Association between subcortical nuclei volume changes and cognition in preschool-aged children with tetralogy of Fallot after corrective surgery: a cross-sectional study.

BACKGROUND: Neurocognitive disorders frequently occur in patients with cyanotic congenital heart disease (CCHD) because of the hemodynamic abnormalities induced by preoperative cardiac structural changes. We aimed to evaluate subcortical nuclei volume changes and cognition in postoperative tetralogy of Fallot (TOF) children, and analyze their relationship with preoperative cardiac structural changes. METHODS: This case-control study involved thirty-six children with repaired TOF and twenty-nine healthy controls (HCs). We utilized three-dimensional (3D) T1-weighted high-resolution structural images alongside the Wechsler Preschool and Primary Scale of Intelligence-Fourth Edition (WPPSI-IV) to evaluate the cognitive differences between the TOF and HC group. RESULTS: We observed notable differences in subcortical nuclei volume between the TOF and HC group, specifically in the left amygdala nucleus (LAM, TOF: 1292.60 ± 155.57; HC: 1436.27 ± 140.62, p < 0.001), left thalamus proper nucleus (LTHA, TOF: 6771.54 ± 666.03; HC: 7435.36 ± 532.84, p < 0.001), and right thalamus proper nucleus (RTHA, TOF: 6514.61 ± 715.23; HC: 7162.94 ± 554.60, p < 0.001). Furthermore, a diminished integrity of LAM ( ß:-19.828, 95% CI: -36.462, -3.193), which showed an inverse relationship with the size of the preoperative ventricular septal defect (VSD), correlated with lower working memory indices in children with TOF. CONCLUSIONS: Our findings indicate that subcortical nuclei structural injuries possibly potentially stemming from cardiac anatomical abnormalities, are associated with impaired working memory in preschool-aged children with TOF. The LAM in particular may serve as a potential biomarker for neurocognitive deficits in TOF, offering predictive value for future neurodevelopmental outcomes, and shedding light on the neurophysiological mechanisms of these cognitive impairments.

Mechanism study of serum extracellular nano-vesicles miR-412-3p targeting regulation of TEAD1 in promoting malignant biological behavior of sub-centimeter lung nodules.

OBJECTIVE: To investigate the impact and potential mechanisms of serum extracellular nano-vesicles (sEVs) miR-412-3p released from sub-centimeter lung nodules with a diameter of ⩽ 10 mm on the malignant biological function of micro-nodular lung cancer (mnLC). METHODS: A total of 87 participants were included and divided into a mnLC group (n= 30), a benign lung nodule (BLN) group (n= 27), and a healthy people control group (n= 30). Transmission electron microscopy (TEM), nanoparticle tracking analysis (NTA) and Western blot (WB) were used to measure the morphological characteristics and surface markers of sEVs. In vitro analysis, real-time quantitative polymerase chain reaction (RT-qPCR), CCK-8 cell proliferation assay, clone formation assay, Transwell, stem cell sphere-forming assay, and WB assay were conducted to verify the effect of miR-412-3p/TEAD1 signaling axis on the biological function of lung cancer cells through, respectively. Further validation was conducted using the serum sEVs of the participants. RESULTS: The expression level of sEVs-miR-412-3p in the mnLC group was significantly higher than that in the BLN and healthy groups (P< 0.01). In lung cancer cell lines, miR-412-3p can negatively regulate the targeted gene TEAD1. The miR-412-3p/TEAD1 signaling axis is involved in promoting the EMT signaling pathway and regulating the malignant biological functions of lung cancer cell proliferation, migration, and stemness (P< 0.05). In addition, sEVs in the mnLC group significantly promoted lung cancer cell proliferation, migration, and stemness compared to the BLN and healthy groups, inhibited the expression of E-cadherin and TEAD1 in lung cancer cells, and promoted the expression of N-cadherin and Vimentin (P< 0.05). CONCLUSION: sEVs-miR-412-3p could promote the biological process of EMT, and lead to the occurrence of malignant biological behavior in sub-centimeter lung nodules. This provides evidence for the miR-412-3p/TEAD1 signaling axis as a potential therapeutic target for mnLC.

