RÉSUMÉ
Objective To explore the risk factors for intracranial infection in patients after neurosurgery,con-struct and validate a Nomogram prediction model.Methods Data of 978 patients who underwent neurosurgery in a hospital in Nanjing from January 1,2019 to December 31,2022 were retrospectively analyzed.Independent risk fac-tors were screened through logistic univariate and multivariate analyses.Modeling variables were screened through Lasso regression.A Nomogram model was constructed and internally validated by logistic regression.Effectiveness of the model was evaluated with receiver operating characteristic(ROC)curve,calibration curve and decision curve.Results Among 978 patients underwent neurosurgery,293 had postoperative intracranial infection,with an inci-dence of healthcare-associated infection of 29.96％.There was no significant difference in age,gender,proportion of coronary heart disease,cerebral infarction,diabetes and hypertension between the infected group and the non-in-fected group(all P＞0.05).Multivariate logistic analysis showed that postoperative intracranial hypertension,fe-ver,increased neutrophil percentage in blood routine examination,turbid cerebrospinal fluid,positive Pan's test,decreased glucose concentration,abnormal ratio of cerebrospinal fluid/serum glucose,positive microbial culture,absence of indwelling external ventricular drainage tubes,presence of indwelling lumbar cistern drainage tubes,use of immunosuppressive agents,and long duration of surgery were independent risk factors for postoperative intracra-nial infection in patients who underwent neurosurgery(all P＜0.05).Fifteen variables were screened out through Lasso regression.Fourteen variables were finally included for modeling after collinear screening,missing data impu-tation(random forest method)and checking pairwise interaction items.A Nomogram prediction model was con-structed,with the area under ROC curve,sensitivity,specificity,and accuracy of 0.885,0.578,0.896,and 0.704,respectively.Internal validation of the model was conducted.The modeling and validation groups presented similar effects.The calibration curve and decision curve also indicated that the model had good predictive efficacy.Conclusion The constructed Nomogram prediction model for postoperative intracranial infection after neurosurgery is scientific,and the prediction indicators are easy to obtain.The model presents with high stability,reliability,and application value,thus can provide reference for the assessment of postoperative intracranial infection after neuro-surgery.
RÉSUMÉ
Objective To examine the clinical distribution of primary intracranial tumors and analyze the risk factors for postoperative complications.Methods From January 2018 to December 2022,the clinical data of 961 patients with primary intracranial tumor in the Department of Neurosurgery of Tiantan Hospital in Beijing were collected and analyzed retrospectively.To examine the clinical distribution of patients with primary intracranial tumor and present the incidence of postoperative complications.To compare the basic data of patients with and without postoperative complications,and analyze the risk factors leading to postoperative complications.Results There were 363 cases of glioma,231 cases of meningioma,158 cases of sellar tumors,142 cases of neurilemmoma and 67 cases of other types of tumors.There were 679 cases of supratentorial tumors and 282 cases of infratentorial tumors.Postoperative complications occurred in 279 patients,and the incidence of postoperative complications was 29.03％.The incidences of intracranial infection,pulmonary infection,hyponatremia,lower extremity venous thrombosis and central nervous system infection were 9.37％,5.41％,4.99％,4.47％and 4.27％,respectively.After surgery,D-dimer(D-D),fibrin degradation products(FPD),prothrombin time(PT)in patients with primary intracranial tumors were significantly higher than those in patients without primary intracranial tumors(P<0.05).Activation of partial thromboplastin time(APTT),and thrombin time(TT)levels were significantly higher than those before surgery(P<0.05).Fibrinogen(FIB)was significantly lower than that before surgery(P<0.05).There were significant differences in tumor location,intraoperative blood loss,operation time,anesthesia recovery time and postoperative coagulation function between patients with and without postoperative complications(P<0.05).Conclusions The common types of primary intracranial tumors include gliomas,meningiomas,sellar tumors and neurilemmoma,etc.Surgical treatment has a high risk of postoperative complications.Common postoperative complications include intracranial infection,pulmonary infection,hyponatremia,lower extremity venous thrombosis,and central nervous system infection.Tumor location,operation duration,intraoperative blood loss,anesthesia recovery time and postoperative coagulation dysfunction are all risk factors for postoperative complications.
