Effect of hematoma volume on the 30-day mortality rate of patients with primary hypertensive brainstem hemorrhage: a retrospective cohort study.

Objective: The purpose of this study is to investigate the effect of hematoma volume on the 30-Day Mortality Rate of patients with Primary Hypertensive Brainstem Hemorrhage (PHBH). Methods: Retrospective analysis was done on the clinical information of 74 patients who underwent treatment for primary hypertensive brainstem hemorrhage at the Department of Neurosurgery of the 908th Hospital of the Joint Logistic Support Force of the Chinese People's Liberation Army between January 2018 and December 2021. Both univariate and multivariate logistic regression were used to assess clinical signs and risk factors that affect 30-day mortality. Results: In the 74 patients with primary hypertensive brainstem hemorrhage included in this investigation, 46 patients died and 28 patients survived. The mortality rate at 30 days was 62.16%. A statistically significant difference was seen (P < 0.001) in the results of the univariate analysis, which suggested that hematoma volume may be a factor affecting the prognosis of patients with hypertensive brainstem hemorrhage. Hematoma volume was further demonstrated to be a risk factor and an independent factor impacting death in patients with brainstem hemorrhage (P < 0.001) by multivariate logistic regression analysis (OR: 2.6, 95% CI: 1.7-3.9, P < 0.001 Crude Model, OR: 3.6, 95% CI: 1.7-7.7, P < 0.001 Multivariate-Adjusted Model). After adjusting for confounding variables such as age, body mass index, sex, history of diabetes mellitus, history of hypertension, admission GCS score, stereotactic aspiration, combined hydrocephalus, admission systolic and diastolic blood pressure, the hematoma volume was revealed to be an independent predictor of 30-day death in patients with brainstem hemorrhage. We discovered by smooth curve fitting that hematoma volume increased in a non-linear manner with 30-day mortality. The 30-day mortality rate did not alter significantly when the hematoma volume was less than 4 ml. When the hematoma volume was greater than 4 ml, the 30-day mortality rate increased rapidly, and when the hematoma volume was 10 ml, the 30-day mortality rate reached the maximum. Conclusions: Hematoma volume is an independent factor affecting 30-day mortality in patients with primary hypertensive brainstem hemorrhage. The severe and extensive neurological damage caused by primary hypertensive brainstem hemorrhage is highly unlikely to be fundamentally altered by a single protocol, and new avenues need to be explored scientifically and continuously.

Markers of blood-brain barrier disruption increase early and persistently in COVID-19 patients with neurological manifestations.

Background: Coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 infection is associated with disorders affecting the peripheral and the central nervous system. A high number of patients develop post-COVID-19 syndrome with the persistence of a large spectrum of symptoms, including neurological, beyond 4 weeks after infection. Several potential mechanisms in the acute phase have been hypothesized, including damage of the blood-brain-barrier (BBB). We tested weather markers of BBB damage in association with markers of brain injury and systemic inflammation may help in identifying a blood signature for disease severity and neurological complications. Methods: Blood biomarkers of BBB disruption (MMP-9, GFAP), neuronal damage (NFL) and systemic inflammation (PPIA, IL-10, TNFα) were measured in two COVID-19 patient cohorts with high disease severity (ICUCovid; n=79) and with neurological complications (NeuroCovid; n=78), and in two control groups free from COVID-19 history, healthy subjects (n=20) and patients with amyotrophic lateral sclerosis (ALS; n=51). Samples from COVID-19 patients were collected during the first and the second wave of COVID-19 pandemic in Lombardy, Italy. Evaluations were done at acute and chronic phases of the COVID-19 infection. Results: Blood biomarkers of BBB disruption and neuronal damage are high in COVID-19 patients with levels similar to or higher than ALS. NeuroCovid patients display lower levels of the cytokine storm inducer PPIA but higher levels of MMP-9 than ICUCovid patients. There was evidence of different temporal dynamics in ICUCovid compared to NeuroCovid patients with PPIA and IL-10 showing the highest levels in ICUCovid patients at acute phase. On the contrary, MMP-9 was higher at acute phase in NeuroCovid patients, with a severity dependency in the long-term. We also found a clear severity dependency of NFL and GFAP levels, with deceased patients showing the highest levels. Discussion: The overall picture points to an increased risk for neurological complications in association with high levels of biomarkers of BBB disruption. Our observations may provide hints for therapeutic approaches mitigating BBB disruption to reduce the neurological damage in the acute phase and potential dysfunction in the long-term.

High Level of Soluble CD146 In Cerebrospinal Fluid Might be a Biomarker of Severity of Anti-N-Methyl-D-Aspartate Receptor Encephalitis.

