Dynamics of neutrophil-to-lymphocyte ratio can be associated with clinical outcomes of children with moderate to severe traumatic brain injury: A retrospective observational study

BACKGROUND

The neutrophil to lymphocyte ratio (NLR) has been reported to be associated with clinical outcomes of patients with severe traumatic brain injury (TBI). This study aimed to evaluate the correlation between the dynamics of NLR and clinical outcomes of pediatric patients with moderate to severe TBI.

METHODS

We retrospectively evaluated the clinical data of a total of 374 pediatric patients with moder-ate to severe TBI who were treated in our department between May 2016 and May 2020. Clinical and laboratory data including the NLR upon admission and the NLR on hospital day four were collected. Poor clinical outcome was defined as Glasgow Outcome Scale (GOS) of 1-3. Multivariable logistic regression analyses were performed to investigate the correlation between the dynamics of NLR and clinical outcome.

RESULTS

Three hundred seventy-four pediatric patients (mean age 7.37 ± 3.11, 52.7% male) were evaluated. Based on the ROC curves, a value of 5 was determined as the NLR cut-off value. The corresponding cutoff value for delta NLR was 1. The Glasgow Coma Scale (GCS) (OR, 3.42; 95% CI: 1.88-5.28; P <0.001), the light reflex (OR, 1.79; 95% CI: 1.34- 2.84; P = 0.027), the Rotterdam CT score (OR, 2.71; 95% CI: 1.72-4.13; P = 0.021), and delta NLR (OR, 1.71; 95% CI: 1.13- 2.52; P = 0.034) were identified as independent predictors for unfavorable outcomes in multivariable logistic regression analysis.

CONCLUSIONS

The result of the present study suggest that delta NLR could be a predictor of poor clinical outcome of pediatrics with moderate to severe TBI. This cost-effective and easily available biomarker could be used to predict clinical outcomes in these patients.

Effects of phytogenic feed additives, probiotic and mannan-oligosaccharides on performance, blood metabolites, meat quality, intestinal morphology, and microbial population of Japanese quail

1. The aim of this experiment was to investigate the effects of ajwain (Trachyspermum ammi) and dill (Anethum graveolens) essential oils (AEO and DEO, respectively), probiotic (PRO) and mannan-oligosaccharides (MOS) on the growth performance, serum metabolites, meat quality, intestinal morphology and microbial populations of Japanese quail.2. A total of 375 one-day-old Japanese quail were randomly allocated into five treatment groups with five replicates of 15 birds each for a 42 d feeding experiment. The dietary treatments were a basal diet (control) or the same diet supplemented with PRO (0.15 g/kg feed), MOS (2 g/kg feed), AEO (0.25 g/kg feed) or DEO (0.25 g/kg feed).3. AEO, MOS, and PRO supplementation increased weight gain, while diets supplemented with AEO decreased feed intake (FI), and improved feed conversion ratio from d 1 to 21 (P < 0.05). The relative weight of the gizzard was higher in birds supplemented with AEO compared to control group, while the birds fed MOS diet had the longest intestine (P < 0.05). Ceca length was greater in control, MOS and PRO groups (P < 0.05). Both essential oils decreased malondialdehyde (MDA) concentration of breast meat and percentage of cooking loss in quail (P < 0.05). The villus length (VL) was greater in birds fed diet supplemented with MOS, AEO, and DEO (P < 0.05).The population of E.coli decreased in Japanese quail fed MOS, while Lactobacilli spp. count was increased in the MOS group (P < 0.05).4. In conclusion, AEO, MOS, and PRO supplementation exhibited a positive effect on growth performance, while lipid peroxidation of the meat decreased in birds fed AEO and DEO diets. The intestinal morphometric indices increased in quail fed the AEO, MOS, and DEO diets. Supplementation with MOS modulated intestinal microbial populations of the Japanese quail.

Validation of subjective rating scales for assessment of surgical workspace during laparoscopy

BACKGROUND

Recently, studies have focused on how to optimize laparoscopic surgical workspace by changes in intra-abdominal pressure, level of muscle relaxation or body position, typically evaluated by surgeons using subjective rating scales. We aimed to validate two rating scales by having surgeons assess surgical workspace in video sequences recorded during laparoscopic surgery.

METHOD

Video sequences were obtained from laparoscopic procedures. Eight experienced surgeons assessed the video sequences on a categorical 5-point scale and a numerical 10-point rating scale. Intraclass correlations coefficients (ICC) and 95% confidence intervals (CI) were calculated for intra- and inter-rater reliability.

RESULTS

The 5-point rating scale had an intra-rater ICC of 0.76 (0.69; 0.83) and an inter-rater ICC of 0.57 (0.45; 0.68), corresponding to excellent and fair reliability, respectively. The 10-point scale had an intra-rater ICC of 0.86 (0.82; 0.89) and an inter-rater ICC of 0.54 (0.39; 0.68), corresponding to excellent and fair as well. All surgeons used the full range of the 5-point scale, but only one surgeon used the full range of the 10-point scale.

CONCLUSION

In conclusion, both scales showed excellent intra-rater and fair inter-rater reliability for assessing surgical workspace in laparoscopy. The 5-point surgical rating scale had all categories employed by all surgeons.