RÉSUMÉ
Objective:To study the past 10 years' experiences of neonatal hydrocephalus in a single-center.Methods:From January 2010 to December 2019, clinical data of infants with hydrocephalus admitted to Neonatology Department of our hospital were retrospectively analyzed. The infants were assigned into different groups according to gestational age, different etiologies and treatments. Their clinical characteristics and outcomes were compared.Results:A total of 223 infants with hydrocephalus were included. 136 (61.0%) infants were in the preterm group and 87 (39.0%) in the full-term group. The incidence of post-intracranial hemorrhage (ICH) hydrocephalus in preterm infants was significantly higher than full-term infants ( P<0.001). According to the etiologies, 58 infants (26.0%) had congenital hydrocephalus (congenital group), 82 cases (36.8%) developed post-ICH hydrocephalus (ICH group), 48 cases (21.5%) had post-CNS-infection hydrocephalus (infection group) and 35 cases (15.7%) had post-ICH+CNS-infection hydrocephalus (ICH+infection group). The incidences of perinatal asphyxia, neonatal resuscitation and endotracheal intubation within 3 d after birth in the ICH group were significantly higher than the other groups ( P<0.05). Among the four groups, the infection group had the highest incidence of neonatal sepsis, the congenital group had the highest incidence of patent ductus arteriosus and the ICH group had the highest incidence of respiratory diseases (all P<0.05).137 cases (61.4%) received non-surgical therapy, 48 cases (21.5%) had temporary drainage, 37 cases (16.6%) with permanent shunt and 1 case (0.4%) intracranial hematoma removal. The congenital group and ICH group with permanent shunt showed significantly higher rate of improvement than temporary drainage group and non-surgical group ( P<0.001). Conclusions:The main etiologies of neonatal hydrocephalus are ICH and CNS infection. The incidence of post-ICH hydrocephalus in premature infants was quite high. Hydrocephalus of different etiologies have different comorbidities. Maternal and infant care during pregnancy and delivery, prevention of neonatal sepsis and ICH are crucial in the prevention of hydrocephalus. More studies are needed for better treatment.
RÉSUMÉ
Suppurative meningoencephalitis is the kind of intracranial infectious disease which exhibits comparatively more severe clinical manifestations, more expensive diagnostic and treatment costs and poorer prognosis. Early diagnosis and effective treatment are essential for better improvement of disease prognosis. Clear identification of intrinsic and extrinsic factors causing the acute phase of suppurative meningoencephalitis, as well as its epidemiological and pathogenic characteristics, clinical manifestations and classifications, imaging features and laboratory tests explanations, may contribute greatly to the diagnostic correctness and treatment efficacy, thus promoting diagnostics and medical treatment of this disease which remains ultimately critical to patients′ prognosis.
RÉSUMÉ
Objective:To study the correlations of cerebrospinal fluid (CSF) routines and biochemical indexes before ventriculoperitoneal shunt with postoperative intracranial infection in adult patients with hydrocephalus.Methods:A retrospective case-control study was conducted on 347 adult patients who underwent ventriculoperitoneal shunt in Department of Functional Neurosurgery, Neurosurgery Center, Zhujiang Hospital of Southern Medical University from January 2016 to December 2021. According to the appearance of postoperative infection or not, these patients were divided into infection group ( n=27) and non-infection group ( n=320). General clinical data and CSF routines and biochemical indexes test results were analyzed and compared between the two groups. The correlations of postoperative intracranial infection with preoperative levels of white blood cells, chlorine, glucose, lactic acids and proteins in the CSF were analyzed by multivariate Logistic regression. Results:There was no significant difference in age, gender, or primary diseases between infection group and non-infection group ( P>0.05). As compared with the non-infection group, the infection group had significantly decreased glucose content and significantly increased lactic acid content in the CSF ( P<0.05). Multivariate Logistic regression analysis showed that glucose content ( OR=21.825, 95%CI: 4.994-95.394, P<0.001) and lactic acid content ( OR=18.430, 95%CI: 6.023-56.391, P<0.001) were independently correlated with infections after ventriculoperitoneal shunt. Risk of patients with glucose content<2.5 to develop intracranial infection after surgery was 21.825 times that of patients with preoperative glucose content≥2.5 mmol/L. Risk of patients with lactic acid content>2.5 mmol/L to develop intracranial infection after surgery was 18.430 times that of patients with preoperative lactic acid content≤2.5 mmol/L. Conclusion:For adult hydrocephalus patients without intracranial infection but only with abnormal CSF (glucose content<2.5 mmol/L or lactic acid content>2.5 mmol/L), ventriculoperitoneal shunt should only be performed after further improvement of CSF indexes to avoid increasing postoperative infection.
