Mei-a Hu

Analysis of Plasma Multiplex Cytokines for Children With Febrile Seizures and Severe Acute Encephalitis

We investigated the plasma cytokine profiles of children with febrile seizures or severe acute encephalitis using multiplex cytometry to evaluate the role of cytokines in these diseases. Interleukin-6, -10, -12p70, -17A, -2, -4, -5, -9, -13, -22, and -1β, interferon-γ, and tumor necrosis factor-α were measured in the plasma from children with febrile seizures (n = 9) or severe acute encephalitis (n = 21). In multivariate analysis, interleukin-6 was significantly increased in the plasma of the febrile seizure patients compared to those with severe acute encephalitis, suggesting that interleukin-6 is activated during the acute stage of a febrile seizure. A lower plasma interleukin-6 concentration was significantly associated with severe acute encephalitis. The cytokine network may be deregulated in severe acute encephalitis via the persistence of an uncontrolled inflammatory state in the brain.

Risk Factors of Respiratory Failure in Children with Guillain-Barré Syndrome

BACKGROUND Respiratory failure is rarely associated with Guillain-Barré syndrome (GBS) in children. The aim of the study was to determine the risk factors of respiratory failure in children with GBS to advance management. METHODS In this retrospective study, the variables that lead to respiratory failure were investigated in 40 children. The risk factors were compared for 4 children with intubation and 36 without. We also analyzed the specific treatments, including corticosteroids, intravenous immunoglobulin, plasmapheresis, and clinical status at discharge. RESULTS Four (10.0%) of the 40 children with GBS required mechanical ventilation. The need for mechanical ventilation was significantly related to the Hughes score at nadir (p<0.001), respiratory distress (p<0.001), and hypotension (p<0.001). Atypical presentation of symptoms such as croup, hoarseness, vomiting, ataxia, consciousness disturbance, and previous event of diarrhea were more predominant in patients younger than 6 years. Disability grades >3 at discharge were found in 15 patients (37.5%), and there was no mortality in the present case series. CONCLUSIONS Respiratory failure in childhood GBS was related to the Hughes score at nadir, respiratory distress, and hypotension. Atypical presentations of symptoms were more predominant in patients younger than 6 years. The prognosis in our series was good and not related to previous events. Understanding the risk factors of severe GBS will provide better treatment strategies and improve the outcomes.

Nitrous oxide myelopathy in a pediatric patient.

Objective Nitrous oxide myelopathy is rare in children. We report a 16-year-old girl who presented at the pediatric emergency department with progressive ascending numbness in 4 limbs for 1 week and sensory ataxia for 4 days. The patient had frequently inhaled nitrous oxide for recreation over the preceding 3 months. Her serum vitamin B12, homocysteine, and folate levels were within normal ranges. Magnetic resonance imaging of the spinal cord T2-weighted images series showed hyperintensities in the central and dorsal cervical spinal cord section over C1 to C6 and suspicious of hyperintensities in the thoracic spinal section over T7 and T8. Conclusions Myelopathy due to nitrous oxide should be considered in a differential diagnosis when adolescents develop neurologic symptoms after nitrous oxide inhalation abuse.

Bilateral passive leg raising attenuates and delays tourniquet deflation-induced hypotension and tachycardia under spinal anaesthesia: a randomised controlled trial.

