Risk Factors and Prognostic Factors of Acute Kidney Injury in Children: a Retrospective Study between 2003 and 2013

Summary： Recent report on epidemiology of acute kidney injury （AKI） is lacking for Chinese children. We aimed to investigate the risk factors for stage and prognostic factors for renal recovery in hospital- ized children. Pediatric patients （〈18 years old） admitted during 2003 to 2013 were enrolled in this study. AKI was defined and staged using Kidney Disease Improving Global Outcomes （KDIGO） crite- ria. Logistic regression analysis was performed to determine the risk factors and prognostic factors. The morbidity of pediatric AKI was 0.31% （205/65 237）. There were 45 （22.0%） cases in stage I, 30 （14.6%） cases in stage II and 130 （63.4%） cases in stage Ill. The majority of etiologies were intrinsic renal defects （85.4%）. Age, weight, vomit, etiology, blood urea nitrogen （BUN） at admission and sev- eral blood gas measurements were associated with AKI stage III. Age （OR=0.894; 95% CI, 0.832- 0.962; P=0.003）, vomit （OR=2.375; 95% CI, 1.058-5.333; P=0.036） and BUN at admission （OR=1.135;95% CI, 1.085-1.187; P〈0.001） were identified as independent risk factors for AKI stage Ill. After treatment, 172 （83.9%） patients achieved complete or partial recovery. The mortality was 3.9%. Variables were found as prognostic factors for renal recovery, such as age, stage, hospital stay, BUN at discharge, white blood cells, red blood cells, platelets （PLTs）, blood pH and urine blood. Among them, AKI stage（stage III vs. stage I ; OR, 6.506; 95% CI, 1.640-25.816; P=0.008）, BUN at discharge （OR, 0.918; 95% CI, 0.856-0.984; P=0.016） and PLTs （OR, 1.007; 95% CI, 1.001- 1.013; P=0.027） were identified as independent prognostic factors. AKI is still common in Chinese hos- pitalized children. Identified risk factors and prognostic factors provide guiding information for clinical management of AKI.

Acute kidney injury following spinal instrumentation surgery in children

AIM To determine acute kidney in jury （AKI） incidence and potential risk factors of AKI in children undergoing spinal instrumentation surgery. METHODS AKI incidence in children undergoing spinal instru-mentation surgery at British Columbia Children’s Hospital between January 2006 and December 2008 was determined by the Acute Kidney Injury Networ classification using serum creatinine and urine output criteria. During this specific time period, all patients following spinal surgery were monitored in the pediatric intensive care unit and had an indwelling Foley catheter permitting hourly urine output recording. Cases of AKI were identifed from our database. From the remaining cohort, we selected group-matched controls that did not satisfy criteria for AKI. The controls were matched for sex, age and underlying diagnosis （idiopathic vs non-idiopathic scoliosis）. RESULTS Thirty five of 208 patients met criteria for AKI with an incidence of 17% （95%CI： 12%-23%）. Of all children who developed AKI, 17 （49%） developed mild AKI （AKI Stage 1）, 17 （49%） developed moderate AKI （Stage 2） and 1 patient （3%） met criteria for severe AKI （Stage 3）. An inverse relationship was observed with AKI incidence and the amount of fluids received intra-operatively. An inverse relationship was observed with AKI incidence and the amount of fuids received intra-operatively classifed by fluid tertiles： 70% incidence in those that received the least amount of fluids vs 29% that received the most fluids （〉 7.9, P = 0.02）. Patients who developed AKI were more frequently exposed to nephrotoxins （non steroidal anti inflammatory drugs or aminoglycosides） than control patients during their peri-operative course （60% vs 22%, P 〈 0.001）. CONCLUSION We observed a high incidence of AKI following spinal instrumentation surgery in children that is potentially related to the frequent use of nephrotoxins and the amount of fuid administered peri-operatively.