RÉSUMÉ
To investigate the risk factors for the occurrence of intracranial infection (ICI) after endoscopic transnasal resection of a pituitary adenoma and to select the best strategy for reconstructing skull base defects. Method: The clinical data of 162 patients with pituitary adenoma admitted into First Hospital of Shanxi Medical University between December 2016 and December 2019 were analyzed retrospectively. The incidence rate of ICI after surgery was analyzed. According to the occurrence of ICI, patients were stratified into ICI and non-ICI groups. The infected and non-infected groups of clinical data were collected and the independent risk factors for ICI after surgery were analyzed. Result: Among the 162 patients, 11 patients (6.79%) developed ICI, whereas 151 patients (93.21%) did not develop ICI. Body mass index (BMI), intraoperative cerebrospinal fluid leakage, postoperative cerebrospinal fluid leakage, and Kelly grades were significantly higher in the ICI group than in the non-ICI group (P<0.05). Logistic regression analysis showed that BMI, intraoperative cerebrospinal fluid leakage, postoperative cerebrospinal fluid leakage, and Kelly grades were independent risk factors for ICI after surgery (P<0.05). Conclusions: The incidence of ICI after endoscopic endonasal surgery is related to BMI, intraoperative cerebrospinal fluid leakage, postoperative cerebrospinal fluid leakage, and Kelly grades. Furthermore, reasonable strategies for skull-base reconstruction should be developed according to the Kelly grading system.
RÉSUMÉ
Background: Febrile seizure is an event in infancy or childhood, usually occurring between 3 months and 5 years of age associated with fever but without evidence of intracranial infection. The aim of the study was to estimate the usefulness of neutrophil-to-lymphocyte ratio (NLR) in patients with simple and complex febrile seizures.Methods: Retrospective case control'' study was done in a paediatric in patients admitted to tertiary care hospital.' Study period'' was from January 2017 to December 2019. 200 children were analysed in the study. 100 out of 200 were under control group (febrile children without seizure). Remaining 100 were under case group (children with febrile seizure), 54 out of 100 children had'' complex febrile seizure, 46 out of 100 had simple febrile seizure. NLR ratio was done in all children.Results: Total 200 children were analysed in this study.'' High NLR ratio'' was noted among the cases (87 out of 100) compared to control (30 out of 100) p value = <0.001. Among the cases CFS had high NLR ratio compared to SFS, however p value was not significant (0.072).Conclusions: Children with febrile seizure had high NLR ratio compared to those without seizures. However no significant difference was noted between those with simple febrile seizure and complex febrile seizure'' However, larger trials are required'' to assess whether higher NLR can be taken as an independent risk factor for febrile seizure.
RÉSUMÉ
Objective: To identify risk factors associated with intracranial infection after endoscopic endonasal skull base surgery. Methods: From January 2011 to December 2016, 150 patients who underwent endoscopic resection of a skull base tumor at the Chinese Academy of Medical Sciences Cancer Hospital (CAMS) were selected. Data related to general patient characteristics, underlying disease, type of operation, postoperative condition, and antimicrobial drug use, etc., were collected. The SPSS21.0 software was used to perform univariate and multivariate logistic analyses. Results: Of 150 patients, 27 had intracranial infection, and the infection rate was 18%. Logistic regression analysis revealed that no antimicrobial agents were used 0.5-1 h before the operation, external ventricular drain or lumbar drainage during operation, skull base reconstruction, and BMI ≥25 were independent risk factors for intracranial infection. Conclusions: Independent risk factors of intracranial infection after endoscopic resection of skull base tumors were screened. The results provide a basis for the accurate management of infection control at surgical sites.
RÉSUMÉ
Objective To establish a two-dimensional high-performance liquid chromatography method for the determination of tigecycline in human cerebrospinal fluid, which can be used for the drug monitoring in patients with intracranial infection. Methods The quantification was carried out by an external standard method. The first-dimension column was a Aston SNX5 phenyl chromatographic column (50 mm×4.6 mm, 5 μm) with ammonium phosphate (pH was adjusted with ammonium hydroxide to 7.5)-methanol (45∶55, V/V) as the mobile phase and the flow rate was 1.2 ml/min. The second-dimension chromatographic column was Aston SC5 C18 (275 mm×4.6 mm, 5 μm), with ammonium phosphate (pH was adjusted with ammonium hydroxide to 7.4)-ammonium phosphate (pH was adjusted with ammonium hydroxide to 3.0)- acetonitrile (30∶50∶20, V/V/V) as the mobile phase and the flow rate was 1.0 ml/min. The detection wavelength was 340 nm. The temperature was 40 ℃ and the injection volume was 200 μl. Results The calibration curve of tigecycline showed good linearity from 64.5 to 1 290.0 ng/ml in human cerebrospinal fluid (r=0.999 8). The RSD of intra and inter-day precision were less than 5.0% with the detection accuracy of 98.80%−106.51%. Conclusion This method is simple, quick, accurate, specific and sensitive. It meets the requirements of tigecycline determination in clinical human cerebrospinal fluid, which offers the individualized therapeutic assurance for patients with intracranial infection.
