Occurrence of hypopituitarism after severe craniocerebral trauma and its predictors / 中华内分泌外科杂志

Objective:To investigate the occurrence and predictors of hypopituitarism after traumatic brain injury (TBI) .Methods:A prospective study was conducted on 185 patients with severe TBI in the Emergency Department of the First Hospital of Shanxi Medical University from Jan. 2020 to May. 2022, of whom 108 were male and 77 were female; age ranged from 18 to 79 years, mean (51.32±9.34) years. Pituitary function was assessed within 3-7 d after the onset of TBI, and the occurrence of hypopituitarism after severe TBI was counted. 41 cases in the hypopituitarism group, 26 males and 15 females, aged (52.76±9.83) years, were divided into the hypopituitarism group (hypopituitarism occurred) and the non-hypopituitarism group (hypopituitarism did not occur) according to whether hypopituitarism occurred. In the non-decompensated group, there were 144 cases, 82 males and 62 females, aged (50.91±9.27) years. The clinical data of the decompensated and non-decompensated groups were compared, and the factors influencing the occurrence of hypopituitarism were analysed, and a logistic prediction model was constructed based on the relevant influencing factors. The value of this model in predicting the occurrence of hypopituitarism after severe TBI was evaluated by using the receiver operating characteristic (ROC) curve.Results:The prevalence of hypopituitarism in the 185 patients with severe TBI in this study was 22.16%; the Glasgow coma scale (GCS) score on admission was lower in the decompensated group than in the non-decompensated group [ (6.36±1.04) vs (7.48±0.59) ], the percentage of hyperbaric oxygen therapy was lower than in the non-decompensated group (21.95% vs 49.31%) , the percentage of intracranial pressure (82.93% vs 49.31%) , midline displacement ≥5 mm (78.05% vs 29.86%) , skull base fracture (34.15% vs. 17.36%) , diffuse cerebral edema (19.51% vs 4.17%) , and serum brain derived neurophic factor (BDNF) . Brain derived neurophic factor (BDNF) was higher than that in the non-reduced group [ (6.35±1.29) ng/ml vs (4.51±1.06) ng/ml], and neuronal-specific enolase (NSE) was higher than that in the non-reduced group [ (33.06±5.42) μg/L vs (23.15±4.97) μg/L]. (4.97) μg/L]. Vascular epithelial growth factor (VEGF) was higher than that in the non-reduced group [ (312.07±24.35) pg/ml vs (226.80±20.96) pg/ml], tumor necrosis factor-α (TNF-α) was higher than that in the non-reduced group [ (281.24±38.91) ng/L vs (186.91) pg/ml], and tumor necrosis factor-α (TNF-α) was higher than that in the non-reduced group (186.55±35.72) ng/L (all P<0.05) . Increased intracranial pressure, midline displacement ≥5 mm, diffuse cerebral edema, serum BDNF, NSE, VEGF, and TNF-α levels were all independent risk factors for the development of hypopituitarism after severe TBI, with admission GCS score and hyperbaric oxygen therapy as protective factors ( P<0.05) ; a logistic prediction model was constructed based on the influencing factors as: Logit ( P) = 5.264-0.880×admission GCS score + 1.618×increased intracranial pressure + 1.941×midline displacement ≥5 mm + 1.289×diffuse cerebral edema+1.306×BDNF+1.426×NSE+1.781×VEGF+1.615×TNF-α-0.758×hyperbaric oxygen therapy; the model predicted the occurrence of severe TBI after the area under the curve (AUC) of hypopituitarism was 0.930 (95% CI 0.883-0.962) , with a predictive sensitivity and specificity of 90.24% and 89.19%, respectively. Conclusions:The incidence of hypopituitarism is higher after severe TBI. Increased intracranial pressure, midline displacement ≥5 mm, diffuse cerebral edema, serum BDNF, NSE, VEGF and TNF-α levels are all used as predictors of hypopituitarism.