BACKGROUND The pneumatic tourniquet is frequently used in total knee arthroplasty. Tourniquet deflation may result in hypotension and tachycardia caused by the rapid shift of blood volume back to the ischaemic limb and a decrease in cardiac preload. Passive leg raising (PLR) represents a ‘self-volume challenge’ that can result in an increase in preload. Such a PLR-induced increase in preload was hypothesised to attenuate the decrease in preload resulting from tourniquet deflation. OBJECTIVE To evaluate the effect of PLR on hypotension and tachycardia following tourniquet deflation. DESIGN A randomised controlled trial. SETTING Single medical centre. PATIENTS Seventy patients who underwent unilateral total knee arthroplasty were randomised into two groups: tourniquet deflation with PLR (n = 35) or without PLR (control group, n = 35). INTERVENTION(S) Patients in both groups were administered a single dose of plain bupivacaine for spinal anaesthesia. The pneumatic tourniquet was inflated on the thigh and the surgery was performed. The study composed of four steps: for the PLR group, step 1 – inflation of the tourniquet while the patient was supine; step 2 – the patients legs were raised to a 45° angle; step 3 – the tourniquet was deflated while the patients legs were still raised; and step 4 – the legs were returned to the supine position. In the control group, the same perioperative procedure was used, but PLR was not conducted. MAIN OUTCOME MEASURES The patients’ blood pressure and heart rate were measured before, during and after tourniquet deflation. RESULTS After tourniquet deflation, the magnitude of the changes in blood pressure and heart rate was less in the PLR group than that in the control group. In addition, the blood pressure nadir also occurred later in the PLR group than in the controls. CONCLUSION Bilateral PLR is a simple, reversible manoeuvre that mimics rapid fluid loading. Bilateral PLR attenuates the severity of, and delays the time to, hypotension and tachycardia following deflation of a lower limb tourniquet. TRIAL REGISTRATION ClinicalTrials.gov number NCT01592669.

Epidemiology and clinical analysis of critical patients with child maltreatment admitted to the intensive care units

Abstract Children with abuse who are admitted to the intensive care unit (ICU) may have high mortality and morbidity and commonly require critical care immediately. It is important to understand the epidemiology and clinical characteristics of these critical cases of child maltreatment. We retrospectively evaluated the data for 355 children with maltreatments admitted to the ICU between 2001 and 2015. Clinical factors were analyzed and compared between the abuse and the neglect groups, including age, gender, season of admission, identifying settings, injury severity score (ISS), etiologies, length of stay (LOS) in the ICU, clinical outcomes, and mortality. In addition, neurologic assessments were conducted with the Pediatric Cerebral Performance Category (PCPC) scale. The most common type of child maltreatments was neglect (n = 259), followed by physical abuse (n = 96). The mean age of the abuse group was less than that of the neglect group (P < .05). Infants accounted for the majority of the abuse group, and the most common etiology of abuse was injury of the central nervous system (CNS). In the neglect group, most were of the preschool age and the most common etiologies of abuse were injury of the CNS and musculoskeletal system (P < .001). The mortality rate in the ICU was 9.86%. The ISS was significantly associated with mortality in both the 2 groups (both P < .05), whereas the LOS in the ICU and injuries of the CNS, musculoskeletal system, and respiratory system were all associated with mortality in the neglect group (all P < .05). The PCPC scale showed poor prognosis in the abuse group as compared to the neglect group (P < .01). In the ICU, children in the abuse group had younger age, higher ISS, and worse neurologic outcome than those in the neglect group. The ISS was a predictor for mortality in the abuse and neglect groups but the LOS in the ICUs, injuries of the CNS, musculoskeletal system, and respiratory system were indicators for mortality in the neglect group. Most importantly, identifying the epidemiological information may provide further strategies to reduce the harm, lower the medical costs, and improve clinical care quality and outcomes in children with abuse.

Effect of External Pressure and Catheter Gauge on Flow Rate, Kinetic Energy, and Endothelial Injury During Intravenous Fluid Administration in a Rabbit Model.

ABSTRACT The effects of intravenous (IV) catheter gauge and pressurization of IV fluid (IVF) bags on fluid flow rate have been studied. However, the pressure needed to achieve a flow rate equivalent to that of a 16 gauge (G) catheter through smaller G catheters and the potential for endothelial damage from the increased kinetic energy produced by higher pressurization are unclear. Constant pressure on an IVF bag was maintained by an automatic adjustable pneumatic pressure regulator of our own design. Fluids running through 16 G, 18 G, 20 G, and 22 G catheters were assessed while using IV bag pressurization to achieve the flow rate equivalent to that of a 16 G catheter. We assessed flow rates, kinetic energy, and flow injury to rabbit inferior vena cava endothelium. By applying sufficient external constant pressure to an IVF bag, all fluids could be run through smaller (G) catheters at the flow rate in a 16 G catheter. However, the kinetic energy increased significantly as the catheter G increased. Damage to the venous endothelium was negligible or minimal/patchy cell loss. We designed a new rapid infusion system, which provides a constant pressure that compresses the fluid volume until it is free from visible residual fluid. When large-bore venous access cannot be obtained, multiple smaller catheters, external pressure, or both should be considered. However, caution should be exercised when fluid pressurized to reach a flow rate equivalent to that in a 16 G catheter is run through a smaller G catheter because of the profound increase in kinetic energy that can lead to venous endothelium injury.