MK-801 attenuates lesion expansion following acute brain injury in rats: a meta-analysis

OBJECTIVE: To evaluate the efficacy and safety of MK-801 and its effect on lesion volume in rat models of acute brain injury.DATA SOURCES: Key terms were "stroke","brain diseases","brain injuries","brain hemorrhage, traumatic","acute brain injury","dizocilpine maleate","dizocilpine","MK-801","MK801","rat","rats","rattus" and "murine". PubMed, Cochrane library, EMBASE, the China National Knowledge Infrastructure, WanFang database, the VIP Journal Integration Platform(VJIP) and SinoMed databases were searched from their inception dates to March 2018.DATA SELECTION: Studies were selected if they reported the effects of MK-801 in experimental acute brain injury. Two investigators independently conducted literature screening, data extraction, and methodological quality assessments.OUTCOME MEASURES: The primary outcomes included lesion volume and brain edema. The secondary outcomes included behavioral assessments with the Bederson neurological grading system and the water maze test 24 hours after brain injury.RESULTS: A total of 52 studies with 2530 samples were included in the systematic review. Seventeen of these studies had a high methodological quality. Overall, the lesion volume(34 studies, n = 966, MD =-58.31, 95% CI:-66.55 to-50.07;P < 0.00001) and degree of cerebral edema(5 studies, n = 75, MD =-1.21, 95% CI:-1.50 to-0.91;P < 0.00001) were significantly decreased in the MK-801 group compared with the control group. MK-801 improved spatial cognition assessed with the water maze test(2 studies, n = 60, MD =-10.88, 95% CI:-20.75 to-1.00;P = 0.03) and neurological function 24 hours after brain injury(11 studies, n = 335, MD =-1.04, 95% CI:-1.47 to-0.60;P < 0.00001). Subgroup analysis suggested an association of reduction in lesion volume with various injury models(34 studies, n = 966, MD =-58.31, 95% CI:-66.55 to-50.07;P = 0.004). Further network analysis showed that 0–1 mg/kg MK-801 may be the optimal dose for treatment in the middle cerebral artery occlusion animal model.CONCLUSION: MK-801 effectively reduces brain lesion volume and the degree of cerebral edema in rat models of experimental acute brain injury, providing a good neuroprotective effect. Additionally, MK-801 has a good safety profile, and its mechanism of action is well known. Thus, MK-801 may be suitable for future clinical trials and applications.

Hydroxyethylstarch revisited for acute brain injury treatment

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.

Effects of acute brain injury on the contents of neurotensin in brain areas,pituitary gland and plasma in rats

The changes of immunoreactive neurotensin(ir-NT)contents in the brain areas,pituitary gland and plasma in the traumatized rats were observed in the present study.The results of radioimmunoassay exhibited significant changes of the ir-NT contents inthe hypothalamus,pituitary gland,plasma,injured tissue,hippocampus,central gray andspinal cord in the posttraumatic rats at different intervals.A predominant characteristicsof the changes of ir-NT levels in the brain areas,pituitary gland and plasma was thedramatical decrease at various times except for the hypothalamus,central gray andhippocampus with biphasic alterations.The ir-NT contents in the frontal cortex andpons-medulla also displayed changes to different extent under the acute craniocerebraltrauma condition.These results suggest that NT may play a role in the pathophysiologyof traumatic head injury.

Effects of positive end-expiratory pressure on intracranial pressure,cerebral perfusion pressure,and brain oxygenation in acute brain injury:Friend or foe?A scoping review

Background Patients with acute brain injury(ABI)are a peculiar population because ABI does not only affect the brain but also other organs such as the lungs,as theorized in brain–lung crosstalk models.ABI patients often require mechanical ventilation(MV)to avoid the complications of impaired respiratory function that can follow ABI;MV should be settled with meticulousness owing to its effects on the intracranial compartment,especially regarding positive end-expiratory pressure(PEEP).This scoping review aimed to(1)describe the physiological basis and mechanisms related to the effects of PEEP in ABI;(2)examine how clinical research is conducted on this topic;(3)identify methods for setting PEEP in ABI;and(4)investigate the impact of the application of PEEP in ABI on the outcome.Methods The five-stage paradigm devised by Peters et al.and expanded by Arksey and O'Malley,Levac et al.,and the Joanna Briggs Institute was used for methodology.We also adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)extension criteria.Inclusion criteria:we compiled all scientific data from peer-reviewed journals and studies that discussed the application of PEEP and its impact on intracranial pressure,cerebral perfusion pressure,and brain oxygenation in adult patients with ABI.Exclusion criteria:studies that only examined a pediatric patient group(those under the age of 18),experiments conducted solely on animals;studies without intracranial pressure and/or cerebral perfusion pressure determinations,and studies with incomplete information.Two authors searched and screened for inclusion in papers published up to July 2023 using the PubMed-indexed online database.Data were presented in narrative and tubular form.Results The initial search yielded 330 references on the application of PEEP in ABI,of which 36 met our inclusion criteria.PEEP has recognized beneficial effects on gas exchange,but it produces hemodynamic changes that should be predicted to avoid undesired consequences on cerebral blood flow and intracranial pressure.Moreover,the elastic properties of the lungs influence the transmission of the forces applied by MV over the brain so they should be taken into consideration.Currently,there are no specific tools that can predict the effect of PEEP on the brain,but there is an established need for a comprehensive monitoring approach for these patients,acknowledging the etiology of ABI and the measurable variables to personalize MV.Conclusion PEEP can be safely used in patients with ABI to improve gas exchange keeping in mind its potentially harmful effects,which can be predicted with adequate monitoring supported by bedside non-invasive neuromonitoring tools.

