Infusion of the colloid hydroxyethylstarch has been used for volume substitution to maintain hemodynamics and microcirculation after e.g., severe blood loss.In the last decade it was revealed that hydroxyethylstarch c...Infusion of the colloid hydroxyethylstarch has been used for volume substitution to maintain hemodynamics and microcirculation after e.g., severe blood loss.In the last decade it was revealed that hydroxyethylstarch can aggravate acute kidney injury, especially in septic patients.Because of the serious risk for critically ill patients, the administration of hydroxyethylstarch was restricted for clinical use.Animal studies and recently published in vitro experiments showed that hydroxyethylstarch might exert protective effects on the blood-brain barrier.Since the prevention of blood-brain barrier disruption was shown to go along with the reduction of brain damage after several kinds of insults, we revisit the topic hydroxyethylstarch and discuss a possible niche for the application of hydroxyethylstarch in acute brain injury treatment.展开更多
Morphometric changes in cortical thickness(CT),cortical surface area(CSA),and cortical volume(CV) can reflect pathological changes after acute mild traumatic brain injury(m TBI).Most previous studies focused on change...Morphometric changes in cortical thickness(CT),cortical surface area(CSA),and cortical volume(CV) can reflect pathological changes after acute mild traumatic brain injury(m TBI).Most previous studies focused on changes in CT,CSA,and CV in subacute or chronic m TBI,and few studies have examined changes in CT,CSA,and CV in acute m TBI.Furthermore,acute m TBI patients typically show transient cognitive impairment,and few studies have reported on the relationship between cerebral morphological changes and cognitive function in patients with m TBI.This prospective cohort study included 30 patients with acute m TBI(15 males,15 females,mean age 33.7 years) and 27 matched healthy controls(12 males,15 females,mean age 37.7 years) who were recruited from the Second Xiangya Hospital of Central South University between September and December 2019.High-resolution T1-weighted images were acquired within 7 days after the onset of m TBI.The results of analyses using Free Surfer software revealed significantly increased CSA and CV in the right lateral occipital gyrus of acutestage m TBI patients compared with healthy controls,but no significant changes in CT.The acute-stage m TBI patients also showed reduced executive function and processing speed indicated by a lower score in the Digital Symbol Substitution Test,and reduced cognitive ability indicated by a longer time to complete the Trail Making Test-B.Both increased CSA and CV in the right lateral occipital gyrus were negatively correlated with performance in the Trail Making Test part A.These findings suggest that cognitive deficits and cortical alterations in CSA and CV can be detected in the acute stage of m TBI,and that increased CSA and CV in the right lateral occipital gyrus may be a compensatory mechanism for cognitive dysfunction in acute-stage m TBI patients.This study was approved by the Ethics Committee of the Second Xiangya Hospital of Central South University,China(approval No.086) on February 9,2019.展开更多
Objective: To explore contrast application on CT and BA in acute cerebrovascular diseases.Method: CT and BA were examined in 718 patients with acute cerebrovascular disease. Results: The different changes of CT and BA...Objective: To explore contrast application on CT and BA in acute cerebrovascular diseases.Method: CT and BA were examined in 718 patients with acute cerebrovascular disease. Results: The different changes of CT and BA were showed in 718 patients with acute cerebrovascular disease. Conclusion: There were separately different advantage and shortcoming in CT and BA in diagnosis of acute cerebrovascular diseases. The value of clinical application of BA was important in acute cerebrovascular diseases.展开更多
BACKGROUND The exact definition of Acute kidney injury(AKI)for patients with traumatic brain injury(TBI)is unknown.AIM To compare the power of the“Risk,Injury,Failure,Loss of kidney function,and End-stage kidney dise...BACKGROUND The exact definition of Acute kidney injury(AKI)for patients with traumatic brain injury(TBI)is unknown.AIM To compare the power of the“Risk,Injury,Failure,Loss of kidney function,and End-stage kidney disease”(RIFLE),Acute Kidney Injury Network(AKIN),Creatinine kinetics(CK),and Kidney Disease Improving Global Outcomes(KDIGO)to determine AKI incidence/stage and their association with the inhospital mortality rate of patients with TBI.METHODS This retrospective study collected the data of patients admitted to the intensive care unit for neurotrauma from 2001 to 2012,and 1648 patients were included.The subjects in this study were assessed for the presence and stage of AKI using RIFLE,AKIN,CK,and KDIGO.In addition,the propensity score matching method was used.RESULTS Among the 1648 patients,291(17.7%)had AKI,according to KDIGO.The highest incidence of AKI was found by KDIGO(17.7%),followed by AKIN(17.1%),RIFLE(12.7%),and CK(11.5%)(P=0.97).Concordance between KDIGO and RIFLE/AKIN/CK was 99.3%/99.1%/99.3%for stage 0,36.0%/91.5%/44.5%for stage 1,35.9%/90.6%/11.3%for stage 2,and 47.4%/89.5%/36.8%for stage 3.The in-hospital mortality rates increased with the AKI stage in all four definitions.The severity of AKI by all definitions and stages was not associated with inhospital mortality in the multivariable analyses(all P>0.05).CONCLUSION Differences are seen in AKI diagnosis and in-hospital mortality among the four AKI definitions or stages.This study revealed that KDIGO is the best method to define AKI in patients with TBI.展开更多
基金supported by a grant from the Forschungskommission der Medizinischen Fakultat,Albert-Ludwigs-Universitat Freiburg(SCHI1123/17,to MAS)。
文摘Infusion of the colloid hydroxyethylstarch has been used for volume substitution to maintain hemodynamics and microcirculation after e.g., severe blood loss.In the last decade it was revealed that hydroxyethylstarch can aggravate acute kidney injury, especially in septic patients.Because of the serious risk for critically ill patients, the administration of hydroxyethylstarch was restricted for clinical use.Animal studies and recently published in vitro experiments showed that hydroxyethylstarch might exert protective effects on the blood-brain barrier.Since the prevention of blood-brain barrier disruption was shown to go along with the reduction of brain damage after several kinds of insults, we revisit the topic hydroxyethylstarch and discuss a possible niche for the application of hydroxyethylstarch in acute brain injury treatment.
