Association between stress hyperglycemia ratio with short-term and long-term mortality in critically ill patients with ischemic stroke.

AIMS: Hyperglycemia on admission is associated with poor prognosis in ischemic stroke (IS) patients. We aimed to investigate the relationship between stress hyperglycemia ratio (SHR) and short-term or long-term mortality in IS patients in the ICU and to explore whether this relationship is influenced by diabetes status. MATERIALS AND METHODS: We collected patients with severe IS requiring ICU admission in the Medical Information Mart for Intensive Care (MIMIC-IV) database and calculated SHR. Outcomes included 30-day, 90-day, and 1-year mortality. The association between SHR and mortality in patients with critical IS was elucidated using Multivariate Cox regression and subgroup analysis for diabetes. RESULTS: A total of 1376 patients were recruited. After adjusting for potential confounders, patients in the third and fourth quartiles had a significantly increased risk of death at 30 days, 90 days, and 1 year compared to the first quartile of SHR (Q3 vs. Q1: HR 1.56-1.80, all p < 0.02; Q4 vs. Q1: HR 1.75-2.15, all p < 0.001; all p for trend < 0.001). In addition, the highest quartile of SHR was significantly associated with short-term or long-term mortality compared with the first quartile, regardless of diabetes status. CONCLUSIONS: Our results suggest that stress hyperglycemia, defined by the glucose/HbA1c ratio, is associated with increased short-term and long-term mortality in patients with ischemic stroke, independent of the patient's diabetes status.

Role of PERK-mediated pathway in the effect of mild hypothermia after cerebral ischaemia/reperfusion.

BACKGROUND: Hypothermia is an effective method of reducing brain injury caused by a variety of neurological insults. It is aimed to elucidate whether a change in the expression of PERK-mediated pathway proteins is an indicator of the neuroprotective effect of mild hypothermia after cerebral ischaemia/reperfusion. METHODS: One hundred and ninety-two male C57BL/6 mice were randomly divided into three groups: a sham group, a cerebral normothermic ischaemia/reperfusion (I/R) group and a cerebral hypothermic I/R group. A cerebral ischaemia model was established by ligating the bilateral common carotid artery for 15 min. Mice in the hypothermia group stayed in a cage that was set at 33°C, sprayed with a spray of 70% ethanol, and blown with two high-speed fans. The state of neurons was assessed on micropreparations stained with haematoxylin-eosin and TUNEL. The expressions of GRP78, p-perk, p-eif2α, ATF4 and CHOP were measured by western blot analysis 6, 12, 24 and 72 h after reperfusion. RESULTS: The number of surviving cells was significantly higher in the hypothermia group than in the group without hypothermia (p < .05). The GRP78 expression in the hypothermia group was statistically higher (p < .05) than in the ischaemia/reperfusion group. Optical densities of p-perk, p-eif2α and ATF4 in hippocampus CA1 neurons ischaemia were statistically significantly lower in the hypothermia group than in the ischaemia/reperfusion group (p < .05). The CHOP expression in the hypothermia group was statistically lower (p < .05) than in the ischaemia/reperfusion group. CONCLUSION: Mild hypothermia for 6 h promoted moderate neuroprotection by mediating the expression of GRP78, p-PERK, p-eIF2α, ATF4 and CHOP.

The role of P2Y6 receptors in the maintenance of neuropathic pain and its improvement of oxidative stress in rats.

AIM: To explore the role of P2Y6 receptors in the maintenance of neuropathic pain and progression of oxidative stress, we investigated the efficacy of the selective P2Y6 receptors antagonist MRS2578 on the antiallodynic effects and improvement of pathological neuropathic pain-induced oxidative stress, thereby finding a potential therapeutic target in neurological disease. MATERIALS AND METHODS: The mechanical allodynia in the ipsilateral spinal dorsal horn (SDH) of rats was observed in rats after chronic constriction injury (CCI). Meanwhile, the messenger RNA (mRNA) levels of biological parameters, including superoxide dismutase (SOD), glutathione (GSH), and heme oxygenase-1 (HO-1) in the SDH of rats were measured by real-time polymerase chain reaction (RT-PCR). In addition, the mRNA expression and protein levels of P2Y6 were measured by RT-PCR and Western blot assay, respectively. Next, the rats subjected to CCI were intrathecally infused with MRS2578 to block the expression of P2Y6 receptors. The positive expression of P2Y6 receptors was examined by immunohistochemistry. RESULTS: In the present study, the results revealed that the P2Y6 expression in the ipsilateral SDH of CCI rats was significantly upregulated. In addition, inhibition of the P2Y6 receptor in SDH increased CCI-induced tactile allodynia. Furthermore, the levels of SOD, GSH, and HO-1 which were correlated with oxidative stress produced by CCI were also decreased. CONCLUSION: The results demonstrated that inhibition of the P2Y6 receptor can generate antiallodynic effects and improved the pathological neuropathic pain-induced oxidative stress. Thus, this study provides a potential approach for the therapy of neurological disease.