Assessment of Social Participation in Three Measurement Times in Children with Traumatic Brain Injuries (TBI) Based on Parental Perceptions

Purpose: The aim of this study was to measure social participation in children with traumatic brain injuries (TBI) on their parental perceptions, retrospectively for the pre-injury period, at the beginning of rehabilitation and one year after return to school. Methods: This study was conducted among 17 children aged 5 to 17 years old with moderate or severe TBI and their parents. Social participation was assessed using the LIFE-H for Children (1.0). Results: A significant decrease (p ≤ 0.001) in the level of accomplishment of life habits was found for all categories between the measurements taken pre-injury and at the beginning of rehabilitation. Significant differences (p ≤ 0.002) related to the increase in the life habit accomplishment scores were also found between measurements taken at the beginning of rehabilitation and one year after return to school. Conclusion: TBI significantly affected the accomplishment of life habits of the participants compared to their pre-injury level. The assessment of social participation at various times provides a report on the client’s progress and allows clinicians to update his or her intervention plan, to plan follow-ups or to end the intervention. This knowledge must be considered by anyone involved in helping these children to achieve their greatest social participation.

FOXO1 reshapes neutrophils to aggravate acute brain damage and promote late depression after traumatic brain injury

Background:Neutrophils are traditionally viewed as first responders but have a short onset of action in response to traumatic brain injury(TBI).However,the heterogeneity,multifunctionality,and time-dependent modulation of brain damage and outcome mediated by neutrophils after TBI remain poorly understood.Methods:Using the combined single-cell transcriptomics,metabolomics,and proteomics analysis from TBI patients and the TBI mouse model,we investigate a novel neutrophil phenotype and its associated effects on TBI outcome by neurological deficit scoring and behavioral tests.We also characterized the underlying mechanisms both invitro and invivo through molecular simulations,signaling detections,gene expression regulation assessments[including dual-luciferase reporter and chromatin immunoprecipitation(ChIP)assays],primary cultures or co-cultures of neutrophils and oligodendrocytes,intracellular iron,and lipid hydroperoxide concentration measurements,as well as forkhead box protein O1(FOXO1)conditional knockout mice.Results:We identified that high expression of the FOXO1 protein was induced in neutrophils after TBI both in TBI patients and the TBI mouse model.Infiltration of these FOXO1high neutrophils in the brain was detected not only in the acute phase but also in the chronic phase post-TBI,aggravating acute brain inflammatory damage and promoting late TBI-induced depression.In the acute stage,FOXO1 upregulated cytoplasmic Versican(VCAN)to interact with the apoptosis regulator B-cell lymphoma-2(BCL-2)-associated X protein(BAX),suppressing the mitochondrial translocation of BAX,which mediated the antiapoptotic effect companied with enhancing interleukin-6(IL-6)production of FOXO1high neutrophils.In the chronic stage,the“FOXO1-transferrin receptor(TFRC)”mechanism contributes to FOXO1high neutrophil ferroptosis,disturbing the iron homeostasis of oligodendrocytes and inducing a reduction in myelin basic protein,which contributes to the progression of late depression after TBI.Conclusions:FOXO1high neutrophils represent a novel neutrophil phenotype that emerges in response to acute and chronic TBI,which provides insight into the heterogeneity,reprogramming activity,and versatility of neutrophils in TBI.

