Neurological Assessment Scores Research Articles

Endothelial junctional protein associated with coronary artery disease (JCAD) as a potential therapeutic target for acute ischemic stroke

Abstract Introduction Acute ischemic stroke (AIS) is a leading cause of mortality and long-time disability worldwide. Despite the increasing availability of early reperfusion, the neurological outcome of patients with AIS is still poor. Junctional protein associated with Coronary Artery Disease (JCAD) is a novel protein, associated to coronary artery disease, arterial thrombosis, atherosclerosis and inflammation. Yet, its role in acute ischemic stroke is unclear. Purpose To investigate the role of JCAD in the pathophysiology of brain acute ischemia and to explore its potential as a pharmacological target in AIS. Methods Transient Middle Cerebral Artery Occlusion (tMCAO) was inducede in mice with either global or endothelial-specific JCAD deletion, and in littermate controls. Stroke size was assessed ex-vivo 48 hours after reperfusion. For neurological assessment, RotaRod Test and Bederson score were recorded 24 and 48 hours after reperfusion. In vivo silencing of JCAD was achieved by intravenous injection of a JCAD small interfering RNA (siRNA) after tMCAO. JCAD silencing was performed in vitro in human brain microvascular endothelial cells (HBMVECs) using siRNA transfection, followed by hypoxia/reoxygenation (H/R) injury. Cell death and monolayer integrity were measured by LDH assay and trans-endothelial electrical resistance (TEER), respectively. Molecular mechanisms were investigated in vivo by immunohistochemistry and in vitro by Western blot, respectively. JCAD plasma levels were measured by ELISA in two independent cohorts of patients with AIS. Results The expression of JCAD was up-regulated in the ipsilateral hemisphere of stroke in wild-type mice. Both global and endothelial-specific JCAD knockout mice displayed reduced stroke size after tMCAO and an improved neurological outcome, similar to mice treated with post-ischemic JCAD silencing (Figure 1). In vitro, JCADsilenced HBMVECs showed a reduced cell death and an improved monolayer integrity after H/R injury, paralleled by a reduced expression of cellular adhesion molecules (CAMs). The intracellular messenger Akt was hyperphosphorylated in JCAD-silenced HBMVECs (Figure 2). The treatment with the Akt/PI3K inhibitor Wortmannin, retrieved the non-silenced phenotype in HBMVECs, following H/R. Circulating levels of JCAD were persistently increased in patients with AIS and higher levels of JCAD at the time of hospitalization were associated with higher inflammation and an increased risk of death 90 days after the event. Conclusions JCAD expression is associated with a larger brain damage in mice in vivo and with a higher mortality in patients. Mechanistic results suggest that JCAD plays a pivotal role in regulating the integrity of endothelium after a H/R injury, inducing cellular death and inflammation through the inhibition of the Akt/PI3K pathway. Thus, in vivo silencing of JCAD may represent a therapeutic target for the treatment of acute ischemic stroke, on top of early reperfusion.Figure 1Figure 2

In vivo study of the utility of selective intra-arterial injection of thiopental for neuroprotection in reversible cerebral ischemia.

Neuroprotective agents are needed to reduce cerebral damage during surgical or neurointerventional procedures including stroke patients. To evaluate if thiopental can be used as a neuroprotective agent when injected intra-arterially in a transient ischemia model. In total, 24 rabbits were studied as four groups of six animals. Group 1 served as the control group. In group 2, transient ischemia was obtained by intracarotid administration of degradable starch microspheres (DSM). Group 3 was administered thiopental intra-arterially via the carotid artery. Group 4 (experimental group) received both thiopental and DSM intra-arterially. DSM and thiopental were administered through a microcatheter placed into the common carotid artery via the central ear artery access. After sacrifice, apoptotic cells in the cerebral tissues of the animals were evaluated in H&E and TUNEL stained slides. There was a significant increase in the number of apoptotic glial or neuronal cells in group 2 compared to the control group and group 3. The mean number of both the apoptotic neuronal cells (6.8 ± 2.1 vs. 2.5 ± 1.3, P < 0.001) and the apoptotic glial cells (9.4 ± 3.1 vs. 4.6 ± 1.6, P < 0.001) were higher in group 2 compared to group 4. In addition, a higher level of neurological improvement was observed in group 4 compared to group 2 based on neurological assessment score. The intra-arterial administration of thiopental has a protective effect on both glial and neuronal cells during temporary cerebral ischemia in low doses.

Neurological burden and outcomes of excessive β-lactam serum concentrations of critically ill septic patients: a prospective cohort study.

