Lipid metabolism: the potential targets for toxoplasmosis treatment.

Toxoplasmosis is a zoonosis caused by Toxoplasma gondii (T. gondii). The current treatment for toxoplasmosis remains constrained due to the absence of pharmaceutical interventions. Thus, the pursuit of more efficient targets is of great importance. Lipid metabolism in T. gondii, including fatty acid metabolism, phospholipid metabolism, and neutral lipid metabolism, assumes a crucial function in T. gondii because those pathways are largely involved in the formation of the membranous structure and cellular processes such as division, invasion, egress, replication, and apoptosis. The inhibitors of T. gondii's lipid metabolism can directly lead to the disturbance of various lipid component levels and serious destruction of membrane structure, ultimately leading to the death of the parasites. In this review, the specific lipid metabolism pathways, correlative enzymes, and inhibitors of lipid metabolism of T. gondii are elaborated in detail to generate novel ideas for the development of anti-T. gondii drugs that target the parasites' lipid metabolism.

Intracranial Pressure Variability Associates with 3-Month Outcomes in Spontaneous Intracerebral Hemorrhage: A Retrospective Analysis of 597 Patients.

BACKGROUND: Spontaneous intracerebral hemorrhage (ICH) is a devastating type of stroke, and most favorable treatments to improve patients' neurologic outcomes are not clear. Invasive intracranial pressure (ICP) monitoring is a common treatment of ICH, but whether patients with ICH could benefit from ICP monitoring is controversial. ICP variability (IPV) has been shown to correlate with poor outcomes in patients with subarachnoid hemorrhage and traumatic brain injury, but this association has not been clearly elucidated in patients with ICH. We hypothesized that 72-hour IPV from time of ICP probe implantation is associated with outcomes in patients with ICH. METHODS: A retrospective chart review analysis of adult patients with ICH who received ICP monitoring at Huashan Hospital, Fudan University between January 2008 and January 2023 was performed. We included patients with ICH within 6 hours of signs or symptoms onset. Outcomes of patients with ICH were assessed using 3-month modified Rankin Scale (mRS) score, and were dichotomized into a poor (mRS score 4-6) and good (mRS score 0-3) outcome group. ICPs were recorded from the implantation of invasive ICP probe until it was removed. ICP was analyzed in the acute period, from 0 to 72 hours after ICP implantation. IPV was analyzed by SD, coefficient of variation, and successive variation of ICP. RESULTS: We analyzed 597 patients' charts. The first mean ICP assessment, immediately after ICP implantation, at a median 117 minutes (interquartile range, 82-231 minutes) after admission was 20.5 (SD 7.8) mm Hg. The second mean ICP assessment, on neurosurgical intensive care unit arrival after operation, was 14.6 (SD 8.3) mm Hg. Poor outcomes occurred in 213 patients (35.68%). In univariate analysis, univariate quintile analysis, or multivariate analysis, ICP SD, ICP coefficient of variation, and ICP successive variation were associated with poor outcomes. CONCLUSIONS: IPV during the first 72 hours after ICP implantation in patients with ICH was independently associated with poor functional outcome at 3 months. Stabilization of IPV during hyperacute and acute periods may be a potential therapeutic target to improve functional outcomes of these patients.

[Feasibility study of protecting ulnar nerve by ultrasound in treating children with supracondylar fracture of humerus by closed reduction and intercross needle fixation].

OBJECTIVE: To explore feasibility of protecting ulnar nerve by ultrasound in treating children with supracondylar fracture of humerus by closed reduction and intercross needle fixation. METHODS: From January 2018 to December 2019, 63 children with supracondylar fractures of humerus were divided into two groups(ultrasound group and X-ray group) depend on the different ways of guidance. Therer were 32 children in ultrasound group treated with closed reduction and Kirschner wire fixation guided by ultrasound, including 20 males and 12 females, aged from 3 to 11 years old with an average of (6.06±2.02) years old. There were 31 children in X-ray group treated with closed reduction and Kirschner wire fixation guided by X-ray, including 17 males and 14 females, aged from 2 to 10 years old with an average of (5.61±1.96) years old. Operation time, X-ray times, fracture healing time, ulnar nerve injury and postoperaqtive Flynn clinical function assessment at 1 year between two groups were recorded and compared. RESULTS: All patients were followed up. The follow-up time of ultrasound group ranged from 9 to 12 months with an average of (11.53±0.76) months, and X-ray group ranged from 10 to 13 months with an average of (11.51±0.72) months. There was no significant difference in operation time, follow-up time and fracture healing time between two groups(P>0.05). The number of intraoperative electrodialysis in ultrasound group was (3.06±1.24) times, and that in X-ray group was (21.65±5.58) times, which was significantly higher than that in ultrasound group(P<0.01). No iatrogenic ulnar nerve injury occurred in ultrasound group, and 2 cases of ulnar nerve injury occurred in X-ray group, the incidence of ulnar nerve injury in ultrasound group was lower than that in X-ray group, but the difference was not statistically significant(P>0.05). At 1 year after operation, Flynn clinical function assessment results in ultrasound group was excellent in 27 cases, 4 cases good and 1 case fair, in X-ray group 23 cases got excellent result, 6 cases good, 1 fair and 1 poor, there was no significant difference between two groups(P>0.05 ). CONCLUSION: Ultrasound guided and X-ray guided treatment of supracondylar fractures of humerus in children have similar effect of opertaion time and fracture healing, while ultrasound guidance could clearly detected the position of ulnar nerve, and avoid occurrence of iatrogenic ulnar nerve injury caused by ulnar puncture, which is a safe and effective treatment method.

