PCa patients, there was 62. 4% allele of PCA3 gene with AG/CA mutation found in the promoter 18?19 bp region of PCA3 gene and it had a close relation with the development of prostate cancer. Conclusions Short tandem repeats are found in the promoter region of the PCA3 gene in PCa patients, and the increase of TAAA repeat sequences highly enhance the relative risk of prostate cancer development. The occurrence of such STR might be related to the mutations in their upstream loci.