Cardiopulmonary Bypass Blood Flow Rates and Major Adverse Kidney Events in Cardiac Surgery: A Propensity Score-adjusted Before-After Study.

OBJECTIVES: Cardiac surgery associated-acute kidney injury is a common and serious postoperative complication of cardiac surgery, which is associated with increased postoperative morbidity and mortality. This study aimed to explore the association between cardiopulmonary bypass (CPB) blood flow rate (BFR), and major adverse kidney events (MAKEs) at day 30. DESIGN: Retrospective single-center before-after observational study. Patients were divided in 2 groups according to CPB flow rates: a first group with an institutional protocol targeting a CPB-BFR of >2.2 L/min/m² (low CPB-BFR group), and a second group with a modified institutional protocol targeting a CPB-BFR of >2.4 L/min/m² (high CPB-BFR group). The primary outcome was MAKE at 30 days, defined as the composite of death, renal replacement therapy or persistent renal dysfunction. SETTING: The data were collected from clinical routines in university hospital. PARTICIPANTS: Adult patients who underwent elective and urgent cardiac surgery without severe chronic renal failure, for whom CPB duration was ≥90 minutes. INTERVENTIONS: We included 533 patients (low CPB-BFR group, n = 270; high CPB-BFR group, n = 263). MEASUREMENTS AND MAIN RESULTS: A significant decrease in MAKE at 30 days was observed in the high CPB-BFR group (3% v 8%; odds ratio [OR], 0.779; 95% confidence interval [CI], 0.661-0.919; p < 0.001) mainly mediated by a lower 30-day mortality in the high CPB-BFR group (1% v 5%; OR, 0.697; 95% CI, 0.595-0.817; p = 0.001), as was renal replacement therapy (1% v 4%; OR, 0.739; 95% CI, 0.604-0.904; p = 0.016). CONCLUSIONS: In patients undergoing cardiac surgery, increased CPB-BFR was associated with a decrease in MAKE at 30 days including mortality and renal replacement therapy.

Visual recovery after oral high-dose methylprednisolone in acute inflammatory optic neuropathy.

PURPOSE: High doses of venous corticosteroids are currently the only validated treatment for the management of optic neuritis (ON). The objective is to assess the changes in visual function parameters after oral high-dose methylprednisolone in patients with ON. METHODS: A retrospective analysis of patients with acute ON was performed. Patients received 1 g per day of oral methylprednisolone for 3 to 5 days. Visual function was measured using the ETDRS test for visual acuity, 30-2 automated visual field test, contrast sensitivity test, and color vision test before treatment, 4 days, 2 weeks, 1 month and 3 months, and 6 months following treatment. To assess anatomical changes, optical coherence tomography of the ganglion cells was performed at various timepoints. RESULTS: Between September 2014 and September 2016, a total of 29 patients were included in the study. More than 80% of patients had recovered normal visual acuity after 3 and 6 months. This recovery of all parameters of visual function was observed as early as 4 days but occurred predominantly within 15 days after the initiation of treatment. We observed a thinning of the ganglion cell layer during the follow-up, which mainly occurs within one month. The P100 wave of visually evoked potentials was discernible in all patients at 6 months. During the 6 years of follow-up, 2 patients had experienced a relapse of ON. No serious adverse effects were observed. CONCLUSION: This study demonstrated a rapid recovery of all visual function parameters after oral high-dose methylprednisolone ON with no serious adverse effects.

Endogenous Extracellular Vesicles Participate in Brain Remodeling after Ischemic Stroke.

Brain remodeling after an ischemic stroke represents a promising avenue for exploring the cellular mechanisms of endogenous brain repair. A deeper understanding of these mechanisms is crucial for optimizing the safety and efficacy of neuroprotective treatments for stroke patients. Here, we interrogated the role of extracellular vesicles, particularly exosomes, as potential mediators of endogenous repair within the neurovascular unit (NVU). We hypothesized that these extracellular vesicles may play a role in achieving transient stroke neuroprotection. Using the established ischemic stroke model of middle cerebral artery occlusion in adult rats, we detected a surged in the extracellular vesicle marker CD63 in the peri-infarct area that either juxtaposed or co-localized with GFAP-positive glial cells, MAP2-labeled young neurons, and VEGF-marked angiogenic cells. This novel observation that CD63 exosomes spatially and temporally approximated glial activation, neurogenesis, and angiogenesis suggests that extracellular vesicles, especially exosomes, contribute to the endogenous repair of the NVU, warranting exploration of extracellular vesicle-based stroke therapeutics.

Identifying the Target Traumatic Brain Injury Population for Hyperbaric Oxygen Therapy.

