Elevated lactate dehydrogenase predicts poor prognosis of acute ischemic stroke

Background

Lactate dehydrogenase (LDH) is associated with the prognosis of many diseases, but the relationship between LDH and the poor prognosis (recurrence and death) of acute ischemic stroke (AIS) has not been fully clarified. This study aimed to investigate the association between admission LDH level and poor prognosis in patients with AIS.

Methods

This retrospective study enrolled AIS patients treated in Taizhou Hospital of Zhejiang Province from July 2019 to December 2019. Poor prognosis included AIS recurrence and all-cause death at 3, 6, and 18 months. The correction between LDH and poor prognosis or all-cause death was assessed. Lasso Cox expression and multivariate Cox expression analyses were used to evaluate the association of LDH with the risk of poor prognosis and all-cause death, respectively. A nomogram was constructed to evaluate the predictive Values of LDH for the poor prognosis and all-cause death of AIS.

Results

732 patients were included in the study. Multivariate analysis shows that admission LDH levels were significantly correlated with poor prognosis [odds ratio (OR),1.003; 95% confidence interval (95% CI), 1.001–1.005; P = 0.001] and all-cause death (OR, 1.005; 95% CI, 1.000–1.009; P = 0.031). The correlation analysis showed that admission LDH level was positively correlated with National Institutes of Health Stroke Scale (NIHSS) score and modified Rankin Scale (mRS) score. Time-dependent receiver operating characteristic (td-ROC) curves analysis showed that the AUC values of admission LDH level for predicting prognosis of AIS patients in 3-month, 6-month, 12-month and 18-month were 0.706 (95% CI, 0.604–0.810), 0.653 (95% CI, 0.583–0.723), 0.616 (95% CI, 0.556–60676) and 0.610 (95% CI, 0.552–0.680), respectively. And td-ROC also showed that the AUC values of admission LDH level for predicting all-cause death of AIS patients in 3-month, 6-month,12-month and 18-month were 0.861 (95% CI, 0.764–0.958), 0.824 (95% CI, 0.753–0.890), 0.726 (95% CI, 0.633–0.819) and 0.715 (95% CI, 0.622–0.807), respectively. The nomograms were constructed to create the predictive models of the poor prognosis and all-cause death of AIS.

Conclusion

Higher LDH levels are independently associated with poor prognosis and all-cause death of AIS.

Comparative evaluation of epidural bupivacaine alone and bupivacaine combined with magnesium sulfate in providing postoperative analgesia: a meta-analysis of randomized controlled trials

Background

The comparative efficacy of epidural bupivacaine alone and bupivacaine combined with magnesium sulfate in providing postoperative analgesia remains controversial.

Methods

We searched Mediline (OvidSP), EMBASE (OvidSP) and Cochrane Central Register of Controlled Trials (CENTRAL) to identify trials that compared epidural bupivacaine and magnesium sulfate combination (intervention) with bupivacaine alone (control). Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework was used to assess the quality of evidence.

Results

Eleven studies fulfilled our inclusion criteria after screening. We found that epidural bupivacaine combined with magnesium sulfate could prolong the time for first rescue analgesics (SMD 4.96; 95% CI [2.75, 7.17], P < 0.00001, I² = 98%), reduce the number of patients who need rescue analgesics (RR 0.38; 95% CI [0.20, 0.74], P = 0.004, I² = 75%) and requirement for rescue analgesics (SMD -2.65; 95% CI [− 4.23, − 1.06], P = 0.001, I² = 96%).

Conclusions

Magnesium suifate as an adjuvant of epidural bupivacaine improved postoperative analgesia. However, we rated the quality of evidence to be very low because of high heterogeneity, imprecise of results and small sample sizes. Furthermore, further large high-quality trials are still needed to confirm the effects of magnesium sulfate on postoperative analgesia.

Effects of dexamethasone on post-operative cognitive dysfunction and delirium in adults following general anaesthesia: a meta-analysis of randomised controlled trials

Background

Several studies have investigated the effects of dexamethasone on post-operative cognitive dysfunction (POCD) or post-operative delirium (POD); however, their conclusions have been inconsistent. Thus, we conducted a meta-analysis to determine the effects of dexamethasone on POCD and POD in adults following general anaesthesia.