Therapeutic drug monitoring (TDM) contributes to optimizing exposure to β-lactam antibiotics. However, how excessive exposure to β-lactams can increase the burden of care of critically ill patients is unclear. In a prospective cohort study, we examined whether excessive β-lactam serum concentrations contribute to neurological deterioration and the associated complications of adult septic patients without recent history of neurological disease treated with β-lactams in a medical ICU. Excessive β-lactam concentrations were defined as serum concentrations that exceeded the upper limit of the therapeutic range recommended by the French Societies of Pharmacology and Therapeutics (SFPT) and Anesthesia and Intensive Care Medicine (SFAR). Neurological deterioration was defined as an increase in the neurological Sequential Organ Failure Assessment score (nSOFA) of ≥1 between the day of starting treatment at admission and the day of TDM performed 2 days after treatment initiation. We included 119 patients [median age: 65 years; males: 78 (65.5%)] admitted for acute respiratory distress [59 (49.6%)] or septic shock [25 (21%)]. In adjusted logistic regression analysis, an excessive β-lactam serum concentration was associated with neurological deterioration [OR (95% CI): 10.38 (3.23-33.35), P < 0.0001]. Furthermore, in adjusted linear regression analysis, an excessive β-lactam serum concentration was associated with longer time to discharge alive (β=0.346, P = 0.0007) and, among mechanically ventilated patients discharged alive, with longer time to extubation following the withdrawal of sedation (β=0.248, P = 0.0030). These results suggest that excessive exposure to β-lactams could complicate the management of septic patients in the ICU and confirm the clinical relevance of the upper concentration limits recommended for dose reduction.

Effect of nalbuphine plus ropivacaine on vaginal labor in epidural analgesia

BackgroundVarious approaches using epidural analgesia have been employed for relieving labor pain and promoting spontaneous delivery. We aimed to evaluate the effect of nalbuphine and ropivacaine versus fentanyl and ropivacaine on the duration of delivery in parturients.MethodsClinical data of 160 full-term primiparous women who received either nalbuphine or fentanyl in combination with ropivacaine infusion for epidural labor analgesia in our hospital from December 2020 to May 2022 were retrospectively analyzed. The participants were divided into two groups based on anesthesia methods: nalbuphine group (NR group, n = 78) received 0.2 mg/mL nalbuphine combined with 0.1% ropivacaine hydrochloride for patient-controlled epidural analgesia (PCEA) and fentanyl group (FR group, n = 82) received 2 ug/mL fentanyl citrate and 0.1% ropivacaine hydrochloride for PCEA. Both groups received an epidural blockade for labor analgesia at lumbar 2–3 interspace. The duration of the first, second, and third stages of labor, the onset of analgesia, and time before delivery (T0), 15 min of analgesia (T1), 30 min of analgesia (T2), full opening of the uterine opening (T3),exerts force during childbirth(T4), heart rate (HR), blood pressure (BP), blood saturation (SpO2), visual analogue pain scale (VAS) score, Ramsay sedation score, and modified Bromage score, and 5 min were recorded at 2 h postpartum (T5). The neonatal Apgar score, neonatal behavioral neurological assessment (NBNA) score, maternal nausea, vomiting, and itchy skin were recorded.ResultsCompared with the FR group, the first stage of labor duration (p < 0.05) and total duration of labor (p < 0.05) were shortened and the onset of analgesia (p < 0.05) was increased in the NR group. NR group had lower incidence of urinary retention than FR group (p < 0.05). The maternal and neonatal investigational parameters and scores had no significant difference between the two groups.ConclusionsNalbuphine combined with ropivacaine in epidural block labor has a faster onset of analgesia and has a lower incidence of urinary retention than fentanyl combined with ropivacaine, and nalbuphine shortens the duration of the first and total stages of labor. Both nalbuphine and fentanyl can reduce pain during labor, have little effect on maternal hemodynamics, and have no significant effect on neonatal Apgar or NBNA scores.

The advantages of the magnetic resonance image compilation (MAGiC) method for the prognosis of neonatal hypoglycemic encephalopathy.

To explore the prognostic value of magnetic resonance image compilation (MAGiC) in the quantitative assessment of neonatal hypoglycemic encephalopathy (HE). A total of 75 neonatal HE patients who underwent synthetic MRI were included in this retrospective study. Perinatal clinical data were collected. T1, T2 and proton density (PD) values were measured in the white matter of the frontal lobe, parietal lobe, temporal lobe and occipital lobe, centrum semiovale, periventricular white matter, thalamus, lenticular nucleus, caudate nucleus, corpus callosum and cerebellum, which were generated by MAGiC. The patients were divided into two groups (group A: normal and mild developmental disability; group B: severe developmental disability) according to the score of Bayley Scales of Infant Development (Bayley III) at 9-12 months of age. Student's t test, Wilcoxon test, and Fisher's test were performed to compare data across the two groups. Multivariate logistic regression was used to identify the predictors of poor prognosis, and receiver operating characteristic (ROC) curves were created to evaluate the diagnostic accuracy. T1 and T2 values of the parietal lobe, occipital lobe, center semiovale, periventricular white matter, thalamus, and corpus callosum were higher in group B than in group A (p < 0.05). PD values of the occipital lobe, center semiovale, thalamus, and corpus callosum were higher in group B than in group A (p < 0.05). Multivariate logistic regression analysis showed that the duration of hypoglycemia, neonatal behavioral neurological assessment (NBNA) scores, T1 and T2 values of the occipital lobe, and T1 values of the corpus callosum and thalamus were independent predictors of severe HE (OR > 1, p < 0.05). The T2 values of the occipital lobe showed the best diagnostic performance, with an AUC value of 0.844, sensitivity of 83.02%, and specificity of 88.16%. Furthermore, the combination of MAGiC quantitative values and perinatal clinical features can improve the AUC (AUC = 0.923) compared with the use of MAGiC or perinatal clinical features alone. The quantitative values of MAGiC can predict the prognosis of HE early, and the prediction efficiency is further optimized after being combined with clinical features.