A case report of heat stroke with early severe brain edema / 环境与职业医学

Heat stroke can be divided into two types: exertional and classic, mainly manifested as a clear history of exposure to hot temperature/high heat environment or intense physical activity in hot environment, core temperature exceeding 40 ℃, accompanied by central nervous system changes (altered consciousness, epilepsy, psychiatric symptoms, etc.) and multiple organ damage, including respiratory failure, impaired liver and kidney function, rhabdomyolysis, coagulation disorders, abdominal distension, and diarrhea. Its pathology may be manifested as organ endothelial cell damage, inflammatory response, extensive thrombosis, and bleeding tendency. The main treatment measures are cooling therapy, and when combined with other organ damage, organ support or replacement therapy should be carried out in time, including blood transfusion to improve coagulation function and blood purification therapy. Hyperbaric oxygen therapy may improve the prognosis of patients with ischemic hypoxic encephalopathy. We reported a case of a firefighter with sudden impaired consciousness and high fever during forest fire fighting. The patient was sent to a local hospital and his head computed tomography (CT) results showed unclear cerebral gyrus, suggesting severe cerebral edema, and finally diagnosed as heat stroke. After being transferred to Liuzhou Workers' Hospital, his condition continued to deteriorate and signs of multiple organ failure appeared. The patient's cerebral edema was reversed and further development of heat stroke was prevented through early cooling, sedation and anti-epilepsy, endotracheal intubation ventilator-assisted breathing, anti-infection, fluid resuscitation, infusion of fresh frozen plasma and platelets to improve coagulation function, immunomodulatory therapy, renal replacement therapy, and timely artificial liver therapy. Hyperbaric oxygen therapy was ordered during the rehabilitation phase, and the patient recovered well at discharge, leaving no obvious neurological sequelae. Its prognosis is much better than that predicted at admission.

Impact of Moderate Altitude on Lung Diseases and Risk of High Altitude Illnesses

ABSTRACT A large world population resides at moderate altitudes. In the Valley of Mexico (2240 m above sea level) and for patients with respiratory diseases implies more hypoxemia and clinical deterioration, unless supplementary oxygen is prescribed or patients move to sea level. A group of individuals residing at 2500 or more meters above sea level may develop acute or chronic mountain disease but those conditions may develop at moderate altitudes although less frequently and in predisposed individuals. In the valley of México, at 2200 m above sea level, re-entry pulmonary edema has been reported. The frequency of other altitude-related diseases at moderate altitude, described in skiing resorts, remains to be known in visitors to Mexico City and other cities at similar or higher altitudes. Residents of moderate altitudes inhale deeply the city's air with all pollutants and require more often supplementary oxygen.

Trombosis venosa cerebral en paciente embarazada. A propósito de un caso / Brain venous thrombosis in pregnant patient. About a case / Trombose venosa cerebral em paciente gestante. Relato de um caso

Resumen: Introducción: La trombosis venosa cerebral (TVC) es una enfermedad grave que afecta con mayor frecuencia a adultos jóvenes, con una incidencia de tres casos por cada 1'000,000 de habitantes en edad adulta. Aproximadamente se reporta 0.5% de los eventos vasculares cerebrales, siendo más frecuente en el género femenino, como factores de riesgo importante está el embarazo, parto, puerperio y uso de anticonceptivos orales (ACO). Caso clínico: Femenino de 34 años, con 8.2 semanas de gestación (SDG) normoevolutivo, que inicia siete días previos a su ingreso con cefalea occipital de intensidad moderada, que se intensifica progresivamente y empeoraba al estar acostada, agregándose náuseas y vómitos, sugestivos de cráneo hipertensivo, por lo que acude a hospital, donde ingresa con Glasgow de 15 puntos, se realiza resonancia magnética (RM), que muestra trombosis del seno venoso transverso izquierdo y hemorragia intraparenquimatosa temporoparietal izquierda, presenta deterioro del estado neurológico, requiere manejo avanzado de vía aérea y traslado a Unidad de Cuidados Intensivos (UCI). La tomografía de cráneo (TC) de ingreso a UCI con hematoma parenquimatoso temporoparietal izquierdo, edema cerebral, colapso de sistema ventricular lateral ipsilateral y desviación de la línea media, valorada por neurocirugía, quien descarta procedimiento quirúrgico y se inicia terapia osmolar con soluciones hipertónicas al 7.5%. La TC cinco días después muestra infarto cerebral en hemisferio izquierdo y sangrado intraparenquimatoso antiguo, el cual se encuentra en procesos de reabsorción; sin embargo, edema cerebral severo, que requiere de craniectomía parietofrontal izquierda. La TC de control con disminución del edema, logrando progresar y destetar de la ventilación mecánica, egresándose a piso de ginecología con Glasgow de 14 puntos y embarazo de 10.2 SDG normoevolutivo. Conclusiones: Esta patología es potencialmente reversible con un diagnóstico precoz y atención médica adecuada. La RM es el estudio de elección.

