Trochanteric fractures result in a high frequency of considerable blood loss, a high incidence of blood transfusions, and a high risk of perioperative morbidity and mortality in elderly patients. This study aimed to evaluate the efficacy and safety of a three-dose regimen of tranexamic acid on blood loss and transfusion rate in elderly patients with trochanteric fractures. Methods: Eligible patients with trochanteric fractures surgically treated by dynamic hip screw and proximal anti-rotating intramedullary nail between March 2016 and October 2017 were enrolled in the study. Patients were randomly assigned to receive 15 mg/kg intravenous tranexamic acid dissolved in 100 mL of saline (TXA group) or 100 mL of saline solution (placebo group) over 10 minutes before, during, and after surgery. Perioperative blood loss, obvious blood loss, and hidden blood loss in the two groups were calculated separately. Vascular events and patient mortality over 6 months' follow-up were noted. Results: In total, 176 patients were included. Compared with the placebo group (n=88), patients

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BackgroundGlioblastoma multiforme (GBM) is characterized by widespread genetic and transcriptional heterogeneity. Aberrant DNA methylation plays a vital role in GBM progression by regulating gene expression. However, little is known about the role of methylation and its association with prognosis in GBM. Our aim was to explore DNA methylation-driven genes (DMDGs) and provide evidence for survival prediction and individualized treatment of GBM patients.MethodsUse of the MethylMix R package identified DMDGs in GBM. The prognostic signature of DMDGs based on the risk score was constructed by multivariate Cox regression analysis. Receiver operating characteristics (ROC) curve and C-index were applied to assess the predictive performance of the DMDG prognostic signature. The predictive ability of the multigene signature model was validated in TCGA and CGGA cohorts. Finally, the role of DMDG β-Parvin (PARVB) was explored in vitro.ResultsThe prognostic signature of DMDGs was constructed based on six genes (MDK, NMNAT3, PDPN, PARVB, SERPINB1, and UPP1). The low-risk cohort had significantly better survival than the high-risk cohort (p < 0.001). The area under the curve of the ROC of the six-gene signature was 0.832, 0.927, and 0.980 within 1, 2, and 3 years, respectively. The C-index of 0.704 indicated superior specificity and sensitivity. The six-gene model has been demonstrated to be an independent prognostic factor for GBM. In addition, joint survival analysis indicated that the MDK, NMNAT3, PARVB, SERPINB1, and UPP1 genes were significantly associated with prognosis and therapeutic targets for GBM. Importantly, our DMDG prognostic model was more suitable and accurate for low-grade gliomas. Finally, we verified that PARVB induced epithelial-mesenchymal transition partially through the JAK2/STAT3 pathway, which in turn promoted GBM cell proliferation, migration, and invasion.ConclusionThis study demonstrated the potential value of the prognostic signature of DMDGs and provided important bioinformatic and potential therapeutic target data to facilitate individualized treatment for GBM, and to elucidate the specific mechanism by which PARVB promotes GBM progression.

Background Risk factors for intraoperative acquired pressure injury (IAPI) in patients undergoing various surgical procedures have been described in previous studies. However, whether risk factors for IAPI in patients undergoing neurosurgery differ remains unknown. The aim of the present study was to explore independent risk factors for IAPI in patients undergoing neurosurgery. Material/Methods Data from 465 patients who underwent neurosurgery between October 2017and December 2018 and who were at high risk of IAPIs were retrospectively analyzed. Independent risk factors for IAPI were evaluated using univariate and multivariate logistic regression models. Results Sixty-nine IAPIs (14.8%) in 465 patients undergoing neurosurgery were assessed. Multivariate logistic regression analyses showed that being overweight (odds ratio [OR] 2.685; 95% confidence interval [CI] 1.206–5.975; P =0.016), prone position (OR 7.502, 95% CI 2.470–22.787. P <0.001), lateral position (OR 15.301, 95% CI 4.903–47.753, P <0.001), use of a head frame (OR 3.716, 95% CI 1.431–9.653, P =0.007), surgical times of 4 to 8 h (OR 7.276, 95% CI 2.249–23.542, P <0.001), and surgical times ≥8 h (OR 173.248, 95% CI 32.629–919.896, P <0.001) all were associated with an increased risk of IAPI in patients undergoing neurosurgery. The factors associated with reduced risk of IAPI were high serum albumin levels (OR 0.099, 95% CI 0.016–0.608, P =0.013) and use of memory sponge pads (OR 0.064, 95% CI 0.020–0.202, P <0.001). Conclusions The present study indicates that being overweight, prone and lateral positioning, use of a head frame, and longer surgical times are associated with an increased risk of IAPI in patients undergoing neurosurgery. Prospective studies should be conducted to verify these findings and consideration should be given to use of these factors in clinical practice to identify high-risk patients.

366Intracranial aneurysms are common. The overall frequency in the general population ranges from 0.2% to 9% (mean frequency, about 5%) in autopsy studies.1,2 However, despite their common occurrence, only 1% of all intracranial aneurysms actually rupture.2 Recent advances in noninvasive neuroimaging technologies, such as magnetic resonance angiography and three-dimensional computed tomography (CT), have increased the likelihood of detecting an unruptured intracranial aneurysm. The treatment of asymptomatic unruptured intracranial aneurysms has been the subject of a great deal of debate in the neurosurgical community. Therefore, it is very important to be able to predict accurately the status of an aneurysm so that neurosurgeons can target interventions to those with the greatest risk of rupture.Aneurysm location, size 3,4 and morphology 5-7 are wellrecognized risk factors in predicting aneurysm rupture. Other factors, 5,8 such as cigarette smoking, familial preponderance, ABSTRACT: Background: Determining factors predictive of the natural risk of rupture of cerebral aneurysms is difficult. We studied morphological factors associated with rupture in a study model of patients with mirror location intracranial aneurysms, one aneurysm that had ruptured and one that had not, each patient served as their own control attempting to eliminate confounding variables. Methods:We collected five one-dimensional measurements and four two-dimensional indices from three-dimensional rotational digital subtraction angiography images of patients in the proposed study model and explored their correlation with aneurysm rupture. Parameters were analyzed with a paired Student's t test for significance and significant parameters were further examined by multivariate conditional logistic regression analysis. Results: Fifty-two patients with 52 pairs of intracranial aneurysms in a mirror location were studied. The maximum perpendicular height, neck diameter, maximum width, maximum height, aspect ratio, size ratio, and bottleneck factor were significantly associated with ruptured aneurysms on bivariate analysis. A logistic regression analysis showed that only size ratio,which was defined as the ratio of the maximal height to parent artery average diameter, is independently correlated with ruptured intracranial aneurysms. Conclusions: In a case-control study of patients with mirror location intracranial aneurysms, size ratio was identified as the unique morphological factor associate with the rupture of cerebral aneurysms. Les données pairées ont été analysés au moyen du test de student et les paramètres dont la valeur statistique était significative ont été examinés par une analyse de régression logistique conditionnelle multivariée. Résultats : Cinquante-deux patients porteurs de 52 paires d'anévrismes intracrâniens localisés en miroir ont été étudiés. À l'analyse bivariée, la hauteur perpendiculaire maximale, le diamètre du col, la largeur maximale, la hauteur maximale, le rapport hauteur/largeur, le rapport de taille et le facteur goul...