Management of zygomatico maxillary complex fractures.

Zygomatic bone fractures should be effectively diagnosed and treated because they affect how the face is shaped for both aesthetically and functional reasons. It is possible to compare different surgical techniques and their comorbidities objectively through using outcome quantitative assessments, which call for a treatment programme and long-term follow-up. The purpose of this study was to compare the outcomes of two procedures and the effectiveness of the zygomatic bone following open reduction internal fixation (ORIF) employing two-point fixation and ORIF employing three-point fixation. Two groups of twenty patients each were randomly assigned to. Twenty patients in Group A had ORIF treatment using two-point miniplate fixation technique, and twenty patients in Group B received three-point miniplate fixation treatment. Differences between the two categories were ascertained after they had been evaluated in terms of their advantages and disadvantages. We discovered that the two-point fixation group had the fewest facial complications and neurological side effects. At 1 month follow up, Group B's average radiological evaluation score was 2.47± 0.30, and then at 6 months follow up, it was found out to be 1.87±0.47. A significant statistical distinction between the average radiological evaluations was observed in study participants of Group A at follow up done after one month and six months of procedure. Student's paired t- statistical test was utilized from this statistical analysis. (t = 6.54, P < 0.01). On carrying out follow up after one month of surgery, average neurological assessment score in study participants of group A was found out to be 0.22± 0.42, and then at 6 months follow up, it was 0.61±0.63. The average neurological evaluation score in study participants of Group A on carrying out follow up after one month of surgical procedure and and after six months of surgical procedure months showed a significant statistical distinction when utilizing Student's paired t- statistical test (t = 2.51, P = 0.021).It was determined that the best available rehabilitation for the treatment of zygomaticomaxillary complex fractures is open reduction and internal fixation employing two-point fixation by miniplates.

General Movement Assessment in Babies Born Preterm: Motor Optimality Score–Revised (MOS-R), Trajectory, and Neurodevelopmental Outcomes at 1 Year

To assess the association between the General Movement Assessment (GMA) findings, including Motor Optimality Scores-Revised (MOS-R) at 16weeks, and neuromotor outcome assessed by the Amiel-Tison Neurological Assessment at 9months of corrected age and the Developmental Assessment Scales for Indian Infants (DASII) at 1year of corrected age in preterm ≤32weeks. Serial GMA videos of infants born preterm ≤32weeks were recorded on day 7, 35weeks of postmenstrual age, 40weeks of postmenstrual age, and 16weeks of corrected age. The association between GMA findings, including MOS-R scores and GM trajectory between 35 to 40weeks and the Amiel-Tison Neurological Assessment and DASII scores, was assessed by Spearman correlation, Fisher exact tests, and ordinal regression. Moderate correlations were observed between MOS-R and the DASII motor DQ (Spearman r=0.70, P<.001) and between MOS-R and DASII Mental DQ (r=0.65, P<.001). The GMA trajectory at 35-40weeks was associated with DASII motor DQ (Fisher exact, P=.002), and also with the Amiel-Tison Neurological Assessment at 9months of corrected age (P<.01 by the Fisher exact test). On analysis by performing ordinal regression of predictive values of the general movements (GM)at 7days of age, GM at 35weeks, GM at 40weeks, GM at 16weeks, and MOS-R at 16weeks, MOS-R alone was a statistically significant predictor of motor DQ at 1year of age (OR -0.59; 95% CI -0.97 to -0.22; Wald statistics, P<.02). Consistent with findings in high-income countries, GMA including MOS-R scores performed in Indian infants born preterm during the neonatal period and early infancy is associated with neurodevelopmental outcomes in the first year of life. GMA can help initiate focused early intervention in low- and middle-income settings, where resources may be limited.

Effect of Continuous Nutrition Management Intervention on Nutritional Status and Development of Premature Infants Based on Mobile Medical APP.