Abstract: Introduction: Cerebral venous thrombosis (CVT) is a serious disease that most frequently affects young adults, with an incidence of three cases per million adult inhabitants. It is the cause of 0.5% of cerebral vascular events. It is more frequent in women, is associated with childbirth, puerperium and the use of oral contraceptives. Clinical case: Female, 34 years old, with 8.2 weeks of gestation, which began seven days prior to admission with intense headache, nausea and vomiting, suggestive of hypertensive skull; went to hospital, where he was admitted with Glasgow 15 points, MRI was performed, which showed thrombosis of the left transverse venous sinus and left parietal temporo intraparenchymal hemorrhage, showed deterioration of neurological status, and required advanced airway management and transfer to Intensive Care Unit. CT (computed tomography) of the skull on admission to the Intensive Care Unit showed parenchymal left parietal temporo hematoma, cerebral edema, collapse of the ipsilateral lateral ventricular system and deviation of the midline. Neurosurgery assessed who ruled out surgical procedure and began osmolar therapy with hypertonic solutions at 7.5%. CT scan five days later showed cerebral infarction in the left hemisphere and old intraparenchymal bleeding in reabsorption process but severe cerebral edema, which required left parietal frontal craniectomy. The control CT scan with decreased edema, achieving weaning from mechanical ventilation, graduated to the floor of gynecology with Glasgow 14 points and pregnancy of 10.2 SDG. Conclusions: It is very important the correct diagnosis and not to confuse pregnancy alterations with neurological symptoms. MR is the study of choice.

Resumo: Introdução: A trombose venosa cerebral (TVC) é uma doença grave que acomete mais frequentemente adultos jovens, com incidência de 3 casos 1'000,000 habitantes na idade adulta. Aproximadamente são relatados 0.5% dos eventos vasculares cerebrais, sendo mais frequentes no sexo feminino, como fatores de risco importantes estão a gravidez, parto, puerpério e uso de anticoncepcionais orais (AO). Caso clínico: Paciente do sexo feminino, 34 anos, com 8.2 semanas de gestação (SDG) evoluindo normalmente, que iniciou 7 dias antes da internação com cefaléia occipital de intensidade moderada, que se intensificava progressivamente e piorava ao deitar, somando-se náuseas e vômitos, sugestivos de crânio hipertenso, busca atenção hospitalar, onde é internada com um Glasgow de 15 pontos, realiza-se ressonância magnética (RM), que mostra trombose do seio venoso transverso esquerdo e hemorragia intraparenquimatosa temporomandibular esquerda, apresenta deterioração do quadro neurológico e requer manejo avançado das vias aéreas e transferência para a Unidade de Terapia Intensiva (UTI). A tomografia de crânio (TC) na admissão na UTI mostrou hematoma parietal temporal esquerdo, edema cerebral, colapso do sistema ventricular lateral ipsilateral e desvio da linha média, avaliada por neurocirurgia que descartou procedimento cirúrgico e iniciou terapia osmolar com soluções hipertônicas a 7.5%. A TC 5 dias depois mostra infarto cerebral no hemisfério esquerdo e sangramento intraparenquimatoso antigo que está em reabsorção, porém edema cerebral grave, que requer craniectomia parietofrontal esquerda. A TC de controle mostrou diminuição do edema, progredindo ao desmame da ventilação mecânica, alta para o andar de ginecologia com escore de Glasgow de 14 e gravidez de 10.2 SDG evoluindo normalmente. Conclusões: Esta patologia é potencialmente reversível com diagnóstico precoce e cuidados médicos adequados. A ressonância magnética é o estudo de eleição.

Seven cases of toxic encephalopathy associated with diquat poisoning / 中华急诊医学杂志

Objective:To improve the understanding of the clinical features of toxic encephalopathy associated with diquat poisoning.Methods:This study collected and analyzed the diagnosis and treatment process of 7 patients with acute diquat poisoning combined with central nervous system complications admitted to the First Affiliated Hospital of Zhengzhou University from April 2021 to April 2022. "Diquat" and "Poisoning" were used as keywords to search in CNKI, Wanfang database and PubMed database, and the literature of previous cases was reviewed for summary analysis.Results:Among the 7 patients in our hospital, there were 2 males and 5 females, with an average age of 31 years (range14-57) and an average dose of 23.14 g [(10-40)g]. During the treatment, 3 patients developed irritability and convulsions, 3 patients occurred coma, and one had generalized tonic-clonic seizures. Four patients died and 3 survived, of which 2 patients returned to normal life and study, and one remained abnormal mental behavior (currently in long-term follow-up). All three survivors developed neurological symptoms later than those who died, and were awake about 30 days after taking the drug.Conclusions:Toxic encephalopathy associated with diquat poisoning has rapid progression, poor prognosis and high mortality. This study found that the survival rate of patients with > 48 h of first onset of neurological symptoms is much higher than that of patients with ≤ 48 h of first onset of neurological symptoms, while sex, age, estimated oral dose, and type of presentation of neurological symptoms for the first time have little effect on the survival rate of hospital discharge. The earlier neurological symptoms appear, the greater the likelihood of a poor prognosis.