Therapies for children with cerebral palsy A Web of Science-based literature analysis

OBJECTIVE： To identify global research trends in three therapies for children with cerebral palsy. DATA RETRIEVAL： We performed a bibliometric analysis of studies on therapies for children with cerebral palsy from 2002 to 2011 retrieved from Web of Science. SELECTION CRITERIA： Inclusion criteria： （a） peer-reviewed published articles on botulinum toxin, constraint-induced movement therapy, or acupuncture for children with cerebral palsy indexed in Web of Science; （b） original research articles, reviews, meeting abstracts, proceedings papers, book chapters, editorial material, and news items; and （c） publication between 2002 and 2011. Exclusion criteria： （a） articles that required manual searching or telephone access; （b） documents that were not published in the public domain; and （c） a number of corrected papers from the total number of articles. MAIN OUTCOME MEASURES： （1） Number of publications on the three therapies; （2） annual publication output, distribution by journals, distribution by institution, and top-cited articles on botulinum toxin; （3） annual publication output, distribution by journal, distribution by institution, and top-cited articles on constraint-induced movement therapy; （4） annual publication, distribution by journal, distribution by institution, and top-cited articles on acupuncture. RESULTS： This analysis, based on Web of Science articles, identified several research trends in studies published over the past 10 years of three therapies for children with cerebral palsy. More articles on botulinum toxin for treating children with cerebral palsy were published than the articles regarding constraint-induced movement therapy or acupuncture. The numbers of publications increased over the 10-year study period. Most papers appeared in journals with a focus on neurology, such as Developmental Medicine and Child Neurology and Journal of Child Neurology.Research institutes publishing on botulinum toxin treatments for this population are mostly in the Netherlands, the United States of America, and Australia; those publishing on constraint-induced movement therapy are mostly in Australia and the United States of America; and those publishing on acupuncture are mostly in China, Sweden and the United States of America.CONCLUSION： Analysis of literature and research trends indicated that there was no one specific therapy to cure cerebral palsy. Further studies are still necessary.

Sports-Related Concussion in School-Age Children

Viewed through the lens of public health, sports-related concussion or mild traumatic brain injury is an epidemic health problem. This paper commences with a scoping review of sport-related concussion and mild traumatic brain injury considering its historical background, clinical definitions, epidemiology, and pathophysiology and treatment. The second section assesses the complex interplay of intrapersonal and interpersonal, community, and societal factors that influence sport-related concussion and mild traumatic brain injury. The third section concludes with recommendations for policy changes and further research to mitigate the health impact of sports-related concussion in adolescent school-age children. The optimal management of sports-related concussion requires care going beyond the acute injury, and into the school setting to maximize their academic and social outcomes. This is more likely to occur when healthcare and educational systems are optimally coordinated.

Amplitude-Integrated Electroencephalography Predicts Outcome in Patients with Coma After Acute Brain Injury

Prognostication of coma patients after brain injury is important, yet challenging. In this study, we evaluated the predictive value of amplitude-integrated electroencephalography （aEEG） for neurological outcomes in coma patients. From January 2013 to January 2016, 128 coma patients after acute brain injury were prospectively enrolled and monitored with aEEG. The 6-month neurological outcome was evaluated using the Cerebral Performance Category Scale. aEEG monitoring commenced at a median of 7.5 days after coma onset. Continuous normal voltage predicted a good 6-month neurological outcome with a sensitivity of 93.6% and specificity of 85.2%. In contrast, continuous extremely low voltage, burst-suppression, or a flat tracing was correlated with poor 6-month neurological outcome with a sensitivity of 76.5% and specificity of 100%. In conclusion, aEEG is a promising predictor of 6-month neurological outcome for coma patients after acute brain injury.

The electrocardiographic changes in acute brain injury patients

Background Electrocardiographic （ECG） changes occurring during the course of acute brain injury （ABI） have been described frequently, but their significances remain uncertain. The present study was designed to investigate the relation of ECG abnormalities to outcome in the patients with ABI. Methods We performed a retrospective, observational study on the ABI patients admitted to the Department of Neurosurgery of the Beijing Tiantan Hospital between December 2005 and December 2007. All the patients accepted 12-lead electrocardiographic examination within 24 hours after injury, then divided into three groups according to the Glasgow coma score （GCS）. In-hospital mortality and one-month outcome assessed by the Glasgow outcome score （GOS） were investigated. Results Of 335 ABI patients （mean ages 32.4 years）, 246 patients （73.4%） had abnormal ECGs. The most common abnormality was ST-T changes （41.5%）, followed by sinus tachycardia （23.6%）. ECG changes had a significant association with the severity and outcome. Logistic regression analysis showed the presence of ST-T changes （OR 2.587, 95%C/1.009 to 6.629, P=0.048） and QT dispersion prolongation （OR 4.656, 95%C/1.956 to 11.082, P=0.001） significantly associated with short outcomes. Conclusions ABI can lead to myocardial damage and ECG changes had a significant association with the severity. ST-T changes and QT dispersion prolongation were the independent prognosis factors for the negative outcome of ABI patients.

