Systematic review on molecular detection of congenital and neonatal infections caused by TORCH and SARS-CoV-2 in newborns' cerebrospinal fluid / Revisáo sistemática sobre deteção molecular de infecções congênitas e neonatais causadas por TORCH e SARS-CoV-2 no líquido cefalorraquidiano de recém-nascidos

ABSTRACT Objective: To verify the use and identify advantages of molecular methods for congenital infections diagnosis in cerebrospinal fluid of neonates. Data source: The review was registered in the International Prospective Register of Systematic Reviews (PROSPERO), under CRD42021274210. The literature search was performed in databases: PubMed, Virtual Health Library/ Latin American and Caribbean Center on Health Sciences Information (VHL/BIREME), Scopus, Web of Science, Excerpta Medica database (EMBASE), Cochrane, ProQuest, and EBSCOhost. The search was carried out from August to October 2021 and updated in December 2022, respecting the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The selection sequence was: 1) Duplicate title removal; 2) Examination of titles and abstracts; 3) Full-text retrieval of potentially relevant reports; and 4) Evaluation of the full text according to eligibility criteria by two independent authors. Inclusion criteria considered randomized and non-randomized control trials, longitudinal, cross-sectional, and peer-reviewed studies in humans, published in English, Spanish, Italian, and Portuguese, with newborns up to 28 days old who had congenital neuroinfections by toxoplasmosis, rubella, cytomegalovirus, herpes simplex (TORCH), and others such as Treponema pallidum, Zika, parvovirus B-19, varicella zoster, Epstein-Barr, and SARS-CoV2, diagnosed by polymerase chain reaction (PCR). Two evaluators extracted the following information: author, year of publication, nationality, subjects, study type, methods, results, and conclusion. Data synthesis: The most studied pathogen was herpes simplex. Several articles reported only nonspecific initial symptoms, motivating the collection of cerebrospinal fluid and performing PCR for etiological investigation. Conclusions: Molecular methods are effective to detect pathogen genomes in cerebrospinal fluid, which can impact clinical evolution and neurological prognosis.

RESUMO Objetivo: Verificar a utilização e identificar as vantagens dos métodos moleculares para diagnóstico de infecções congênitas no líquido cefalorraquidiano de neonatos. Fontes de dados: A revisão foi registrada na base PROSPERO (International Prospective Register of Systematic Reviews) sob CRD42021274210. A busca bibliográfica foi realizada nas bases de dados PubMed, Biblioteca Virtual em Saúde/ Centro Latino-Americano e do Caribe de Informação em Ciências da Saúde (BVS/BIREME), Scopus, Web of Science, Excerpta Medica database (EMBASE), Cochrane, ProQuest, e EBSCOhost. A busca foi feita no período de agosto a outubro de 2021 e atualizada em dezembro de 2022, respeitando as orientações do Preferred Reporting Items for Systematic Reviews e Meta-Analyises (PRISMA). A sequência da seleção dos estudos foi: 1) Remoção de duplicatas; 2) Exame de títulos e resumos; 3) Recuperação dos textos completos potencialmente relevantes; e 4) Avaliação do texto completo conforme critérios de elegibilidade por dois autores independentes. O critério de inclusão considerou ensaios clínicos randomizados e não randomizados, estudos longitudinais, transversais, revisados por pares, estudos em humanos, publicados em inglês, espanhol, italiano e português, com recém-nascidos de até 28 dias que sofreram neuroinfecções congênitas pelos agentes toxoplasmose, rubéola, citomegalovírus, herpes simples (TORCH), e outros como Treponema pallidum, Zika, parvovírus B-19, varicela zoster, Epstein-Barr, e SARS-CoV-2, diagnosticadas por reação em cadeia de polimerase (PCR). Dois avaliadores extraíram as seguintes informações: autor, ano de publicação, nacionalidade, sujeitos, tipo de estudo, métodos, resultados e conclusão. Síntese dos dados: O patógeno mais estudado foi Herpes Simples. Muitos artigos relataram somente sintomas iniciais inespecíficos, motivando a coleta de líquido cefalorraquidiano e realização da PCR para investigação etiológica. Conclusões: Os métodos moleculares são eficazes para detectar o genoma do patógeno no líquido cefalorraquidiano, o que pode impactar na evolução clínica e no prognóstico neurológico.

Características clínico-epidemiológicas de la meningitis tuberculosa en pacientes internados en el Servicio de Clínica Médica del Centro Médico Nacional en el periodo 2015 ­ 2023 / Clinical-epidemiological characteristics of tuberculous meningitis in inpatients in the Servicio de Clínica Médica of the National Medical Center in the period 2015 ­ 2023

RESUMEN Introducción: la meningitis tuberculosa es la forma más grave de tuberculosis extrapulmonar, esto se debe a la gran mortalidad y morbilidad en los pacientes, con alta prevalencia en los países en desarrollo, lo que constituye un problema de salud pública. Su diagnóstico es difícil y la mayoría de casos se logran identificar a base de criterios clínicos y características del líquido cefalorraquídeo que la mayoría de veces son inespecíficos. Objetivo: determinar las características clínico-epidemiológicas en pacientes con tuberculosis meníngea de los pacientes internados en área de clínica médica en el Hospital Nacional en el periodo 2015-2023. Metodología: estudio observacional descriptivo de corte transversal de pacientes adultos con tuberculosis meníngea internados en el Centro Médico Nacional en el periodo 2015- 2023. Resultados: se incluyeron 32 pacientes entre 20 y 85 años (edad media: 39 años); varones 68,75 %, mujeres 32,25 %. Mayoría provenientes del interior del país. En la mayoría de los casos los pacientes presentaron un aumento de proteínas en el líquido cefalorraquídeo y celularidad predominio de mononucleares, la positividad de GeneXpert de Mycobacterium del líquido cefalorraquídeo fue 62,5 %, en ningún caso se aisló BAAR. Fueron seropositivos para VIH 37,5 % y tenían afección pulmonar concomitante a la meningitis 43,75 %. La mortalidad fue de 31,25 %. Conclusión: la meningitis tuberculosa en nuestra investigación afectó mayormente a hombres de mediana edad provenientes del interior, cuya clínica inicial es la fiebre en mayor porcentaje seguido de cefalea presentando una alta mortalidad.