Application strategies of continuous blood purification in pediatric patients with cerebral edema / 中国小儿急救医学

Continuous blood purification(CBP)has been extensively used in pediatric critical care and proven effective in pediatric patients with cerebral edema.However, as a causative factor of changes in blood pressure, blood volume, plasma osmotic pressure, and drug metabolism, CBP may have reduced efficacy and even exacerbate the cerebral edema when pediatric patients are provided with inadequate clinical evaluation and intervention or inappropriate settings of treatment parameters.This paper presented a literature review on the application strategies of CBP as a treatment of pediatric patients with cerebral edema to provide a reference for clinical practice.

Timing of brain computed tomography for predicting neurological prognosis in comatose cardiac arrest survivors: a retrospective observational study / 世界急诊医学杂志（英文）

@#BACKGROUND: To assess the association between relevant brain computed tomography (CT) parameters at different time and neurological prognosis in adult comatose survivors after cardiac arrest (CA). METHODS: A total of 94 CA patients who underwent early and late CT scans (within 24 h and 24 h to 7 d respectively after CA) between January 2018 and April 2020 were enrolled in this retrospective study. According to the Cerebral Performance Category (CPC) score at hospital discharge, the patients were divided into either a good outcome (CPC 1-2) group or a poor-outcome group (CPC 3-5). The grey-to-white matter ratio (GWR) and the proportion of cerebrospinal fluid volume (pCSFV) were measured. In predicting poor outcomes, the prognostic performance of relevant CT parameters was evaluated, and the comparison analysis (expressed as the ratio of parameters in late CT to those in the early CT) of different CT time was conducted. RESULTS: Totally 26 patients were in the good-outcome group, while 68 patients were in the poor-outcome group. The putamen density, GWR, and pCSFV in late CT were significantly lower in the poor-outcome group (P<0.05). The ratios of GWR and pCSFV in the poor-outcome group were significantly decreased according to comparison analysis of different CT time (P<0.05), while there was no significant difference in the ratio of putamen density. GWR-basal ganglia <1.18 in late CT showed the best predictive value. The ratio of pCSFV <0.98 predicted unfavorable neurological outcomes with a sensitivity of 65.9% and a specificity of 93.8% (P=0.001). CONCLUSIONS: Brain CT performed >24 h after CA may be a good choice as a neuroimaging approach to evaluating prognosis. To predict neurological prognosis, comparison analysis of different CT time can be used as another promising tool in comatose CA survivors.

Research progress of diabetic ketoacidosis complicated withcerebral edema in children / 预防医学

Abstract@#Diabetic ketoacidosis (DKA) is a serious complication of diabetes in children. A small number of children with DKA can be complicated by cerebral edema, leading to acute brain dysfunction, which is the main cause of death in children with diabetes. Because of unclear pathogenesis and non-specific clinical manifestations, DKA complicated with brain edema is easy to be missed or misdiagnosed. The identification and management of risk factors of DKA complicated with brain edema and early identification of brain edema are of great importance for improving the prognosis. This article reviewed the literature about the pathogenesis, clinical manifestations, risk factors, treatment and prevention of DKA complicated with brain edema, so as to provide reference for its early clinical identification and intervention.

Bloodletting Puncture at Hand Twelve Jing-Well Points Relieves Brain Edema after Severe Traumatic Brain Injury in Rats via Inhibiting MAPK Signaling Pathway / 中国结合医学杂志

OBJECTIVE@#To investigate whether blood-brain barrier (BBB) served a key role in the edema-relief effect of bloodletting puncture at hand twelve Jing-well points (HTWP) in traumatic brain injury (TBI) and the potential molecular signaling pathways.@*METHODS@#Adult male Sprague-Dawley rats were assigned to the sham-operated (sham), TBI, and bloodletting puncture (bloodletting) groups (n=24 per group) using a randomized number table. The TBI model rats were induced by cortical contusion and then bloodletting puncture were performed at HTWP twice a day for 2 days. The neurological function and cerebral edema were evaluated by modified neurological severity score (mNSS), cerebral water content, magnetic resonance imaging and hematoxylin and eosin staining. Cerebral blood flow was measured by laser speckles. The protein levels of aquaporin 4 (AQP4), matrix metalloproteinases 9 (MMP9) and mitogen-activated protein kinase pathway (MAPK) signaling were detected by immunofluorescence staining and Western blot.@*RESULTS@#Compared with TBI group, bloodletting puncture improved neurological function at 24 and 48 h, alleviated cerebral edema at 48 h, and reduced the permeability of BBB induced by TBI (all P<0.05). The AQP4 and MMP9 which would disrupt the integrity of BBB were downregulated by bloodletting puncture (P<0.05 or P<0.01). In addition, the extracellular signal-regulated kinase (ERK) and p38 signaling pathways were inhibited by bloodletting puncture (P<0.05).@*CONCLUSIONS@#Bloodletting puncture at HTWP might play a significant role in protecting BBB through regulating the expressions of MMP9 and AQP4 as well as corresponding regulatory upstream ERK and p38 signaling pathways. Therefore, bloodletting puncture at HTWP may be a promising therapeutic strategy for TBI-induced cerebral edema.

