Altered Mental Status as the Primary Presentation of Intussusception in a 3-Month-Old Child Diagnosed by Point-Of-Care Ultrasonography

BackgroundIntussusception can lead to significant morbidity in affected children secondary to tissue ischemia and necrosis. When a child outside of the classic age range presents with symptoms other than intermittent abdominal pain, the diagnosis of intussusception can be difficult and is often delayed.Case ReportWe present the case of a three-month-old boy who presented to the emergency department with waxing and waning mental status and seizure-like activity who was ultimately diagnosed with intussusception. The effective use of bedside ultrasonography, by the attending pediatric radiologist, enabled an interdisciplinary team to explore abdominal etiologies in parallel with testing for more commonly seen causes of altered mental status. This led to an expedited diagnosis and successful definitive management.Why Should an Emergency Physician Be Aware of This?Intussusception is a common pediatric emergency encountered by emergency physicians where a timely diagnosis can have a profound impact on patient outcomes. Previous case reports highlight how easily intussusception can be overlooked with this atypical neurologic presentation. Furthermore, because patients with profound altered mental status are often too ill to leave the emergency department for diagnostic testing, bedside abdominal ultrasonography may be helpful in these patients.     

Inhibition of miR-495-3p ameliorated sevoflurane induced damage through BDNF/ERK/CREB signaling pathways in HT22 cells

ObjectiveSevoflurane is used in anesthesia for surgery including in organ transplantation. We investigated the role of a non-coding single-stranded microRNA, miR-495-3p, in the sevoflurane-induced neurotoxicity using a mouse hippocampal neuronal cell line (HT22).MethodsThe levels of miR-495-3p in sevoflurane-exposed mice and HT22 cells were determined via RT-qPCR. The role of miR-495-3p on cell viability and apoptosis were determined by CCK-8 and flow cytometric assay, respectively. Western blotting was explored to measure levels of Bax, Bcl-2, active caspase 3, BDNF, p-ERK/ERK and p-CREB/CREB in HT22 cells. ELISA assay was used to examine the levels of reactive oxygen species (ROS), superoxide dismutase (SOD) and glutathione peroxidase (GPX) in cells. Dual luciferase reporter assay was used to explore the interaction of miR-495-3p and BDNF.ResultsThe level of miR-495-3p was increased sevoflurane-exposed mice and in sevoflurane-treated HT22 cells. Downregulation of miR-495-3p inhibited sevoflurane-induced apoptosis and promoted cell proliferation by upregulating the proteins of Bcl-2 and downregulating the expressions of Bax and active caspase-3 in HT22 cells. In addition, inhibition of miR-495-3p alleviated sevoflurane-induced oxidative injuries in HT22 cells via decline of ROS and upregulation of SOD and GPX. MiR-495-3p can inhibit the ERK/CREB pathway by targeting BDNF.ConclusionDownregulation of miR-495-3p can decrease oxidative status in HT22 cells and alleviate sevoflurane-induced cytotoxicity through stimulating the BDNF/ERK/CREB pathway.     

Temporal bone resection for lateral skull-base malignancies

Journal of Neuro-Oncology - This study was performed to determine the maximum tolerated dose (MTD) or recommended phase 2 dose (RP2D) of the immunomodulatory agent, lenalidomide, when administered...