A prospective study of early versus late craniectomy after traumatic brain injury.

BACKGROUND: Decompressive craniectomy is an important method for managing traumatic brain injury (TBI). At present, controversies about this procedure exist, especially about the optimum operative time for patients with TBI. METHODS: A prospective study was performed at the First Affiliated Hospital, College of Medicine, Zhejiang University. From January 2008 to December 2009, 25 patients who underwent early decompressive craniectomy were included in the study group, and 19 patients who underwent "late" decompressive craniectomy as a second-tier therapy for intracranial hypertension were included as a comparison group. RESULTS: The 30-day mortality after the operation was 16% in the study group. The overall mortality rate was 20% at the 6-month follow-up. A total of 52% of the patients (13 patients) had good outcomes, and 7 patients remained in a severely disabled or vegetative state. In the comparison group, 4 patients died, and 12 had good outcomes at the 6-month follow-up. The remaining 3 patients had poor outcomes. The study group was well matched with the comparison group. However, the outcomes in the study group were not better than those in the comparison group, as evaluated by the 6-month GOS score. CONCLUSION: Early decompressive craniectomy as a first-tier therapy for intracranial hypertension did not improve patient outcome when compared with "late" decompressive craniectomy for managing TBI.

Meta-analysis of the effects of furosemide combined with hydration therapy on contrast-induced acute kidney injury after coronary intervention.

OBJECTIVE: A meta-analysis was performed to evaluate the effect of furosemide combined with hydration therapy on the incidence and prognosis of contrast-induced acute kidney injury (CI-AKI) in patients after coronary intervention. MATERIALS AND METHODS: Through the PubMed, EMBASE, Cochrane Library and Web of Science databases, all relevant literature from database establishment until October 1, 2020, was retrieved and screened. Quality evaluation was performed using the risk of bias evaluation tool recommended by the Cochrane Collaboration network, data extraction was performed based on pre-selected effect indicators, and statistics were calculated using Review Manager 5.3 analysis software. RESULTS: A total of 2084 patients in 9 studies were included in the meta-analysis. The results showed that furosemide combined with hydrotherapy had no effect on the incidence of CI-AKI (OR = 0.85, 95% CI [0.46, 1.60], p = 0.62) and can significantly decrease the incidence of major adverse cardiovascular events (MACEs) (OR = 0.43, 95% CI [0.27, 0.67], p = 0.0003) and mortality (OR = 0.24, 95% CI [0.08, 0.79], p = 0.02) in patients. However, it had no significant impact on the need for postoperative dialysis treatment, postoperative creatinine level or length of hospital stay. CONCLUSIONS: Furosemide combined with hydration therapy has no significant effect on the incidence of CI-AKI in patients after coronary intervention but can reduce the incidence of MACEs and mortality, thereby providing clinical benefits.

Shunt implantation in a special sub-group of post-traumatic hydrocephalus--patients have normal intracranial pressure without clinical representations of hydrocephalus.

BACKGROUND: Post-traumatic hydrocephalus (PTH) is a frequent complication secondary to traumatic brain injury (TBI) and controversy remains over whether to perform a shunt placement for patients with normal pressure hydrocephalus when the patient is too injured to display symptoms or has atypical symptoms. METHOD: A hospital-based retrospective study was performed in patients who developed normal pressure hydrocephalus, without atypical symptoms, from January 2004 to June 2007. Information regarding patients' demographics, TBI, hydrocephalus and outcome was collected. RESULTS: A total of 31 patients were involved in this study. At the 12-month follow-up, 20 patients (64.5%) showed clear improvement. Among the 10 patients who developed PTH after decompressive craniectomy, cranioplasty was performed after shunt implantation and clinical improvement was observed in nine patients. Additionally, in this series, the patients' age and the severity of hydrocephalus, assessed by CT imaging before shunt placement, significantly correlated with improvement. CONCLUSION: Although the effect was not definitively established, many patients in the sub-group of PTH patients described here would benefit from shunt placement, especially when they simultaneously have large cranial defects after surgical decompression and underwent cranioplasties after shunt placement. Additionally, younger patients and those with less severe hydrocephalus before shunt placement may expect a better outcome after shunt placement.