Objective To explore the effect of continuous nutrition management intervention based on mobile medical APP on the nutritional status and development of premature infants. Methods Eighty premature infants treated in our hospital from May 2019 to April 2021 were enrolled. The patients were randomly divided into the control group and research group. The control group received routine nursing, and the research group received continuous nutrition management intervention based on mobile medical APP. The Neonatal Behavioral Neurological Assessment (NBNA) score, pain score, height, weight, head circumference, intellectual development score, serum Prealbumin (PA), retinol-binding protein (RBP), and disease occurrence were elucidated. Results First of all, the NBNA scores of the two groups were compared. The behavioral ability, passive muscle tension, active muscle tension, original reflex, and general evaluation scores of the research group were significantly higher when compared to the control. Secondly, we compared the pain scores of the two groups, there was no significant difference between the two groups before nursing (P > 0.05), but the pain scores of the research group were lower compared to the control group during the period of blood collection, recovery, discharge, and 6 months after discharge (P < 0.05). Compared with the growth and development indexes of the two groups, there was no significant difference between the two groups before nursing (P > 0.05). After nursing, the GDS score of the two groups increased, and the GDS score of the research group was higher than that of the control group. The difference of data was statistically significant (P < 0.05). Compared with the motor scores of the two groups, there was no significant difference between the two groups before nursing (P > 0.05). After nursing, the motor scores of the two groups increased, and the scores of PDMS-2 and TIMP in the research group were higher than those in the control group, and the difference was statistically significant (P < 0.05). There was no significant difference in serum PA and RBP before nursing, but the serum PA and RBP in the two groups increased after nursing, and the PA and RBP in the research group were higher than those in the control group, and the difference was statistically significant (P < 0.05). Finally, we compared the incidence of diseases between the two groups. Before nursing, the incidence of infection, retinopathy, chronic lung injury and anemia in the research group was lower, when compared to the control, and the difference was statistically significant (P < 0.05). Conclusion The intervention strategy of continuous nutrition management based on mobile medical APP for premature infants can significantly strengthen their nutritional status after discharge, promote their growth and development, improve their nutritional status, reduce the incidence of diseases in premature infants, and then enhance their quality of life.

Whole-volume ADC histogram of the brain as an image biomarker in evaluating disease severity of neonatal hypoxic-ischemic encephalopathy.

PurposeTo examine the diagnostic significance of the apparent diffusion coefficient (ADC) histogram in quantifying neonatal hypoxic ischemic encephalopathy (HIE).MethodsAn analysis was conducted on the MRI data of 90 HIE patients, 49 in the moderate-to-severe group, and the other in the mild group. The 3D Slicer software was adopted to delineate the whole brain region as the region of interest, and 22 ADC histogram parameters were obtained. The interobserver consistency of the two radiologists was assessed by the interclass correlation coefficient (ICC). The difference in parameters (ICC > 0.80) between the two groups was compared by performing the independent sample t-test or the Mann–Whitney U test. In addition, an investigation was conducted on the correlation between parameters and the neonatal behavioral neurological assessment (NBNA) score. The ROC curve was adopted to assess the efficacy of the respective significant parameters. Furthermore, the binary logistic regression was employed to screen out the independent risk factors for determining the severity of HIE.ResultsThe ADCmean, ADCmin, ADCmax,10th−70th, 90th percentile of ADC values of the moderate-to-severe group were smaller than those of the mild group, while the group's variance, skewness, kurtosis, heterogeneity, and mode-value were higher than those of the mild group (P < 0.05). All the mentioned parameters, the ADCmean, ADCmin, and 10th−70th and 90th percentile of ADC displayed positive correlations with the NBNA score, mode-value and ADCmax displayed no correlations with the NBNA score, the rest showed negative correlations with the NBNA score (P < 0.05). The area under the curve (AUC) of variance was the largest (AUC = 0.977; cut-off 972.5, sensitivity 95.1%; specificity 87.8%). According to the logistic regression analysis, skewness, kurtosis, variance, and heterogeneity were independent risk factors for determining the severity of HIE (OR > 1, P < 0.05).ConclusionsThe ADC histogram contributes to the HIE diagnosis and is capable of indicating the diffusion information of the brain objectively and quantitatively. It refers to a vital method for assessing the severity of HIE.

Effectiveness of Nursing Risk Management in Neonatal Asphyxia Resuscitation Care.