Atoh1 mediated disturbance of neuronal maturation by perinatal hypoxia induces cognitive deficits.

Neurodevelopmental disorders are currently one of the major complications faced by patients with congenital heart disease (CHD). Chronic hypoxia in the prenatal and postnatal preoperative brain may be associated with neurological damage and impaired long-term cognitive function, but the exact mechanisms are unknown. In this study, we find that delayed neuronal migration and impaired synaptic development are attributed to altered Atoh1 under chronic hypoxia. This is due to the fact that excessive Atoh1 facilitates expression of Kif21b, which causes excess in free-state α-tubulin, leading to disrupted microtubule dynamic stability. Furthermore, the delay in neonatal brain maturation induces cognitive disabilities in adult mice. Then, by down-regulating Atoh1 we alleviate the impairment of cell migration and synaptic development, improving the cognitive behavior of mice to some extent. Taken together, our work unveil that Atoh1 may be one of the targets to ameliorate hypoxia-induced neurodevelopmental disabilities and cognitive impairment in CHD.

From Cosmetic Surgery to Critical Care: Clinical Mimicry of Acute Respiratory Distress Syndrome Following Gluteal Augmentation Surgery.

Gluteal augmentation surgery, commonly known as the Brazilian Butt Lift (BBL), has become increasingly popular and is offered at numerous surgical centers. Typically performed on an outpatient basis, the procedure takes less than four hours, making it an appealing option for many patients. However, BBL is associated with multiple complications, some of which can be severe, resulting in high mortality rates. Most such post-operative adverse events necessitate urgent transfer to hospitals for optimal care, with post-operative respiratory distress being one such critical sign. Fat embolism syndrome (FES) is a notable complication of BBL. The diagnosis of FES is primarily clinical, supported by imaging studies such as chest X-rays and CT scans. FES often goes underdiagnosed due to the lack of definitive diagnostic criteria and its clinical and radiological similarities to other conditions. Despite its underdiagnosis, FES is reported in approximately 0.06% of patients undergoing BBL. Failure to diagnose it early can lead to complications from empiric treatment of other suspected conditions, potentially worsening the prognosis. Our patient developed respiratory failure within an hour after undergoing BBL. The time to symptom onset and the patient's agitation before the respiratory episode broadened the differential for her condition. This case report highlights the importance of recognizing FES and exploring potential preventive measures, including advancements in surgical techniques and prophylactic strategies.

Association between serum vitamin C and body mass index in adolescents aged 12-19 years.

BACKGROUND: Evidence on the association between serum vitamin C (sVC) levels and obesity is limited. This study aimed to explore the relationship between sVC and body mass index (BMI) in adolescents aged 12 to 19 years. METHODS: We analyzed data from the National Health and Nutrition Examination Survey (NHANES) 2003-2006, with 3952 participants. sVC and BMI were independent variables and dependent variables, respectively. The associations of sVC with BMI were examined using multivariable linear regression models. Age, sex, and race/ethnicity were analyzed as subgroups. Then, we devised smooth curve fittings and saturation threshold analysis to address the nonlinear relationship. RESULTS: sVC had a negative correlation with BMI after adjusting for all covariates (ß: -1.020, 95% CI: -1.359, -0.680). In the subgroup analysis by age, sex, and race/ethnicity, there was still a negative correlation between sVC and BMI (p < 0.05). The analysis of saturation effects of sVC and BMI showed the relationship between sVC and BMI in female adolescents followed an N-shaped curve, whereas the relationship between sVC and BMI in adolescents aged 12-15 years and Mexican Americans followed a U-shaped curve. CONCLUSION: Based on the results, proper vitamin C supplementation may be beneficial to weight loss. However, considering the threshold effect, large-scale and good-quality randomized controlled trials are required to obtain the optimal vitamin C level for weight control.

Coronavirus HKU1 infection and development of pediatric acute liver failure with immune dysregulation phenotype.