ABSTRACT Introduction: tuberculous meningitis is the most serious form of extrapulmonary tuberculosis, this is due to the high mortality and morbidity in patients, its diagnosis is difficult and the majority of cases can be identified based on clinical criteria and characteristics of the cerebrospinal fluid that the majority Sometimes they are nonspecific. Objective: determine the clinical-epidemiological characteristics in patients with meningeal tuberculosis of patients admitted to the medical clinic area at the National Hospital in the period 2015-2023. Methodology: retrospective descriptive observational cross-sectional study of adult patients with meningeal tuberculosis admitted to the National Hospital in the period 2015-2023. Results: 32 patients between 20 and 80 years old (mean age: 39 years) were included; men 68.75 %, women 32.25 %. Mostly coming from the interior of the country. In most cases, patients presented an increase in proteins in the cerebrospinal fluid and predominantly mononuclear cellularity. The genxpert positivity of Mycobacterium from the cerebrospinal fluid was 62.5 %; in no case was AFB isolated. 37.5 % were seropositive for HIV and 43.75 % had pulmonary disease concomitant to meningitis. Mortality was 31.25 %. Conclusion: tuberculous meningitis in our research mainly affected middle-aged men from the interior, whose initial symptoms are fever in a higher percentage followed by headache, presenting a high mortality.

Pérdida de proteínas en líquido peritoneal de pacientes críticos con abdomen abierto / Protein loss in peritoneal fluid of critically ill patients with open abdomen

Introducción. Los pacientes con patología abdominal quirúrgica que requieren manejo con abdomen abierto son susceptibles a la pérdida de proteínas desde la cavidad expuesta. El objetivo de este estudio fue caracterizar la pérdida proteica a través de dos tipos de cierre temporal abdominal. Métodos. Se realizó un estudio decohorte prospectivo, con pacientes críticos manejados durante el año 2021 con abdomen abierto mediante dos tipos de cierre temporal: bolsa de Bogotá y ABThera™. Se recolectaron muestras intraoperatorias seriadas de líquido peritoneal (días 1, 3 y 5). Se calcularon frecuencias y promedios, y se compararon con las pruebas de Chi cuadrado y t de Student. Resultados. Se incluyeron 25 pacientes. El promedio de pérdida de proteínas en líquido peritoneal fue mayor con el sistema ABThera™ (44,38 g/L) comparado con la bolsa de Bogotá (25,18 g/L; p=0,0185). Durante el seguimiento se observó la tendencia a la disminución del promedio de proteínas perdidas por ambos sistemas, pero con ABThera™ se perdieron en promedio 15,47 gr/L más de proteínas, independientemente del estado nutricional y del aporte proteico recibido (p=0,042). No hubo diferencias según la etiología que llevó al manejo con abdomen abierto, los procedimientos quirúrgicos realizados o el estado de infección por COVID-19. Conclusiones. El abdomen abierto representa una fuente importante de pérdida de proteínas, que es diferente según el tipo de cierre temporal usado. Estas pérdidas deberían considerarse en los cálculos de soporte nutricional en la unidad de cuidado intensivo.

Introduction. Patients with surgical abdominal pathology requiring management with an open abdomen are susceptible to protein loss from the exposed cavity. The objective of this study was to characterize protein loss through two types of temporary abdominal closure. Methods. A prospective cohort study was carried out with critically ill patients managed during 2021 with an open abdomen using two types of temporary closure: Bogota bag and ABThera™. Serial intraoperative peritoneal fluid samples were collected (days 1, 3, and 5). Frequencies and averages were calculated and compared with the Chi square and Student's t tests. Results. Twenty-five patients were included. The average protein loss in peritoneal fluid was higher with the ABThera™ system (44.38 g/L) compared to the Bogota bag (25.18 g/L; p-value=0.0185). During follow-up, a tendency to decrease the average protein lost by both systems was observed, but with ABThera™ an average of 15.47 gr/L more protein was lost, regardless of the nutritional status and protein intake received (p=0.042). There were no differences based on etiology leading to open abdomen management, surgical procedures performed, or Covid-19 infection status. Conclusions. The open abdomen represents an important source of protein loss, which is different depending on the type of temporary closure used. These losses should be considered in calculations of nutritional support in the intensive care unit.

Fluidoterapia reflexiva: desde la fisiología a la práctica clínica / Reflexive fluid therapy: From physiology to clinical practice

Introducción. La fluidoterapia es una intervención ampliamente usada en la práctica clínica. No obstante, su aplicación no está exenta de riesgos y demanda una evaluación cuidadosa de la tolerancia del paciente y su respuesta al volumen. La práctica empírica de la reanimación con líquidos puede ser potencialmente letal. El propósito de esta revisión fue proporcionar una visión general de los principios fisiológicos y terapéuticos para la administración de líquidos intravenosos en pacientes críticamente enfermos, abordando poblaciones especiales, como los pacientes quirúrgicos, sépticos y politraumatizados. Métodos. Se hizo una revisión narrativa a partir de artículos publicados en PUBMED, ScienceDirect y LILACS, entre 2001 y 2023. Para la búsqueda se emplearon los términos MESH fluid therapy, crystalloid solutions y colloids. Resultados. Se encontraron 371 artículos, de los cuales se seleccionaron los estudios clínicos aleatorizados, las revisiones narrativas, las revisiones sistemáticas y los metaanálisis que analizaron el rol de los cristaloides y coloides. Se incluyeron manuscritos publicados en fechas por fuera del rango de búsqueda, que se consideraron relevantes para la descripción de la fisiopatología y los fundamentos del uso de líquidos endovenosos. Conclusión. La reanimación reflexiva se fundamenta en un entendimiento holístico de la fisiología y la individualización de la fluidoterapia. El uso liberal de líquidos endovenosos tiene potenciales efectos nocivos y las estrategias de reanimación deben ser guiadas por medidas dinámicas y estáticas individuales, que proporcionan un panorama seguro para el manejo de los líquidos.

