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BACKGROUND: Approximately one-third of spontaneous intracerebral hemorrhage patients did not know the onset time and were excluded from studies about time-dependent treatments for hyperacute spontaneous intracerebral hemorrhage. AIMS: To help clinicians explore the benefit of time-dependent treatments for unclear-onset patients, we presented artificial intelligence models to identify onset time using non-contrast computed tomography (NCCT) based on weakly supervised multitask learning (WS-MTL) structure. METHODS: The patients with reliable symptom onset time (strong label) or repeat CT (weak label) were included and split into training set and test set (internal and external). The WS-MTL structure utilized strong and weak labels simultaneously to improve performance. The models included three binary classification models for classifying whether NCCT acquired within 6, 8 or 12 h for different treatments measured by area under curve, and a regression model for determining the exact onset time measured by mean absolute error. The generalizability of models was also explored in comprehensive analysis. RESULTS: A total of 4004 patients with 10,780 NCCT scans were included. The performance of WS-MTL classification model showed high accuracy, and that of regression model was satisfactory in ≤6 h subgroup. In comprehensive analysis, the WS-MTL showed better performance for larger hematomas and thinner scans. And the performance improved effectively as training amounts increasing and could be improved steadily through retraining. CONCLUSIONS: The WS-MTL models showed good performance and generalizability. Considering the large number of unclear-onset spontaneous intracerebral hemorrhage patients, it may be worth to integrate the WS-MTL model into clinical practice to identify the onset time.

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The programmed cell death 4 (PDCD4) tumor-suppressor gene regulates cell apoptosis, protein translation, signal transduction, and induction of mediators of inflammation. However, the mechanism by which PDCD4 is down-regulated and regulates tumor growth remains elusive. In this study, we showed that PDCD4 is down-regulated in glioma cells and acts as a tumor suppressor. Based on the TCGA data, we confirmed that AKT2, but not AKT1 or AKT3, interacts with PDCD4, thus leading to the suppression of PDCD4 in glioma cells. Moreover, the analysis suggested that PDCD4 regulates the expression of IL-5, CCL-5, VEGF, and CXCL10 via the NF-kB pathway. Additionally, depletion of levels of PDCD4 promoted angiogenic activity of glioma cells via the VEGF-STAT3 pathway. When tumor cells over-expressing PDCD4 were injected into nude mice, the increased expression of PDCD4 blocked tumorigenesis and prolonged overall survival. Our study indicates the need to develop drugs that can modulate the expression of PDCD4 and test their efficacy in clinical trials.

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Objective:To investigate the preoperative endocrinological characteristics of pituitary apoplexy of infarcted type.Methods:Twenty-six patients with pituitary apoplexy of infarcted type, confirmed by pathological pathology in our hospital from January 2010 to October 2019, were chosen. All patients were performed pituitary adenoma stroke scale before surgery, and endocrine examinations were performed on three pituitary target gland axes, namely the pituitary-thyroid axis, pituitary-gonadal axis and pituitary-adrenal axis, to evaluate the pituitary function and functions of three target gland axes.Results:Preoperative pituitary adenoma stroke scale scores were (1.92±1.78), ranged from 2 to 8. Twenty-five patients (96%) were with impaired pituitary function, including 13 patients (50%) with panhypopituitarism and 12 patients (46%) with partial hypopituitarism; in these 12 patients with partial hypopituitarism, 9 patients were noted to be involved two target gland axes, and 3 patients were noted to be involved one target gland axis. There were 22 patients (85%) with hypophysia-gonadal axis hypopituitarism, 14 (54%) with hypophysia-thyroid axis hypopituitarism, and 13 (50%) with hypophysia-adrenal axis hypopituitarism. Preoperative levels of prolactin in 26 patients (100%), testosterone in 26 patients (100%), luteinizing hormone in 18 patients (75%), progestational hormone in 18 patients (75%), thyroid stimulating hormone in 18 patients (69%), free triiodothyronine in 17 patients (65%), free thyroxine in 14 patients (54%), estradiol in 13 patients (54%), cortisol in 13 patients (52%), follicle stimulating hormone in 9 patients (38%), adrenocorticotrophic hormone in 9 patients (35%), growth hormone in 3 patients (15%) were lower as compared with baseline levels.Conclusion:Hypophysia-gonadal axis hypopituitarism is most common in pituitary apoplexy of infarcted type, and the endocrinological features are the sharp decrease of prolactin and testosterone levels.

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Objective@#To test whether the tryptophan metabolism was abnormal in newly diagnosed ITP patients as well as in these patients after treatment with dexamethasone.@*Methods@#Newly diagnosed patients with ITP between Jan 2014 and May 2015 were enrolled, including 14 females and 11 males, with a median age of 57 years and a median PLT count of 16 (0-32) ×109/L. All patients were treated with oral dexamethasone. The expression levels of IDO mRNA and TTS mRNA in peripheral blood mononuclear cells (PBMC) were analyzed by real-time quantitative polymerase chain reaction. ELISA was used to test the concentrations of IDO and TTS in serum. The concentrations of plasma kynurenine and tryptophan were detected by high-pressure liquid chromatography. Samples from healthy individuals were tested as controls.@*Results@#①After dexamethasone treatment, 17 patients resulted in persistent remission, 2 cases were ineffective, and relapse occurred in 6 cases at a median follow-up of 11 (6-18) months. ②Before and after dexamethasone treatment, the relative expression of indoleamine2,3-dioxygenase (IDO) mRNA and tryptophanyl t-RNA synthetase (TTS) mRNA showed that there were significant decline in persistent remission group (2.54±0.86 vs 19.85±5.36, t=3.188, P=0.003; 0.68±0.19 vs 45.39±15.83, t=2.842, P=0.008) , compared with the normal control group, the difference was not statistically significant (t=2.313, P=0.027; t=1.127, P=0.268) . After treatment, the IDO concentration decreased [ (19.34±0.42) U/ml] and the TTS concentration was markedly increased [ (13.37±0.54) μg/L] in sustained remission group compared with that before treatment [ (21.91±0.37) U/ml] as well as that in normal controls. In particularly, abnormal tryptophan catabolism could be recovered in these 17 patients with persistent remission [Try: (19.85±5.36) μmol/L vs (19.65±4.55) μmol/L, t=1.027, P=0.311; Kyn: (0.56±0.26) μmol/L vs (0.58±0.23) μmol/L, t=2.075, P=0.448]. ③There was no obviously difference in the relative expression of IDO mRNA and TTS mRNA, the concentration of IDO and TTS and the abnormal tryptophan catabolism between before and after treatment of dexamethasone in patients without response and relapsed patients (all P>0.01) .@*Conclusion@#The tryptophan catabolism was abnormal in ITP patients, and it could be recovered in patients with persistent remission.