Pediatric acute liver failure is a rare but serious complication of Coronavirus infections. Our patient is a previously healthy 8-year-old male who presented with acute liver failure in the setting of human coronavirus HKU1 (HCoV-HKU1) infection while asymptomatic from a respiratory perspective. During the hospital course, he developed acute hepatic encephalopathy and was listed for liver transplantation, but fortunately recovered remaining status 7 (inactive) on the transplant list. With a negative diagnostic evaluation other than his viral infection and hyperdense CD8 T-cells on liver immunohistochemical staining, pediatric acute liver failure (PALF) immune dysregulation phenotype was diagnosed.

Association between serum vitamin A and body mass index in adolescents from NHANES 1999 to 2006.

Vitamin A plays a pivotal role in health, particularly in regulating fat metabolism. Despite its significance, research into the direct relationship between vitamin A levels and obesity, especially among adolescents, is sparse. This study aims to explore this association within the adolescent population in the United States. This cross-sectional study analyzed the National Health and Nutrition Examination Survey (NHANES) data from 1999 to 2006, with 8218 participants. The levels of vitamin A in the serum were determined based on utilizing high-performance liquid chromatography with photodiode array detection. The relationship between serum vitamin A concentrations and body mass index (BMI) was evaluated using weighted multiple linear regression models, incorporating subgroup analyses by sex and race/ethnicity to provide nuanced insights. A positive correlation was observed between serum vitamin A levels and BMI, with BMI increasing progressively across vitamin A quartiles (P < 0.001). Using the lowest quartile of serum vitamin A as a reference, the BMI of the highest quartile of serum vitamin A was 1.236 times higher (95% CI 0.888, 1.585). Subgroup analyses revealed that this positive association persisted across different genders and racial/ethnic groups (P < 0.001). Notably, smooth curve fitting and saturation threshold analysis unveiled an inverted U-shaped relationship between serum vitamin A and BMI among female adolescents, non-Hispanic Whites, Mexican Americans, and other races/ethnicities groups. Our study substantiates the association between serum vitamin A levels and the risk of obesity/overweight status in adolescents. The findings suggest the potential serum vitamin A is an early biomarker for identifying obesity risk, although further studies are needed to determine to clarify its role as a contributing factor to obesity. This study contributes to the understanding of nutritional influences on adolescent obesity, highlighting the need for targeted interventions based on serum biomarkers.

Technical tips for EUS-guided embolization of varices and pseudoaneurysms.

Backgrounds and Aims: EUS-guided vascular intervention has expanded the horizons of diagnostic as well as therapeutic interventions for vascular pathology. EUS-guided embolization is a commonly performed technique for the treatment of gastric varices. However, there is a lack of data on the standardization of the technique. Here, we review the techniques and difficulties encountered during EUS-guided embolization of varices and pseudoaneurysms. Methods: This article and accompanying video describe the EUS-guided embolization techniques for various vascular lesions. EUS-guided embolization was achieved by combination therapy using coils and cyanoacrylate. Complete obliteration of the lesions was documented on follow-up. The existing literature of EUS-guided embolization therapy is also reviewed. Results: Patients with various vascular lesions, including gastric varices, ectopic duodenal varices, and splenic artery pseudoaneurysms, were successfully treated with EUS-guided coil plus cyanoacrylate injection. Patients with gastric varices underwent treatment with 2 EUS-guided techniques: (1) direct puncture of the varix and embolization and (2) feeder vessel embolization. Following embolization, the absence of Doppler flow within the varix and pseudoaneurysm was documented. Conclusions: Techniques of EUS-guided embolization of varices and pseudoaneurysms are demonstrated. Understanding the techniques and the challenges encountered during therapy is crucial to optimize outcomes and reduce adverse events.

Ultrasound guided costoclavicular block in pediatric population: A prospective observational study.