Introduction. Fluid therapy is an intervention widely used in clinical practice. However, its application is not without risks and requires a careful evaluation of patient's tolerance and response to volume. The empirical practice of fluid resuscitation can be potentially lethal. The purpose of this review was to provide an overview of the physiological and therapeutic principles for the administration of intravenous fluids in critically ill patients, addressing special populations, such as surgical, septic, and trauma patients. Methods. A narrative review was carried out based on articles published in PUBMED, ScienceDirect, and LILACS between 2001 and 2023. MESH terms fluid therapy, crystalloid solutions, and colloids were employed. Results. A total of 371 articles were found, of which randomized clinical trials studies, narrative reviews, systematic reviews, and meta-analyses that analyzed the role of crystalloids and colloids were selected. Manuscripts published on dates outside the search range, which were considered relevant for the description of the pathophysiology and the rationale for the use of intravenous fluids, were included. Conclusion. Reflective resuscitation is based on a holistic understanding of physiology and individualization of fluid therapy. The liberal use of intravenous fluids has potential harmful effects and resuscitation strategies should be guided by individual dynamic and static measures, which provide a safe framework for fluid management

Effects of intravenous hydration with hypotonic saline in oligohydramnios

Background: The amniotic fluid encloses and protects the fetus within the amniotic cavity in uterus. Amniotic fluid allows room for fetal growth, movement and development. The abnormal amniotic fluid either high or low volumes helps to diagnose the reduced fetal outcomes. This fluid is an important predictive tool for assessing the development of pregnancy.Methods: The present study is done to assess the effectiveness of intravenous (IV) hypotonic saline fluid maternal hydration on oligohydramnios. This study was conducted in department of obstetrics and gynecology, CHRI for 18 months. About 30 participants of third trimester with amniotic fluid index (AFI)<8 cm with the gestational age of 34-40 weeks were included. The study was done on pregnant mothers with AFI<8 cm and gestational age of 34-40 weeks. Measurement of AFI was done for all participants. The patients received 2 liters of hypotonic saline fluid over 4 hours. AFI was measured again 24 hours after baseline measurement. Treatment with IV infusion of hypotonic saline fluid is resulted in better increase in AFI in oligohydramnios.Results: After hypotonic saline infusion, the patient抯 AFI level was 7.14�31 with the p=0.000*** and it was statistically significant.Conclusions: The blood parameters and the electrolytes showed no notable changes before and after the infusion of hypotonic saline with regular antenatal visits, oligohydramnios can be detected early by clinical examination and routine ultrasonography and the proper treatment will help in preventing the complications of oligohydramnios.

Suprapiamadre: Análisis Etimológico y Propuesta Terminológica para la Cuarta Meninge en Terminologia Anatomica, Terminologia Neuroanatomica y Terminologia Histologica / Suprapiamadre: Etymological Analysis and Terminological Proposal for the Fourth Meninge in Terminologia Anatomica, Terminologia Neuroanatomica and Terminologia Histologica

A lo largo de la historia, el conocimiento sobre las meninges ha evolucionado desde los primeros registros en el papiro de Edwin Smith hasta la actualidad, donde se ha descrito SLYM, una cuarta meninge que separa el espacio subaracnoideo en un compartimiento superficial y otro profundo, a la que se le atribuyen funciones de barrera semipermeable y de nicho de células inmunes para la vigilancia y protección del sistema nerviosos central. La FIPAT contiene un grupo de terminologías que son mundialmente aceptadas para la descripción de las estructuras del cuerpo humano, sin embargo, en Terminologia Anatomica, Ter- minologia Neuroanatomica y Terminologia Histologica, aún no se encuentra incluido el término SLYM para representar una cuarta meninge, quizás porque sea un reciente descubrimiento. El objetivo de este estudio fue sugerir un nuevo término que concuerde con los lineamientos de la FIPAT y con las reglas de Terminología Anatómica Regular (RAT) en reemplazo de SLYM, además de proponer su inclusión en Terminologia Anatomica, Terminologia Neuroanatomica y Terminologia Histologica, previa revisión y aprobación por parte del comité respectivo de la FIPAT. Se revisó el acrónimo SLYM y los elementos que lo conforman (membrana subaracnoidea de tipo linfática), desde un enfoque etimológico, este análisis estuvo acompañado de una revisión a las reglas RAT aceptadas por la FIPAT, que fueron consideradas para examinar su cumplimiento por parte del acrónimo SLYM. Se encontró que SLYM, al igual que los términos que lo componen no cumplen totalmente con las reglas RAT. El acrónimo SLYM no proporciona una descripción adecuada de la estructura que representa, lo que contradice las reglas RAT. Se propone el término Suprapiamater como alternativa, para su inclusión en Terminologia Anatomica, Terminologia Neuroanatomica y Terminologia Histologica, basado en elementos latinos que describen su ubicación y función, mejorando la precisión y claridad en la comunicación científica.

