穴位贴敷联合中医情志疗法能够缓解硬膜下血肿清除术后患者的焦虑情绪

Evacuation of chronic subdural hematoma (CSDH) will be one of the most common neurosurgical procedures in the future in the increasingly aging societies. Performing cranial surgery on awake patients may place a psychological burden on them. Aim of this study was to evaluate the psychological distress of patients during awake CSDH relief. Patients with awake evacuation of CSDH via burr hole trepanation were included in our monocentric prospective study. Patient perception and satisfaction were measured using standardized surveys 3-5 days and 6 months after surgery. Among other questionnaires, the Hospital Anxiety and Depression and the Impact of Event Scale, were used to quantify patients' stress. A total of 50 patients (mean age 72.9 years (range 51 - 92)) were included. During surgery, 28 patients reported pain (mean 4.1 (SD 3.3)). Postoperatively, 26 patients experienced pain (mean 2.7 (SD 2.6)). Patients' satisfaction with intraoperative communication was reported with a mean of 8.3 (SD 2.1). There was a significant negative correlation between intraoperatively perceived pain and satisfaction with intraoperative communication (p = 0.023). Good intraoperative communication during evacuation of CSDH in awake patients is associated with positive patient perception and correlates with pain reduction.

BACKGROUND Perianal fistulizing Crohn’s disease (PFCD) is one of the most destructive complications of inflammatory bowel disease. Delayed postoperative wound healing, persistent inflammation, and a high risk of recurrence remain major challenges in clinical management. In recent years, external traditional Chinese medicine therapies have attracted increasing attention in postoperative recovery from perianal disorders, and time-specific intervention based on chronomedicine principles, such as the Ziwu-Liuzhu theory, may further optimize therapeutic outcomes. AIM To evaluate the effects of Ziwu-Liuzhu-guided combined external therapy on wound healing, disease activity, inflammation, and anxiety in postoperative PFCD patients. METHODS This single-center retrospective cohort study included 217 postoperative PFCD patients (2023-2025). They were divided into sitz bath-only (n = 72), sitz bath plus acupoint application (n = 69), and Ziwu-Liuzhu time-specific combined therapy (n = 76) groups. Outcomes included Crohn’s Disease Activity Index (CDAI), Perianal Disease Activity Index (PDAI), wound healing scores, exudate, pain, granulation, healing time, C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and Generalized Anxiety Disorder-7 scale (GAD-7). Between-group comparisons, regression, survival analysis, and propensity score matching were performed. RESULTS After 4 weeks, all three groups showed significant improvements in CDAI and PDAI, with the greatest reductions observed in the Ziwu-Liuzhu group. This group also exhibited significantly lower wound healing, exudate, pain, and granulation scores, along with a markedly shorter median healing time (18 days vs 24 days and 31 days). Kaplan-Meier analysis demonstrated a higher wound healing probability in the Ziwu-Liuzhu group (log-rank P < 0.001). Levels of CRP, TNF-α, and IL-6 were significantly lower in the Ziwu-Liuzhu group than in the other two groups. The reduction in GAD-7 score was also greatest in this group. Multivariable regression and propensity score matching consistently confirmed that Ziwu-Liuzhu therapy was independently associated with superior healing and overall clinical efficacy. CONCLUSION Ziwu-Liuzhu-guided combined external therapy promotes wound healing, reduces inflammation and anxiety, and improves disease activity in postoperative PFCD, representing a valuable adjunctive integrated management approach.