Occurrence of early epilepsy in children with traumatic brain injury:a retrospective study

Background Early post-traumatic seizures(EPTS)refer to epileptic seizures occurring within one week after brain injury.This study aimed to define the risk factors of EPTS and the protective factors that could prevent its occurrence.Methods This is a single-center retrospective study in the PICU,Beijing Children's Hospital.Patients diagnosed with traumatic brain injury(TBI),admitted with and without EPTS between January 2016 and December 2020 were included in the study.Results We included 108 patients diagnosed with TBI.The overall EPTS incidence was 33.98%(35/108).The correlation between EPTS and depressed fractures is positive(P=0.023).Positive correlations between EPTS and intracranial hemorrhage and subarachnoid hemorrhage had been established(P=0.011 and P=0.004,respectively).The detection rates of EPTS in the electroencephalogram(EEG)monitoring was 80.00%.There was a significant difference in the EEG monitoring rate between the two groups(P=0.041).Forty-one(37.86%,41/108)post-neurosurgical patients were treated with prophylactic antiepileptic drugs(AEDs),and eight(19.51%,8/41)still had seizures.No statistical significance was noted between the two groups in terms of prophylactic AEDs use(P=0.519).Logistic regression analysis revealed that open craniocerebral injury and fever on admission were risk factors for EPTS,whereas,surgical intervention and use of hypertonic saline were associated with not developing EPTS.Conclusions Breakthrough EPTS occurred after severe TBI in 33.98%of pediatric cases in our cohort.This is a higher seizure incidence than that reported previously.Patients with fever on admission and open craniocerebral injuries are more likely to develop EPTS.

Intraoperative Blood Glucose Levels and Postoperative Acute Kidney Injury in Pediatric Patients Having Congenital Heart Surgery under Cardiopulmonary Bypass

Purpose:This study sought to explore the effect of intraoperative mean blood glucose levels and variability on postoperative acute kidney injury(AKI)in children undergoing congenital cardiac surgery.Methods:We conducted a prospective nested case-control study in children(age<18 years)undergoing congenital heart surgery with cardiopulmonary bypass(CPB)at the Fuwai Hospital between April 01,2022 and July 30,2022.Cases were individuals who developed AKI within the first postoperative 7 days(AKI group)and controls were those without AKI(Non-AKI group)according to KDIGO criteria.AKI and Non-AKI groups unmatched and 1:1 matched by age,sex,and baseline serum creatinine were separately analyzed.Multivariate logistic and conditional logistic regressions were used to assess the associations between blood glucose variables and AKI.Results:688 consecutively approached patients were included in the final analysis.On multivariate analysis,intra-CPB(adjusted odds ratio[OR]0.802;95%confidence interval[CI],0.706 to 0.912;p=0.001)and post-CPB(adjusted OR 0.830;95%CI,0.744 to 0.925;p=0.001)blood glucose levels were associated with postoperative AKI.There were no significant differences in pre-CPB blood glucose(adjusted OR 0.926;95%CI,0.759 to 1.129;p=0.446)or intraoperative glycemic fluctuations(adjusted OR 0.905;95%CI,0.723 to 1.132;p=0.382)between AKI and Non-AKI groups.Results based on matched cases and controls were consistent with those from the unmatched analyses.Conclusion:Higher intraoperative blood glucose levels during and after CPB were protective factors against postoperative AKI in pediatric patients after congenital heart surgery.

Plasma gelsolin level predicts acute kidney injury after cardiopulmonary bypass in infants and young children

Background Acute kidney injury(AKI)after cardiopulmonary bypass(CPB)is a common complication especially in pedi-atric population.Plasma gelsolin(pGSN)is an anti-inflammatory factor through binding with actin and pro-inflammatory cytokines in circulation.Decrease in pGSN has been reported in some pathologic conditions.The purpose of the study was to determine the alterations of pGSN level in infants and young children after CPB and the role of pGSN as a predictor for the morbidity and severity of post-CPB AKI.Methods Sixty-seven infants and young children at age≤3 years old undergoing CPB were prospectively enrolled.PGSN levels were measured during peri-operative period with enzyme-linked immuno-sorbent assay and normalized with plasma total protein concentration.Other clinical characteristics of the patients were also recorded.Results In patients developing AKI,the normalized pGSN(pGSN_(N))levels significantly decreased at 6 h post-operation and remained low for 24 h post-operation as compared to the patients with non-AKI.PGSNN at 6 h post-operation combining with CPB time presents an excellent predictive value for AKI.Conclusions Decreased pGSN_(N)identifies post-CPB AKI in the patients≤3 years old,and is associated with adverse clini-cal outcomes.The findings suggest that circulating GSN in post-CPB patients may have beneficial effects on diminishing inflammatory responses.