RÉSUMÉ
Objective:To explore the clinical value of extra-long subcutaneous tunnel ventricular drainage in patients with hydrocephalus.Methods:From March 2016 to March 2020, 33 patients who were not suitable for ventriculoperitoneal shunt, who would have expected time of external ventricular drainage longer than 7 d, who had external ventricular drainage reaching for 7 d and still could not expect for drainage tube drawing for the next 7 d, or who had hydrocephalus after external ventricular drainage were chosen in our study. These patients accepted extra-long subcutaneous tunnel ventricular drainage. The curative effects in the patients were analyzed retrospectively.Results:The drainage tube was kept for a maximum of 24 months and the shortest time was 13 d, with average of 69.3 d; 32 patients (97%) had drainage time longer than 14 d. There was no secondary infection after operation.Conclusion:Extra-long subcutaneous tunnel extraventricular drainage tube has a long duration of catheter placement, could avoid multiple drainage and secondary intracranial infection, so it is a safe and effective new technology for hydrocephalus.
RÉSUMÉ
Objective To investigate the changes and clinical significance of Caveolin-1,matrix metalloproteinase-9 (MMP-9) and interleukin-1β (IL-1β) in cerebrospinal fluid of children with bacterial meningitis or viral encephalitis.Methods Thirty-six cases of children with bacterial meningitis,42 cases of children with viral encephalitis,and 20 cases of children with non-nervous system infection were selected from September 2016 to June 2018 at the Third Affiliated Hospital of Zhengzhou University.The levels of Caveolin-1,MMP-9 and IL-1β in cerebrospinal fluid were detected by using enzyme linked immunosorbent assay (ELISA).Results Cerebrospinal fluid Caveolin-1,MMP-9,IL-1β levels in the acute phase of bacterial meningitis were(49.06 ± 8.96) ng/L,(134.79 18.88)μg/L,(100.02 ± 14.67) μg/L,respectively,and (29.13 ± 7.25) ng/L,(18.69 ± 7.23) μg/L,(47.57 ± 8.95)pg/L in recovery phase,which were higher than those of the controls [(11.18 ± 2.24) ng/L,(11.53 ± 3.54) μg/L,(39.75 ± 7.08) μg/L)],and the differences were significant (all P ＜ 0.05).Cerebrospinal fluid Caveolin-1,MMP-9,IL-1β levels in the acute phase of viral encephalitis were (42.71 ± 10.48) ng/L,(62.78 ± 17.39) μg/L,(57.97 ± 11.28) μg/L,respectively,and (29.13 ± 7.25) ng/L,(18.69 ± 7.23) μg/L,(47.57 ± 8.95) μg/L in recovery phase,which were higher than those of controls,and the differences were significant (all P ＜ 0.05).The levels of Caveolin-1,MMP-9 and IL-1β in cerebrospinal fluid of bacterial meningitis group and viral encephalitis group were significantly higher than those of convalescent group (all P ＜ 0.05).The levels of Caveolin-1,MMP-9,IL-1β in cerebrospinal fluid of bacterial meningitis group were significantly higher than those in viral encephalitis group (all P ＜ 0.05) in the acute phase,and no significant difference was found in the recovery phase(all P ＞ 0.05).Cerebrospinal fluid Caveolin-1,MMP-9,IL-1β showed no significant difference among children with different severity of intracranial infection.Correlation analysis showed that there was a positive correlation between Caveolin-1,MMP-9 and IL-1 β levels in cerebrospinal fluid of acute in bacterial meningitis group and viral encephalitis group (Caveolin-1 and MMP-9:R2 =0.239,P ＜ 0.05;MMP-9 and IL-1β:R2 =0.766,P ＜0.01;Caveolin-1 and IL-1β:R2 =0.245,P ＜ 0.05).Conclusions Caveolin-1,MMP-9 and IL-1 β involved in the pathogenesis of intracranial infection in children,and the effects of different pathogens on intracranial infection were different.
