The prognostic value of elevated neutrophil–lymphocyte ratio for cardiac surgery-associated acute kidney injury: A systematic review and meta-analysis

Background

Patients undergoing cardiac surgery are at significant risk of developing postoperative acute kidney injury (AKI). Neutrophil–lymphocyte ratio (NLR) is a widely available inflammatory biomarker which may be of prognostic value in this setting.

Methods

We conducted a systematic review and meta-analysis of studies reporting associations between perioperative NLR with postoperative AKI. We searched Medline, Embase and the Cochrane Library, without language restriction, from inception to May 2022 for relevant studies. We meta-analysed the reported odds ratios (ORs) with 95% confidence intervals (CIs) for both elevated preoperative and postoperative NLR with risk of postoperative AKI and need for renal replacement therapy (RRT). We conducted a meta-regression to explore inter-study statistical heterogeneity.

Results

Twelve studies involving 10,724 participants undergoing cardiac surgery were included, with eight studies being deemed at high risk of bias using PROBAST modelling. We found statistically significant associations between elevated preoperative NLR and postoperative AKI (OR 1.45, 95% CI 1.18–1.77), as well as postoperative need for RRT (OR 2.37, 95% CI 1.50–3.72). Postoperative NLR measurements were not of prognostic significance.

Conclusions

Elevated preoperative NLR is a reliable inflammatory biomarker for predicting AKI following cardiac surgery.     

Effect of Solanum trilobatum on hepatic drug metabolising enzymes during diethylnitrosamine-induced hepatocarcinogenesis promoted by Phenobarbital in rat

The present study was aimed to investigate the chemopreventive effects of Solanum trilobatum (ST) extract against diethylnitrosamine (DEN)-induced hepatocarcinogenesis promoted by Phenobarbital (PB) in Wistar rats. Hepatocarcinogenesis was initiated by a single intraperitoneal injection of DEN (200 mg/kg b.w.) and promoted with PB (0.05%) in basal diet. The experimental study extended for periods of 13 and 26 weeks. Alcoholic extract of ST was orally administered for the entire experimental period after initiation along with commencement of promotion. The chemopreventive effect of ST was assessed from the incidence of nodules, drug metabolizing phase I components such as contents of cytochrome P450, cytochrome b(5), activities of NADPH cytochrome c reductase, NADH - cytochrome b(5) reductase and phase II components such as levels of glutathione, activities of UDP-glucuronyl transferase, glutathione S-transferase and gamma-glutamyl transpeptidase in the liver. Lipid peroxidation at basal and prooxidants-induced (NADPH + ADP + Fe and Ascorbate + Fe) states was assessed in the microsomes. Animals administered with ST extract evidenced significant inhibition of tumor nodular incidence in DEN + PB + ST animals compared to DEN + PB animals, with favorable alterations in the hepatic drug-metabolizing phase I and phase II components. Administration of ST inhibited basal and pro-oxidant-induced lipid peroxidation. The present result suggests the probable mediation of chemoprevention by ST against DEN-induced carcinogenesis by the modulation of drug metabolizing components in the liver of treated animals.     

Volume-rendered helical computerized tomography angiography in the detection and characterization of intracranial aneurysms

OBJECT: The goal of this study was to evaluate the utility of volume-rendered helical computerized tomography (CT) angiography in patients with intracranial aneurysms. The authors compared the abilities of CT angiography, digital subtraction (DS) angiography, and three-dimensional time-of-flight magnetic resonance (MR) angiography to characterize aneurysms. METHODS: Helical CT angiography was performed in 45 patients with suspected intracranial aneurysms by using volume-rendered multiplanar reformatted (MPR) images. Digital subtraction angiography was performed using biplane angiography. These studies and those performed using MR angiography were interpreted in a blinded manner. Two neurosurgeons and two interventional neuroradiologists independently graded the utility of CT angiography with respect to aneurysm characterization. Fifty-five aneurysms were detected. Of these, 48 were evaluated for treatment. Computerized tomography angiography was judged to be superior to both DS and MR angiography in the evaluation of the arterial branching pattern at the aneurysm neck (compared with DS angiography, p = 0.001, and with MR angiography, p = 0.007), aneurysm neck geometry (compared with DS angiography, p = 0.001, and with MR angiography, p = 0.001), arterial branch incorporation (compared with DS angiography, p = 0.021, and with MR angiography, p = 0.001), mural thrombus (compared with DS angiography, p < 0.001), and mural calcification (compared with DS angiography, p < 0.001, and with MR angiography, p < 0.001). For surgical cases, CT angiography had a significant impact on treatment path (p = 0.001), operative approach (p = 0.001), and preoperative clip selection (p < 0.001). For endovascular cases, CT angiography had an impact on treatment path (p < 0.02), DS angiography study time (p = 0.01), contrast agent usage (p = 0.01), and coil selection (p = 0.02). Computerized tomography angiography provided unique information about 39 (81%) of 48 aneurysms, especially when compared with DS angiography (p = 0.003). The sensitivity and specificity of CT angiography compared with DS angiography was 1. The sensitivity and specificity of CT and DS angiography studies compared with operative findings were 0.98 and 1, respectively. CONCLUSIONS: Computerized tomography angiography is equal to DS angiography in the detection and superior to DS angiography and MR angiography in the characterization of brain aneurysms. Information contained in volume-rendered CT angiography images had a significant impact on case management.     

