BackgroundLow serum T3 level is considered as a strong predictor of mortalities and poor prognosis in critical care patients. Few reports, however, focus on neurocritical patients. The application of hormone replacement therapy (HRT) in neurocritical patients with low T3 syndrome also remains controversial.We studied the role of low T3 state as a predictor in neurocritical patients and presented our experience of HRT from a single-center perspective. MethodsFrom January 2012 to October 2018, a total of 32 neurocritical patients with low T3 syndrome were admitted to the neuro-intensive care unit (NICU) of Peking Union Medical College Hospital. Among them, 18 (56.25%) patients received HRT (HRT group) since the diagnosis of low T3 syndrome, while the other 14 (43.75%) patients did not (non-HRT group). We collected the clinical baseline and laboratory data of all the patients and conducted follow-up from 3 to 72 months. Overall survival was assessed by the Kaplan-Meier curve and compared by the log-rank test. Univariate and multivariate

Normal-pressure hydrocephalus is a clinical syndrome that mainly targets the elderly population. It features dementia, impaired walking, and the malfunction of sphincters. The rapid identification and large-scale screening of patients with normal-pressure hydrocephalus (NPH) are of great significance as surgical interventions can greatly improve or even reverse the symptoms. This review aims to summarize the traditional parameters used to diagnose NPH and the emerging progression in neuroimaging of the disease, hoping to provide an up-to-date overall perspective and summarize the possible direction of its future development.

ObjectiveThe purpose of this study was to verify that hypothalamus-pituitary dysfunction is one of the risk factors for postoperative central nervous system infections (PCNSIs).MethodWe performed a retrospective analysis of all patients with sellar region lesions who underwent surgery between January 2016 and November 2019 at Peking Union Medical College Hospital. In total, 44 age− and sex-matched controls were enrolled. Univariate and multivariate analyses were performed to identify risk factors for PCNSIs.ResultWe enrolled 88 patients, 44 of whom had PCNSIs. Surgical approach (TCS) (P<0.001), previous surgery on the same site (P=0.001), intraoperative cerebral spinal fluid (CSF) leakage (P<0.001), postoperative adrenal insufficiency (P=0.017), postoperative DI (P=0.004) and the maximum Na+ levels(<0.001) correlated significantly with PCNSIs. Multivariate analysis showed that Surgery approach (TCS)(OR: 77.588; 95%CI: 7.981-754.263; P<0.001), intraoperative CSF leakage (OR: 12.906; 95%CI: 3.499-47.602; P<0.001), postoperative DI (OR: 6.999; 95%CI:1.371-35.723; P=0.019) and postoperative adrenal insufficiency (OR: 6.115; 95%CI: 1.025-36.469; P=0.047) were independent influencing factors for PCNSIs.ConclusionTCS, intraoperative CSF leakage, postoperative DI and postoperative adrenal insufficiency are risk factors for PCNSIs in patients with sellar region tumors.

Neurocritical care (NCC) is not only generally guided by principles of general intensive care, but also directed by specific goals and methods. This review summarizes the common pulmonary diseases and pathophysiology affecting NCC patients and the progress made in strategies of respiratory support in NCC. This review highlights the possible interactions and pathways that have been revealed between neurological injuries and respiratory diseases, including the catecholamine pathway, systemic inflammatory reactions, adrenergic hypersensitivity, and dopaminergic signaling. Pulmonary complications of neurocritical patients include pneumonia, neurological pulmonary edema, and respiratory distress. Specific aspects of respiratory management include prioritizing the protection of the brain, and the goal of respiratory management is to avoid inappropriate blood gas composition levels and intracranial hypertension. Compared with the traditional mode of protective mechanical ventilation with low tidal volume (Vt), high positive end-expiratory pressure (PEEP), and recruitment maneuvers, low PEEP might yield a potential benefit in closing and protecting the lung tissue. Multimodal neuromonitoring can ensure the safety of respiratory maneuvers in clinical and scientific practice. Future studies are required to develop guidelines for respiratory management in NCC.