Objective: To explore the intervention effect of internal nourishing qigong combined with acupoint application on anxiety and depression in patients undergoing chemotherapy for gastrointestinal tumors. Methods: A total of 144 patients with gastrointestinal tumors, admitted to the oncology and gastrointestinal surgery departments of a tertiary hospital from October 2023 to May 2024, were conveniently selected and randomly divided into four groups using a random number table: the internal nourishing qigong group (36 cases), the acupoint application group (36 cases), the combined group (36 cases), and the control group (36 cases). The anxiety (SAS) and depression (SDS) scores of the four groups were assessed at four time points: before the intervention, after one cycle (21 days per cycle), after two cycles, and after three cycles. Results: Before the intervention, there were no statistically significant differences in baseline data, SAS, and SDS scores among the four groups (P > 0.05). After one, two, and three cycles of intervention, the RPFS, SAS, and SDS scores of the intervention groups were significantly lower than those of the control group (P < 0.05). The SAS and SDS scores of the combined group were significantly lower than those of the internal nourishing qigong group and the acupoint application group (P < 0.05). The SAS and SDS scores of the internal nourishing qigong group were significantly lower than those of the acupoint application group (P < 0.05). The main effects of the intervention and time on anxiety and depression were statistically significant (P < 0.05). Conclusion: Internal nourishing qigong combined with acupoint application can effectively improve anxiety and depression levels in patients undergoing chemotherapy for gastrointestinal cancer. 

Ulcerative colitis is a diffuse, non-specific inflammatory bowel disease of unknown etiology, mainly involving the colorectal mucosa, and the main symptom is mucoempyema. Ulcerative colitis is a life-long condition that can have profound emotional and social effects on those who suffer from it. Anxiety is a common complication of ulcerative colitis. At present, Western medicine mainly uses immunosuppressants, glucocorticoids, and other drugs in the treatment of ulcerative colitis, but long-term use will lead to serious side effects and increase the financial burden on patients. According to the syndrome differentiation of Chinese medicine, ulcerative colitis can be classified as “dysentery”, “intestinal wind”, and other categories. Chinese medicine has rich experience and unique insights in the treatment of dysentery. Chinese medicine acupoint application and ear point pressure bean are the characteristic external treatments of Chinese medicine, with remarkable effects, convenient operation, and economic safety. This paper introduces an effective method to improve intestinal symptoms and relieve anxiety in patients with ulcerative colitis, that is, to stimulate specific acu-points of patients with acupoint application and auricular point pressure therapy.

This study aimed to determine the effects of natural herbal acupoint application on anxiety in long-term hemodialysis patients and analyze the corresponding nursing measures. Between March 2020 and January 2022, 150 long-term hemodialysis patients admitted to our hospital were surveyed for this study. A questionnaire survey was conducted to determine the anxiety status of the patients. Patients with anxiety were registered and randomly divided into a research group and a control group. The control group received traditional routine nursing care, while the research group received personalized interventional nursing care combined with natural herbal acupoint application. The comfort level, sleep quality, emotional management ability, and negative emotional status before and after the intervention were compared between the two groups. The 58 (38.66%) patients who experienced anxiety were divided into control and research groups, with 29 patients per group. No significant differences in baseline characteristics were detected between the two groups (P >0.05). The research group had significantly higher General Comfort Questionnaire (GCQ) scores and significantly lower Pittsburgh Sleep Quality Index (PSQI) scores compared with the scores in the control group (P <0.05 for both). The research group had higher scores in emotional processing, interpersonal relationships, and psychological activity management than the control group, indicating better emotional management ability (P <0.05). Moreover, the research group had significantly lower scores on the Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) than the control group (P <0.05). In this study, targeted interventions combining individualized nursing care and traditional Chinese medicine acupoint patching were administered to patients, which effectively promoted their physical and mental well-being, enhanced patient comfort, improved sleep quality, and effectively managed patient anxiety, as well as alleviated negative emotions. Therefore, natural herbal patches are worthy of promotion and application in clinical settings.