SUMMARY: Throughout history, knowledge about the meninges has evolved from the first records in the Edwin Smith papyrus to the present, where SLYM, a fourth meninge that separates the subarachnoid space into a superficial compartment and another, has been described deep, to which semipermeable barrier and immune cell niche functions are attributed for the surveillance and protection of the central nervous system. The FIPAT contains a group of terminologies that are globally accepted for the description of the structures of the human body, however, in Terminologia Anatomica, Terminologia Neuroanatomica and Terminologia Histologica, the term SLYM to represent a fourth meninge is not yet included, perhaps because be a recent discovery. The objective of this study was to suggest a new term that agrees with the FIPAT guidelines and with the Regular Anatomical Terminology (RAT) rules to replace SLYM, in addition to proposing its inclusion in Terminologia Anatomica, Terminologia Neuroanatomica and Terminologia Histologica, previously review and approval by the respective FIPAT committee. The acronym SLYM and the elements that make it up (Subarachnoid Lymphatic-like Membrane) were reviewed from an etymological approach. This analysis was accompanied by a review of the RAT rules accepted by FIPAT, which were considered to examine their compliance by the acronym SLYM. It was found that SLYM, like the terms that compose it, do not fully comply with the RAT rules. The SLYM acronym does not provide an adequate description of the structure it represents, which contradicts the RAT rules. The term suprapiamater is proposed as an alternative, for inclusion in Terminologia Anatomica, Terminologia Neuroanatomica and Terminologia Histologica, based on Latin elements that describe its location and function, improving precision and clarity in scientific communication.

Epidemiological and clinical profiles of septic arthritis in children of 0-2 years of age in Eastern Uttar Pradesh, India

Background: Septic arthritis identified as infectious arthritis is a serious joint infection following the invasion of joint cavities by infectious agents usually bacteria. Due to speediness of joint destruction untreated septic arthritis may result in morbidity and mortality.Methods: Out of 71 sick children attending pediatric OPD/IPD of BRDMC Gorakhpur with musculoskeletal infection during November 2019 to October 2020, 52 patients of 0-2 years of age were enrolled for study. The computerized charts containing various parameters related to the epidemiological and clinical profiles of the patients were recorded and analyzed following statistical package for the social sciences (SPSS) version 23.Results: Out of 52 children 28.8% were neonates under the age of 28 days, 73.1% were full-term infants and 23.1% were premature. Likewise, 17.3% of the cases were with low birth weight whereas 7.7% had a history of septic infection. Hip joints in 65.4%, knee joints in 23.1% and elbow and shoulder joints in 5.8% of patients were infected. 44.2% of cases had right side involvement, 36.5% left side, 19.2% e bilateral joints, 80.8% Mono-articular and 19.2% showed poly-articular involvement. 84.6% of cases showed joint pain whereas 92.3% showed joint swelling. In 20% patients microbial culture of joint fluid revealed the growth of Staphylococcus aureus, Candida spp, E. coli and Pseudomonas spp. In 78.8% cases no growth of any pathogen was recorded in their blood culture. Ultrasonography (USG) diagnosis revealed fluid collection at joints in 94.2% cases while 5.8% exhibited pus collection.Conclusions: Septic arthritis was more common in males than females, monoarticular involvement was more common on the right side, hip joints were most affected joints and Staphylococcus aureus was the most common pathogen affecting the patients.

Experimental animal models in traumatic brain injury research: a comprehensive review of methods and outlook

Traumatic brain injury (TBI) remains a significant public health concern worldwide, necessitating effective research models to elucidate its pathophysiology and develop therapeutic interventions. Animal models play a crucial role in TBI research, offering valuable insights into injury mechanisms and potential treatments. However, selecting the appropriate model can be challenging due to diverse array of available options and their respective advantages and limitations. In this comprehensive review, we examine four commonly used animal models of TBI: the weight drop, fluid percussion, cortical impact, and blast injury models. Each model is characterized by distinct injury mechanisms, allowing researchers simulate various aspects of TBI pathology. We discuss the unique advantages and disadvantages of each model, providing insights into their applications and considerations for model selection based on research objectives and outcome measures. Furthermore, we highlight emerging directions in TBI modelling, emphasizing the importance of refining and innovating models to replicate the complexity of human TBI. By critically evaluating and understanding the subtlety of different TBI models, researchers can make informed decisions to enhance the translational potential of preclinical TBI research and ultimately improve clinical outcomes for TBI patients.

Fetomaternal outcome in abnormal liquor volume pregnancies

Background: Variation in the amniotic fluid reflects fetal compromise, and congenital anomalies and also may predict perinatal morbidity and mortality.Methods: Singleton pregnancy subjects with well-established dates at ?28 weeks of gestational age were taken into study. These subjects were ultrasonographically diagnosed to have abnormal liquor volumes. This study was a hospital-based single-center prospective observational study conducted in Midnapore medical college and hospital, west Bengal. The chi-square test was applied for statistical significance and a p<0.05 was considered to be significant.Results: In all subjects of abnormal liquor volume, the incidence of oligohydramnios and polyhydramnios are in the proportion of 3:1 in our study. Postdated pregnancy (28.4%), hypertensive disease (16.8%), intrauterine growth restriction (IUGR) (12.6%), and anemia (2.2%) were associated with oligohydramnios. Congenital anomalies (23.3%), GDM (16.6%), and Rh-incompatibility (3.3%) were associated with polyhydramnios. The incidence of caesarean section, meconium-stained liquor and 5-minute APGAR score <7 and NICU admission was higher in the oligohydramnios group as compared to polyhydramnios. In abnormal liquor volume, the statistical association was significant with onset of labour (p=0.00), mode of delivery (p=0.00), the colour of liquor(p-0.00), and fetal outcome (p=0.00).Conclusions: Postdated pregnancy, IUGR, and hypertensive disorders were associated with oligohydramnios and congenital anomalies, and GDM and Rh-isoimmunization were associated with polyhydramnios. In abnormal liquor volume onset of labour, mode of delivery, the colour of the liquor, and fetal outcome were significant.

