Hepatitis B virus in cerebrospinal fluid of a patient with purulent bacterial meningitis detected by multiplex-PCR: A case report.

BACKGROUND: Bacterial meningitis (BM) is a common central nervous system inflammatory disease. BM may cause serious complications, and early diagnosis is essential to improve the prognosis of affected patients. CASE SUMMARY: A 37-year-old man was hospitalized with purulent meningitis because of worsening headache for 12 h, accompanied by vomiting, fever, and rhinorrhea. Head computed tomography showed a lesion in the left frontal lobe. Infectious disease screening showed positivity for hepatitis B surface antigen, hepatitis B e antigen, and hepatitis B core antigen. Cerebrospinal fluid (CSF) leak was suspected based on clinical history. Streptococcus pneumoniae (S. pneumoniae) was detected in CSF by metagenomic next-generation sequencing (mNGS) technology, confirming the diagnosis of purulent BM. After treatment, multiplex PCR indicated the presence of hepatitis B virus (HBV) DNA and absence of S. pneumoniae DNA in CSF samples. CONCLUSION: We report a rare case of HBV in the CSF of a patient with purulent BM. Multiplex PCR is more sensitive than mNGS for detecting HBV DNA.

Incidence and mortality prognosis of dysnatremias in neurologic critically ill patients.

BACKGROUND: Dysnatremia, which is associated with increased mortality in general intensive care units (ICU), has not been thoroughly studied in neurologic ICU (NICU). METHODS: Prevalence of dysnatremia was retrospectively assessed. The multivariable binary logistic regression model was used to determine the influence of dysnatremia on mortality. RESULTS: Of 519 patients, 106 (20.4%) were admitted with hyponatremia and 177 (34.10%) with hypernatremia. Hypernatremia was detected in 69 (13.29%) patients on admission to NICU and in 108 patients (20.81%) during the ICU stay. However, the incidence of dysnatremia did not differ across the neurological categories (p = 0.4690). ICU stay in patients with acquired hypernatremia (22.3 ± 25.35 days) was longer than those with admission hypernatremia (13.5 ± 12.8 days) or with consistent normonatremia (16.16 ± 20.06 days). The other indicators such as Acute Physiology and Chronic Health Evaluation II, Glasgow Coma Scale score, urinary catheterization, and incidence of pneumonia were also associated with the serum sodium concentrations. Hypernatremia both on admission and acquired in NICU could significantly differentiate between survivors and nonsurvivors (p = 0.002 and <0.0001). However, only NICU-acquired hypernatremia was the independent risk factor for mortality with high sensitivity (p = 0.000). CONCLUSIONS: Dysnatremia is more common in NICU, whereas only acquired-hypernatremia was independently associated with outcome.

An overview of neurocritical care in China: a nationwide survey.

BACKGROUND: Little quantitative evidence was available regarding the development of NICUs in China. The purpose of this survey was to evaluate the current situation of neurointensive care units (NICUs) across China. METHODS: The directors of NICUs from 100 tertiary care hospitals across China were contacted and asked to complete a closed response questionnaire regarding their NICUs. Basic information, equipment, and technology information available in the units, as well as staffing information were investigated. RESULTS: Seventy-six questionnaires were returned (a 68% response rate). Of 76 NICUs, 43 units constituted the majority. The number of each NICU bed varied from 4 to 45, occupying 2%-30% of the total department beds. Over 70% of NICUs were equipped with many emergency treatment equipments as well as physiological and biochemical monitoring equipments, while 34%-70% of NICUs still lacked some kinds of equipments such as defibrillators. Some specialist equipments were still partially lacking in 62%-95% of NICUs. A vast majority of the NICUs were equipped with neurocritical care directors, full-time attending physicians, and head nurses, but full-time NICU residents and neurocritical care nurses were still lacking in nearly half (53%) and one-third (33%-37%) of NICUs, respectively. In 76 NICUs, full-time neurointensivists and nurses added up to 359 and 852, respectively. In addition, 78%-97% of all the surveyed NICUs were severely short of non-neurological professional staffs. CONCLUSION: In China, neurocritical care has developed rapidly, but there is still a shortage of well-equipped and well-staffed NICUs across the nation currently.