RÉSUMÉ
Non-tuberculous mycobacteria (NTM) refers to the mycobacteria other than M. tuberculosis complex and M. leprae complex, which is widely distributed in the natural environment and people can infect NTM from the environment. With the increased number of acquired immunodeficiency syndrome (AIDS) and the continuous use of immunosuppressants around the world, the number of diseases caused by NTM are also increasing continuously. However, NTM related intracranial infection is still a rare or even rare disease in clinic, which is often misdiagnosed or even missed diagnosis since the negative results of cerebrospinal fluid bacteria culture, the poor effect of anti-tuberculosis treatment and the high mortality. In present paper, we intend to summarize the documents that have been reported so far in order to review the definition of NTM, the susceptible population, classification, diagnosis and treatment of NTM related intracranial infection for further strengthening and improving awareness of such a kind of the disease.
RÉSUMÉ
OBJECTIVE： To analyze effectiveness and economy of domestic vancomycin hydrochloride for injection （trade name： Laikexin） vs. imported vancomycin hydrochloride for injection （trade name： Vancocin） in treatment of intracranial infection induced by MRSA， and to provide decision-making reference for the selection of clinical drugs. METHODS： Clinical data of patients with suspected MRSA intracranial infections receiving Laikexin or Vancocin were collected by retrospective study method from neurosurgery department of our hospital during Jan. 2016 to Jun. 2017， including 115 cases of Laikexin and 42 cases of Vancocin. Using response rate （including clinical cure and clinical improvement） as indexes， cost-effectiveness analysis was performed for Laikexin and Vancocin in the treatment of intracranial infection induced by MRSA by using decision tree model. Sensitivity analysis was conducted for 10％ decrease of cost and response rate. RESULTS： Response rate and excepted cost of Laikexin were 85.21％ and 13 125.96 yuan， cost-effectiveness ratio （CER） was 15 404.25. Response rate and excepted cost of Vancocin were 78.57％ and 15 619.17 yuan， CER was 19 879.31. There was no statistical significance in response rate between Laikexin and Vancocin （P＜0.05）. There was no difference between sensitivity analysis and cost-effectiveness analysis. CONCLUSIONS： The efficacy of Laikexin and Vancocin in the treatment of MRSA intracranial infection is similar， but the CER of Laikexin is lower than that of Wenkexin.
RÉSUMÉ
Objective To investigate the clinical application value of the levels of heparin-binding protein (HBP) in cerebrospinal fluid (CSF) for intracranial infectious diseases. Methods A case-control study was conducted. 150 patients after craniotomy(73 in the postoperative bacterial intracranial infection group, 77 in the postoperative non-infection group) admitted to the Department of Neurology of the People's Hospital of Liaoning Province from December 2016 to May 2018 were collected. At the same time, 46 patients without operation (14 in the non-bacterial intracranial infection group, 32 patients without intracranial infection were selected as control group whose white blood cell count (WBC) values in CSF were all below 10 × 106/L) in the same period were also collected. According to the diagnostic criteria for severe intracranial infection, the patients with bacterial intracranial infection were divided into 26 cases of mild intracranial infection group and 47 cases of severe intracranial infection group. According to the Glasgow Outcome Scale (GOS) score at the time of discharge, the patients were divided into 30 cases of good prognosis group (GOS score 4-5 points) and 43 cases of poor prognosis group (GOS score 1-3 points). The concentrations of HBP