Background Intestinal pseudo-obstruction (IPO) accompanied by hepatobiliary dilatation and ureterohydronephrosis is extremely rare in systemic lupus erythematosus (SLE). This triad is also called visceral muscle dysmotility syndrome (VMDS). Only 9 cases have been reported in the literature. Here, we report a rare case of VMDS with mechanical intestinal obstruction that was clinically relieved by surgery. Case presentation This report refers to a 31-year-old woman with SLE and gastrointestinal symptoms presented as abdominal pain, nausea and stoppage of the passage of flatus or stool without obvious reasons. The patient suffered from severe abdominal distension because of massive flatulence. Contrast-enhanced computed tomography (CT) of the abdomen performed in our hospital showed localized stenosis of the bowel, ureterohydronephrosis, and biliary tract dilatation. Endoscopy showed a stenotic segment located in the sigmoid colon. The colon biopsy samples suggested that the stenosis was caused by inflammatory tissues. Biochemical investigations showed hypoalbuminemia, electrolyte disturbance and decreased C3. Antinuclear antibody was positive. After careful assessment, transverse colostomy was performed for this patient. Gastrointestinal symptoms were clinically relieved after the surgery. Conclusion To the best of our knowledge, no VMDS patients have presented with mechanical ileus before. This case is the first documented occurrence of SLE with VMDS and mechanical intestinal obstruction symptoms relieved by surgery. Due to the low incidence of this condition, no standard treatment regimen has been established. However, surgical treatment offers significant benefit in specific situations.

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Background Low serum T3 level is considered as a strong predictor of mortalities and poor prognosis in critical care patients. Few reports, however, focus on neurocritical patients. The application of hormone replacement therapy (HRT) in neurocritical patients with low T3 syndrome also remains controversial. We studied the role of low T3 state as a predictor in neurocritical patients and presented our experience of HRT from a single-center perspective.Methods From January 2012 to October 2018, a total of 32 neurocritical patients with low T3 syndrome were admitted to the neuro-intensive care unit (NICU) of Peking Union Medical College Hospital. Among them, 18 (56.25%) patients received HRT (HRT group) since the diagnosis of low T3 syndrome, while the other 14 (43.75%) patients did not (non-HRT group). We collected the clinical baseline and laboratory data of all the patients and conducted follow-up from 3 to 72 months. Overall survival was assessed by the Kaplan-Meier curve and compared by the log-rank test. Univariate and multivariate regression analysis was applied to estimate the prognostic power of HRT for mortality. We also performed the Mann-Whitney U test or t-test to assess the influence of HRT on the final neurological function.Results The cohort consists of 32 patients, with an average Glasgow Coma Scale (GCS) of 6.41 (HRT=6.44±3.14, non-HRT=6.36±2.06). The neurocritical events include postoperative complications (n=18), traumatic brain injury (n=8), and spontaneous intracerebral hemorrhage (n=6). A total of 15 (46.87%) deaths were recorded (HRT=7, non-HRT=8). In the HRT group, the low T3 situation in 5 patients (33.3%) was corrected and 10 (66.7%) were not. It turns out that the overall survival rate of the non-HRT group was significantly lower than that of the HRT group (P=0.034, 16.445 vs. 47.470 months). The non-HRT group has 3.322 times the mortality risk of the HRT group, according to univariate regression analysis, while the multivariate regression analysis showed no significant difference in mortality risk between the two groups (P=0.087, HR=0.340 95%CI 0.099-1.172). There was no significant difference in the short and long-term effects of HRT on neurological function (short-term GCS P=0.587, long-term GCS P=0.419, long-term GOS P=0.419).Conclusion Low T3 syndrome can significantly influence the prognosis of neurocritical patients. Therefore much attention should be paid to the changes in serum T3 level during treatment. Although it is unclear to what extent can HRT improve the short or long-term outcome of neurological function, it can significantly benefit the survival of neurocritical patients.

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