Calibre e formato de agulhas e sua relação com a incidência de cefaleia pós-punção dural: uma revisão sistemática / Needles gauge and shape and its relation to post-dural puncture headache incidence: a systematic review

Introdução: A cefaleia pós punção dural (CPPD) é uma complicação da punção lombar, um procedimento que, apesar de bem tolerado, está sujeito a adversidades, ocorrendo devido a um vazamento persistente do líquido cefalorraquidiano (LCR) do local da punção dural. A incidência de CPPD pode estar relacionada às características dos pacientes e dos procedimentos. Notou-se que em mulheres jovens até 30 anos, o risco de CPPD é maior quando comparado aos homens, não apresentando diferença a partir da quinta década de vida. Objetivo: investigar os diferentes sintomas e efeitos gerados pelos diferentes tipos de agulha, como calibre e modo de inserção, que visem reduzir a CPPD. Métodos: Trata-se de uma revisão sistemática de literatura realizada no período de 2 de agosto a 20 de novembro de 2023 por meio de pesquisas no PubMed. Foram utilizados os descritores: "Post-Dural Puncture Headache" e suas variações do MeSH, sendo submetidos aos critérios de inclusão: estudos em humanos, nos últimos 10 anos, ensaios clínicos e ensaios clínicos controlados e randomizados. Para garantir a qualidade da revisão sistemática foi aplicada a lista de verificação PRISMA de 2020. Resultados: Após investigação estatística, observou-se que as agulhas 25W e 25S demandaram maior tempo médio para a coleta de LCR (15 e 7 min, respectivamente). Ao se comparar 25W com 20Q (3 min), 22S (5 min) e 25S quanto à esta variável, observouse diferença significativa em todas as comparações. Conclusão: As agulhas do tipo atraumática foram associadas com redução do risco de desenvolvimento de CPPD quando comparadas às convencionais. Foi constatado que, dentre as agulhas convencionais, a traumática de 25G é melhor para a prevenção de CPPD que a de 22G.

Introduction: Post-Dural Puncture Headache (PDPH) is a complication of lumbar puncture, a procedure that, despite being well-tolerated, is subject to adversities, occurring due to a persistent leakage of cerebrospinal fluid (CSF) from the site of dural puncture. The incidence of PDPH may be related to patient and procedural characteristics. It has been noted that in young women up to 30 years old, the risk of CPPD is higher compared to men, with no difference between sexes from the fifth decade of life onward. Objective: To investigate the different symptoms and effects generated by different types of needles, such as gauge and insertion method, aiming to reduce CPPD. Methods: Is a systematic literature review conducted from August to October 2023 through searches on PubMed. The descriptors "Post-Dural Puncture Headache" and its MeSH variations were used. A total of 1,839 articles were found, which were then subjected to inclusion criteria: studies conducted in the last 10 years, controlled trials, and randomized clinical trials. Results: After statistical investigation, it was observed that the 25W and 25S needles required a longer average time for cerebrospinal fluid collection (15 and 7 minutes, respectively). When comparing 25W with 20Q (3 minutes), 22S (5 minutes), and 25S regarding this variable, a significant difference was observed in all comparisons. Conclusion: Atraumatic needles were associated with a reduction in the risk of developing CPPD compared to conventional needles. It was found that among conventional needles, the traumatic 25G needle is better for preventing CPPD than the 22G needle.

Effects of physical exercise on cognition and glymphatic system of patients with mild cognitive impairment or Alzheimer's disease ­ study protocol

Objective: To evaluate the impact of a multicomponent physical exercise program on clinical variables associated with the glymphatic clearance system, sleep-awake patterns, and cognitive function in individuals with mild cognitive impairment or mild Alzheimer's disease. Methods: This is a single-center parallel randomized controlled trial involving pre- and post-intervention assessments. The intervention consists of a 12 (±3)-week multicomponent aerobic and resistance physical exercise program of moderate intensity divided into 2 groups: an experimental group (undergoing multicomponent training) and a control group (no intervention). Eligible participants are those diagnosed with probable mild cognitive impairment or mild Alzheimer's disease. Expected results: Anticipated outcomes suggest that the multicomponent training protocol, incorporating both aerobic and resistance physical exercises at a moderate intensity, will yield improvements in glymphatic clearance dynamics, sleep-awake parameters, and performance on cognitive, functional, and behavioral tasks among eligible patients. Relevance: The need to move beyond cognitive clinical testing justifies our trial, which proposes an assessment employing neuroimaging techniques and the analysis of biomarkers present in cerebrospinal fluid in conjunction with clinical tests for physical and cognitive assessment. (AU)

Fibrina rica en plaquetas y leucocitos en abordajes endonasales endoscópicos

Introducción: La medicina regenerativa y terapia celular representa una alternativa segura y eficaz en la regeneración hística. La fibrina rica en plaquetas y leucocitos favorece la cicatrización de la base craneal, con una disminución significativa en las complicaciones, en especial la fístula de líquido cefalorraquídeo. Objetivo: Describir los resultados del empleo de la fibrina rica en plaquetas y leucocitos como elemento accesorio en la reparación de la base craneal. Métodos: Se realizó un estudio descriptivo, transversal en 250 pacientes en el Hospital Hermanos Ameijeiras, operados por procedimientos endonasales endoscópicos con diversos tumores de la base craneal, en los cuales se empleó la fibrina rica en plaquetas y leucocitos durante la fase de reconstrucción. Se realizó una evaluación de la barra de reparación y las complicaciones presentes. Para el análisis de los datos se utilizaron frecuencias absolutas y relativas como medidas resumen. Resultados: El 97,2 % de las barreras de reparación fue catalogada de óptima. Se reporta con el uso de la fibrina rica en plaquetas y leucocitos 2,0 % de fístula de líquido cefalorraquídeo, 0,8 % de infección del sistema nervioso central, 4,0 % de costras nasales posoperatorias. Conclusiones: El presente estudio evidencia el efecto positivo del empleo de la fibrina rica en plaquetas y leucocitos en la reparación del base craneal con gran impacto en el índice de fístula de líquido cefalorraquídeo y la calidad de vida nasosinusal.