BACKGROUND Noninvasive mechanical ventilation (NIPPV) can improve oxygenation and ventilation in patients with acute exacerbation chronic obstructive pulmonary disease (AECOPD), but some patients may struggle to acclimate to it, ultimately leading to treatment failure. AIM To determine the impact of acupoint application and massage on the comfort degree and stress state of patients with AECOPD undergoing NIPPV. METHODS A total of160 AECOPD patients were endeavored to study with a retrospective study. The 160 participants were randomly divided into NIPPV group and acupoint application and massage accompany with NIPPV groups with 80 cases each. Changes in the comfort degree, anxiety index, stress indicators, satisfaction degree, hospitalization time, stop using NIPPV time, blood gas indicators before and after NIPPV treatment, and the treatment effect were detected for the two groups. RESULTS In contrast to NIPPV as a solitary treatment, the integration of acupoint therapy and massage with NIPPV markedly enhanced patient comfort and eased their stress levels; it substantially diminished the anxiety index, alleviated frontal sinus pain and abdominal bloating, reduced the duration of offline periods and hospital stays, and significantly betters the eating and sleeping quality of patients (P < 0.05). CONCLUSION Acupoint application and massage can improve the comfort degree, stress state, and anxiety; shorten the NIPPV time and hospital stay; reduce the intubation rate; and improve the treatment effect of patients with AECOPD undergoing NIPPV.

Background Patients undergoing video-assisted thoracoscopic surgery (VATS) often experience preoperative anxiety, which can significantly impact the surgical process and postoperative recovery. However, the efficacy of Transcutaneous Electrical Acupoint Stimulation (TEAS) in managing preoperative anxiety in VATS patients is unknown. Methods A total of 82 patients scheduled for thoracoscopic surgery were randomly divided into TEAS group (n = 41) and sham TEAS (STEAS) group (n = 41). The TEAS/STEAS intervention began 3 days before the thoracoscopic surgery, with one session lasting 30 min per day for three consecutive days. The primary outcome measure will be the change in Generalized Anxiety Disorder Scale scores between the day before surgery and the baseline. Secondary outcome include intraoperative anesthetic consumption, time to postoperative chest tube removal, postoperative analgesic consumption and pain scores, length of postoperative hospital stay, serum concentrations of 5-hydroxytryptamine (5-HT), norepinephrine (NE), and gamma-aminobutyric acid (GABA). Results On the third intervention day, anxiety levels in the TEAS group were significantly lower than in the STEAS group (p < 0.01). TEAS patients required less intraoperative sufentanil, remifentanil, and dexamethasone (p < 0.01). Chest tube removal time and hospital stay were shorter in the TEAS group (p < 0.01). Postoperative meperidine consumption and VAS pain scores were lower in the TEAS group (p < 0.01). Serum 5-HT levels were lower in the TEAS group on day three (p < 0.01), while NE levels remained lower from day three of intervention to postoperative day three (p < 0.05). GABA levels were higher in the TEAS group (p < 0.01). Conclusion TEAS effectively reduces preoperative anxiety, decreases intraoperative anesthetic and anti-inflammatory drug use, shortens postoperative chest tube removal time and hospitalization, and alleviates postoperative pain. These results indicate that TEAS, as an adjunctive therapy, has valuable potential in improving surgical outcomes and postoperative experience for patients with pulmonary nodules. Clinical trial registration https://clinicaltrials.gov, NCT04887090.

PURPOSE Traditional acupuncture provides sedative and analgesic effects but is invasive and requires skilled practitioners. Transcutaneous electrical acupoint stimulation (TEAS) is a noninvasive alternative with advantages such as ease of use and reproducibility. This study aimed to evaluate the impact of TEAS on preoperative anxiety and related outcomes. DESIGN A systematic review and meta-analysis of randomized controlled trials. METHODS Randomized controlled trials from eight databases were analyzed using RevMan5.4 (Version 5.4; Cochrane Collaboration, Oxford, England). The outcomes assessed included anxiety, heart rate, mean arterial pressure, and sleep quality, all of which were measured preoperatively, while pain was the sole outcome evaluated postoperatively. FINDINGS A total of 1,026 patients across 12 studies were included. TEAS significantly reduced preoperative anxiety (standardized mean difference [SMD] = -1.07, P = .0002), heart rate (mean difference [MD] = -8.61, P = .02), mean arterial pressure (SMD = -1.53, P = .04), and postoperative pain (SMD = -1.89, P < .0001). The effect on sleep quality was not significant (SMD = 0.72, P = .13). CONCLUSIONS TEAS may reduce preoperative anxiety, heart rate, mean arterial pressure, and postoperative pain, but its effect on sleep quality is inconclusive. Further well-designed randomized controlled trials are needed.