BACKGROUND: The costoclavicular space serves as an alternative approach to the infraclavicular brachial plexus block, and numerous studies in adults have demonstrated promising outcomes for distal upper limb surgery. Blocking the brachial plexus at this level is potentially advantageous because the cords are relatively superficial, located in close proximity to each other and easily identified using ultrasound. AIMS: This study aimed to assess the success rate and feasibility of costoclavicular block in children undergoing unilateral below elbow upper limb surgery. METHODS: Thirty children aged 2-12 years scheduled for unilateral below elbow surgery under general anesthesia were included. Costoclavicular block was performed under ultrasound and nerve stimulator guidance with 0.5% ropivacaine, 0.5 mL/kg. Success was evaluated based on the absence of significant hemodynamic response to skin incision made 20 min after the block. The sono-anatomy of costoclavicular space, ease of needling, complications, and the post-operative pain scores were assessed. RESULTS: The mean age and weight of the children were 6.5 ± 3.8 years and 19.7 ± 9.1 kg, respectively. The success rate of costoclavicular block in our cohort is 100%. Sonographic visualization was graded as excellent (Likert Scale 2) in 90% of cases. The plexus was located at a depth of 1.4 ± 0.3 cm from the skin, the lateral extent of cords from the artery was 0.8 ± 0.4 cm and they were observed inferior and lateral to the artery. The mean needling time was 3.6 ± 1.1 min. None of the children experienced complications such as vascular or pleural puncture, hematoma, Horner's syndrome or diaphragmatic palsy. Postoperative pain scores were low, and no rescue analgesia was required. CONCLUSIONS: In conclusion, the costoclavicular block exhibited a notably high success rate in pediatric population. This study substantiates that the three cords of the brachial plexus are consistently visible and superficial during ultrasound examination using this approach, confirming their separation from vascular structures and the reliable achievement of blockade without observed complications.

Comparison of BlockBuster laryngeal mask with Air-Q intubating laryngeal airway as a conduit for fiber-optic guided intubation in children: A prospective randomized controlled study.

BACKGROUND: The pediatric sizes of BlockBuster supraglottic airway (SGA) have been introduced recently. Its efficacy as a conduit for endotracheal intubation in children has not been assessed. Newer devices are often compared with Air-Q SGA to assess their intubating capability. AIMS: The primary objective was to compare the time taken for fiber-optic-guided intubation through the BlockBuster and the Air-Q SGAs. METHODS: Sixty children aged 6 months to 12 years with normal airways were randomized into two groups: Air-Q SGA (Group A) and Blockbuster SGA (Group B). After administration of general anesthesia, an appropriately sized SGA was inserted. The time taken for fiber-optic-guided intubation through the SGA, success, ease, and time for SGA insertion and removal were noted. The glottic view was graded by fiber-optic bronchoscopy. RESULTS: Demographic parameters were comparable. The time to intubate with the BlockBuster 62.40 ± 17.2 s was comparable to the Air-Q 60.8 ± 18.5 s (mean difference 1.6 s, 95% CI -7.65 to10.85; p = .73). The average time for SGA insertion in BlockBuster and Air-Q was 14.57 ± 3.2 s and 16.67 ± 5.39 s, respectively (mean difference -2.1, 95% CI -4.39 to 0.19 s; p = .07). The first-attempt intubation success and overall intubation success rates were comparable in both groups, 96.7% and 100%, respectively. In Group B, 25/3/1/1/0 cases had a glottic view grade of 1/2/3/4/5, respectively. In Group A, 23/3/2/2/0 cases had grade of 1/2/3/4/5 glottic views respectively. The average time to SGA removal was comparable between the BlockBuster (20.17 ± 5.8 s) and the Air-Q (22.5 ± 12.8 s) groups (mean difference -2.3 s, 95% CI -7.5 to 2.82 s; p = .37). None of the children had any perioperative complications. CONCLUSION: BlockBuster SGA may be a useful alternative to Air-Q for SGA-assisted, fiber-optic-guided tracheal intubation in children.

Lactobacillus plantarum L168 improves hyperoxia-induced pulmonary inflammation and hypoalveolarization in a rat model of bronchopulmonary dysplasia.

