BACKGROUND Intracerebral hemorrhage(ICH)comprises 9%-27%of stroke patients.Hematoma expansion(HE)occurs in approximately 20%of patients following ICH,typically within the first 24 hours.HE increases mortality and long...BACKGROUND Intracerebral hemorrhage(ICH)comprises 9%-27%of stroke patients.Hematoma expansion(HE)occurs in approximately 20%of patients following ICH,typically within the first 24 hours.HE increases mortality and long-term disability in these patients and is being investigated as a therapeutic target to improve the outcome in these patients by limiting HE.Non-contrast computed tomography(NCCT)has potential in predicting HE,which can identify the individuals at risk.AIM To evaluate NCCT markers for predicting HE in patients with ICH and to develop a simple,practical grading system for risk stratification.METHODS This prospective observational study evaluated 192 patients with spontaneous ICH who underwent a baseline NCCT within four hours of admission,followed by a follow-up scan after six hours or earlier if there was clinical deterioration.Hematoma volumes and imaging characteristics that predicted HE were evaluated.A simple five-point grading system score was created to predict HE.In RESULTS Of the 192 patients studied,HE was seen in 106(55.2%).The mean baseline hematoma volume was significantly greater among patients in the HE group(44.1 mL)compared to those in the non-HE group(12.2 mL),with a P-value<0.05.Additionally,imaging biomarkers such as the island sign,swirl sign,and black hole sign were observed with significantly higher frequency in the HE group relative to the non-HE cohort(all P-values<0.05).The island sign was strongly associated with HE[odds ratio(OR)13.7;95%confidence interval(CI):10.15-16.37;P<0.001].Similarly,the black hole sign(OR 9.4;95%CI:7.4-11.62;P<0.001)and the swirl sign(OR 5.2;95%CI:3.72-6.53;P<0.001)emerged as significant predictors of HE.Initial hematoma volume≥30 mL also showed a sig-nificant association(OR 1.9;95%CI:1.41-2.74;P=0.039).A five-point predictive scoring model demonstrated a strong positive association between increasing scores and the probability of HE.Specifically,the likelihood of HE corresponding to scores of 0,1,2,3,4,and 5 was 7.4%,37.5%,75%,85%,93.3%,and 100%,respectively.CONCLUSION The five variables demonstrated statistically significant associations with HE.This simple and practical 5-point prediction score can enable identification of patients at elevated risk of HE based on baseline NCCT findings.This can facilitate timely recognition of high-risk individuals who may benefit from targeted anti-expansion therapy.展开更多
Obstructed defecation syndrome(ODS)represents an important cause of constipation,primarily arising from dysfunctions within the pelvic floor.Characterized by an inability to complete defecation or effectively evacuate...Obstructed defecation syndrome(ODS)represents an important cause of constipation,primarily arising from dysfunctions within the pelvic floor.Characterized by an inability to complete defecation or effectively evacuate fecal material despite the urge to defecate,ODS results in a persistent sensation of incomplete evacuation and often requires excessive straining during defecation.Conventional clinical examinations fail to adequately assess the complex dynamic dysfunctions of the pelvic floor and anorectal region.Magnetic resonance defecography(MRD),a sophisticated form of dynamic pelvic floor imaging,provides a comprehensive,non-invasive means of visualizing and quantifying various anorectal and pelvic floor abnormalities.By allowing detailed assessment of structural and functional deficits during the defecation process,MRD plays a crucial role in the diagnostic workup of ODS,enabling colorectal surgeons to formulate more precise and individualized treatment strategies.This manuscript highlights the important anatomical and functional disorders of pelvic floor that are associated with ODS.展开更多
文摘BACKGROUND Intracerebral hemorrhage(ICH)comprises 9%-27%of stroke patients.Hematoma expansion(HE)occurs in approximately 20%of patients following ICH,typically within the first 24 hours.HE increases mortality and long-term disability in these patients and is being investigated as a therapeutic target to improve the outcome in these patients by limiting HE.Non-contrast computed tomography(NCCT)has potential in predicting HE,which can identify the individuals at risk.AIM To evaluate NCCT markers for predicting HE in patients with ICH and to develop a simple,practical grading system for risk stratification.METHODS This prospective observational study evaluated 192 patients with spontaneous ICH who underwent a baseline NCCT within four hours of admission,followed by a follow-up scan after six hours or earlier if there was clinical deterioration.Hematoma volumes and imaging characteristics that predicted HE were evaluated.A simple five-point grading system score was created to predict HE.In RESULTS Of the 192 patients studied,HE was seen in 106(55.2%).The mean baseline hematoma volume was significantly greater among patients in the HE group(44.1 mL)compared to those in the non-HE group(12.2 mL),with a P-value<0.05.Additionally,imaging biomarkers such as the island sign,swirl sign,and black hole sign were observed with significantly higher frequency in the HE group relative to the non-HE cohort(all P-values<0.05).The island sign was strongly associated with HE[odds ratio(OR)13.7;95%confidence interval(CI):10.15-16.37;P<0.001].Similarly,the black hole sign(OR 9.4;95%CI:7.4-11.62;P<0.001)and the swirl sign(OR 5.2;95%CI:3.72-6.53;P<0.001)emerged as significant predictors of HE.Initial hematoma volume≥30 mL also showed a sig-nificant association(OR 1.9;95%CI:1.41-2.74;P=0.039).A five-point predictive scoring model demonstrated a strong positive association between increasing scores and the probability of HE.Specifically,the likelihood of HE corresponding to scores of 0,1,2,3,4,and 5 was 7.4%,37.5%,75%,85%,93.3%,and 100%,respectively.CONCLUSION The five variables demonstrated statistically significant associations with HE.This simple and practical 5-point prediction score can enable identification of patients at elevated risk of HE based on baseline NCCT findings.This can facilitate timely recognition of high-risk individuals who may benefit from targeted anti-expansion therapy.
文摘Obstructed defecation syndrome(ODS)represents an important cause of constipation,primarily arising from dysfunctions within the pelvic floor.Characterized by an inability to complete defecation or effectively evacuate fecal material despite the urge to defecate,ODS results in a persistent sensation of incomplete evacuation and often requires excessive straining during defecation.Conventional clinical examinations fail to adequately assess the complex dynamic dysfunctions of the pelvic floor and anorectal region.Magnetic resonance defecography(MRD),a sophisticated form of dynamic pelvic floor imaging,provides a comprehensive,non-invasive means of visualizing and quantifying various anorectal and pelvic floor abnormalities.By allowing detailed assessment of structural and functional deficits during the defecation process,MRD plays a crucial role in the diagnostic workup of ODS,enabling colorectal surgeons to formulate more precise and individualized treatment strategies.This manuscript highlights the important anatomical and functional disorders of pelvic floor that are associated with ODS.