Evaluation of neuro-intensive care unit performance in China: predicting outcomes of Simplified Acute Physiology Score II or Glasgow Coma Scale.

BACKGROUND: Severity scoring systems are useful tools for measuring the severity of the disease and its outcome. This pilot study was to verify and compare the prognostic performance of the Simplified Acute Physiology Score II (SAPS II) and Glasgow Coma Scale (GCS) in neuro-intensive care unit (N-ICU) patients. METHODS: A total of 1684 patients consecutively admitted to the N-ICU at Xuanwu Hospital between January 1, 2005 and December 31, 2011 were enrolled in this study. The data-base included admission data, at 24-, 48-, and 72-hour SAPS II and GCS. Repeated measure data analysis of variance, Logistic regression analysis, the Hosmer-Lemeshow goodness-of-fit statistic, and the area under the receiver operating characteristic were used to evaluate the performance. RESULTS: There was a significant difference between the SAPS II or GCS score at four time points (F = 16.110, P = 0.000 or F = 8.108, P = 0.000). The SAPS II scores or GCS score at four time points interacted with the outcomes with significant difference (F = 116.771, P = 0.000 or F = 65.316, P = 0.000). Calibration of the SAPS II or GCS score at each time point on all patients was good. The percentage of a risk estimate prediction corresponding to observed mortality was also good. The 72-hour score have the greatest consistency. Discriminations of the SAPS II or GCS score at each time were all satisfactory. The 72-hour score had the greatest discriminative power. The cut-off value was 33 (sensitivity of 85.2% and specificity of 74.3%) and 6 (sensitivity of 70.6% and specificity of 65.0%). The SAPS II at each time point on all patients showed better calibration, consistency and discrimination than GCS. The binary Logistic regression analysis identified physiological variables, GCS, age, and disease category as significant independent risk factors of death. After the two variables including underlying disease and type of admission were excluded, we built the simplified SAPS II model. A correlation was suggested between the simplified SAPS II score at each time point and outcome, regardless of the diagnosis. CONCLUSIONS: The GCS scoring system tends to be a little weaker in the predictive power than the SAPS II scoring system in this Chinese cohort of N-ICU patients. The advantage of SAPS II scoring system still exists that it dose not need to take into account the diagnosis or diseases categories, even in the special N-ICU. The simplified SAPS II scoring system is considered a new idea for the estimation of effectiveness.

Decompressive hemicraniectomy in malignant middle cerebral artery infarct: a randomized controlled trial enrolling patients up to 80 years old.

BACKGROUND: Decompressive hemicraniectomy (DHC) has proven efficacious for the treatment of malignant middle cerebral artery infarction (mMCAI) only in patients less than 60 years. This study aimed to assess the effectiveness of DHC in patients up to 80. METHODS: This is a prospective, randomized, controlled trail comparing the outcomes with or without DHC in patients aged 18-80 with mMCAI (ChiCTR-TRC-11001757). The primary outcome measure was the modified Rankin Scale (mRS) scores at 6 months. The secondary outcome measures included the 6- and 12-month mortality and the mRS scores after 1 year. The prognosis of patients was evaluated independently by two blinded investigators. In addition, subgroup analyses were done for those above 60 years of age. All analyses were by intention-to-treat. RESULTS: A significant reduction in the poor outcome (mRS > 4) following DHC was reached after 36 patients had completed the follow-up period of 6 months. The trial was then terminated when 47 participants (24 in the surgical group vs. 23 in the medical group) had been recruited. The final analysis, based on the outcome data of the 47 patients, showed that DHC significantly reduced mortality at 6 and 12 months (12.5 vs. 60.9 %, P = 0.001 and 16.7 vs. 69.6 %, P < 0.001, respectively), and significantly fewer patients had a mRS score >4 after surgery (33.3 vs. 82.6 %, P = 0.001 and 25.0 vs. 87.0 %, P < 0.001, respectively). Similar results were present in the subgroup analyses of elderly participants CONCLUSIONS: For patients up to 80 years who suffered mMCAI, DHC within 48 h of stroke onset not only is a life-saving treatment, but also increases the possibility of surviving without severe disability (mRS = 5).