Introduction: Regenerative medicine and cell therapy represents a safe and effective alternative in tissue regeneration. Fibrin rich in platelets and leukocytes promotes healing of the cranial base, with a significant decrease in complications, especially cerebrospinal fluid leak. Objective: Describe the results of using fibrin rich in platelets and leukocytes as an accessory element in the repair of the cranial base. Methods: A descriptive, cross-sectional study was carried out in 250 patients at the "Hermanos Ameijeiras" Hospital operated by endoscopic endonasal procedures with various tumors of the cranial base, in which fibrin rich in platelets and leukocytes was used during the reconstruction phase. An evaluation of the repair bar and the complications present was performed. For data analysis, absolute and relative frequencies were used as summary measures. Results: 97.2% of the repair barriers were classified as optimal. With the use of fibrin rich in platelets and leukocytes, 2.0% of cerebrospinal fluid leak, 0.8% of central nervous system infection, 4.0% of postoperative nasal scabs are reported. Conclusions: The present study evidences the positive effect of the use of leukocyte-platelet-rich fibrin in the repair of the skull cranial base, with great impact on the rate of cerebrospinal fluid leak and sinonasal quality of life.

Management of diabetic ketoacidosis in internal medicine: insulin protocols, electrolyte balance, and clinical outcomes

Diabetic ketoacidosis (DKA) is a critical complication of diabetes mellitus (DM), characterized by hyper-glycemia, acidosis, and ketosis. It poses a substantial risk of morbidity and mortality, especially in type 1 DM patients. DKA can be triggered by various factors, including insulin deficiency, infections, alcohol abuse, and other medical conditions. Hospital admissions for DKA are increasing, with mortality rates of up to 5-9%, often linked to severe underlying illnesses and complications such as myocardial infarction and stroke. Effective DKA management involves rehydration, correction of electrolyte imbalances, insulin administration, and addressing precipitating factors. Fluid resuscitation with isotonic saline is vital to restore hydration, and continuous intravenous insulin infusion is the preferred method to control blood glucose and suppress ketone production. Electrolyte imbalances, particularly potassium, sodium, phosphate, and magnesium, require careful monitoring and correction. Clinical outcomes in DKA management include resolving acidosis, normalizing blood glucose, and restoring electrolyte balance, all while achieving and maintaining clinical stability. Complications like cerebral edema and acute respiratory distress syndrome can significantly impact the prognosis. Long-term considerations encompass diabetes management, patient education, and follow-up care.

Analysis on Components Absorbed into Blood and Cerebrospinal Fluid of Schisandrae Chinensis Fructus Based on Sequential Metabolism / 中国实验方剂学杂志

ObjectiveTo identify the prototypical components and metabolites absorbed into blood and cerebrospinal fluid of Schisandrae Chinensis Fructus（SCF） based on sequential metabolism combined with liquid chromatography-mass spectrometry. MethodBlood and cerebrospinal fluid samples of integrated metabolism， intestinal metabolism and hepatic metabolism were collected from male SD rats after gavage and in situ intestinal perfusion administration， and ultra-performance liquid chromatography-quadrupole/electrostatic field orbitrap high-resolution mass spectrometry（UPLC Q-Exactive Orbitrap MS） was used to analyze and compare the differences in the spectra of SCF extract， blank plasma， administered plasma， blank cerebrospinal fluid and administered cerebrospinal fluid with ACQUITY UPLC BEH Shield RP18 column（2.1 mm×100 mm， 1.7 µm）， the mobile phase was acetonitrile（A）-0.1% formic acid aqueous solution（B） for gradient elution（0-7 min， 95%B； 7-12 min， 95%-35%B； 12-17 min， 35%-15%B； 17-20 min， 15%-12%B； 20-22 min， 12%-5%B； 22-23 min， 5%B； 23-25 min， 5%-95%B； 25-28 min， 95%B）. And heated electrospray ionization（HESI） was used with positive and negative ion modes， the scanning range was m/z 100-1 500. The prototypical constituents and their metabolites absorbed into blood and cerebrospinal fluid of SCF were identified according to the retention time， characteristic fragments， molecular formulae and the information of reference substances. ResultA total of 42 chemical components were identified in the extract of SCF， including lignans， flavonoids， amino acids， tannins， and others， of which lignans were the main ones. A total of 27 prototypical components and 14 metabolites were identified in plasma samples from different sites. A total of 15 prototypical components and 9 metabolites were identified in cerebrospinal fluid. The main metabolic reactions involved in the formation of metabolites were mainly demethylation， methylation， demethoxylation and hydroxylation. ConclusionThrough the systematic identification of the prototypical components and metabolites of SCF in rats， it provides data support for further better exploring the material basis of SCF in the treatment of central nervous system diseases.