Alteration of gut microbiota can affect chronic lung diseases, such as asthma and chronic obstructive pulmonary disease, through abnormal immune and inflammatory responses. Previous studies have shown a feasible connection between gut microbiota and bronchopulmonary dysplasia (BPD) in preterm infants. However, whether BPD can be ameliorated by restoring the gut microbiota remains unclear. In preterm infants with BPD, we found variance in the diversity and structure of gut microbiota. Similarly, BPD rats showed gut dysbiosis, characterized by a deficiency of Lactobacillus, which was abundant in normal rats. We therefore explored the effect and potential mechanism of action of a probiotic strain, Lactobacillus plantarum L168, in improving BPD. The BPD rats were treated with L. plantarum L168 by gavage for 2 weeks, and the effect was evaluated by lung histopathology, lung function, and serum inflammatory markers. Subsequently, we observed reduced lung injury and improved lung development in BPD rats exposed to L. plantarum L168. Further evaluation revealed that L. plantarum L168 improved intestinal permeability in BPD rats. Serum metabolomics showed altered inflammation-associated metabolites following L. plantarum L168 intervention, notably a marked increase in anti-inflammatory metabolites. In agreement with the metabolites analysis, RNA-seq analysis of the intestine and lung showed that inflammation and immune-related genes were down-regulated. Based on the information from RNA-seq, we validated that L. plantarum L168 might improve BPD relating to down-regulation of TLR4 /NF-κB /CCL4 pathway. Together, our findings suggest the potential of L. plantarum L168 to provide probiotic-based therapeutic strategies for BPD.

Overlap Syndrome of Immune Reconstitution Inflammatory Syndrome Secondary to Disseminated Mycobacterial Infection and Hemophagocytic Lymphohistiocytosis in a Patient With Newly Diagnosed HIV/AIDS.

Immune reconstitution inflammatory syndrome (IRIS) following initiation of antiretroviral therapy (ART) has variable incidence but is not uncommon and has the potential to cause long-term consequences and fatal outcomes in patients with HIV. Hemophagocytic lymphohistiocytosis (HLH) is a separate syndrome of excess immune activation, but may coexist with IRIS and necessitate a unique treatment approach. In this report, the case of a patient with newly diagnosed HIV/AIDS who was found to have both mycobacterial IRIS and HLH is presented.

Early predictors of bacterial pneumonia infection in children with congenital heart disease after cardiopulmonary bypass: a single-centre retrospective study.

OBJECTIVES: The objective of this study was to evaluate the early predictors of bacterial pneumonia infection in children with congenital heart disease (CHD) after cardiopulmonary bypass (CPB). DESIGN: Retrospective study. SETTING: A freestanding tertiary paediatric hospital in China. PARTICIPANTS: Patients admitted to the hospital due to CHD who underwent open-heart surgery. OUTCOME MEASURES: We retrospectively reviewed and analysed data from 1622 patients with CHD after CPB from June 2018 to December 2020 at the Children's Hospital of Nanjing Medical University. Enrolled patients were assigned to an infection group or a non-infection group according to the presence of postoperative bacterial pneumonia infection, and the differences in clinical indicators were compared. Potential predictors were analysed by multivariate logistic regression analysis and area under the curve (AUC) analysis. RESULTS: Among the 376 patients (23.2%) in the infection group, the three most common bacteria were Streptococcus pneumoniae in 67 patients (17.8%), Escherichia coli in 63 patients (16.8%) and Haemophilus influenzae in 53 patients (14.1%). The infection group exhibited a lower weight (8.0 (6.0-11.5) kg vs 11.0 (7.5-14.5) kg, p<0.001). In the infection group, procalcitonin (PCT) (ng/mL: 4.72 (1.38-9.52) vs 1.28 (0.47-3.74), p<0.001) and C reactive protein (CRP) (mg/L: 21.0 (12.1-32.0) vs 17.0 (10.0-27.0), p<0.001) levels were significantly greater than those in the non-infection group. Binary logistic regression analysis revealed that weight, PCT and CRP were independent risk factors for pulmonary bacterial infection after CPB. The AUCs of weight, PCT, CRP and PCT+CRP for predicting pulmonary bacterial infection after CPB were 0.632 (95% CI 0.600 to 0.664), 0.697 (95% CI 0.667 to 0.727), 0.586 (95% CI 0.554 to 0.618) and 0.694 (95% CI 0.664 to 0.724), respectively, and the cut-off values were ≤10.25 kg, ≥4.25 ng/mL, ≥6.50 mg/L and ≥0.20, respectively. The sensitivities were 69.7%, 54.0%, 93.9% and 70.2%, and the specificities were 53.5%, 77.7%, 19.4% and 59.1%, respectively. CONCLUSIONS: In our study, weight, PCT and CRP were found to be independent predictors of pulmonary bacterial infection after CPB. Moreover, PCT was the most specific predictor, and CRP was the most sensitive independent predictor that might be beneficial for the early diagnosis of pulmonary bacterial infection after CPB in patients with CHD.