Atypical involuntary movements following fentanyl anesthesia.

Postanesthetic involuntary movements are triggered by a variety of drugs, including propofol, sevoflurane, anti-emetics, and anti-psychotics. A case of acute involuntary movements in a healthy man after fentanyl exposure is presented. The movements consisted of large-amplitude motions of the upper limbs of the elbow joint for flexion and extension, and shaking of the head from side to side.

Risk Factors for Delayed Neuropsychiatric Sequelae in Carbon Monoxide Poisoning: Ten Years' Experience in a Pediatric Emergency Department

Objective: The occurrence of Delayed Neuropsychiatric Sequelae (DNS) after Carbon Monoxide (CO) poisoning is uncommon in children. Early identification of risk factors for the development of DNS in pediatric emergency departments is important. The objective of this study was to analyze risk factors for DNS after CO poisoning. Methods: We retrospectively analyzed children with CO poisoning admitted to the pediatric emergency department from 2001 to 2010. Clinical, demographic, and laboratory data were collected; chi-square and univariate analyses were performed to assess risk factors for DNS. Results: Among 68 children with CO poisoning, seven (10.3%) developed DNS. Clinical parameters such as Glasgow Coma Scales (GCS), Methemohemoglobin (MetHb), troponin-I, CPK level, myocardial injury, and neuroimaging abnormalities, were important associated risk factors for DNS. Decreased GCS level (OR = 0.701) and Methemohemoglobin (MetHb) ≥ 0.8% (OR = 19.54) are associated with DNS. Carboxyhemoglobin, and inadequate HBO therapy were not risk factor. Conclusions: Prompt treatment of CO poisoning and identify risk factor for DNS is still challenge in PED. Our data demonstrate that decreased GCS level and increased MetHb level were independent risk factors associated with DNS. Early recognition and prompt treatment is important to prevent further neurological damage.

Intramedullary spinal arteriovenous malformation in a boy of familial cerebral cavernous hemangioma

ObjectThe coexistence of spinal arteriovenous malformation (AVM) and a familial cerebral cavernous hemangioma (CCH) is extremely rare.MethodsA 9-year-old boy suddenly developed severe paraplegia and urinary dysfunction. Spinal magnetic resonance imaging (MRI) scan revealed a cervical and upper thoracic intramedullary lesion. Due to acute neurological dysfunction, the patient underwent emergency surgical exploration. An intramedullary vascular lesion was found and excised. Pathologically, AVM was noted. After the surgery, the boy was ambulatory with left lower limb stiffness. MRI scan of the brain revealed multiple cerebral cavernous hemangioma. Symptomatic multiple CCH in his mother and grandmother were also noted.ConclusionsWe concluded that the presence of spinal AVM should be suspected if the patient with familial CCH develops the signs of space-occupying lesion of the spinal cord, facilitating early diagnosis of the spinal AVM.

Association of developing childhood epilepsy subsequent to febrile seizure: A population-based cohort study

PURPOSE Epilepsy is an important neurological condition that frequently associated with neurobehavioral disorders in childhood. Our aim was to identify the risk of developing epilepsy subsequent to febrile seizure and the association between epilepsy risk factors and neurobehavioral disorders. SUBJECTS AND METHODS This longitudinal population-based cohort data included 952 patients with a febrile seizure diagnosis and 3808 age- and sex-matched controls. Participants were recruited for the study from 1996 to 2011, and all patients were followed up for maximum 12.34 years. RESULTS The association of epilepsy was significantly higher (18.76-fold) in individuals that experienced febrile seizure compared to controls. Further, of those individuals who experienced febrile seizure, the frequency of subsequent development of epilepsy was 2.15-fold greater in females, 4.846-fold greater in patients with recurrent febrile seizure, and 11.26-fold greater patients with comorbid autism. CONCLUSIONS Our study showed that being female, comorbid autism with febrile seizure and recurrent febrile seizure had an increased association with development of epilepsy. Increased recognition the association for epilepsy might be warranted in those febrile seizure children with certain characteristics.