Genetic polymorphisms of orosomucoid on the Han population in Nanjing of China.

Human orosomucoid (ORM) is a major binding protein for various basic drugs. The genetic polymorphisms of ORM could be responsible for interindividual variation in the plasma binding of basic drugs, which might influence their effects or toxicities. The genetic polymorphisms of ORM on the Han population in Nanjing of China were analyzed by isoelectric focusing (IEF) on polyacrylamide gels following by immunoblotting. After desialylation of sera from 220 unrelated Chinese subjects, the band patterns of ORM showed that the polymorphism of the structural locus ORM1 is controlled by three codominant autosomal alleles, ORM1*F1, ORM1*F2 and ORM1*S, which presented five phenotypes, ORM1 F1, ORM1 S, ORM1 F1F2, ORM1 F1S, and ORM1 F2S. The allele frequencies were: ORM1*F1=0.7068, ORM1*F2=0. 0182, ORM1*S=0.2750. The results presented in this paper indicate the ORM1 locus is polymorphic and the ORM2 locus is monomorphic in sera from the Han population in Nanjing of China.

[Spectrotemporal mapping of signal-averaged electrocardiogram for identification of patients with sustained ventricular tachycardia].

Frequency analysis of multiple segments (spectrotemporal mapping, STM) of signal-averaged ECG (SAECG) considerably enhanced the detection of late potentials in patients with VTs/VF, but has not yet been verified in large samples. In this study, the modified protocol of STM, using the time when vector summed QRS forces last decreased to 40 microV at 25-250Hz filtering (40 microV/25-250Hz) as the onsets of the window, was performed in 119 normal subjects (group I), 26 patients with VTs/VF (group II), and 202 patients with organic heart diseases of different causes not accompanied by VTs/VF. The minimal normal factors (NF) of individual X, Y, Z leads were compared, significant differences were found between each 2 groups. 95% confidential values of minimal NF from group I were calculated, and NF < 33% on any lead was recommended as abnormal, ie, LP present. With this standard, 81% of the patients with VTs/VF, 94% of the normal subjects and 80% of the patients without VTs/VF were correctly discriminated despite the presence of intraventricular block (IVB, including bundle branch block and nonspecific intraventricular block). In conclusion, the method of STM of SAECG using terminal 40 microV/25-250Hz as window onsets offered promise for identification of patients with VTs/VF, and had better clinical applicability than time domain analysis for patients with IVB may not be excluded during STM.

Equilibrium susceptibilities of superparamagnets: longitudinal and transverse, quantum and classical.

The equilibrium susceptibility of uniaxial paramagnets is studied in a unified framework which permits us to connect traditional results of the theory of quantum paramagnets, S = 1/2,1,3/2,..., with molecular magnetic clusters, S∼5,10,20 all the way up (S = 30,50,100,...,) to the theory of classical superparamagnets. This is done using standard tools of quantum statistical mechanics and linear-response theory (the Kubo correlator formalism). Several features of the temperature dependence of the susceptibility curves (crossovers, peaks, deviations from Curie law) are studied and their scalings with S identified and characterized. Both the longitudinal and transverse susceptibilities are discussed, as well as the response of the ensemble with anisotropy axes oriented at random. For the latter case a simple approximate formula is derived too, and its range of validity assessed, which could be used in the modelization of experiments.

[Measurement of rat myocardial mitochondria permeability transition with spectrophotometer].

AIM: Mitochondrial permeability transition (MPT) is an important index to indicate the integrity and function of mitochondria. The principle of measurement for MPT is to observe the change of absorbance at 540 nm, due to the swelling of mitochondria by the disturbance of permeability transition of mitochondrial membrane when MPT increase. Consulting the literature and according to the reality in our laboratory, we established a spectrophotometric method for measuring myocardial MPT by using UV-240 spectrophotometer. METHODS: The decrease of absorbance and the time to equilibrium deltaA/min indicates the change of MPT. RESULTS AND CONCLUSION: The results showed that the optimal pH, concentration of protein and temperature for measuring MPT in our laboratory are pH 7.4, 0.5 mg protein/ml of mitochondria and 25 degrees C respectively.