Role of ultrasound evaluation for the diagnosis and monitoring of thyroid tuberculosis: A case report and review of the literature.

Thyroid tuberculosis (TT) is an extremely rare condition, with acute abscess formation being the most uncommon form of presentation. Mycobacterium tuberculosis may affect the thyroid gland through hematogenous spread from an extra-thyroid focus of disease or by direct extension from adjacent cervical lymph nodes. Due to the non-specific imaging findings and the variable clinical manifestations, TT is rarely diagnosed promptly prior to percutaneous biopsy or surgery. The present study reports the dynamic monitoring of the sonographic features of a case with thyroid tuberculosis that was diagnosed by a thyroid ultrasound (US) scan, confirmed by a US-guided core-needle biopsy and followed-up sonographically during the whole course of treatment.

Combined neurolytic block of celiac and superior hypogastric plexuses for incapacitating upper abdominal cancer pain.

PURPOSE: To evaluate the efficacy of a combined neurolytic block of the celiac and superior hypogastric plexuses for incapacitating upper abdominal cancer pain. METHODS: Fifty-two patients with advanced upper abdominal malignancies and incapacitating pain were equally randomized to receive a combined neurolytic block of the celiac and superior hypogastric plexuses (combined group) or a neurolytic celiac plexus block alone (NCPB group) using a 90% ethanol trans-intervertebral disk approach under CT guidance. Visual analogue scores (VAS), morphine consumption, and quality of life (QoL) were assessed before the procedure and 24 hrs, 1 week, 1 month, and 3 months after the procedure. The complications and side effects were also recorded. RESULTS: The amount of ethanol used was 30 ± 5 ml in the combined group and 21 ± 3 ml in the NCPB group. VAS scores and morphine consumption decreased significantly pre- compared to post-procedure in both groups (p<0.05). QoL significantly improved 24 hrs, 1 week, and 1 month after the procedure compared with each group pre-procedure (p<0.05), but not after 3 months (p>0.05). The combined group had significantly lower VAS and morphine consumption than the NCPB group (p<0.05). QoL scores were significantly higher in the combined group 24 hrs, 1 week, and 1 month post-procedure than the NCPB group (p<0.05), but not after 3 months (p>0.05). CONCLUSION: A combined neurolytic block of the celiac and superior hypogastric plexuses is more effective than neurolytic celiac plexus block alone in pain relief for patients with advanced upper abdominal cancer.

[A prospective cohort study of the risk factors of emergence agitation in pediatric after general anesthesia].

OBJECTIVE: To evaluate risk factors associated with emergence agitation (EA) in pediatrics after general anesthesia. METHODS: A prospective cohort study was conducted in 268 pediatric patients aged 2-9 years, who received general anesthesia for various operative procedures in our hospital between January 2008 and October 2011. The incidence of EA was assessed. Difficult parental-separation behavior, pharmacologic and non-pharmacologic interventions, and adverse events were also recorded. Univariate and multivariate analysis were used to determine the factors associated with EA. A p-value of less than 0.05 was considered significant. RESULTS: One hundred and sixteen children (43.3%) had EA, with an average duration of 9.1 ± 6.6 minutes. EA associated with adverse events occurred in 35 agitated children (30.2%). From univariate analysis, factors associated with EA were difficult parental-separation behavior, preschool age (2 - 5 years), and general anesthesia with sevoflurane. However, difficult parental-separation behavior, and preschool age were the only factors significantly associated with EA in the multiple Logistic regression analysis with OR = 3.091 (95%CI: 1.688, 5.465, P < 0.01) and OR = 1.965 (95%CI: 1.112, 3.318, P = 0.024), respectively. CONCLUSION: The present study indicated that the incidence of EA was high in PACU. Preschool children and difficult parental-separation behavior were the predictive factors of emergence agitation.