Brain Multimodality Monitoring: Updated Perspectives

The challenges posed by acute brain injury (ABI) involve the management of the initial insult in addition to downstream inflammation, edema, and ischemia that can result in secondary brain injury (SBI). SBI is often subclinical, but can be detected through physiologic changes. These changes serve as a surrogate for tissue injury/cell death and are captured by parameters measured by various monitors that measure intracranial pressure (ICP), cerebral blood flow (CBF), brain tissue oxygenation (PbtO₂), cerebral metabolism, and electrocortical activity. In the ideal setting, multimodality monitoring (MMM) integrates these neurological monitoring parameters with traditional hemodynamic monitoring and the physical exam, presenting the information needed to clinicians who can intervene before irreversible damage occurs. There are now consensus guidelines on the utilization of MMM, and there continue to be new advances and questions regarding its use. In this review, we examine these recommendations, recent evidence for MMM, and future directions for MMM.     

The Efficacy of Lymph Node Embolization Using N-Butyl Cyanoacrylate Compared to Ethanol Sclerotherapy in the Management of Symptomatic Lymphorrhea after Pelvic Surgery

Purpose

To compare the efficacy of lymph node (LN) embolization using N-butyl cyanoacrylate versus ethanol sclerotherapy in the management of symptomatic postoperative pelvic lymphorrhea.

Femoral Stem Survivorship in Dorr Type A Femurs After Total Hip Arthroplasty Using a Cementless Tapered Wedge Stem: A Matched Comparative Study With Type B Femurs

Background

There is a lack of understanding on relationship between the femoral geometry and outcomes of total hip arthroplasty (THA). We investigated clinical and radiographic outcomes of THA using a cementless tapered wedge stem in patients with Dorr type A proximal femoral morphology and compared with those of type B femurs at a minimum follow-up of 5 years.

Association Between Parental Marital Status and Types of Suicidal Behavior Among Korean Adolescents: A Cross-sectional Study

ObjectivesAdolescent suicide is a global problem. This study aimed to identify associations between parental marital status and suicidal behavior.MethodsThis study analyzed 118 715 middle and high school students from the 13th and 14th Korea Youth Risk Behavior Web-based Survey. The odds ratios (ORs) of suicidal ideation, planning, and attempts were calculated based on parental marital status, living situation, and socioeconomic factors. The data were analyzed using multiple logistic regression.ResultsWhen compared to those living with 2 married biological parents, the ORs of suicidal ideation among adolescents living with either remarried or no parents were 1.34 (95% confidence interval [CI], 1.17 to 1.53) and 1.36 (95% CI, 1.11 to 1.66), respectively. For suicidal planning, the OR of those living with 1 remarried biological parent was 1.24 (95% CI, 1.01 to 1.52), and that of those living without parents was 1.28 (95% CI, 0.95 to 1.73), when compared to adolescents living with 2 married biological parents. For suicide attempts, when compared to adolescents with 2 married biological parents, the OR of those living with 1 remarried biological parent was 1.48 (95% CI, 1.17 to 1.87) and that of those living without parents was 2.02 (95% CI, 1.44 to 2.83). For adolescents living with 1 remarried biological parent, suicidal behavior was strongly associated with having no siblings and were weakly associated with not living with grandparents.ConclusionsSuicidal behavior among adolescents was associated with the remarriage and loss of parents. Therefore, special attention and interventions are needed for adolescents in those situations.     

Inflammatory Effects of Edwardsiella ictaluri Lipopolysaccharide Modifications in Catfish Gut

Bacterial lipopolysaccharides (LPS) are structural components of the outer membranes of Gram-negative bacteria and also are potent inducers of inflammation in mammals. Higher vertebrates are extremely sensitive to LPS, but lower vertebrates, like fish, are resistant to their systemic toxic effects. However, the effects of LPS on the fish intestinal mucosa remain unknown. Edwardsiella ictaluri is a primitive member of the Enterobacteriaceae family that causes enteric septicemia in channel catfish (Ictalurus punctatus). E. ictaluri infects and colonizes deep lymphoid tissues upon oral or immersion infection. Both gut and olfactory organs are the primary sites of invasion. At the systemic level, E. ictaluri pathogenesis is relatively well characterized, but our knowledge about E. ictaluri intestinal interaction is limited. Recently, we observed that E. ictaluri oligo-polysaccharide (O-PS) LPS mutants have differential effects on the intestinal epithelia of orally inoculated catfish. Here we evaluate the effects of E. ictaluri O-PS LPS mutants by using a novel catfish intestinal loop model and compare it to the rabbit ileal loop model inoculated with Salmonella enterica serovar Typhimurium LPS. We found evident differences in rabbit ileal loop and catfish ileal loop responses to E. ictaluri and S. Typhimurium LPS. We determined that catfish respond to E. ictaluri LPS but not to S. Typhimurium LPS. We also determined that E. ictaluri inhibits cytokine production and induces disruption of the intestinal fish epithelia in an O-PS-dependent fashion. The E. ictaluri wild type and ΔwibT LPS mutant caused intestinal tissue damage and inhibited proinflammatory cytokine synthesis, in contrast to E. ictaluri Δgne and Δugd LPS mutants. We concluded that the E. ictaluri O-PS subunits play a major role during pathogenesis, since they influence the recognition of the LPS by the intestinal mucosal immune system of the catfish. The LPS structure of E. ictaluri mutants is needed to understand the mechanism of interaction.