Background: Disruption of the blood-brain barrier (BBB) is an important pathophysiological process of anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis. A recent multi-center study showed that soluble (s) CD146 is a potential biomarker for monitoring early BBB damage and central nervous system inflammation, but little is known about sCD146 in anti-NMDAR encephalitis. Method: Twenty-three anti-NMDAR encephalitis patients and seventeen controls with non-inflammatory neurological diseases were recruited. sCD146 and inflammatory cytokines in cerebrospinal fluid (CSF) and serum were detected by ELISA. Modified Rankin scale (mRS) scores were used to assess the neurological status of each patient. A follow-up review was completed three months after discharge. Results: sCD146 levels in the CSF of patients with the acute stage anti-NMDAR encephalitis were significantly increased compared with controls and accompanied by increases in TNF-α, IL-6 and IL-10. CSF sCD146 was positively correlated with neuroinflammatory factors in the CSF and with mRS score. Three months after effective treatment, CSF sCD146 in patients was significantly decreased but remained significantly different compared with the controls. Conclusion: Our data suggested that higher expression of CSF sCD146 correlated with more serious neurological damage. Therefore, levels of CSF sCD146 may represent a promising indicator for monitoring disease and optimizing clinical treatment decisions in the early stages of anti-NMDAR encephalitis.

Comprehensive hippocampal metabolite responses to PM2.5 in young mice.

Fine particulate matter (PM2.5) exposure alters brain development, clinical cognition and behavior in childhood. Previous studies of this subject have mainly been epidemiological investigations or analyses of gene and protein levels; however, gas chromatography-mass spectrometry (GC-MS)-based metabolic profiling, which will help clarify the molecular mechanisms of susceptibility in PM2.5-induced neurotoxicity, is lacking. In the present study, C57BL/6 mice at different ages (4 weeks, 4 months and 10 months) received oropharyngeal aspiration of PM2.5 (3 mg/kg) every other day for 4 weeks. The Morris water maze showed that PM2.5 exposure caused deterioration of spatial learning and memory in young (4 week old) mice. In addition, the levels of several metabolites belonging to different metabolite classes were significantly changed by PM2.5 exposure in 4-week-old mice. Based on metabolic pathway analysis, we speculated that the decline in spatial learning and memory due to PM2.5 exposure may be directly or indirectly associated with hippocampal region-specific metabolic alterations involving energy metabolism (citric acid, succinic acid, malic acid, maltose and creatinine); cholesterol metabolism (desmosterol, lanosterol and campesterol); arachidonic acid metabolism (methyl arachidonic acid, nonanoic acid and linoleic acid); inositol phosphate metabolism (myo-inositol, myo-inositol-1-phosphate and methyl-phosphate) and aspartic acid metabolism (aspartic acid, asparagine and homoserine).

Síndrome de niño sacudido: aspectos clínicos, sociales y normativos / The battered child syndrome: clinical, social and normative aspects

El maltrato infantil es uno de los problemas y fenómenossociales más relevantes y dramáticos de laactualidad. El síndrome de niño sacudido (SDNS) esuna forma de maltrato infantil. Se caracteriza básicamentepor la triada trauma craneal cerrado, daño delsistema nerviosos central y hemorragia retiniana. Lavaloración del segmento anterior y oftalmoscópica esvital para el diagnóstico diferencial de la hemorragiaretiniana y el SDNS. Los profesionales de la salud,en especial de la salud visual y ocular, deben conocercómo actuar en caso de detectar un episodio demaltrato infantil, principalmente SDNS.

The physical abuse is one of the most relevant and dramatic problem and social phenomena at the present time. The Battered child syndrome (BCS) is a form of infantile physical abuse. It is characterized basically by three aspects: closed craneal trauma, damage of the central system nervous and retinal hemorrhage. The evaluation of the anterior and posterior segment is important for the differential diagnosis of the retinal hemorrhage and the BCS. The health professional, specially the visual and ocular health care professional, must know what to do in case of detecting an episode of child abuse, mainly BCS.

Concentraciones de mercurio total en sangre y cabello por ingesta de pescado en niños, mujeres embarazadas y en edad reproductiva residentes de los municipios aledaños al lago de Chapala, Jalisco - México / Concentrations of total mercury in blood and hair and fish intake in children, residents of the municipalities bordering to the Chapala lake, Mexico

Environmental pollution (water, sediment and fish) poses serious threats to the Chapala lake, Mexico. We seek to identify the concentrations of totalMercury (Hg) in children, pregnant women and in reproductive age from the communities around the lake. We will use blood samples and hair samples as biomarkers. Exposure will be assessed by dietary habits (quantity, frequency, species and type of fish consumed).Taking in consideration that some groups may be more susceptible to Mercury (Hg). In particular, the fetus, newborn babies and infants are at high risk because their nervous system is particularly delicate. Exposure to Hg during pregnancy can affect the neuronal connection and the mielinization of the nervous system, which may result in reduced number of cells neurons " in active" at the end of life. Very limited data exists in Mexico, protection measures are difficult to support without reliable information (e.g., possible damage from fish consumption). Therefore, this investigation seeks to generate hypothesis (cross sectional study) regarding the concentrations of Hg inside the organism soon after the fish consumption. We will evaluate the possible health risk e.g., children'sneurological damages, pregnant women and those in reproductive age.