Stage 1 acute kidney injury is independently associated with infection following cardiac surgery

ObjectivesSevere acute kidney injury (AKI) is a known risk factor for infection and mortality. However, whether stage 1 AKI is a risk factor for infection has not been evaluated in adults. We hypothesized that stage 1 AKI following cardiac surgery would independently associate with infection and mortality.MethodsIn this retrospective propensity score–matched study, we evaluated 1620 adult patients who underwent nonemergent cardiac surgery at the University of Colorado Hospital from 2011 to 2017. Patients who developed stage 1 AKI by Kidney Disease Improving Global Outcomes creatinine criteria within 72 hours of surgery were matched to patients who did not develop AKI. The primary outcome was an infection, defined as a new surgical-site infection, positive blood or urine culture, or development of pneumonia. Secondary outcomes included in-hospital mortality, stroke, and intensive care unit (ICU) and hospital length of stay (LOS).ResultsStage 1 AKI occurred in 293 patients (18.3%). Infection occurred in 20.9% of patients with stage 1 AKI compared with 8.1% in the no-AKI group (P < .001). In propensity-score matched analysis, stage 1 AKI independently associated with increased infection (odds ratio [OR]; 2.24, 95% confidence interval [CI], 1.37-3.17), ICU LOS (OR, 2.38; 95% CI, 1.71–3.31), and hospital LOS (OR, 1.30; 95% CI, 1.17-1.45).ConclusionsStage 1 AKI is independently associated with postoperative infection, ICU LOS, and hospital LOS. Treatment strategies focused on prevention, early recognition, and optimal medical management of AKI may decrease significant postoperative morbidity.     

A 4‐year follow‐up case of extrusive luxation in a patient with cerebral palsy

Cerebral palsy (CP) is a condition caused by brain damage before, during, or shortly after birth. Communication can be a challenge when treating patients with CP. Some patients can communicate verbally, while others use augmentative alternative communication tools or have individualized means of communication. Therefore, professional dental treatment in individuals with CP is challenging, especially if the patient is affected by dental trauma and requires emergency treatment. This report shows how individualized communication skills assessment allowed us to successfully manage a 9‐year‐old patient with CP, who suffered extrusive luxation of the permanent lower incisor. In the present case, the teeth were repositioned briefly after the trauma had occurred and then stabilized with a flexible splint according to international guidelines. The teeth remained vital and periodontal repair was observed during the 4‐year follow‐up.     

脱细胞基质面神经修复材料的制备

目的 制备具有天然神经组织结构的支架,构建组织工程化面神经用于修复面神经损伤。方法 取家兔面神经,改良化学萃取法制备脱细胞神经基质,HE染色形态学观察去细胞及脱髓鞘情况,荧光分光光度计测定支架内细胞经Quant-iT PicoGreen工作液染色后的DNA含量。MTT法检测细胞在支架上的相对生长率从而检测支架的细胞毒性。结果 支架移植体呈圆柱形,弹性与正常神经基本一致,组织观察显示细胞结构未见残余完整细胞及细胞碎片残留,未见神经髓鞘及轴突结构,细胞外基质形成纵向排列结构,结构之间可见空隙。兔脱细胞面神经基质支架内残留的DNA含量较正常兔面神经明显下降(P<0.01)。神经基质供体无细胞毒性。结论 改良化学萃取法可有效去除面神经细胞,天然结构保存完好,细胞毒性低,可作为组织工程化面神经的支架。     