PENG Qinghua's Clinical Experience in Treating Dry Eye by the Therapeutic Method of “Maintaining with the Sweet and Restoring the Body Fluids” / 中医杂志

This paper summarized PENG Qinghua's clinical experience in treating dry eye by applying therapeutic method of maintaining with sweet medicinals and restoring the body fluids. It is believed that the spleen earth insufficiency and fluids damage transforming into dryness are the main pathogenesis of the disease， and the basic therapeutic principle is maintaining with the sweet and restoring the body fluids by mainly using sweet medicines. It is advocated to use mild-sweet herbs， such as Baibiandou （Lablab purpureus subsp. purpureus）， Fuling （Smilax glabra Roxb.）， and Yiyiren （Coix lacryma-jobi L.）， to transport spleen earth， so that qi is restored and body fluids are recovered； moderate-sweet herbs， such as Dangshen （Codonopsis pilosula ［Franch.］ Nannf.）， Taizishen （Pseudostellaria heterophylla ［Miq.］ Pax）， Shanyao （Dioscorea oppositifolia L.） and Zhigancao （Glycyrrhiza glabra L.） are suggested to cultivate earth and generate metal， so as to move qi and circulate fluid； sweet-cool herbs， such as Nanshashen （Adenophora triphylla ［Thunb.］ A.DC.）， Beishashen （Glehnia littoralis ［A.Gray］ F.Schmidt ex Miq.）， Yuzhu （Polygonatum odoratum ［Mill.］ Druce）， Tianhuafen （Trichosanthes kirilowii Maxim.） are suggested to nourish yin and increase body fluids， so as to promote fluid production to moisten dryness. In this way， when the source of fluid is restored and the fluid is circulated， the fluid can be produced continuously， which provides new ideas for the treatment of dry eyes with traditional Chinese medicine.

Evolution and innovation of preservation fluid for donor liver / 器官移植

Organ preservation fluid could mitigate cold ischemia injury and maintain normal function of the grafts. At present, how to reduce a series of injury caused by cold ischemia of donor liver and improve the preservation quality of grafts are the hot and challenging spots in this field. Currently, preservation fluid in clinical practice has not achieved ideal preservation effect, especially for the protection of marginal donor organs. In the context of severe donor shortage, the key solution is still to explore the optimal preservation protocol for donor liver to prevent grafts from cold ischemia injury. In this article, the mechanism of donor liver injury during cold ischemia, the classification and evolution of donor liver preservation fluid were summarized, the development direction and challenges of donor liver preservation fluid were discussed, aiming to provide novel ideas and references for the research and development of donor liver preservation fluid.

Mechanism of Linggui Zhugantang in Promoting Astrocyte Endocytosis and Degradation of Amyloid β / 中国实验方剂学杂志

ObjectiveTo investigate the effects of Linggui Zhugantang （LGZGT）-containing serum on primary astrocytes （AS） induced by β amyloid 1-42 （Aβ1-42） in a rat model of Alzheimer's disease （AD） and explore the phagocytic and degradative effects of LGZGT on Aβ. MethodAn AD model was established by inducing AS with Aβ1-42. The cells were divided into normal group， model group， LGZGT low-， medium-， and high-dose （LGZGT-L， LGZGT-M， and LGZGT-H） groups， and donepezil hydrochloride group. The model group was treated with Aβ1-42 at a final concentration of 10 μmol∙L-1. The LGZGT-L， LGZGT-M， and LGZGT-H groups were treated with 10% serum containing LGZGT on the basis of the model group. Cell viability was assessed using a cell counting kit-8 （CCK-8）， lactate dehydrogenase （LDH） activity was measured using an LDH assay kit， and cell morphology was observed using an inverted microscope. The expression of Aβ-related degradation enzymes insulin-degrading enzyme （IDE） and cathepsin D （CTSD） was detected using Western blot， and the fluorescence intensity of cathepsin B （CTSB） was measured using immunofluorescence. The content of Aβ1-42 in cells was determined using an enzyme-linked immunosorbent assay （ELISA）. ResultCompared with the normal group， the viability of AS in all groups decreased， and Aβ1-42 at different concentrations had inhibitory effects on AS proliferation. After administration， compared with the normal group， the cell survival rate of the model group decreased significantly （P<0.05）. Compared with the model group， the cell survival rates of the LGZGT-H group and donepezil hydrochloride group increased significantly （P<0.05）. The LDH activity of cells in the model group was significantly increased compared with that in the normal group （P<0.05）， and cell bodies were swollen and enlarged with increased protrusions and elongation， suggesting more obvious cell damage. Compared with the model group， the LDH activity of cells in the donepezil hydrochloride， LGZGT-L， LGZGT-M， and LGZGT-H groups decreased significantly （P<0.05）. After administration， the cell swelling in the LGZGT-M， LGZGT-H， and donepezil hydrochloride groups improved， cell protrusions shortened， and cell clustering decreased. Compared with the normal group， the expression of IDE and CTSD in the model group decreased significantly （P<0.05）. Compared with the model group， the expression of IDE increased significantly in the LGZGT-M and LGZGT-H groups （P<0.05）. Compared with the model group， the expression of CTSD increased significantly in the LGZGT-L， LGZGT-M， LGZGT-H， and donepezil hydrochloride groups （P<0.05）. The average fluorescence intensity of CTSB in the model group was significantly lower than that in the normal group （P<0.05）. Compared with the model group， the average fluorescence intensity of CTSD in the LGZGT-L， LGZGT-M， LGZGT-H， and donepezil hydrochloride groups increased significantly （P<0.05）. The intracellular content of Aβ1-42 in cells in the model group was significantly higher than that in the normal group （P<0.05）. After administration， compared with the model group， the intracellular content of Aβ1-42 in cells in the LGZGT-L， LGZGT-M， LGZGT-H， and donepezil hydrochloride groups decreased significantly （P<0.05）， and LGZGT-containing serum reduced Aβ1-42 in a dose-dependent manner （P<0.05）. ConclusionLGZGT has a protective effect on Aβ1-42-induced AS and can promote the degradation of Aβ. Its mechanism may be related to reducing Aβ toxicity， enhancing cell viability， promoting the expression of IDE， CTSD， and CTSB， and restoring lysosomal function.