in CSF were tested with latex immunoturbidimetry, and the concentrations of procalcitonin(PCT) in cerebrospinal fluid and serum were tested with electrochemiluminescence, and cerebrospinal fluid routine were tested with instrument method, and the concentrations of total protein(TP) in cerebrospinal fluid were tested with turbidimetry. The differences of the laboratory test indicators in each group were statistically analyzed, and the levels of HBP in CSF of patients with different degrees of intracranial infection and different prognosis were compared. Comparison of two independent samples was performed using the Mann-Whitney U test. Results The HBP levels in cerebrospinal fluid were 187.00 (73.00, 635.00) ng/ml, 10.00 (3.50, 32.00) ng/ml, 1.50 (0, 4.00) ng/ml, 3.00 (1.00, 4.00) ng/ml in post-craniotomy bacterial intracranial infection group, uninfected group after craniotomy, non-bacterial intracranial infection group and control group respectively. The cerebrospinal fluid levels of WBC count were 1280.00 (363.00, 4327.00)×106/L, 63.00 (18.50, 300.00)×106/L, 5.00 (3.00, 14.75)×106/L, 3.00 (2.00, 5.75)×106/L. The absolute value of cerebrospinal fluid neutrophils were 1216.00 (225.50, 3895.50)×106/L, 24.00 (2.00, 209.50)×106/L, 1.00 (1.00, 3.00)×106/L, 1.00 (1.00, 1.00)×106/L. The cerebrospinal fluid levels of PCT were 0.16 (0.10, 0.32) ng/ml, 0.09 (0.07, 0.14) ng/ml, 0.07 (0.06, 0.12) ng/ml, 0.07 (0.06, 0.13) ng/ml. The serum levels of PCT were 0.36 (0.15, 1.09) ng/ml, 0.09 (0.04, 0.16) ng/ml, 0.08 (0.04, 0.13) ng/ml, 0.07 (0.03, 0.11) ng/ml. The levels of HBP, WBC, neutrophils, PCT in CSF and serum PCT in the post-craniotomy bacterial intracranial infection group were significantly higher than those in the uninfected group after craniotomy (Z=-9.246,-6.759,-6.741,-4.477,-6.202, P<0.05), non-bacterial intracranial infection group(Z=-5.840,-5.412,-5.259,-2.923,-5.104,P<0.05) and the control group (Z=-7.905,-7.919,-7.335,-4.397,-5.474, P<0.05). There were significant differences in the levels of HBP, WBC and neutrophils in CSF(Z=-3.763,-3.444,-3.041,P<0.05) and no significant differences in CSF and serum PCT (Z=- 0.869, - 1.850, P>0.05)between the uninfected group after craniotomy and the non-bacterial intracranial infection group. There were significant differences in the levels of HBP, WBC and neutrophils in CSF(Z=-4.496,-6.685,-4.842,P<0.05) and no significant differences in CSF and serum PCT(Z=-0.676,-1.303, P>0.05)between the uninfected group after craniotomy and the control group. There were no significant differences in the levels of HBP, PCT in CSF and serum PCT (Z=-0.861,-0.514,-0.273, P>0.05)and significant differences in the levels of WBC and neutrophils in CSF(Z=-2.756,-3.060, P<0.05) between the non-bacterial intracranial infection group and the control group. The levels of HBP in CSF in the severe intracranial infection group were significantly higher than those in the mild intracranial infection group(Z=-6.267, P<0.05). The levels of HBP in CSF in the poor prognosis group were significantly higher than those in the good prognosis group(Z=-7.064, P<0.05). The area under the ROC curve for the diagnosis of bacterial intracranial infection by HBP, WBC, neutrophils, TP, PCT in CSF and PCT in serum was 0.986, 0.987, 0.945, 0.945, 0.770 and 0.914, respectively. The area under the ROC curve for differential diagnosis of bacterial intracranial infection and non-bacterial intracranial infection was 0.994, 0.958, 0.961, 0.929, 0.747 and 0.936, respectively. Conclusions HBP in CSF is an ideal indicator for the diagnosis of bacterial intracranial infection. It is important to distinguish between bacterial intracranial infection and non-bacterial intracranial infection. The extent of increase is related to the severity of infection and prognosis of the disease.