Objective To analyze the effectiveness of nursing risk management in neonatal asphyxia resuscitation care and to observe and summarize the nursing measures and outcomes. Methods A total of 60 neonatal asphyxia cases from January 2021 to December 2021 were recruited and assigned via a random number table method at a ratio of 1 : 1 to receive either routine care plus nursing risk management (the observation group, n = 30) or routine care (the control group, n = 30). Outcome measures included blood gas index, neonatal Apgar score, neonatal behavioral neurological assessment (NBNA) score, nursing satisfaction, and complications. Results The differences in partial pressure of oxygen (PaO2) and partial pressure of carbon dioxide (PaCO2) between the two groups before care were not statistically significant (P > 0.05), while after care, PaO2 in the observation group had a higher level of PaO2 and a lower level of PaCO2 than the control group (P < 0.01). The two groups showed similar Apgar scores and NBNA scores before care (P > 0.05), while after care, routine care plus nursing risk management resulted in higher Apgar scores and NBNA scores versus routine care alone (P < 0.01). The nursing satisfaction rate in the observation group (96.67%) was significantly higher than that of the control group (73.33%) (P=0.030). Nursing risk management plus routine care was associated with a significantly lower incidence of complications (6.67%) compared to routine care (26.67%) (P=0.038). Conclusion Nursing risk management in neonatal asphyxia resuscitation care showed outstanding outcomes in improving neonatal blood gas index, neurological function, and Apgar score, while reducing the occurrence of complications and achieving high nursing satisfaction.

The effects of topical iodine containing antiseptics on thyroidal status and early neurodevelopment of preterm infants.

The goal of this study was to determine the quality of these disinfectants' effects on thyroid function and neurological scores in premature newborns aged 28 to 36 gestational weeks (GW). This cohort study was conducted from October 2020 to September 2021 among 28-36GW preterm infants at the neonatal care unit of Jiangnan University Hospital. We divided this 12month period into two consecutive 6month periods. Composite iodine disinfectants and alcohol are used for skin and umbilical cord disinfection of preterm infants, respectively. Urinary iodine concentration (UIC), thyroid hormone levels, and neonatal behavioral and neurological assessment (NBNA) scores were determined in both groups. A total of 126 patients were included in the study, 65 in the iodine exposed group and 61 in the alcohol group. The second UIC and the incidence of serum T4≤5μg/dL and TSH≥10mIU/L in the iodine exposed group were significantly higher than those in the alcohol group (p<0.05). The first NBNA score was lower in the iodine exposed group than in the alcohol group (p<0.05). However, whether it has clinical significance remains to be explored. There was a linear relationship between the two NBNA scores (iodine exposure group, R 2=0.344; alcohol group, R 2=0.227). No sepsis or other adverse outcomes occurred in the two groups of preterm infants after disinfection with different disinfectants. Iodine-containing disinfectants seem to have the potential to cause an increased rate of thyroid dysfunction and a decreased neurological score and should be evaluated in further studies.

Efficacy and Prognosis of Hyperbaric Oxygen as Adjuvant Therapy for Neonatal Hypoxic-Ischemic Encephalopathy: A Meta-Analysis Study.

BackgroundPreclinical and clinical evidence suggests that hyperbaric oxygen therapy (HBOT) may benefit newborns. The effectiveness of HBOT for neonatal hypoxic-ischemic encephalopathy (HIE) remains controversial. We conducted a meta-analysis to evaluate the efficacy and prognosis of HBOT in neonates with HIE.MethodsA systematic search of eight databases was performed for available articles published between January 1, 2015, and September 30, 2020, to identify randomized controlled clinical trials (RCTs) on HBOT for neonatal HIE. Methodological quality assessment was performed by applying the simple procedure detailed by the Cochrane collaboration. Afterward, quality assessment and data analysis were performed using Revman 5.3 software. STATA 15 software was used to detect publication bias as well as for sensitivity analysis.ResultsA total of 46 clinical RCTs were selected for the study and included 4,199 patients with neonatal HIE. The results indicated that HBOT significantly improved the total efficiency (TEF) of treatment for neonatal HIE patients [odds ratio (OR) = 4.61, 95% confidence interval (CI) (3.70, 5.75), P < 0.00001] and reduced the risk of sequelae (OR = 0.23, 95% CI (0.16, 0.33), P < 0.00001) and the neonatal behavioral neurological assessment (NBNA) scores [mean difference (MD) = 4.51, 95%CI (3.83,5.19, P < 0.00001)].ConclusionIn light of the effectiveness of HBOT neonatal HIE, this meta-analysis suggested that HBOT can be a potential therapy for the treatment of neonatal HIE. Due to the heterogeneity of studies protocol and patient selection being only from China, more research is needed before this therapy can be widely implemented in the clinic.Protocol RegistrationPROSPERO (ID: CRD42020210639). Available online at: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020210639.

Efficacy and safety of dexmedetomidine-ropivacaine versus sufentanil-ropivacaine for epidural labor analgesia: a randomized controlled trial.