Prevalencia de edema cerebral en pacientes con cetoacidosis diabética / Prevalence of cerebral edema among diabetic ketoacidosis patients

Introducción. El edema cerebral (EC) es la complicación más grave de la cetoacidosis diabética (CAD) en niños. La patogénesis del EC no se conoce con exactitud y su aparición ha sido relacionada con la terapia de rehidratación endovenosa en el tratamiento inicial.Objetivos. Estimar la prevalencia de EC en pacientes con CAD tratados en el Hospital General de Niños Pedro de Elizalde mediante rehidratación endovenosa y analizar potenciales factores de riesgo para el desarrollo de EC.Materiales y método. Estudio de diseño transversal para prevalencia y un análisis exploratorio para comparar las características clínicas y de laboratorio entre los pacientes con y sin EC. Se incluyeron pacientes de 1 a 18 años hospitalizados con diagnóstico de CAD desde el 1 de enero de 2005 hasta el 31 de diciembre de 2014.Resultados. Se analizaron 693 episodios de CAD en 561 historias clínicas. En 10 pacientes, se evidenció EC (el 1,44 %; intervalo de confianza del 95 %: 0,8-2,6). Los pacientes con EC presentaron mayor uremia (p < 0,001), menor presión de dióxido de carbono (p < 0,001) y menor natremia (p < 0,001) que aquellos pacientes sin EC.Conclusión. La prevalencia de EC en pacientes con CAD fue del 1,44 %, menor que la reportada en nuestro país (del 1,8 %). Los factores de riesgo al ingresar asociados a su desarrollo fueron la presencia de uremia elevada, hiponatremia e hipocapnia.

Introduction. Cerebral edema (CE) is the most severe complication of diabetic ketoacidosis (DKA) in children. There is no accurate knowledge of CE pathogenesis and its onset has been related to intravenous rehydration therapy during the initial treatment.Objectives. To estimate the prevalence of CE among DKA patients treated at Hospital General de Niños Pedro de Elizalde with intravenous rehydration and analyze potential risk factors for the development of CE.Materials and methods. Cross-sectional prevalence study and exploratory analysis to compare clinical and laboratory characteristics between patients with and without CE. Patients aged 1-18 years hospitalized with the diagnosis of DKA between January 1st, 2005 and December 31st, 2014 were included.Results. A total of 693 DKA events from 561 medical records were analyzed. Ten patients had evidence of CE (1.44 %; 95 % confidence interval: 0.8-2.6). Patients with CE had higher serum urea levels (p < 0.001), lower carbon dioxide pressure (p < 0.001), and lower serum sodium levels (p < 0.001) than those without CE.Conclusion. The prevalence of CE among DKA patients was 1.44 %, smaller than that reported in our country (1.8 %). The risk factors at admission associated with CE development were high serum urea levels, hyponatremia, and hypocapnia.

Un ejemplo de respuesta adaptativa integrada: la aclimatación humana a la altitud / An example of integrated adaptive response: human acclimatization to altitude

Se describen las respuestas fisiológicas que el ser humano desarrolla en respuesta a la exposición a la altitud geográfica. Se describen no sólo las alteraciones debidas a una mala coordinación de los ajustes fisiológicos desencadenados durante la aclimatación a la altura sino también sus manifestaciones clínicas más relevantes. Se detallan los mecanismos moleculares subyacentes a tales respuestas y cómo su mejor conocimiento puede permitir aplicar la exposición intermitente a hipoxia como una herramienta útil para la resolución o alivio de determinadas alteraciones y patologías.

We depict the physiological responses developed by the human body in response to the exposure to geographic altitude. The main alterations due to a noncoordinated setup of the physiological adjustments triggered during the acclimatization at altitude are also described, as its most relevant clinical manifestations. The molecular mechanisms underlying such responses are detailed, and how a better knowledge of these processes can allow us to apply intermittent exposure to hypoxia programs as a useful tool for the resolution or relief of certain disorders and pathologies.