RÉSUMÉ
Objective@#To investigate the changes and clinical significance of Caveolin-1, matrix metalloproteinase-9(MMP-9) and interleukin-1β(IL-1β)in cerebrospinal fluid of children with bacterial meningitis or viral encephalitis.@*Methods@#Thirty-six cases of children with bacterial meningitis, 42 cases of children with viral encephalitis, and 20 cases of children with non-nervous system infection were selected from September 2016 to June 2018 at the Third Affiliated Hospital of Zhengzhou University.The levels of Caveolin-1, MMP-9 and IL-1β in cerebrospinal fluid were detected by using enzyme linked immunosorbent assay(ELISA).@*Results@#Cerebrospinal fluid Caveolin-1, MMP-9 , IL-1β levels in the acute phase of bacterial meningitis were(49.06±8.96) ng/L, (134.79±18.88) μg/L, (100.02±14.67) μg/L, respectively, and (29.13±7.25) ng/L, (18.69±7.23) μg/L, (47.57±8.95) μg/L in recovery phase, which were higher than those of the controls[(11.18±2.24) ng/L, (11.53±3.54) μg/L, (39.75±7.08) μg/L)], and the differences were significant (all P<0.05). Cerebrospinal fluid Caveolin-1, MMP-9, IL-1β levels in the acute phase of viral encephalitis were (42.71±10.48) ng/L, (62.78±17.39) μg/L, (57.97±11.28) μg/L, respectively, and (29.13±7.25) ng/L, (18.69±7.23) μg/L, (47.57±8.95) μg/L in recovery phase, which were higher than those of controls, and the differences were significant (all P<0.05). The levels of Caveolin-1, MMP-9 and IL-1β in cerebrospinal fluid of bacterial meningitis group and viral encephalitis group were significantly higher than those of convalescent group (all P<0.05). The levels of Caveolin-1, MMP-9, IL-1β in cerebrospinal fluid of bacterial meningitis group were significantly higher than those in viral encephalitis group (all P<0.05) in the acute phase, and no significant difference was found in the recovery phase(all P>0.05). Cerebrospinal fluid Caveolin-1, MMP-9, IL-1β showed no significant difference among children with different severity of intracranial infection.Correlation analysis showed that there was a positive correlation between Caveolin-1, MMP-9 and IL-1 β levels in cerebrospinal fluid of acute in bacterial meningitis group and viral encephalitis group(Caveolin-1 and MMP-9: R2=0.239, P<0.05; MMP-9 and IL-1β: R2=0.766, P<0.01; Caveolin-1 and IL-1β: R2=0.245, P<0.05).@*Conclusions@#Caveolin-1, MMP-9 and IL-1 β involved in the pathogenesis of intracranial infection in children, and the effects of different pathogens on intracranial infection were different.
RÉSUMÉ
Objective To observe the trend of temperature changes after ventriculoperitoneal shunt and its relation with postoperative infection.Methods A retrospective cohort study was conducted on 272 patients underwent ventriculoperitoneal shunt in our hospital from January 2015 to December 2018.Patients were divided into infected group and non-infected group according to whether intracranial infection occurred after surgery.According to the occurring time of postoperative intracranial infection,patients were divided into early infection group and delayed infection group.Temperature levels of all patients were monitored on the surgery day,and on the first,yd,5th and 7th d of surgery,and the temperature changes and fever rate of the two groups were compared.Results Among 272 patients,intracranial infection occurred in 25 (9.19％),including 21 with early infection and 4 with delayed infection,and un-infection in 247 (90.81％).As compared with those in the non-infected group,the fever rate and body temperature of the infected group were significantly higher on the 3rd,5th and 7th d after surgery (P＜0.05).There was no significant difference in fever rate and body temperature changes between the early infection group and the delayed infection group on the surgery day and on the first,3rd,5th and 7th d of surgery (P＞0.05).Conclusions The fever rate is higher and the body temperature decreases faster after ventriculoperitoneal shunt.The fever since the third d of surgery is closely related to postoperative intracranial infection,which has a certain predictive significance for postoperative infection,so we should consider anti-infection treatment in time.
RÉSUMÉ
OBJECTIVE:To investigate clinical efficacy and safety of linezolid in the treatment of intracranial infection after neurosurgery operation. METHODS:Medical information of 39 intracranial infection patients receiving linezolid in Xijing Hospital of Air Force Medical University during Jul. 1st,2015-Aug. 29th,2016 were analyzed retrospectively. The clinical efficacy andsafety of linezolid in the treatment of intracranial infection after neurosurgery operation were evaluated according to indexes of intracranial infection patient,such as symptoms,signs,lab indexes test and bacterial culture results. RESULTS:Total response rate of 39 intracranial infection patients after neurosurgery operation was 79.49％ after linezolid treatment. After treatment,the patients' body temperature,white blood cell,neutrophil absolute value,white blood cell in cerebrospinal fluid and cerebrospinal fluid protein level were all significantly lower than before treatment,with statistical significance(P<0.05). Of 39 patients,cerebrospinal fluid of 27 patients were cultured before treatment,and 8 cases(29.6％)of which were positive,among which there were 6 cases (75.0％) of Gram-positive bacteria such as Staphylococcus and Enterococcus. No obvious ADR related to linezolid was found in patients. CONCLUSIONS:Linezolid can effectively control the intracranial infection caused by Gram-positive bacteria such as Staphylococcus and Enterococcus with good safety.
