2022年 · 第102卷第05期

About 12% of patients with apparent preoperative cognition developed symptoms of postoperative cognitive dysfunction (POCD) after undergoing anesthesia and non-cardiac surgery, a phenomenon more pronounced in older patients over 65 years of age. Recent studies have found difficulties in determining the existence of any clear link between anesthesia and POCD, in part because of a lack of consistency in definition and diagnosis. While physiological mechanisms that affect protein deposition in the brain do exist, POCD is usually self-limiting and rarely lasts for longer periods of time. The main reason for the difficulty of clinical research in this area is usually the lack of uniform definitions and consistent testing.

Recent studies have shown that changes in RNA metabolism during stress play an important role in the pathophysiology of neurodegenerative diseases, particularly in amyotrophic lateral sclerosis, frontotemporal dementia, and Alzheimer's disease. RNA-binding proteins can control mRNA utilization during stress by forming a membraneless organelle called a stress particle. These structures are formed by a liquid-liquid phase separation process. Various biochemical pathways can regulate the formation of stress granules. The main signaling pathways that regulate stress granule formation include the mammalian rapamycin target protein (mTOR) -alpha subunit pathways of eukaryotic translation initiation factor 4F (eIF4F) and eukaryotic translation initiation factor eIF2, while the pathways that regulate stress granule dispersion and transfer are mediated by valcasein-containing proteins and autophagy. Post-translational modifications of RNA-binding proteins are also involved in the regulation of stress particles. There is evidence that stress granules are transient structures, but chronic stress associated with aging leads to chronic persistent stress granule formation that may act as a focus for disease-associated protein aggregation. Intrinsic vulnerability in cellular RNA metabolism may lead to pathological aggregation of RNA-binding proteins when stress particles persist. Therefore, the pathophysiology of neurodegenerative diseases is likely to stem from the intrinsic fragility in cellular metabolism. This process accelerates the pathological process of some neurodegenerative diseases and provides new targets for disease intervention.

Acute kidney injury (AKI) after cardiac surgery is the second most common cause of severe AKI in critically ill adult patients. AKI is also an important problem after cardiac surgery in children. Although the diagnosis and treatment of AKI have improved at present, the occurrence of AKI after cardiac surgery in children still has a high correlation with patient mortality, so early diagnosis and intervention of AKI after cardiac surgery in children are particularly important. To evaluate the utility of postoperative urinary albumin (uAlb) immediately after admission to the intensive care unit (ICU) as a diagnostic marker to predict the occurrence and severity of AKI after cardiac surgery in children, 376 pediatric patients who met the inclusion and exclusion criteria from July 2010 to July 2012 were included. Applying the diagnostic and stratification criteria for acute kidney injury in children (pRIFLE), 133 patients (35.4%) were diagnosed as non-AKI patients (normal) and 243 (64.6%) were diagnosed as AKI patients, of which 172 were at risk (R, 45.7%), 44 were at injury (I, 11.7%), and 27 were at failure (F, 7.2%). Immediate postoperative uAlb and urinary creatinine-corrected urinary albumin (uAlb/Cr) levels were higher in AKI patients than in non-AKI patients [uAlb: 13.5 (6.4-39.6) vs 6.0 (3.4-16.0) μ g/ml,P<0.001； uAlb/Cr: 325 (138-760) vs 121 (53-269) mg/gCr,P<0.001］； Furthermore, patients with heavier pRIFLE classification had higher uAlb levels regardless of whether uAlb was corrected for urinary creatinine. The results of the subject operating characteristic curve (ROC) analysis of uAlb/Cr predicting AKI occurrence after cardiac surgery in children showed that the area under the curve was 0.71 (P<0.001), the best cutoff, sensitivity, specificity, positive and negative predictive values for uAlb were: (1) uAlb: 5.1 μ g/ml, 81.9%, 46.7%, 74.1%, 58.2%; (2) uAlb/Cr: 282 mg/gCr, 56%, 77%, 81.9%, 48.4%. In summary, it is considered that the assessment of early uAlb levels after cardiac surgery in children is helpful in predicting the occurrence of postoperative AKI in patients. In the future, the origin and role of uAlb in the pathophysiology of AKI after cardiac surgery in children should be explored. In addition, since kidney function in children varies by age, it is necessary to conduct relevant studies according to age classification in a large sample size study population.