Comparison of outcome of milwaukee regimen and 48 hours regimen in diabetic ketoacidosis in a tertiary care hospital in Chitradurga, Karnataka, India

Background: Diabetic ketoacidosis (DKA) is an acute life threatening and a medical emergency that accounts for the majority of diabetes related mortality and morbidity in the pediatric age group who are suffering from type 1 Diabetes Mellitus (DM). Objective of this study was to compare the clinical outcome in a patient with DKA who are been treated with Milwaukee regimen (24hours) and 48 hours regimen.Methods: A retrospective study was conducted in PICU of tertiary care hospital in Chitradurga, Karnataka. Data was collected from 2015 to May 2018. Diagnosis of DKA was made by plasma glucose level higher than 200mg/dl, venous blood PH of <7.3 and /or bicarbonate <15 mmol/L, presence of ketonuria. Among 56 cases, 36 cases were treated with 48 hours regimen and 20 cases were treated with Milwaukee regimen and results were compared.Results: The median age of presentation was 7.52 years (Range: 2-14 years) with female: male ratio of 1:1.3. Newly diagnosed type 1 DM cases constituted 80.7%. The most common presenting complaints were hurried breathing and altered sensorium. The average length of stay in the ICU was 3.5 days for 48 hours regimen and 4.5 days for Milwaukee regimen. The mortality rate was 10.71 % (6 cases), among which 15% (3 cases) were patients treated with Milwaukee and 8.3% (3 cases) were patients treated with 48 hours regimen. Cerebral edema was found to be the commonest cause of fatality.Conclusions: There is lack of awareness regarding dog bite and its management among the rural population.

Protective effect of the Potentilla anserina polysaccharide on high altitude cerebral edema and high altitude pulmonary edema in rats / 国际药学研究杂志

Objective: To test the anti-plateau hypoxia effect of Potentilla anserina polysaccharide(PAP), Cynomorium songarieum Rupr. polysaccharide(SCRP), Sphallerocarpus gracilis polysaccharide(SGP)and Lilium brownii polysaccharide(LP), and then investigate the protective effect of most effective polysaccharide on the high altitude cerebral edema(HACE)and high altitude pulmonary edema(HAPE)in rats. Methods: PAP, CSRP, SGP and LP were prepared by the water extraction-alcohol precipitation method. The normobaric hypoxia test and acute hypoxia test were performed to find out the polysaccharide with the best anti-hypoxia effect and the related dose-dependent effect in mice. A large hypobaric hypoxia chamber stimulating 8000 m altitude was used to investigate pathological changes and water contents in rat brain and lung tissue before and after hypoxia, and the concerned oxidative stress and inflammation related parameters were also measured. The protective effect of PAP on the high altitude cerebral and pulmonary edema was evaluated by the rat model experiments. Results: PAP showed the best and dose-dependent anti-hypoxia effect among the four polysaccharides. The water content in brain and lung tissues of rats increased obviously in the hypoxia model(HM)group, and the brain tissue cell hierarchical fuzzy, lung tissue congestion and edema as well as the heavy inflammatory cell infiltration, widening of alveolar interval and thickening of alveolar wall were also found in the HM group. The enzymatic activity of SOD was notablely depressed, while both the MDA and IL-1β contents in brain and lung tissues remarkably increased(P<0.01)in the HM group. Com- pared with the HM group, the water content in the rat brain and lung tissues significantly decreased in each of the different dose PAP groups(P<0.05 or P<0.01), and the inflammatory cell infiltration, alveolar interval, and thickness of alveolar wall all notabely decreased in the HM group. Furthermore, the enzymatic activity of SOD increased, while both the MDA and IL-1β contents decreased, all significantly in the PAP groups than in the HM group(P<0.05 or P<0.01). Conclusion: PAP showed a good anti-hypoxia effect and effectively inhibited HACE and HAPE to exert a certain protective effect in a rat model.

Neuro-imaging study in eclampsia

Background: Eclampsia is associated with increased risk of maternal death varying from 1.8 % in developed countries to 14 % in developing countries. Cerebral complications are the major cause of death in eclampsia patients. Eclampsia along with hypercoagulopathy of pregnancy is a high risk fact for patient in respect of development of cerebrovascular thrombosis/haemoorhage. Eclampsia patients have been found to have various CNS pathological conditions amenable to the medical treatment. The aim of the study is to know the neuropathophysiology behind an eclamptic seizure to reduce the morbidity associated with it.Methods: Prospective study design included 50 patients for the study. All patients were admitted in the eclampsia room with h/o convulsions. All patients were put on MgSO4 therapy and anti-hypertensive. Cranial CT scan examinations were performed for all patients within 24hours of last convulsion without intravenous contrast material injection. Time taken to recover from all the clinical symptoms like altered consciousness, defective vision, headache and seizure and the maternal outcome are compared.    Results: 62% of patients with eclampsia had detectable pathological changes in CT scan. Cerebral edema was the most common CT scan finding with parietal lobe was the most common site (90.32%) of pathological changes. Mortality rate was high among eclamptic patients with cerebral hemorrhage.Conclusions: CT scan was found to be effective in detecting cerebral pathology in more than half of the eclamptic patients. The most common pathological changes detected are cerebral edema and cerebral infarction. CT scan may not be required for the diagnosis of eclampsia, but it must be used in certain complicated patients to detect cerebral pathology at the earliest so that specific management could be provided to reduce the maternal mortality.