Against the backdrop of refined healthcare management, traditional Chinese Medicine (TCM) Five-Tone Therapy faces limitations like insufficient personalization. This study aims to construct a personalized clinical therapeutic music management system integrating TCM Five-Tone Therapy with generative artificial intelligence technology and explore its application value and implementation pathways in enhancing patient satisfaction, alleviating anxiety, and improving pain management. Centered on the TCM theory linking the Five Tones ("Gong, Shang, Jue, Zhi, Yu") to the Five Zang Organs and Five Emotions, the system adopts a closed-loop architecture with multimodal data collection, Five-Tone feature mapping, personalized music generation, and feedback optimization, tailored to patients’ clinical conditions, real-time emotional states, and musical preferences. It converts relevant indicators into quantifiable musical parameters aligned with Five-Tone Therapy principles, generating music precisely matching patients’ physical and psychological needs. This system provides an innovative pathway for clinical emotional regulation, enhances hospital service quality, and shows significant potential in anxiety and pain management, deserving promotion in healthcare institutions.

No abstract available

No abstract available

This study aimed to explore how comprehensive psychological intervention combined with traditional Chinese medicine (TCM) external therapy affects treatment adherence and quality of life in breast cancer patients undergoing chemotherapy. The research included 124 patients from January 2023 to December 2023, randomly assigned to either a control group (n=60) receiving standard chemotherapy and routine care and an intervention group (n=64) receiving additional psychological support (mindfulness training, cognitive restructuring, group therapy) and TCM therapies (moxibustion, acupoint application, herbal fumigation). Results showed that the intervention group had significantly better chemotherapy completion (92.2% vs 85.0%) and dose intensity (89.1% vs 80.0%), with fewer delays (10.9% vs 20.0%) and regimen changes (15.6% vs 26.7%). Quality of life improved notably, particularly in emotional (Δ=16.7) and social functions (Δ=14.2). Psychological metrics also improved, with anxiety and depression rates dropping significantly. Additionally, the intervention group experienced fewer severe side effects such as myelosuppression, nausea, fatigue, and neuropathy. These findings suggest that combining psychological support with TCM therapies enhances treatment adherence, quality of life, and psychological well-being while reducing chemotherapy-related adverse effects, offering a promising approach for supportive care in breast cancer patients.

Chemotherapy-related fatigue, sleep disturbance, and psychological distress significantly impair quality of life (QoL) in cancer patients. Traditional Chinese medicine (TCM) non-pharmacological therapies are increasingly used as supportive care, yet their comparative effectiveness remains unclear. This study aimed to evaluate and compare five TCM-based interventions for improving QoL and emotional well-being in chemotherapy patients. A systematic review and network meta-analysis was conducted, including randomized controlled trials (RCTs) published through April 2025. Five TCM-based interventions (acupuncture, auricular therapy, manual acupoint therapy, mind–body exercise therapy, and moxibustion) were evaluated. Primary outcomes included QoL, sleep quality, fatigue, general mood, anxiety, and depression. Effect sizes were calculated as standardized mean differences (SMDs) with 95% confidence intervals (CIs). Treatment ranking was determined using surface under the cumulative ranking curve (SUCRA). Thirty-five RCTs involving 2025 chemotherapy patients were included. Manual acupoint therapy ranked highest for improving QoL (SUCRA 63.4%; SMD vs. control, 2.29; 95% CI, 0.95 to 3.63) and sleep quality (SUCRA 91.9%; SMD vs. auricular therapy, −9.92; 95% CI, −14.83 to −5.01). Mind–body exercise therapy was most effective for enhancing mood (SUCRA 68.0%; SMD vs. control, 0.72; 95% CI, 0.20 to 1.24) and reducing depression (SUCRA 70.8%; SMD vs. control, −0.92; 95% CI, −1.79 to −0.05). Auricular therapy showed the greatest benefit for fatigue (SUCRA 100%; SMD vs. control, −8.13; 95% CI, −10.15 to −6.11) and anxiety (SUCRA 92.9%; SMD vs. control, −1.53; 95% CI, −2.48 to −0.58). TCM non-pharmacological therapies demonstrate distinct, symptom-specific efficacy in cancer patients undergoing chemotherapy. Manual acupoint therapy is most effective for QoL and sleep, mind–body exercise therapy for mood and depression, and auricular therapy for fatigue and anxiety. These findings support individualized integration of TCM interventions into supportive cancer care.