Sufentanil combined with ropivacaine is commonly used for epidural labor analgesia, but it may cause some adverse effects. Dexmedetomidine is suitable for long-term and short-term intraoperative sedation and analgesia, and it can reduce the use of the opioid sufentanil. This study compared the efficacy and safety of dexmedetomidine and sufentanil combined with ropivacaine for epidural labor analgesia. A randomized, triple-blinded, controlled trial was performed for epidural labor analgesia. All included parturient women were randomized 1:1 by computer to receive ropivacaine combined with dexmedetomidine (group RD) or sufentanil (group RS) from October 2020 to February 2021. The primary outcomes were the pain relief of parturient women assessed by the visual analog scale (VAS) score, and the physical status of newborns assessed by the neonatal behavioral neurological assessment (NBNA) score and Apgar score. Secondary outcomes included the duration of labor stages and adverse reactions of parturient women and newborns. A total of 160 parturient women were included in this study, with 80 in each group. The VAS scores were lower in both groups after the injection of analgesics (in 120 min; RD: 2.6±1.0 vs. RS: 2.5±0.8; P=0.489), and there was no significant difference. The newborns' NBNA (RD: 39.9±0.4 vs. RS: 39.8±0.5; P=0.368) and Apgar scores (RD: 9.8±0.7 vs. RS: 9.7±0.8; P=0.424) were higher than normal standard (NBNA >37; Apgar >7) in both groups, and there were also no significant differences. No differences in parturient women's demographic characteristics, vital signs, Ramsay Sedation Scale (RSS) values, blood loss, duration of labor stages (first and second stages), onset time of analgesia, and dose of analgesics were found between the 2 groups (all P>0.05). The incidence of adverse reactions in parturient women and newborns was low in both groups. Dexmedetomidine or sufentanil combined with ropivacaine for epidural labor analgesia had similar analgesic effects in clinical practice. Chinese Clinical Trial Registry ChiCTR2000038702.

Cerebral perfusion changes of the basal ganglia and thalami in full-term neonates with hypoxic-ischaemic encephalopathy: a three-dimensional pseudo continuous arterial spin labelling perfusion magnetic resonance imaging study.

Neonatal hypoxic-ischemic encephalopathy (HIE) is one of the common causes of neurological injury in full-term neonates following perinatal asphyxia. The conventional magnetic resonance technique has low sensitivity in detecting variations in cerebral blood flow in patients with HIE. This article evaluates the clinical diagnostic value of three-dimensional pseudo-continuous arterial spin labelling (3-D pcASL) perfusion magnetic resonance imaging (MRI) for early prediction of neurobehavioral outcomes in full-term neonates with HIE. All neonates diagnosed with HIE underwent MRI (conventional and 3-D pcASL perfusion MRI). Cerebral blood flow values were measured in the basal ganglia (caudate nuclei, lenticular nuclei), thalami and white matter regions (frontal lobes, corona radiata). After 1-month follow-up, the Neonatal Behavioral Neurological Assessment scores were used to divide patients into favourable outcome group versus adverse outcome group. Twenty-three patients were enrolled in this study. There were no statistical differences between the symmetrical cerebral blood flow values of bilateral basal ganglia, thalami and white matter regions. However, the cerebral blood flow values of grey matter nuclei were higher than the white matter regions. The average value of cerebral blood flow in the basal ganglia and thalami in the adverse outcome group was 37.28±6.42ml/100g/min, which is greater than the favourable outcome group (22.55 ± 3.21ml/100g/min) (P<0.01). The area under the curve (AUC) of 3-D pcASL perfusion MRI was 0.992 with a cutoff value of 28.75ml/100g/min, with a Youden's index of 0.9231. The sensitivity and specificity were 92.3% and 100%, respectively. The 3-D pcASL demonstrated higher perfusion alteration in the basal ganglia and thalami of neonatal HIE with adverse outcomes. The 3-D pcASL perfusion MRI has the potential to predict neurobehavioral outcomes of neonates with HIE.

Abstract WMP100: Stroke Predictors And Outcomes From The Amplatzer™ Amulet™ Left Atrial Appendage Occluder Randomized Controlled Trial

Introduction: Left atrial appendage occlusion (LAAO) devices seal off the LAA in order to reduce the risk of stroke in patients with non-valvular atrial fibrillation. The Amulet IDE Trial compared the Amplatzer™ Amulet™ LAA Occluder (Abbott) to the Watchman™ LAA closure device (Boston Scientific). In this analysis we investigate predictors of stroke in the 2 years after trial enrolment. Methods: Subjects were at a high risk of stroke or systemic embolism defined as CHADS2 score ≥ 2 or a CHA2DS2-VASc score of ≥ 3 and randomized to LAAO with one of the 2 devices. Screening for outcomes occurred at discharge, 45 days, 3, 6, 9, 12, 18, and 24 months. Annual follow-up for years 3-5 is ongoing. The Questionnaire for Verifying Stroke Free Status was administered at each study visit. All suspected strokes or TIAs were referred for neurological assessment. For confirmed strokes, TEEs and neurological assessment scores were obtained. All events were adjudicated by an independent clinical events committee who also determined relatedness to the procedure and/or device. Predictors of stroke were determined through a univariable and multivariable analysis. For a post-hoc analysis, strokes were classified as disabling (mRS score ≥2, with an increase of at least 1 point compared to pre-stroke baseline) or non-disabling. Results: At 108 sites, 1,878 subjects were randomized to an Amulet occluder (N=934) or a Watchman device (N=944) of whom 1,644 completed the 2-year follow-up visit. Baseline characteristics were well-matched between the two groups. Strokes occurred in a total of 67 patients (3.6%) and TIAs in 31 patients (1.7%). Outcome predictors include prior history of stroke/TIA and increased CHA2DS2-VASc score. Disabling strokes and device specific outcomes will be discussed at the time of presentation. Conclusions: The predictors of stroke at 2-years and device-specific outcomes will permit comparison of the long-term effectiveness of the Amulet™ occluder compared to the Watchman™ device.