Relationship between short-chain fatty acids in the gingival crevicular fluid and peri-odontitis of stage Ⅲ or Ⅳ / 北京大学学报(医学版)

Objective:To analyze the concentration of formic acid,propionic acid and butyric acid in gingival crevicular fluid(GCF)of patients with stages Ⅲ and Ⅳ periodontitis,and their relationship with periodontitis.Methods:The study enrolled 37 systemically healthy patients with periodontitis and 19 healthy controls who visited Department of Periodontology,Peking University School and Hospital of Sto-matology from February 2008 to May 2011.Their GCFs were collected from the mesial-buccal site of one molar or incisor in each quadrant.Periodontal clinical parameters,including plaque index(PLI),probing depth(PD),bleeding index(BI),and attachment loss(AL).Concentrations of formic acid,propionic acid and butyric acid in the supernatant of the GCFs were analyzed by high-performance capil-lary electrophoresis(HPCE).The prediction ability of formic acid,propionic acid and butyric acid with the risk of periodontitis and the differences between grade B and grade C periodontitis were analyzed.Results:In this study,32 patients with stage Ⅲ and 5 patients with stage Ⅳ were enrolled,including 9 patients with grade B and 28 patients with grade C.Clinical periodontal variables in the patients with pe-riodontitis were significantly higher than those in the control group(P＜0.001).Formic acid was signifi-cantly lower in periodontitis than that in the control group[5.37(3.39,8.49)mmol/L vs.12.29(8.35,16.57)mmol/L,P＜0.001].Propionic acid and butyric acid in periodontitis were significantly higher than those in the control group:Propionic acid,10.23(4.28,14.90)mmol/L vs.2.71(0.00,4.25)mmol/L,P＜0.001;butyric acid,2.63(0.47,3.81)mmol/L vs.0.00(0.00,0.24)mmol/L,P＜0.001.There was no significant difference in formic acid,propionic acid and butyric acid concentrations between grade B and grade C periodontitis(P＞0.05).Propionic acid and butyric acid in the deep pocket were significantly higher than in the shallow pocket,while the concentration of formic acid decreased with the increase of PD.Propionic acid(OR=1.51,95％CI:1.29-1.75)and butyric acid(OR=3.72,95％CI:1.93-7.17)were risk factors for periodontitis,while formic acid(OR=0.87,95％CI:0.81-0.93)might be a protective factor for periodontitis.Propionic acid(AUC=0.852,95％CI:0.805-0.900),butyric acid(AUC=0.889,95％CI:0.841-0.937),f(formic acid,AUC=0.844,95％CI:0.793-0.895)demonstrated a good predictive capacity for the risk of periodontitis.Conclusion:The concentration of formic acid decrease in the GCF of periodontitis patients,which is a protective factor for periodontitis,its reciprocal have good predictive capacity.However,propionic acid and butyric acid increase,which are risk factors for periodontitis and have good predictive capacity.The concentration of formic acid,propionic acid,and butyric acid vary with probing depth,but there is no significant difference between grade B and grade C periodontitis.

Summary of optimal evidences for early fluid resuscitation management in patients with acute pancreatitis / 重庆医学

Objective To systematically retrieve,evaluate and integrate the best evidences on the early fluid resuscitation management in the patients with acute pancreatitis(AP)at home and abroad to provide ref-erence for clinical decision.Methods The related evidences on the early fluid resuscitation management in the AP patients were retrieved by computer from the databases of BMJ Best Practice,Up To Date,JBI,National Institute for Health and Care Excellence,Registered Nurses Association of Ontario,Guideline International Network,Scottish Intercollegiate Guidelines Network,International Association of Pancreatology,American Pancreatic Association,American College of Gastroenterology,Yimaitong,Cochrane Library,PubMed,Em-bass,CINAHL,The Web of Science,CNKI,Wanfang databases.The retrieval time limit was from the data-base establishment to March 20,2022.The literatures types included thematic evidence summarization,guide-lines,evidence summaries,systematic reviews and expert consensus.The researchers conducted the literature quality evaluation.The literatures meeting the standard conducted the evidence extraction.Results A total of 13 arti-cles were included,including 3 special subject evidence summary,4 guidelines,2 evidence summary,2 systematic evalu-ation and 2 expert consensus.A total of 16 pieces of best evidence were integrated,involving 4 aspects of organization management,evaluation and monitoring,fluid infusion strategy and health education.Conclusion It is recommended to use the target-oriented therapy for early fluid resuscitation management,and perform the fluid resuscitation immediate-ly after diagnosis,according to the patient's underlying disease,disease changes and monitoring indicators,implement precise early fluid resuscitation in order to reverse pancreatic microcirculation disorder,increase tissue perfusion and improve the patient's prognosis.

Hemodynamic simulation study of tandem carotid artery stenosis / 介入放射学杂志

Objective By using the computational fluid mechanic(CFD)method the tandem carotid artery stenosis(TCAS)was simulated on the model,and to compare the postoperative hemodynamic changes of different surgical procedures.Methods One patient with tandem stenosis of internal carotid artery(ICA)and common carotid artery(CCA)was selected.CFD technique was used to establish four three-dimensional(3-D)models of the carotid bifurcations,including one model of a real patient and three models of presumptive surgery.The hemodynamic analysis was performed with these models so as to explore the development mechanism of TCAS and to discuss the selection of suitable surgical plan.Results In tandem stenosis,the stenosis was preferentially formed in CCA and subsequently led to ICA stenosis.The local hemodynamic situation in TCAS was more complex and more risky than in single carotid artery stenosis.In tandem stenosis,the treatment of one stenosis site would affect the blood flow at the next stenosis site and cause restenosis or plaque rupture.Conclusion In treating patients with TCAS,CFD simulation examination should be performed when the surgical plan is formulated,which can help clinicians to predict the postoperative changes in blood flow and to choose the appropriate surgical plan.