Síndrome de Reye: presentación de un caso / Reye syndrome: a case report

Se presenta el caso clínico e histopatológico de una lactante menor atendida en el Hospital San Jerónimo, de Montería, Colombia, con una enfermedad fulminante caracterizada por vómitos, encefalopatía, hipoglucemia, alargamiento del TP, desequilibrio hidroelectrolítico, in ltración grasa del hígado y edema cerebral, compatible con síndrome de Reye.

We present the clinical and histopathological case of an infant attended at the San Jerónimo Hospital in Montería, Colombia, with a fulminating disease characterized by vomiting, encephalopathy, hypoglycemia, PT elongation, electrolyte imbalance, fatty in ltration of the liver and cerebral edema, compatible with Reye syndrome.

Identifying risk factors for development of diabetic ketoacidosis in type 1 diabetes mellitus

Background: DKA [ Diabetic keto acidosis] It is the commonest cause of diabetes-related death in children. Children with diabetic ketoacidosis at diagnosis have poorer glycemic control, to identify the risk factors for the development of Diabetic Ketoacidosis in Type1 Diabetes Mellitus in a tertiary care center.Methods: The study was conducted in Kovai Medical Centre And Hospital Coimbatore in 2018.22 children were included in present study. Each consultant followed different standard DKA treatment protocols. The two protocols used were Milwaukee and BSPED guidelines.Results: Among the 22 children, 3 children (13%) had recurrent DKA (>1 episode). One child had his third episode and the rest 2 children had their second episode.19 children had their first episode of DKA.Conclusions: There was no death among the 22 children treated. This was because of the care is given by the team of doctors and adherence to treatment protocol (Milwaukee or BSPED) of DKA.

Related factors of aggravated cerebral edema after meningioma surgery / 局解手术学杂志

Objective To investigate the risk factors of aggravated cerebral edema after meningioma surgery.MethodsRespectively analyze the clinical data of 187 patients received neurosurgery operation in our hospital from January 1, 2016 to February 5, 2018 and their postoperative aggravated cerebral edema, the related risk factors for brain edema after meningioma surgery was summarized.Results The incidence of aggravated cerebral edema in patients without preoperative edema (26.23％) was higher than that in patients with preoperative edema (13.8％), the difference was not statistically significant, probably due to the small number of cases or other related factors.Multivariate analysis of all related factors found that preoperative edema was the influencing factor for the increase of brain edema after meningioma surgery (P=0.005).It was found by single factor analysis that tumor site was a risk factor for the aggravation of cerebral edema after meningioma surgery.Multivariate analysis and multiple rate comparisons revealed that the sagittal sinus falx area was an independent risk factor for the aggravation of cerebral edema after meningioma surgery.ConclusionThe presence of peritumoral edema before surgery may be a protective factor for the postoperative brain edema.The incidence of postoperative cerebral edema was significantly higher in meningiomas located near the sagittal sinus falx than that of other sites.Therefore, meningiomas located near the sagittal sinus falx should be attached great importance.During the operation, the venous drainage should be protected, the perioperative management should be strengthened, and hormone and subsequent dehydration should be given timely to improve the prognosis of patients.

Pseudo-Subarachnoid Hemorrhage; Chronic Subdural Hematoma with an Unruptured Aneurysm Mistaken for Subarachnoid Hemorrhage / 대한신경손상학회지

Subarachnoid hemorrhage (SAH) usually occurs due to aneurysmal rupture of intracranial arteries and its typical computed tomography (CT) findings are increased attenuation of cisterns and subarachnoid spaces. However, several CT findings mimicking SAH are feasible in diverse conditions. They are so-called as pseudo-SAH, and this report is a case of pseudo-SAH which is misdiagnosed as aneurysm rupture accompanied by bilateral chronic subdural hematoma (cSDH). A 42-year-old male with severe headache visited our institute. Non-contrast brain CT images showed increased attenuation on basal cistern, and cSDH on both fronto-temporo-parietal convexity with midline shifting. Trans-femoral cerebral angiography was done and we confirmed small aneurysm at right M1 portion of middle cerebral artery. Under diagnosis of SAH, we planned an operation in order to clip aneurysmal neck and remove cSDH. cSDH was removed as planned, however, there was no SAH and we also couldn't find the rupture point of aneurysm. Serial follow-up CT showed mild cumulative cSDH recurrence, but the patient was tolerant and had no neurologic deficit during hospitalization. We have checked the patient via out-patient department for 6 months, there are no significant changes in volume and density of cSDH and the patient also have no neurologic complications.