RÉSUMÉ
OBJECTIVE:To compare the clinical efficacy,safety and economy of vancomycin and linezolid in the treatment of intracranial infections after neurosurgery operation. METHODS:Clinical data of 53 patients with intracranial infections receivingvancomycin (32 cases) and linezolid (21 cases) after neurosurgery from Jan. 2015 to Nov. 2017 were collected from medical record inquiry system of Xijing Hospital of Air Force Medical University. Pathogen detection,clinical efficacy and cerebrospinal fluid indexes were compared between 2 groups before and after treatment. The occurrence of ADR was observed in 2 groups,and treatment duration of total effective patients and total cost of antibiotics was compared. RESULTS:The bacterial culture of cerebrospinal fluid was positive in 20 patients,with positive rate of 38.46％(20/52). There was no statistical significance in pathogen positive rates and total effective rates between 2 groups (P>0.05). White blood cell count, red blood cell count, neutrophil percentage and the contents of protein in cerebrospinal fluid of 2 groups were lower than before treatment,while the contents of glucose were higher than before treatment,with statistical significance(P<0.05),besides patients with therapy failure. But there was no statistical significance in these indexes between 2 groups after treatment (P>0.05). There was no statistical significance in duration of antibiotics use and incidence of ADR between 2 groups (P>0.05). The total cost of antibiotics in vancomycin group was significantly lower than linezolid group,with statistical significance (P<0.05). CONCLUSIONS:The effectiveness and safety of vancomycin are similar to linezolid in the treatment of Gram-positive bacterial intracranial infection after neurosurgery. Vancomycin is superior to linezolid in terms of economy. If patients do not have obvious liver or kidney insufficiency,or allergies,etc.,vancomycin should still be the first choice for treatment.
RÉSUMÉ
The whole process of consultation practice of clinical pharmacist for one case of pseudomonas aeruginosa intracranial in-fection was introduced and the role of clinical pharmacist in the anti-infective treatment was discussed. The three consultation recom-mendations of clinical pharmacist were accepted by doctors,and the patient's intracranial infection was effectively controlled and the pa-tient discharged soon. Pharmacists can help doctors develop anti-infective drug program through pharmacy thinking,horizontal thinking and risk thinking to guarantee the safety and effectiveness of patients' medication.
RÉSUMÉ
Objective To compare the differences in biochemical and routine manifestations of cerebrospinal fluid (CSF) in critically ill patients with intracranial infection caused by different pathogens in department of neurosurgery. Methods The patients with intracranial infection after neurosurgery were admitted in the department of intensive care unit (ICU) of Beijing Tiantan Hospital, Capital Medical University from January 1, 2013 to December 31, 2016, their examination results of positive CSF samples were obtained, and the differences in biochemical and routine test results among different classes of bacterial pathogens in CSF were compared. Results A total of 404 samples of 310 patients were analyzed; Gram-positive (G+) bacteria were the major cause of infection (308 case-times, 76.2%), among which, Staphylococci epidermidis was the leading causative pathogen (115 cases, 37.3%), followed by coagulase-negative Staphylococci (76 cases, 24.6%), and Staphylococcus aureus (52 cases, 16.9%); bacteria were detected in 96 case-times, accounting for 23.8% and occupying the secondary position. The overall indicator levels of CSF with G- pathogen were higher than those with G+bacteria, among which CSF with G- bacteria pathogen protein content [mg/L: 1 795 (1 999) vs. 1 068 (1 251)], white blood cell (WBC) count [×106/L: 1 069.5 (5 295.8) vs. 446.5 (1 689.3)], proportion of neutrophils [N: 0.877 (0.218) vs. 0.788 (0.416)] were obviously higher than those in CSF with G+bacteria pathogen, however, glucose (Glu) concentration level was lower than that in CSF with positive G- bacteria [mmol/L: 1.7 (2.5) vs. 2.6 (1.7), P < 0.05]. Simultaneously, it was also found that in culture G- bacteria appeared slightly later than G+bacteria [days: 9.0 (10.0) vs. 8.0 (7.0)], Acinetobacter and other negative bacteria being obvious, but as a whole there was no statistical significant difference. Conclusions G+bacteria are the major pathogens for intracranial infections patients after neurosurgery, and its time of isolation in bacterial culture has a tendency of being earlier than that of G- bacteria; in the comparisons between biochemical and routine results of CSF with positive G- bacteria and with positive G+bacteria, there are protein, glucose, WBC and N levels having statistical significant differences, suggesting that these indicators have potential values to differentiate these two kinds of bacteria.