BACKGROUND Conventional treatments for thyroid nodules (TNs), whether based on Western medicine or limited to emotional regulation, diet, and lifestyle adjustments, have shown modest effectiveness. AIM To evaluate the efficacy of Jianpi Huazhuo Xiaoying Decoction (JPHZXYD), a formula designed to strengthen the spleen, resolve turbidity, and disperse nodules, combined with emotional conditioning therapy in the management of TNs. METHODS A total of 123 patients with TNs (January 2023 to November 2024) were enrolled and divided into two groups: A control group (n = 60) receiving conventional nonpharmacological management (emotional guidance, dietary adjustments, and lifestyle modifications) and an observation group (n = 63) receiving JPHZXYD plus emotional conditioning therapy. Outcomes compared between the two groups included traditional Chinese medicine symptom scores, anxiety and depression levels, overall treatment effectiveness, TN morphology (number, diameter, and vascularity), pulsatility index, resistance index, thyroid function indicators (free triiodothyronine, free thyroxine, and thyroid-stimulating hormone), and thyroid autoantibodies (thyroid peroxidase antibody and thyroglobulin antibody). RESULTS Compared with both baseline measurements and the control group, the observation group showed significant reductions in traditional Chinese medicine symptom scores, pulsatility index, resistance index, thyroid-stimulating hormone, thyroid peroxidase antibody, and thyroglobulin antibody levels. Patients in the observation group also experienced greater improvements in anxiety and depression, higher overall treatment effectiveness, and more pronounced reductions in TN diameter, number, and microvascular density, along with greater posttreatment increases in free triiodothyronine and free thyroxine levels compared with controls. CONCLUSION JPHZXYD combined with emotional conditioning therapy enhances therapeutic efficacy and alleviates anxiety and depression in patients with TNs.

Social phobia, also known as social anxiety disorder, is a high-risk factor for secondary depression and substance abuse. It is very important to understand the dysfunction and causes of social phobia individuals for their treatment research. For this modern mental and psychological disease caused by the public, especially young people, the treatment method of traditional Chinese medicine is still unique. This paper discusses the emotional performance and zang-fu physiological function of organs of individuals with social phobia from the aspects of etiology and pathogenesis and application and treatment of “thinking wins fear”. It discusses the connotation of traditional Chinese medicine contained in “thinking wins fear” from emotion and cognition. It discusses the mutual victory effect of a kind of emotional transformation on the traditional mutual restraint relationship of emotional inter-resistance therapy, so as to better provide theory and ideas for the formulation of intervention measures for social phobia.