Methods

The Cochrane Central Register of Controlled Trials (2018, Issue 11 of 12) in the Cochrane Library (searched 17 November 2018), MEDLINE OvidSP (1946 to 16 November 2018) and Embase OvidSP (1974 to 16 November 2018) were searched for randomised controlled trials that evaluated the incidence of POCD and POD following dexamethasone administration in adults (age ≥ 18 years) under general anaesthesia. We used the Grading of Recommendations, Assessment, Development and Evaluations framework to assess the quality of the evidence.

Results

Five studies were included (three studies with 855 participants in the dexamethasone group and 538 participants in the placebo group for the incidence of POCD, and two studies with 410 participants in the dexamethasone group and 420 participants in the placebo group for the incidence of POD). There was no significant difference between the dexamethasone group and the placebo group in terms of the incidence of POCD 30 days after surgery (RR [relative risk] 1.00; 95% CI [confidence interval: 0.51, 1.96], P = 1.00, I² = 77%) or the incidence of POD (RR 0.96; 95% CI [0.68, 1.35], P = 0.80, I² = 0%). However, both analyses had some limitations because of limited evidence and clinical heterogeneity, and we considered the quality of the evidence for the post-operative incidence of POCD and POD to be very low.

Conclusions

This meta-analysis revealed that prophylactic dexamethasone did not reduce the incidence of POCD and POD. Trials of alternative preventive strategies for POCD and POD, as well as a better understanding of the pathophysiology of those complex syndromes, are still needed to make progress in this field.

Trial registrationr

This study is registered with PROSPERO, 23 October 2018, number CRD42018114552. Available from https://www.crd.york.ac.uk/PROSPERO/#recordDetails.

Electronic supplementary material

The online version of this article (10.1186/s12871-019-0783-x) contains supplementary material, which is available to authorized users.

Concentrations of polychlorinated biphenyl congeners in cultivated oysters (Crassostrea gigas) in western Taiwan

Spatial and temporal variations of polychlorinated biphenyl (PCB) concentrations in cultivated oysters from five aquaculture areas along the western coast of Taiwan were investigated. Poor correlations between total PCB concentrations (ng/g dry weight [dw]) and physiologic parameters of oysters (shell length, width, thickness, and lipid content) were found. Total PCB concentrations ranged from 3.4 to 94 cng/g dw. The highest value was found in oysters from the Lu'ermen aquaculture area, which receives wastewater from a sodium hydroxide and pentachlorophenol factory. Furthermore, principal component analysis confirmed that the PCB congener pattern in this area was distinct from others and that two additional pollution sources might exist in the Tainan and Hsinchu areas. Oysters with PCB concentrations > 1 SD above the geometric mean were found mainly in Tainan (stations TN5 to TN9) with only one increased concentration in the Yunlin (station YL2) and Hsinchu (station HC4) aquaculture areas. Except for four confined stations, TN3 to TN6, where total PCB concentrations were higher (p = 0.028) in the warmer (May and July) than in the colder season (November and March), seasonal variation of total PCB concentrations in oysters was not significant. Geometric mean and geometric mean plus 1 SD of total PCB concentrations in this study are lower than those in South Korea and the United States (Mussel Watch).

Concentrations of chlorobenzenes, hexachlorobutadiene and heavy metals in surficial sediments of Kaohsiung coast, Taiwan

This work analyzes surface sediment samples collected from 40 stations along the Kaohsiung coast in southern Taiwan for chlorobenzenes (CBs), hexachlorobutadiene (HCBD) and heavy metals (Cu, Zn, Pb, Cd, Ni, Fe, Mn and Cr). The highest CBs concentrations are recorded in station T7-15 (about 10 km west off the outlet of Da-lin-pu ocean outfall pipe), with total di-, tri-, tetra-, penta- and hexa-chlorobenzenes concentrations of 290.5, 117.1, 64.5, 15.7 and 22.3 ng/g, respectively. The major pollution source of HCBD is most likely located in the Tso-yin ocean outfall field; while the Dah-lin-pu ocean outfall field and Kao-ping Chi estuary, located in the southern portion of Kaohsiung coast, are the major contributors of hexachlorobenzene. The concentration of CBs congeners correlate fairly well with each other, as do metals. However, concentrations of organics (CBs and HCBD) did not correlate with metals. This finding implies that the pollution characteristics of organics and heavy metals in this highly utilized coastal zone markedly differ from each other.