Traumatic brain injury (TBI) results from direct penetrating and indirect non-penetrating forces that alters brain functions, affecting millions of individuals annually. Primary injury following TBI is exacerbated by secondary brain injury; foremost is the deleterious inflammatory response. One therapeutic intervention being increasingly explored for TBI is hyperbaric oxygen therapy (HBOT), which is already approved clinically for treating open wounds. HBOT consists of 100% oxygen administration, usually between 1.5 and 3 atm and has been found to increase brain oxygenation levels after hypoxia in addition to decreasing levels of inflammation, apoptosis, intracranial pressure, and edema, reducing subsequent secondary injury. The following review examines recent preclinical and clinical studies on HBOT in the context of TBI with a focus on contributing mechanisms and clinical potential. Several preclinical studies have identified pathways, such as TLR4/NF-kB, that are affected by HBOT and contribute to its therapeutic effect. Thus far, the mechanisms mediating HBOT treatment have yet to be fully elucidated and are of interest to researchers. Nonetheless, multiple clinical studies presented in this review have examined the safety of HBOT and demonstrated the improved neurological function of TBI patients after HBOT, deeming it a promising avenue for treatment.

Complex functional brain network properties in anorexia nervosa.

BACKGROUND: Anorexia nervosa (AN) is a disorder characterized by an incapacitating fear of weight gain and by a disturbance in the way the body is experienced, facets that motivate dangerous weight loss behaviors. Multimodal neuroimaging studies highlight atypical neural activity in brain networks involved in interoceptive awareness and reward processing. METHODS: The current study used resting-state neuroimaging to model the architecture of large-scale functional brain networks and characterize network properties of individual brain regions to clinical measures. Resting-state neuroimaging was conducted in 62 adolescents, 22 (21 female) with a history of AN and 40 (39 female) healthy controls (HCs). Sensorimotor and basal ganglia regions, as part of a 165-region whole-brain network, were investigated. Subject-specific functional brain networks were computed to index centrality. A contrast analysis within the general linear model covarying for age was performed. Correlations between network properties and behavioral measures were conducted (significance q < .05). RESULTS: Compared to HCs, AN had lower connectivity from sensorimotor regions, and greater connectivity from the left caudate nucleus to the right postcentral gyrus. AN demonstrated lower sensorimotor centrality, but higher basal ganglia centrality. Sensorimotor connectivity dyads and centrality exhibited negative correlations with body dissatisfaction and drive for thinness, two essential features of AN. CONCLUSIONS: These findings suggest that AN is associated with greater communication from the basal ganglia, and lower information propagation in sensorimotor cortices. This is consistent with the clinical presentation of AN, where individuals exhibit patterns of rigid habitual behavior that is not responsive to bodily needs, and seem "disconnected" from their bodies.

Individuals with anorexia nervosa (AN) usually report a fear of gaining weight. They often develop a dislike and distrust of their bodies, feeling that their bodies had somehow let them down. These fears can in turn lead to dangerous weight loss behaviors. Magnetic resonance imaging of the brain is a tool that helps highlight the underlying biological processes associated with AN. In the current study we aim to investigate how the connections in key regions of the brain are related to clinical and behavioral factors associated with AN. We found regions of two main networks were associated with body dissatisfaction and drive for thinness, which are key features of AN. The brain regions involved help explain why patients with AN have characteristics of feeling disconnected from their bodies, having difficulty labeling and regulating emotions, responding to biological needs such as hunger and fatigue, and differentiating experiences that will be rewarding. These results can help guide interventions that will be directed towards helping individuals with AN to better sense, decipher, and act on the various signals being communicated by their body.

The use of visible light spectroscopy to measure tissue oxygenation in free flap reconstruction.

The loss of a free flap is a feared complication for both the surgeon and the patient. Early recognition of vascular compromise has been shown to provide the best chance for flap salvage. The ideal monitoring technique for perioperative free flap ischemia would be noninvasive, continuous, and reliable. Visible light spectroscopy (VLS) was evaluated as a new method for predicting ischemia in microvascular cutaneous soft tissue free flaps. In an Institutional Review Board-approved prospective trial, 12 patients were monitored after free flap reconstructions. The tissue hemoglobin oxygen saturation (StO (2)) and total hemoglobin concentration (THB) of 12 flaps were continuously monitored using VLS for 72 hours postoperatively. Out of these 12 flaps 11 were transplanted successfully and 1 flap loss occurred. The StO (2 )was 48.99% and the THB was 46.74% for the 12 flaps. There was no significant difference in these values among the flaps. For the single flap loss, the device accurately reflected the ischemic drop in StO (2) indicating drastic tissue ischemia at 6 hours postoperatively before the disappearance of implantable Doppler signals or clinical signs of flap compromise. VLS, a continuous, noninvasive, and localized method to monitor oxygenation, appeared to predict early ischemic complications after free flap reconstruction.

Onset of alopecia areata after Epstein-Barr virus infectious mononucleosis.

BACKGROUND: The pathogenesis of alopecia areata (AA) is incompletely known. A positive family history in some points to a genetic predisposition, and discordance of the disease in identical twins suggests environmental triggers exist. OBJECTIVE: We sought to determine whether the Epstein-Barr virus (EBV) is a possible environmental trigger for AA. METHODS: We queried the National AA Registry for all patients who self-reported sudden onset of AA with concurrent EBV mononucleosis. RESULTS: Among the 6256 individuals registered between December 2001 and August 2007, 1586 patients reported an environmental trigger-including 12 individuals who had an EBV infection within 6 months before the onset of AA. LIMITATIONS: This study relies on self-reported data, and not all medical records confirming EBV infections were available for review. CONCLUSION: The association between EBV and AA is worthy of further investigation.