Cancer patients frequently experience anxiety and depression, which adversely affect their quality of life and may compromise treatment outcomes. Five-element music therapy, rooted in traditional Chinese medicine, has shown potential in alleviating emotional distress. This study aimed to evaluate the effects of five-element music therapy combined with acupuncture based on the “Inhibiting Wood and Supporting Earth” theory on anxiety, depression, and quality of life in cancer patients. A total of 100 cancer patients with anxiety and depression [Hospital Anxiety and Depression Scale (HADS) score ≥8] were randomly assigned to either the control group ( n  = 50) or the intervention group ( n  = 50). Both groups received routine oncology care. The control group received five-element music therapy (Gong tone) for 30 min daily for 30 days. The intervention group received the same Gong tone music therapy combined with acupuncture at the following acupoints: Taichong (LR3, liver meridian), Zusanli (ST36, stomach meridian), Neiguan (PC6, pericardium meridian), and Sanyinjiao (SP6, spleen meridian). Acupuncture was administered three times weekly for 4 weeks. Outcomes included HADS, Quality of Life Questionnaire-Core 30 (QLQ-C30), and Pittsburgh Sleep Quality Index (PSQI) assessed at baseline and after 30 days of intervention. T lymphocyte subsets were also measured in a subset of 60 patients (30 per group). After 30 days of intervention, the intervention group showed significantly greater reductions in HADS-Anxiety scores (mean difference: −3.2, 95% CI: −4.1 to −2.3) and HADS-Depression scores (mean difference: −2.8, 95% CI: −3.6 to −2.0) compared to the control group (both P  < 0.001). The intervention group also demonstrated significant improvements in QLQ-C30 functional subscales and global health status ( P  < 0.05). PSQI scores improved in both groups, with the intervention group showing superior sleep quality ( P  = 0.012). CD3 + and CD4 + T-cell counts increased significantly in the intervention group compared to controls ( P  < 0.05). Five-element music therapy combined with acupuncture based on “Inhibiting Wood and Supporting Earth” theory is more effective than music therapy alone in reducing anxiety and depression and improving quality of life in cancer patients. This combined approach shows promise as a safe and effective intervention. These findings support further research into its implementation, and the approach has the potential to be incorporated into routine oncology care following confirmatory studies and health economic evaluations.

COVID‐19 (coronavirus) has spread all over the world with a high infection rate. Currently, there are no targeted therapeutic drugs for COVID‐19 as well as for stress induced by COVID‐19. The unpredictable events of COVID‐19 can trigger feelings of fear, worry, or unease in people, leading to stress‐related disorders such as depression and anxiety. It has been reported that individuals, including COVID‐19 patients, medical staff, and ordinary people, are under both physical and psychological pressure, and many of them have developed depression or anxiety during this pandemic. Traditional Chinese medicine (TCM) has been widely used in treating depression with relatively better safety and efficacy and may have an important role in treating stress‐related disorders induced by COVID‐19. In this review, we collected the common TCM treatment methods including Qigong, Acupuncture, Five Elements Musical Therapy, Five Elements Emotional Therapy, and Chinese herbal medicine from the databases of PubMed and the China National Knowledge Internet to illustrate the effect of TCM on depression. The better knowledge of TCM and implementation of TCM in COVID‐19 clinics may help to effectively improve depression induced by COVID‐19, may assist people to maintain a healthy physical and mental quality, and may alleviate the current shortage of medical resources.

Background: Western psychological practices have traditionally treated only the mind, not the body. By contrast, traditional Chinese medicine (TCM) treats both body and mind as a single gestalt. This paper presents a single case study where Western and TCM therapies were integrated into a short-term structured treatment. Study Population: One male client suffering from neurotic depression and anxiety manifesting in both emotional and physiological distress, including insomnia and diarrhea. One therapist participant trained in both Western psychiatric practices and TCM. Method: A course of treatment was devised combining Western psychotherapeutic technique and TCM’s diagnostic and therapy practices. Modern methods of focusing psychotherapy, narrative, and mindfulness were used to determine the specific traumatic events causing the patient’s issues. Treatment was undergone by “thought imprint therapy” and finally concluded using “psychological acupuncture”. Results: The patient reported that his emotional and physical symptoms were greatly alleviated. He was able to sleep without medication and his anxiety towards taking exams was gone. Conclusion: Although a single case study, we are optimistic that this integrative method has great promise for future psychiatric practice.