Distribution of lysine-specific demethylase 1 in the brain of rat and its response in transient global cerebral ischemia.

The lysine-specific histone demethylase 1 (LSD1) is a chromatin modifying enzyme that specifically removes methyl groups from lysine 4 of histone 3 (H3-K4) and induces transcriptional repression. However, limited knowledge exists, regarding the existence and significance of LSD1 in the brain. We identified the distribution of LSD1 and H3-K4 mono-, di-, and tri-methylation in the brain of rats, respectively. The temporal and spatial distribution of LSD1 during ischemic brain injury was also explored. LSD1 immunoreactive cells were nucleus positive and were concentrated in the neurons of the hippocampus, cerebral cortex, striatum and amagdala. The distributions of H3-K4 mono-, di-, and tri-methylation exhibited exactly the same pattern as LSD1. LSD1 expression was induced both region and cell specifically after ischemic/perfusion, and complied with the two-peak mode of expression. These studies revealed a tightly regulated distribution for LSD1 in the brain of rats under ischemic insult, suggesting a critical role in neuron function.

[Therapeutic effect of glucose-6-phosphate polyclonal antibody on vasogenic brain edema in rats].

OBJECTIVE: To observe the therapeutic effect of glucose-6-phosphate polyclonal antibody (G-6-P pAb) on vasogenic brain edema (VBE) in rats. METHODS: Sixty Wistar rats were randomly divided into normal control group, VBE group, mannitol-treated edema group, and G-6-P pAb-treated edema group. After establishment of rat models of VBE by intraperitoneal injection of phenylephrine in the latter 3 groups, mannitol was injected through the femoral vein in mannitol group and G-6-P pAb injected intraperitoneally in G-6-P pAb group. The permeability of the blood-brain barrier (BBB) was determined by Evans blue (EB) extravasation method, and the brain water content in the gray and white matter measured with a moisture analyzer. RESULTS: G-6-P pAb administration significantly reduced the permeability of BBB as well as the water content in the white matter in comparison with mannitol treatment (P<0.01), but the two treatments showed no obvious difference in reducing the water content in the gray matter (P>0.05). CONCLUSION: Changes in G-6-P activity results in BBB permeability alteration in the condition of VBE, and G-6-P pAb has a selective therapeutic effect against VBE, especially white matter edema.

[Meningoencephalitis caused by Angiostrongylus cantonensis: report of 1 case].

One rare case of meningoencephalitis caused by Angiostrongylus cantonensis is reported. The development of the disease, clinical features, accessory examinations, and the subsequent treatment were described and analyzed briefly.

Detection of an unkown peak at 1.2 ppm in proton magnetic resonance spectra of cats with cerebral ischemic necrosis.

OBJECTIVE: To confirm an unknown peak (Pu) in proton magnetic resonance spectra ((1)H-MRS) in cats with permanent focal cerebral ischemia, and surmise its potential value of application. METHODS: After focal cerebral ischemia, diffusion-weighted imaging (DWI) was used to identify regions of ischemia for (1)H-MRS voxel localization with the assistance of stereotaxic atlas of cat brain. (1)H-MRS was used to monitor the progression of focal cerebral ischemia in 6 cats over a period of 7 d following middle cerebral artery occlusion (MCAO). The changes in lactate, N-acetyl-aspartate (NAA), choline, creatine, and Pu were observed. RESULTS: In the involved regions, lactate was elevated almost immediately after the onset of cerebral ischemia, and NAA declined within several hours of acute infarction. The Pu at 1.2 ppm was persistently detected in the affected cerebral areas 2 to 7 d after MCAO. CONCLUSION: Pu has a close relationship with cerebral ischemia necrosis and may be a intrinsic production of the necrotic tissue, which can be utilized as a specific marker and therefore has important clinical diagnostic value.