不同TGF-β表达量的hAMSCs尾静脉移植对异种周围神经移植小鼠坐骨神经功能的影响

目的探讨不同转化生长因子-β(TGF-β)表达量的人羊膜间充质干细胞(hAMSCs)尾静脉移植对异种周围神经移植小鼠坐骨神经功能的恢复作用。方法从健康剖宫产产妇志愿捐献的新鲜羊膜中分离出hAMSCs,并进行纯化及鉴定。构建上调和下调TGF-β表达的慢病毒质粒,并转染纯化的hAMSCs,构建出稳定的上调或下调TGF-β表达的hAMSCs。分离并剪去C57BL/6小鼠的部分坐骨神经,将SD大鼠的坐骨神经分离剪取并移植至小鼠的坐骨神经缺损处,构建出异种周围神经移植小鼠模型。将模型小鼠按随机数字表分为对照组、未修饰的hAMSCs治疗组、高表达TGF-β的hAMSCs治疗组、低表达TGF-β的hAMSCs治疗组,每组10只。各组于造模前1 d分别经尾静脉注射磷酸盐缓冲液或相应的hAMSCs重悬液进行移植治疗。于治疗后第14天时采用DigGait步态分析系统评估各组小鼠的坐骨神经功能恢复情况。结果治疗后第14天时,高表达TGF-β的hAMSCs治疗组小鼠的坐骨神经功能指数(-25.820±0.286)明显高于低表达TGF-β的hAMSCs治疗组(-33.413±0.920)和未修饰的hAMSCs治疗组(-30.755±0.421),差异均有统计学意义(P<0.05)。结论高表达TGF-β的hAMSCs尾静脉移植能够更有效地改善异种周围神经移植小鼠的坐骨神经功能,其可能成为周围神经损伤治疗的新突破口。     

Diagnostic sensitivity of electrophysiology and ultrasonography in ulnar neuropathies of different severity

ObjectiveTo assess the diagnostic performance of electrophysiology and nerve ultrasound in ulnar neuropathies of varying clinical severity in 135 consecutive patients.MethodsClinical severity of ulnar neuropathy was graded on a 4 point scale from very mild (symptoms only) to severe (marked atrophy of intrinsic hand muscles). Sensitivity and localization ability of electrophysiology and nerve ultrasound were assessed for each point of the scale.ResultsUltrasound had higher sensitivity than electrophysiology in clinically very mild (20% and 3% for ultrasound and electrophysiology, respectively) and mild (62% and 47% for ultrasound and electrophysiology, respectively) neuropathies, had greater localizing ability in axonal ulnar neuropathies, and identified nerve hypermobility.Ultrasound nerve cross-sectional area had strong positive correlation with both clinical and electrophysiological severity scores, but with significant overlap across the severity groups.ConclusionThe diagnostic work-up of ulnar neuropathies was improved by using both electrophysiology and ultrasound at all levels of clinical severity. Ultrasound increased the diagnostic yield in very mild and mild neuropathies, localized all the ulnar neuropathies with abnormal non-localizing electrophysiology and identified nerve hypermobility.SignificanceThis is the first detailed analysis of the diagnostic performance of electrophysiology and ultrasound in ulnar neuropathies of varying severity.     

Utility of INR For Prediction of Delayed Intracranial Hemorrhage Among Warfarin Users with Head Injury

BackgroundIncidence of delayed intracranial hemorrhage (DICH) in patients on warfarin has been controversial. No previous literature has reported the utility of international normalized ratio (INR) in predicting traumatic DICH.ObjectivesUtilizing INR to risk stratify head trauma patients who may be managed without repeat imaging.MethodsThis was a retrospective study at a Level II trauma center. All patients on warfarin with head injuries from March 2014 to December 31, 2017 were included. Each patient underwent an initial head computed tomography scan (HCT) and subsequent repeat HCT 12 h after. Patients presenting > 12 h after head injury received only one HCT. Two blinded neuroradiologists reviewed each case of DICH. Statistical analysis evaluated Glasgow Coma Scale (GCS), Injury Severity Score (ISS), heart rate, systolic blood pressure (SBP), age, and platelet count.ResultsThere were 395 patients who qualified for the protocol; 238 were female. Average age was 79 years. Seventy-seven percent of patients underwent repeat HCT. Five resulted in DICH (INR 2.6–3.0), three of which might have been present on initial HCT; incidence rate of 0.51–1.27%. One patient required neurosurgical intervention. Among 80 patients with INR < 2, no DICH was identified, resulting in high sensitivity, but with a wide confidence interval; sensitivity of 100% (95% confidence interval [CI] 47.8–100), specificity 21% (95% CI 16.6–28.9). Correlation of factors: ISS (p = 0.039), GCS (p = 0.978), HR (p = 0.601), SBP (p = 0.198), age (p = 0.014), and platelets (p = 0.281).ConclusionNo patient with INR < 2 suffered DICH, suggesting that warfarin users presenting with INR < 2 may be managed without repeat HCT. For INR > 2, patients age and injury severity can be used for shared decision-making to discharge home with standard head injury precautions and no repeat HCT.