No abstract available

No abstract available

Objectives: This study investigates the latest clinical studies on Korean medicine treatment of chronic subdural hematoma (CSDH) in China.Methods: A CNKI search investigated the last 10 years of clinical studies of Korean medicine treatments in Chinese medical journals for CSDH. The search focused on authors, publication years, types of studies, purposes of studies, methods and duration of treatment, evaluation criteria, and results of treatment.Results: In 19 studies, there were 14 randomized controlled trials (RCTs), 4 case series, and 1 case-control study. In all 19 studies, Korean medical treatment and Western treatment were combined. Herbal medicine was used in 19 studies and acupuncture treatment in 2 studies. The most frequently used prescription was Hyeolbuchukeo-tang-gagambang, and the most frequently used acupoint was PC6. In all 19 studies, the effectiveness of Korean medicine treatment performed in parallel with Western treatment was confirmed.Conclusions: In this study, Korean medicine combined with Western treatment for CSDH was effective. More clinical studies and case reports are required to develop a guided treatment for CSDH.

Abstract Introduction Chronic subdural hematoma (CSDH) often occurs 3 weeks to 3 months after brain injury, which is mainly caused by bleeding of the bridging vein. For patients with ventriculoperitoneal (V-P) shunt, excessive drainage can also cause CSDH. We present a rare case of CSDH caused by shunt valve breakdown in brain injury. Case Report We report a 68-year-old man with V-P shunt for 8 years. He presented with bilateral CSDH with disappearance of lateral ventricles nearly 1 month after a brain injury caused by being hit with a stick. After burr hole drainage (BHD), the patient’s symptoms improved and lateral ventricles reappeared, but disappeared rapidly with CSDH recurrence within a short time. We considered the cause to be medium pressure shunt valve breakdown caused by hitting with a stick, which was confirmed by the engineer’s test after the operation and excessive drainage of cerebrospinal fluid. BHD replaced the adjustable pressure shunt valve, and the patient recovered. Conclusion V-P shunt is a common operation in neurosurgery, and postoperative shunt valve breakdown may lead to poor outcome. We report a rare case of CSDH caused by shunt valve breakdown due to excessive external forces, suggesting that patients after V-P shunt should pay attention to the protection of the shunt valve.

No abstract available

No abstract available

No abstract available

This study presents an investigation of the impact of virtual reality technology on pain and anxiety levels in neurosurgical patients in the postoperative period. The study included 22 patients with neurovascular pathology. 12 patients underwent therapy sessions using virtual reality technology for 3 days after surgery (main group), 10 patients were included in the control group. All patients received questionnaires to determine the level of anxiety according to Beck and Zung one day before the surgery. The next day, the patients underwent surgery — clipping of the aneurysm neck from a standard pterional approach. All patients were assessed for anxiety and pain within 3 days after surgery, and hemodynamic parameters were measured — blood pressure, heart rate. According to the results of statistical data processing, no statistically significant difference was found between the main and control groups in the change in the level of anxiety and pain by the end of the study. There were also no statistically significant differences in the use of painkillers and antiemetics between the two groups in the first 3 days after surgery. When assessing hemodynamic parameters, a statistically significant difference was noted only in the change in systolic pressure — in patients in the main group, systolic pressure decreased to a greater extent than in the control group. The use of virtual reality technology as a method for reducing pain and anxiety is a promising direction, but did not show a statistically significant result. The effectiveness of this method may be reduced due to individual limitations in mastering the skills of using the equipment, and therefore additional studies with a larger group of subjects are required.