Effect of 13-Methyltetradecanoicacid on brain edema after cerebral ischemia in rats / 中国药理学通报

Aim To investigate the effect of 13-methyl- tetradecanoic acid (13-MTD) on brain edema after cerebral ischemia in rats and its mechanism. Methods The model of middle cerebral artery occlusion (MCAO) was prepared by suture embolization method. Thirty minutes prior to the insertion of the embolus, tail vein injection of 13-MTD 40, 80, 120 nig • kg"1 (M40, M80, M120) was respectively performed. The negative control group was given an equal volume of liposomes. 6, 12 and 24 h after ischemia, neurological deficits were observed with Ixmga neurological deficit scores; brain infarct volume was observed with TTC staining; brain edema was calculated with AutoCAD image analysis software; brain water content was measured with brain dry weight; the blood-brain barrier (KB). AQP4 mRNA expression in the injured brain tissue was detected by KT-PCR. The expression of AQP4 protein in the injured brain tissues was detected by immunohistochemistry. Results 13-MTD could significantly improve the symptoms of neurological deficits in rats with cerebral ischemia, reduce the volume of cerebral infarction, decrease brain water content and cerebral edema, and down-regulate EB leakage, and up-regulate the expression of AQP4 in the ischemic brain tissues. Conclusion 13-MTD can reduce brain edema after cerebral ischemia in rats by regulating AQP4 expression.

Hipotermia terapéutica controlada. Experiencia en un Hospital de Tercer Nivel / Therapeutic hypothermia. Experience in a Third Level Hospital / Hipotermia terapêutica controlada experiência em um hospital de alta complexidade

Resumen: Objetivo: Presentar la experiencia relacionada a hipotermia terapéutica controlada en pacientes graves que presentaron lesión neurológica aguda. Material y métodos: Estudio clínico, retrospectivo, observacional y descriptivo, en el Departamento de Medicina Crítica de Adultos de un Hospital de Tercer Nivel en un periodo comprendido del 01 de enero de 2016 al 31 de julio de 2017. Pacientes llevados a hipotermia terapéutica. Resultados: Cinco pacientes incluidos en el estudio, con una media de edad de 52.4 años, 80% con padecimientos neurocríticos. El promedio de estancia en la UCI fue de 15.2 días, y de hospitalización 63 días. La media de días de ventilación mecánica fue de 13.8 días. Sesenta porciento de los pacientes desarrolló neumonía asociada a la ventilación mecánica. Cuarenta porciento de los pacientes presentó una discapacidad grave. Conclusiones: La hipotermia terapéutica en el grupo estudiado no impactó de manera positiva en los desenlaces neurológicos. La complicación más frecuente fue la neumonía asociada a la ventilación mecánica.

Abstract: Objective: To present the experience related to controlled therapeutic hypothermia in severe patients who presented acute neurological injury. Material and methods: Clinical, retrospective, observational and descriptive study in the Department of Critical Care of Adults of a Hospital of Third Level in a period between January 1, 2016 and July 31, 2017. Patients taken to therapeutic hypothermia. Results: Five patients included in the study, with a mean age of 52.4 years, 80% with neurocritical conditions. The average stay in the ICU was 15.2 days, and hospitalization was 63 days. The mean number of days of mechanical ventilation was 13.8 days. Sixty percent of patients developed ventilator-associated pneumonia. Forty percent of the patients had a severe disability. Conclusions: Therapeutic hypothermia in the study group did not positively impact neurological outcomes. The most frequent complication was ventilator-associated pneumonia.

Resumo: Objetivo: Apresentar a experiência relacionada à hipotermia terapêutica controlada em pacientes graves que apresentaram lesão neurológica aguda. Material e métodos: Estudo clínico, retrospectivo, observacional e descritivo, no Departamento de Medicina Crítica de adultos, no período de 1 de janeiro de 2016 a 31 de julho de 2017. Pacientes submetidos à Hipotermia Terapêutica. Resultados: Foram incluídos no estudo 5 pacientes com idade média de 52.4 anos, 80% com alterações neurológicas. A permanência média na UTI foi de 15.2 dias e de hospitalização 63 dias. A média de dias de ventilação mecânica foi de 13.8. 60% dos pacientes desenvolveram pneumonia associada à ventilação mecânica. 40% dos pacientes tinham um incapacidade grave. Conclusões: A hipotermia terapêutica no grupo estudado não teve impacto positivo nos desfechos neurológicos. A complicação mais frequente foi pneumonia associada à ventilação mecânica.