Preoperative serum cortisone levels are associated with cognition in preschool-aged children with tetralogy of Fallot after corrective surgery: new evidence from human populations and mice.

BACKGROUND: Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease. Children with TOF would be confronted with neurological impairment across their lifetime. Our study aimed to identify the risk factors for cerebral morphology changes and cognition in postoperative preschool-aged children with TOF. METHODS: We used mass spectrometry (MS) technology to assess the levels of serum metabolites, Wechsler preschool and primary scale of intelligence-Fourth edition (WPPSI-IV) index scores to evaluate neurodevelopmental levels and multimodal magnetic resonance imaging (MRI) to detect cortical morphological changes. RESULTS: Multiple linear regression showed that preoperative levels of serum cortisone were positively correlated with the gyrification index of the left inferior parietal gyrus in children with TOF and negatively related to their lower visual spaces index and nonverbal index. Meanwhile, preoperative SpO2 was negatively correlated with levels of serum cortisone after adjusting for all covariates. Furthermore, after intervening levels of cortisone in chronic hypoxic model mice, total brain volumes were reduced at both postnatal (P) 11.5 and P30 days. CONCLUSIONS: Our results suggest that preoperative serum cortisone levels could be used as a biomarker of neurodevelopmental impairment in children with TOF. Our study findings emphasized that preoperative levels of cortisone could influence cerebral development and cognition abilities in children with TOF.

CARD9 mediated MAPK/NF-κB signal pathway participates in the pathophysiological process of septic hepatitis: The role of tiliroside.

The purpose of the present study was to search for biomarker and effective treatment measures for septic hepatitis. Lipopolysaccharide (LPS) was used to establish septic hepatitis (SH) model in vivo and in vitro. Proteomics, immunoprecipitation, molecular docking techniques, and CARD9 knockout (KO) mice and silence Chang liver Cell(CLC) were used to search for biomarker and possible treatment targets and treatment measures for SH. 46 differentially expressed proteins were found in the liver tissues of sepsis mice, among which CARD9 changed most. CARD9 KO and silence significantly relieved sepsis induced SH in vivo and in vitro. Tiliroside (TIS), an effective component of Buddleja officinalis Maxim, significantly improved SH by regulating CARD9 mediated MAPK/NF-κB signal pathway. In conclusion, CARD9 may be the important molecular targets for SH. TIS could protect SH via CARD9 mediated MAPK/NF-κB signal pathway. The findings provide a new treatment target for SH and a potential treatment measure.

Late Presentation of Acute Coronary Syndrome Complicated by Ventricular Septal Rupture.

Acquired ventricular septal rupture (VSR) is a rare but potentially fatal complication of late-presenting myocardial infarction (MI). In the era of revascularization and reperfusion therapy, the incidence of VSR has significantly decreased. Ruptures occur predominantly in patients with late-presenting ST elevation MI. Patients may present with a wide variety of symptoms ranging from chest pain and mild hemodynamic instability to profound cardiogenic shock. Inotropes, vasopressors, and mechanical support with intra-aortic balloon pumps and extracorporeal membrane oxygenation can be used to bridge patients to surgery. Despite treatment with ventricular septal repair, postsurgical mortality remains high. There is a wide variety of complications that can occur in the postoperative period. A multidisciplinary approach is vital in these patients who develop VSR. Improving awareness among healthcare professionals regarding the symptoms of acute coronary syndrome can hopefully help prevent delayed presentation of patients to healthcare facilities.

A nomogram for predicting the risk of Bronchopulmonary dysplasia in premature infants.