Acute drivers of neuroinflammation in traumatic brain injury

Neuroinflammation is initiated as a result of traumatic brain injury and can exacerbate evolving tissue pathology.Immune cells respond to acute signals from damaged cells,initiate neuroinflammation,and drive the pathological consequences over time.Importantly,the mechanism(s)of injury,the location of the immune cells within the brain,and the animal species all contribute to immune cell behavior following traumatic brain injury.Understanding the signals that initiate neuroinflammation and the context in which they appear may be critical for understanding immune cell contributions to pathology and regeneration.Within this paper,we review a number of factors that could affect immune cell behavior acutely following traumatic brain injury.

Acute kidney injury in traumatic brain injury intensive care unit patients

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.

Effects of Remifentanil Pretreatment on Inflammatory Response in Rats with Acute Cerebral Ischemia Injury

[Objectives]This study was conducted to investigate the effects of remifentanil pretreatment on inflammatory factors in rats with acute cerebral ischemia.[Methods]Sixty SD rats were randomly divided into the normal control group,sham operation group,ischemic brain injury group,and remifentanil pretreatment group.Except the normal control group,each group was divided into three subgroups(six in each group)according to the sampling time points of 6,12 and 24 h after execution.After modeling,the rats were scored for neurological deficit,and observed for pathological changes of neurons in the brain tissue by HE staining and the brain infarct volume by TTC staining,and the expression levels of TNF-α,IL-6 and IL-8 were detected by RT-PCR.[Results]HE staining:No significant changes were observed in the pathological morphology of the brain tissue in the blank group and sham operation group;and the neuronal structure of rats in the acute cerebral ischemia group was obviously damaged,and the neuronal damage in the remifentanil pretreatment group was less than that in the acute cerebral ischemia group at each time point.TTC staining:The gray brain infarct area in the remifentanil pretreatment group was significantly smaller than that in the cerebral ischemia group(P<0.05).RT-PCR detection results:The expression levels of TNF-α,IL-6 and IL-8 in the blank group and sham surgery group did not show significant changes at different times(P>0.05);and compared with the cerebral ischemia group,the expression levels of TNF-α,IL-6,and IL-8 in the remifentanil pretreatment group were significantly reduced at all time points(P<0.05).[Conclusions]Remifentanil pretreatment could protect the brain by reducing the expression of inflammatory factors after cerebral ischemia injury.

Morphometric changes in the cortex following acute mild traumatic brain injury

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.

Influence of ginkgolide combined with edaravone on the brain function of elderly patients with acute cerebral infarction and its preventive effect on ischemia reperfusion injury

Objective: To explore the influence of ginkgolide combined with edaravone on the brain function of elderly patients with acute cerebral infarction and its preventive effect on ischemia reperfusion injury. Methods: A total of 126 patients with acute cerebral infarction who were treated in Dazhou Central Hospital between February 2016 and May 2017 were divided into the control group (n=67) and ginkgolide group (n=59) according to different therapies. Control group received routine intravenous thrombolysis + edaravone therapy, and ginkgolide group received routine intravenous thrombolysis + edaravone + ginkgolide therapy. The differences in brain function and nerve ischemia reperfusion injury extent were compared between the two groups. Results: At T1 and T2, serum nerve function indexes NT-proBNP and NSE levels of ginkgolide group were lower than those of control group whereas BDNF levels were higher than those of control group;serum inflammatory mediators MCP-1, NF-κB, CRP and TNF-α levels were lower than those of control group;serum apoptosis molecules caspase-3 and Bax levels were lower than those of control group whereas Bcl-2 levels were higher than those of control group. Conclusion: Ginkgolide combined with edaravone therapy on the basis of intravenous thrombolysis can effectively optimize the brain function and alleviate the ischemia reperfusion injury caused by inflammatory response and apoptosisis in elderly patients with acute cerebral infarction.