基金supported by the National Natural Science Foundation of China,No.81671671 (to JL)。
文摘Morphometric changes in cortical thickness(CT),cortical surface area(CSA),and cortical volume(CV) can reflect pathological changes after acute mild traumatic brain injury(m TBI).Most previous studies focused on changes in CT,CSA,and CV in subacute or chronic m TBI,and few studies have examined changes in CT,CSA,and CV in acute m TBI.Furthermore,acute m TBI patients typically show transient cognitive impairment,and few studies have reported on the relationship between cerebral morphological changes and cognitive function in patients with m TBI.This prospective cohort study included 30 patients with acute m TBI(15 males,15 females,mean age 33.7 years) and 27 matched healthy controls(12 males,15 females,mean age 37.7 years) who were recruited from the Second Xiangya Hospital of Central South University between September and December 2019.High-resolution T1-weighted images were acquired within 7 days after the onset of m TBI.The results of analyses using Free Surfer software revealed significantly increased CSA and CV in the right lateral occipital gyrus of acutestage m TBI patients compared with healthy controls,but no significant changes in CT.The acute-stage m TBI patients also showed reduced executive function and processing speed indicated by a lower score in the Digital Symbol Substitution Test,and reduced cognitive ability indicated by a longer time to complete the Trail Making Test-B.Both increased CSA and CV in the right lateral occipital gyrus were negatively correlated with performance in the Trail Making Test part A.These findings suggest that cognitive deficits and cortical alterations in CSA and CV can be detected in the acute stage of m TBI,and that increased CSA and CV in the right lateral occipital gyrus may be a compensatory mechanism for cognitive dysfunction in acute-stage m TBI patients.This study was approved by the Ethics Committee of the Second Xiangya Hospital of Central South University,China(approval No.086) on February 9,2019.
文摘Objective: To explore contrast application on CT and BA in acute cerebrovascular diseases.Method: CT and BA were examined in 718 patients with acute cerebrovascular disease. Results: The different changes of CT and BA were showed in 718 patients with acute cerebrovascular disease. Conclusion: There were separately different advantage and shortcoming in CT and BA in diagnosis of acute cerebrovascular diseases. The value of clinical application of BA was important in acute cerebrovascular diseases.
文摘BACKGROUND The exact definition of Acute kidney injury(AKI)for patients with traumatic brain injury(TBI)is unknown.AIM To compare the power of the“Risk,Injury,Failure,Loss of kidney function,and End-stage kidney disease”(RIFLE),Acute Kidney Injury Network(AKIN),Creatinine kinetics(CK),and Kidney Disease Improving Global Outcomes(KDIGO)to determine AKI incidence/stage and their association with the inhospital mortality rate of patients with TBI.METHODS This retrospective study collected the data of patients admitted to the intensive care unit for neurotrauma from 2001 to 2012,and 1648 patients were included.The subjects in this study were assessed for the presence and stage of AKI using RIFLE,AKIN,CK,and KDIGO.In addition,the propensity score matching method was used.RESULTS Among the 1648 patients,291(17.7%)had AKI,according to KDIGO.The highest incidence of AKI was found by KDIGO(17.7%),followed by AKIN(17.1%),RIFLE(12.7%),and CK(11.5%)(P=0.97).Concordance between KDIGO and RIFLE/AKIN/CK was 99.3%/99.1%/99.3%for stage 0,36.0%/91.5%/44.5%for stage 1,35.9%/90.6%/11.3%for stage 2,and 47.4%/89.5%/36.8%for stage 3.The in-hospital mortality rates increased with the AKI stage in all four definitions.The severity of AKI by all definitions and stages was not associated with inhospital mortality in the multivariable analyses(all P>0.05).CONCLUSION Differences are seen in AKI diagnosis and in-hospital mortality among the four AKI definitions or stages.This study revealed that KDIGO is the best method to define AKI in patients with TBI.