The expression and clinical value of ubiquitin carboxyl-terminal hydrolase L1 in the blood of neonates with hypoxic ischemic encephalopathy.

BackgroundNeonatal hypoxic ischemic encephalopathy (HIE) can result in mental retardation due to the associated brain damage. Early identification of brain injury is vital for the prevention and treatment of brain damage in neonates. This study investigated the expression levels of serum ubiquitin carboxy-terminal hydrolase L1 (UCH-L1) in neonates with HIE and its correlation with brain damage.MethodsFrom January 2019 to December 2020, 56 cases of neonatal patients with HIE were selected as the observation group, and 60 cases of healthy newborns delivered in our hospital during the same period were selected as the control group. Blood samples were obtained from neonates and the serum expression of UCH-L1 was detected by enzyme-linked immunosorbent assays (ELISAs). The relationship between UCH-L1 and neonatal prognosis and clinical features was analyzed.ResultsCompared with the healthy control group, the serum levels of UCH-L1 in the observation group was significantly higher (2.28±1.21 vs. 0.81±0.39 ng/mL, P=0.000). Furthermore, at 6 hours after birth, the serum levels of UCH-L1 were significantly higher in neonates with moderate to severe HIE compared to patients with mild HIE (2.92±0.80 and 1.76±0.72 ng/mL, respectively, P=0.000). Pearson correlation analysis showed that the expression levels of UCH-L1 were negatively correlated with the development quotient (DQ), intelligence index (MI), and the Neonatal Behavioral Neurological Assessment (NBNA) score of HIE newborns (P<0.05).ConclusionsThe level of UCH-L1 protein expression is elevated in the serum of newborns with HIE, and this may have a certain clinical value in predicting the intelligence of children.

COVID-19 ARDS Is Characterized by Increased Dead Space Ventilation Compared With Non-COVID ARDS.

ARDS in patients with coronavirus disease 2019 (COVID-19) is characterized by microcirculatory alterations in the pulmonary vascular bed, which could increase dead-space ventilation more than in non-COVID-19 ARDS. We aimed to establish if dead-space ventilation is different in patients with COVID-19 ARDS when compared with patients with non-COVID-19 ARDS. A total of 187 subjects with COVID-19 ARDS and 178 subjects with non-COVID-19 ARDS who were undergoing invasive mechanical ventilation were included in the study. The association between the ARDS types and dead-space ventilation, compliance of the respiratory system, subjects' characteristics, organ failures, and mechanical ventilation was evaluated by using data collected in the first 24 h of mechanical ventilation. Corrected minute ventilation (V˙E), a dead-space ventilation surrogate, was higher in the subjects with COVID-19 ARDS versus in those with non-COVID-19 ARDS (median [interquartile range] 12.6 [10.2-15.8] L/min vs 9.4 [7.5-11.6] L/min; P < .001). Increased corrected V˙E was independently associated with COVID-19 ARDS (odds ratio 1.24, 95% CI 1.07-1.47; P = .007). The best compliance of the respiratory system, obtained after testing different PEEPs, was similar between the subjects with COVID-19 ARDS and the subjects with non-COVID-19 ARDS (mean ± SD 38 ± 11 mL/cm H2O vs 37 ± 11 mL/cm H2O, respectively; P = .61). The subjects with COVID-19 ARDS received higher median (interquartile range) PEEP (12 [10-14] cm H2O vs 8 [5-9] cm H2O; P < .001) and lower median (interquartile range) tidal volume (5.8 [5.5-6.3] mL/kg vs 6.6 [6.1-7.3] mL/kg; P < .001) than the subjects with non-COVID-19 ARDS, being these differences maintained at multivariable analysis. In the multivariable analysis, the subjects with COVID-19 ARDS showed a lower risk of anamnestic arterial hypertension (odds ratio 0.18, 95% CI 0.07-0.45; P < .001) and lower neurologic sequential organ failure assessment score (odds ratio 0.16, 95% CI 0.09-0.27; P < .001) than the subjects with non-COVID-19 ARDS. Indirect measurements of dead space were higher in subjects with COVID-19 ARDS compared with subjects with non-COVID-19 ARDS. The best compliance of the respiratory system was similar in both ARDS forms provided that different PEEPs were applied. A wide range of compliance is present in every ARDS type; therefore, the setting of mechanical ventilation should be individualized patient by patient and not based on the etiology of ARDS.