Background: Bronchopulmonary dysplasia (BPD) is a prevalent and critical complication among premature infants, with potentially long-lasting adverse effetcs. The present study aimed to establish a nomogram model to predict the risk of BPD in premature infants born at <32 weeks gestational age. Methods: A retrospective single-center study was conducted on premature infants admitted to the neonatal intensive care unit (NICU) of the Children's Hospital of Nanjing Medical University from January 2018 to December 2020. Data were collected from clinical medical records, including the perinatal data and the critical information after birth. Clinical parameters and features were analyzed using univariate and multivariate logistic regression. A nomogram based on clinical data was established and validated using bootstrapping samples. The specificity and sensitivity of the nomogram were estimated using the receiver operating characteristic (ROC) based area under the curve (AUC). Results: A total of 542 premature babies were included, and 152 infants (28.04%) were diagnosed with BPD. Birth weight, cesarean delivery, invasive/non-invasive ventilation at day 7 and 14 were identified as significant factors (p < 0.05) using univariate and the multivariate logistic regression analysis, and were entered into a nomogram. The calibration curve for BPD probability demonstrated a favorable concurrence between actual probability and predicted ability of the BPD nomogram. The nomogram showed potential differentiation, with an AUC of 0.925, 89.90% sensitivity, 76.71% specificity, and 86.35% accuracy. Conclusion: The nomogram developed in this study provides a straightforward tool to predict the probability of BPD and assist clinicians in optimizing treatment regimens for premature infants born at <32 weeks gestational age. This study highlights the importance of identifying and monitoring significant clinical factors associated with BPD in premature infants to improve clinical outcomes.

Effect of Lung Compliance-Based Optimum Pressure Versus Fixed Positive End-Expiratory Pressure on Lung Atelectasis Assessed by Modified Lung Ultrasound Score in Laparoscopic Gynecological Surgery: A Prospective Randomized Controlled Trial.

BACKGROUND:  Lung protective ventilation during the intraoperative period is now well established. However, the additional role of positive end-expiratory pressure (PEEP) during the intraoperative period remains uncertain in major laparoscopic gynecological surgery. The authors hypothesized that compliance-based optimum PEEP titration reduces postoperative lung atelectasis and improves outcomes. METHODS:  Patients undergoing major laparoscopic pelvic gynecological surgeries with healthy lungs were randomized to the fixed PEEP group (PEEP 5 cm H2O and recruitment maneuver {RM}) and optimum PEEP group (compliance-based PEEP and RM). Lung ultrasound and arterial blood gas analysis were performed at four time points. Modified lung ultrasound scoring was done, and the same was used as means of assessing lung aeration and the amount of lung atelectasis. Postoperative supplemental oxygen requirement and duration were also assessed and compared. RESULTS: Lung ultrasound score (LUS) 30 minutes after extubation in fixed (Group F) and optimum (Group O) PEEP groups were median (interquartile range {IQR}) 3 (2-3) versus 1 (1-2), p=0.0001. Ventilatory parameters between Group F and Group O after lung recruitment were tidal volume (mean 357 mL {SD: 35} versus 362 mL {SD: 22}, p=0.46), PEEP (median, 5 cm H2O {IQR: 5-5} versus median 16 cm H2O {IQR: 14-18}), peak airway pressure (median 26 cm H2O {IQR: 24-28} versus median 30 cm H2O {IQR: 28-32} p<0.0001), plateau pressure (median 22 cm H2O {IQR: 20-24} versus median 26 cm H2O {IQR: 24-28} p<0.0001), static compliance (32.07±8.36 mL cm H2O-1 versus 39.58±8.99 mL cm H2O-1, p=0.0002). The number of patients requiring postoperative oxygen therapy to maintain SpO2 >94% after extubation in postanesthesia care unit (PACU) was statistically significantly greater in group F (39/41 {95%} versus 30/41 {73%}, p=0.007). Median (IQR) duration of oxygenation therapy in the first 24 hours of the postoperative period between Group F and Group O differed with statistical significance, with the median (IQR) values being 25 (20-30) minutes versus 10 (0-15) minutes (p<0.0001). CONCLUSIONS:  The modified lung ultrasound score significantly differed intraoperatively between the two groups, with lower scores in the optimum PEEP group. This has reflected improved postoperative outcomes in optimum PEEP group patients, with fewer patients requiring postoperative oxygen supplementation and reduced supplemental oxygen requirement duration.