Association between neutrophil-to-lymphocyte ratio and major postoperative complications after carotid endarterectomy:A retrospective cohort study

BACKGROUND Carotid artery cross-clamping during carotid endarterectomy(CEA)may damage local cerebral perfusion and induce cerebral ischemia–reperfusion injury to activate local inflammatory responses.Neutrophil-to-lymphocyte ratio(NLR)is an indicator that reflects systemic inflammation.However,the correlation between NLR and complications after CEA remains unclear.AIM To investigate the association between NLR and major complications after surgery in patients undergoing CEA.METHODS This retrospective cohort study included patients who received CEA between January 2016 and July 2018 at Beijing Tiantan Hospital.Neutrophil and lymphocyte counts in whole blood within 24 h after CEA were collected.The primary outcome was the composite of major postoperative complications including neurological,pulmonary,cardiovascular and acute kidney injuries.The secondary outcomes included infections,fever,deep venous thrombosis,length of hospitalization and cost of hospitalization.Statistical analyses were performed using EmpowerStats software and R software.RESULTS A total of 224 patients who received CEA were screened for review and 206 were included in the statistical analyses;of whom,40(19.42%)developed major postoperative complications.NLR within 24 h after CEA was significantly correlated with major postoperative complications(P=0.026).After confounding factors were adjusted,the odds ratio was 1.15(95%CI:1.03–1.29,P=0.014).The incidence of major postoperative complications in the high NLR group was 8.47 times that in the low NLR group(P=0.002).CONCLUSION NLR is associated with major postoperative complications in patients undergoing CEA.

Awake craniotomy for auditory brainstem implant in patients with neurofibromatosis type 2:Four case reports

BACKGROUND The auditory brainstem implant(ABI)is a significant treatment to restore hearing sensations for neurofibromatosis type 2(NF2)patients.However,there is no ideal method in assisting the placement of ABIs.In this case series,intraoperative cochlear nucleus mapping was performed in awake craniotomy to help guide the placement of the electrode array.CASE SUMMARY We applied the asleep-awake-asleep technique for awake craniotomy and hearing test via the retrosigmoid approach for acoustic neuroma resections and ABIs,using mechanical ventilation with a laryngeal mask during the asleep phases,utilizing a ropivacaine-based regional anesthesia,and sevoflurane combined with propofol/remifentanil as the sedative/analgesic agents in four NF2 patients.ABI electrode arrays were placed in the awake phase with successful intraoperative hearing tests in three patients.There was one uncooperative patient whose awake hearing test needed to be aborted.In all cases,tumor resection and ABI were performed safely.Satisfactory electrode effectiveness was achieved in awake ABI placement.CONCLUSION This case series suggests that awake craniotomy with an intraoperative hearing test for ABI placement is safe and well tolerated.Awake craniotomy is beneficial for improving the accuracy of ABI electrode placement and meanwhile reduces non-auditory side effects.

Perioperative massive cerebral stroke in thoracic patients:Report of three cases

BACKGROUNDPerioperative stroke is a rare but devastating complication. The risk factors formassive cerebral stroke in surgical patients include older age, male sex, priorcerebrovascular disease, hypertension, renal failure, smoking, diabetes mellitus,and atrial fibrillation.CASE SUMMARYWe describe two cases of perioperative massive cerebral stroke following thoracicsurgery and one case following bronchoscopy. Neurologic symptoms, includingchanges in mental status and hemiplegia, occurred within 10 h after surgery in thethree patients. All three patients died after the surgery.CONCLUSIONPerioperative massive cerebral stroke may be more likely to occur in thoracicsurgical patients if there are pre-existing factors including previous stroke,hypotension, and hypoxemia. Sufficient pain control after surgery and timelyneurology consultation and management are helpful for the diagnosis and controlof stroke in high-risk patients.

Changes in Rat Brain MicroRNA Expression Profiles Following Sevoflurane and Propofol Anesthesia

Background： Sevoflurane and propofol are widely nsed anesthetics focused on changes in protein expression properties and membrane for surgery. Studies on the mechanisms of general anesthesia have lipid. MicroRNAs （miRNAs） regulate neural function by altering protein expression. We hypothesize that sevoflurane and propofol affect miRNA expression profiles in the brain, expect to understand the mechanism of anesthetic agents. Methods： Rats were randomly assigned to a 2% sevoflurane group, 600 μg-kg -1min propofol group, and a control group without anesthesia （n = 4, respectively）. Treatment group was under anesthesia for 6 h, and all rats breathed spontaneously with continuous monitoring of respiration and blood gases. Changes in rat cortex miRNA expression profiles were analyzed by miRNA microarrays and validated by quantitative real-time polymerase chain reaction （qRT-PCR）. Differential expression of miRNA using qRT-PCR among the control, sevoflurane, and propotbl groups were compared using one-way analysis of variance （ANOVA）. Results： Of 677 preloaded rat miRNAs, the microarray detected the expression of 277 miRNAs in rat cortex （40.9%）, of which 9 were regulated by propofol and （or） sevoflurane. Expression levels of three miRNAs （rno-miR-339-3p, rno-miR-448, rno-miR-466b- 1 ＊） were significantly increased following sevoflurane and six （rno-miR-339-3p, rno-miR-347, rno-miR-378＊, rno-miR-412＊, rno-miR-702-3p, and rno-miR-7a-2＊） following propofol. Three miRNAs （rno-miR-466b-I ＊, rno-miR-3584-Sp and rno-miR-702-3p） were differentially expressed by the two anesthetic treatment groups. Conclusions： Sevoflurane and propofol anesthesia induced distinct changes in brain miRNA expression patterns, suggesting differential regulation of protein expression. Determining the targets of these differentially expressed miRNAs may help reveal both the common and agent-specific actions of anesthetics on neurological and physiological function.