The effect of kangaroo mother care on aEEG activity and neurobehavior in preterm infants: a randomized controlled trial

Objective To evaluate the effect of kangaroo mother care (KMC) versus traditional care (TC) on aEEG activity and neurobehavior in preterm infants. Methods A prospective randomized control single-blinded trial conducted in a tertiary level neonatal intensive care unit between October 2019 and October 2020. Preterm infants with gestational age of 31–33 weeks were randomly divided into either a KMC group or a TC group. Outcomes were compared between the groups including aEEG scores, the percentage of mature sleep–wake cycling (SWC) and background activity continuity, narrowband upper and lower bound amplitude, narrowband bandwidth, and neonatal behavioral neurological assessment (NBNA) scores on day 1, day 7, and day 14 after randomization. Results A total of 65 infants (32 in KMC group and 33 in TC group) completed protocol. No significant differences were observed in outcomes on day 1. aEEG scores (p = .027 and p = .007, respectively) and the percentage of mature SWC (p = .034 and p = .039, respectively) were significantly higher in KMC group on day 7 and day 14. Compared to the TC group, KMC group had a narrower bandwidth on day 7 (p = .003) and day 14 (p = .016) and higher lower bound amplitude on day 14 (p = .002). Upper bound amplitude and the percentage of continuity were comparable between the groups on day 7 and day 14. The NBNA scores in the KMC group were significantly higher than that of the TC group on day 7 (p < .001) and day 14 (p < .001). Conclusions Preterm infants submitted to the KMC, compared to those non-submitted, have more mature aEEG activity and better neurobehavior performance on day 7 and day 14 after random. Trial registration Chinese Clinical Trial Registry: ChiCTR1900026363.

The Prognostic Value of Brain Dysfunction in Critically Ill Patients with and without Sepsis: A Post Hoc Analysis of the ICON Audit.

Brain dysfunction is associated with poor outcome in critically ill patients. In a post hoc analysis of the Intensive Care over Nations (ICON) database, we investigated the effect of brain dysfunction on hospital mortality in critically ill patients. Brain failure was defined as a neurological sequential organ failure assessment (nSOFA) score of 3–4, based on the assumed Glasgow Coma Scale (GCS) score. Multivariable analyses were performed to assess the independent roles of nSOFA and change in nSOFA from admission to day 3 (ΔnSOFA) for predicting hospital mortality. Data from 7192 (2096 septic and 5096 non-septic) patients were analyzed. Septic patients were more likely than non-septic patients to have brain failure on admission (434/2095 (21%) vs. 617/4665 (13%), p < 0.001) and during the ICU stay (625/2063 (30%) vs. 736/4665 (16%), p < 0.001). The presence of sepsis (RR 1.66 (1.31–2.09)), brain failure (RR 4.85 (3.33–7.07)), and both together (RR 5.61 (3.93–8.00)) were associated with an increased risk of in-hospital death, but nSOFA was not. In the 3280 (46%) patients in whom ΔnSOFA was available, sepsis (RR 2.42 (1.62–3.60)), brain function deterioration (RR 6.97 (3.71–13.08)), and the two together (RR 10.24 (5.93–17.67)) were associated with an increased risk of in-hospital death, whereas improvement in brain function was not.

Role of Neonatal Behavioral Neurological Assessment combined with magnetic resonance diffusion tensor imaging in evaluating white matter development in preterm infants.

To study the correlation of fractional anisotropy (FA) on magnetic resonance diffusion tensor imaging with Neonatal Behavioral Neurological Assessment (NBNA) score in preterm infants, and to study the role of FA in evaluating white matter development from the perspective of imaging. A prospective study was performed for 98 preterm infants who were admitted to the Neonatal Intensive Care Unit of the Third Affiliated Hospital of Zhengzhou University within 24 hours after birth from October 2016 to January 2020. According to the results of NBNA, they were divided into an abnormal group with 51 infants (NBNA score <37) and a normal group with 47 infants (NBNA score ≥37). The FA values of 10 regions of interest were collected and compared between the two groups. The correlations of FA value and umbilical arterial blood gas pH value with the NBNA score were analyzed. Compared with the normal group, the abnormal group had significantly lower FA value of the posterior limb of the internal capsule and umbilical arterial blood pH (P<0.05). The FA value of the posterior limb of the internal capsule and umbilical arterial blood pH were positively correlated with the NBNA score (r=0.584 and 0.604 respectively, P<0.001), and the FA value of the posterior limb of the internal capsule was positively correlated with umbilical arterial blood pH (r=0.426, P<0.05). The FA value of the posterior limb of the internal capsule can quantitatively reflect white matter development in preterm infants and is correlated with the NBNA score. The combination of the two indices can help to evaluate white matter development in preterm infants more accurately and objectively. Citation.