BACKGROUND Patients receiving standard treatment for chronic subdural hematoma have a high risk of treatment failure. The effect of adjunctive middle meningeal artery embolization on the risk of treatment failure in this population remains unknown. METHODS We randomly assigned patients with symptomatic chronic subdural hematoma to undergo middle meningeal artery embolization as an adjunct to standard treatment (embolization group) or to receive standard treatment alone (control group). Either surgical or nonsurgical standard treatment had been chosen for each patient before randomization. The primary efficacy outcome was a composite of the following events: recurrent or residual chronic subdural hematoma (measuring >10 mm) at 180 days; reoperation or surgical rescue within 180 days; or major disabling stroke, myocardial infarction, or death from neurologic causes within 180 days. The primary safety outcome was a composite of major disabling stroke or death from any cause within 30 days. RESULTS Among 310 enrolled patients, 149 were randomly assigned to the embolization group and 161 to the control group; 189 patients were to receive surgical standard treatment and 121 nonsurgical standard treatment. The mean age of the patients was 73 years, and 70% were men. In the primary efficacy analysis, a primary-outcome event occurred in 19 of 120 patients (16%) in the embolization group, as compared with 47 of 129 patients (36%) in the control group (odds ratio, 0.36; 95% confidence interval, 0.20 to 0.66; P = 0.001). In the primary safety analysis, 4 of 144 patients (3%) in the embolization group and 5 of 166 patients (3%) in the control group either had a major disabling stroke or died within 30 days. Through 180 days, 12 patients (8%) in the embolization group and 9 patients (5%) in the control group had died, with death from neurologic causes occurring in 1 patient (1%) in the embolization group and in 3 patients (2%) in the control group. CONCLUSIONS Among patients with symptomatic chronic subdural hematoma, adjunctive middle meningeal artery embolization resulted in a lower risk of treatment failure than standard treatment alone, without resulting in an increased incidence of disabling stroke or death in the short term. Further study of longer-term safety outcomes is warranted. (Funded by Balt USA; STEM ClinicalTrials.gov number, NCT04410146.).

The pathogenesis of chronic subdural hematoma (CSDH) has traditionally been associated with inflammation, but the efficacy of anti-inflammatory drug therapy is limited. Recent literatures suggest that immune dysregulation rather than sole inflammation, plays a vital role in the development of CSDH. In this study, the dynamics of macrophage polarization were explored to elucidate changes in immune status during CSDH evolution. Nakaguchi computerized tomography (CT) classification method was employed to categorize CSDH into four types, including homogeneous, laminar, separated and trabecular subtypes. Samples from the hematoma cavity were collected. The percentages of M1 and M2 macrophages and the M1/M2 proportion were determined by flow cytometry. The M1-related inflammatory (IL-1β, IL-6, IL-12, and TNF-α) and M2-related anti-inflammatory factors (IL-4, IL-10, IL-13, and TGF-β) were measured by ELISA. The relationship among CT subtypes, macrophage polarization and recurrence were evaluated by univariate and multivariate logistic regression analyses. A nomogram was established to score significant factors, and the bootstrap method was used for internal validation to calculate the concordance index (C-index) and generating calibration plots. A total of 127 patients with CSDH were included, among which 28 cases (22.04%) experienced recurrence within three months post-surgery. Significant differences were found in the percentages of M1 and M2 macrophages, the M1/M2 ratio, and related cytokines among different subtypes in CT classifications (P < 0.001). As CSDH evolved according to different CT subtypes, M1 macrophages gradually decreased, while M2 macrophages significantly increased, accompanied by a downregulation of the M1/M2 ratio. The similar changes were found in M1-related inflammatory cytokines (IL-1β, IL-6, IL-12, and TNF-α) and M2-related anti-inflammatory cytokines. Additionally, compared to the non-recurrence group, the recurrence group had higher percentages of M1 and M1/M2 ratio, but lower percentages of M2 (P < 0.05). LASSO regression analysis identified the dichotomized Nakaguchi CT classification, degree of brain atrophy, postoperative drainage volume, and hematoma volume were independent risk factors of recurrence (P < 0.05). Based on this, the established nomogram prediction model showed an AUC of 0.898, indicating good predictive efficacy and accuracy. The study demonstrated that the immune status within the hematoma cavity shifts from an inflammatory to an anti-inflammatory state during CSDH progression. Furthermore, it was found that altered immune balance gives rise to CSDH evolution and recurrence following surgery instead of inflammation itself.