Evaluation of MindMatters Buddy Support to Secondary Schools in South West Sydney

This study assessed the outcomes of a buddy support scheme designed to increase the capacity of secondary schools to adopt a whole school approach to improving the well-being of students and to enhance uptake of MindMatters. The scheme supported schools implementing MindMatters, forming partnerships, and creating links with health services, organisations and community groups. The results showed that intervention schools were significantly more likely to ensure internal support by assigning a person responsible for MindMatters (90% vs 38%), forming a core team (79% vs 21%), reporting changes (94% vs 26%) and connectedness (100% vs 21%) and continuing MindMatters implementation (90% vs 33%) than non-intervention schools. They also reported positive outcomes in student and community participation, policy development and implementation. The results indicated the usefulness of the scheme and a plausible contribution to a greater level of sustainable changes than standard delivery of MindMatters. To assess the impact, further investigation with a larger sample is needed.     

Real-Time Monitoring of High-Intensity Focused Ultrasound Thermal Therapy Using the Manifold Learning Method

High-intensity focused ultrasound (HIFU) induces thermal lesions by increasing the tissue temperature in a tight focal region. The main ultrasound imaging techniques currently used to monitor HIFU treatment are standard pulse-echo B-mode ultrasound imaging, ultrasound temperature estimation and elastography-based methods. The present study was carried out on ex vivo animal tissue samples, in which backscattered radiofrequency (RF) signals were acquired in real time at time instances before, during and after HIFU treatment. The manifold learning algorithm, a non-linear dimensionality reduction method, was applied to RF signals which construct B-mode images to detect the HIFU-induced changes among the image frames obtained during HIFU treatment. In this approach, the embedded non-linear information in the region of interest of sequential images is represented in a 2-D manifold with the Isomap algorithm, and each image is depicted as a point on the reconstructed manifold. Four distinct regions are chosen in the manifold corresponding to the four phases of HIFU treatment (before HIFU treatment, during HIFU treatment, immediately after HIFU treatment and 10-min after HIFU treatment). It was found that disorganization of the points is achieved by increasing the acoustic power, and if the thermal lesion has been formed, the regions of points related to pre- and post-HIFU significantly differ. Moreover, the manifold embedding was repeated on 2-D moving windows in RF data envelopes related to pre- and post-HIFU exposure data frames. It was concluded that if mean values of the points related to pre- and post-exposure frames in the reconstructed manifold are estimated, and if the Euclidean distance between these two mean values is calculated and the sliding window is moved and this procedure is repeated for the whole image, a new image based on the Euclidean distance can be formed in which the HIFU thermal lesion is detectable.     

Conformational dynamics of superoxide dismutase (SOD1) in osmolytes: a molecular dynamics simulation study

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease caused by the misfolding of Cu, Zn superoxide dismutase (SOD1). Several earlier studies have shown that monomeric apo SOD1 undergoes significant local unfolding dynamics and is the predecessor for aggregation. Here, we have employed atomistic molecular dynamics (MD) simulations to study the structure and dynamics of monomeric apo and holo SOD1 in water, aqueous urea and aqueous urea–TMAO (trimethylamine oxide) solutions. Loop IV (zinc-binding loop) and loop VII (electrostatic loop) of holo SOD1 are considered as functionally important loops as they are responsible for the structural stability of holo SOD1. We found larger local unfolding of loop IV and VII of apo SOD1 as compared to holo SOD1 in water. Urea induced more unfolding in holo SOD1 than apo SOD1, whereas the stabilization of both the form of SOD1 was observed in ternary solution (i.e. water/urea/TMAO solution) but the extent of stabilization was higher in holo SOD1 than apo SOD1. The partially unfolded structures of apo SOD1 in water, urea and holo SOD1 in urea were identified by the exposure of the hydrophobic cores, which are highly dynamic and these may be the initial events of aggregation in SOD1. Our simulation studies support the formation of aggregates by means of the local unfolding of monomeric apo SOD1 as compared to holo SOD1 in water.

Change in conformations of apo and holo SOD1 in water and in osmolytes in terms of configurational entropy (S).     

Localization and DNA sequence analysis of the transforming domain (mtrII) of human cytomegalovirus.

To define the morphological transforming region II (mtrII) of human cytomegalovirus (HCMV), a series of subclones of the Xba I/BamHI fragment EM was constructed in vitro and tested for focus-forming activity and tumorigenicity. A 980-base-pair subclone of fragment EM was identified, and its nucleotide sequence revealed three small open reading frames (ORFs), encoding 79, 83, and 34 amino acid residues. S1 nuclease analysis of HCMV-infected cells identified several distinct early RNA species within mtrII, two of which (P1 and P2) were of particular interest, since the length of the protected DNA fragments would position the 5' end of the RNAs upstream of the open reading frames. In addition, the 980-base-pair transforming sequence revealed DNA elements capable of forming stem-loop structures. Thus the transforming mtrII domain of HCMV strain Towne contains both small open reading frames that are expressed in lytically infected cells and sequences resembling insertion-like structures that may be involved in transformation.