Characteristics and therapeutic profile of TBI patients who underwent bilateral decompressive craniectomy: experience with 151 cases.

BACKGROUND: Decompressive craniectomy (DC) and intracranial pressure (ICP) monitoring are common approaches to reduce the death rate of Traumatic brain injury (TBI) patients, but the outcomes of these patients are unfavorable, particularly those who receive bilateral DC. The authors discuss their experience using ICP and other potential methods to improve the outcomes of TBI patients who receive bilateral DC. METHODS: Data from TBI patients receiving bilateral DC from Jan. 2008 to Jan. 2022 were collected via a retrospective chart review. Included patients who received unplanned contralateral DC after initial surgery were identified as unplanned secondary surgery (USS) patients. Patients' demographics and baseline medical status; pre-, intra-, and postoperative events; and follow-up visit outcome data were analyzed. RESULTS: A total of 151 TBI patients were included. Patients who underwent USS experienced more severe outcomes as assessed using the 3-month modified Rankin Scale score (P = 0.024). In bilateral DC TBI patients, USS were associated with worsen outcomes, moreover, ICP monitoring was able to lower their death rate and was associated with a lower USS incidence. In USS patients, ICP monitoring was not associated with improved outcomes but was able to lower their mortality rate (2/19, 10.5%, vs. 10/25, 40.0%; P = 0.042). CONCLUSION: The avoidance of USS may be associated with improved outcomes of TBI patients who underwent bilateral DC. ICP monitoring was a potential approach to lower USS rate in TBI patients, but its specific benefits were uncertain.

[Determination of the lung function by impulse oscillometry in 549 healthy children in Chengdu area].

OBJECTIVE: Impulse oscillometry (IOS) is a new method for determination of breathing mechanics, which features convenient operation, good repeatability and wider range analysis. As there is no standardized normal value in China at present, this study will provide a normal value of lung function determination by impulse oscillometry for children in Chengdu area. METHOD: Totally 549 children were chosen at random from Chengdu area, with 292 boys and 257 girls who were 4 to 14 years old. The subjects were assigned into 10 age groups according to their chronological age with one year difference between every two adjacent groups. The respiratory total impedance (Zrs), viscosity resistance (Rrs) and elastic resistance (Xrs) at various oscillation frequency were measured by the Master Screen IOS which was manufactured by German Jaeger Company. The measured data were treated with the linear stepwise multiple regression, and established the prediction equation. At the same time, paired comparison was carried out with the measured data and equation obtained from this study, Lechtenboerger equation and prediction equation obtained from Guangzhou area. RESULT: The total impedance and airway resistance were negatively correlated with the children's height and age. Zrs (male) = -0.756 + 189.586/height, r = -0.782, P < 0.001; Zrs (female) = -0.497 + 152.468/height, r = -0.726, P < 0.001. Rrs became the same in trend; while Xrs were proportional to the height, e.g. the values increased as the height increased. The difference of the airway resistance (R(5)-R(20)) was negatively correlated with the children's height: R(5)-R(20) (male) = 0.601 - 0.0034 x height, r = -0.677, P < 0.001; R(5)-R(20) (female) = 0.549 - 0.0031 x height, r = -0.658, P < 0.001. Among the relationships with many impulse oscillometry parameters, height ranked at first place; age at second. The multiple regression equation of IOS primary index was established. Both the measured data and the correlation coefficient of the study obtained equation were greater than the coefficient correlation of the Lechtenboerger equation, but had no significant difference compared with that of prediction equation in Guangzhou area. CONCLUSION: The normal value in impulse oscillometry in children in Chengdu area is different from the predicted parameters in other countries. The equation obtained from this study seems to be more suitable for the children in its local area. It is recommended to apply the predicted value from the corresponding population in the determination of the lung function by impulse oscillometry.