Postoperative recovery can be impaired by many conditions, some of which are difficult to diagnose clinically. These include type 2 neurological complications such as hypoactive subtype of postoperative delirium (PD) and early postoperative cognitive dysfunction (ePOCD). Hope for their timely detection may lie with novel biomarkers. Plasma concentrations of microRNA-1-3p, microRNA-21-5p, glial fibrillary acidic protein (GFAP), neuroserpin (NSP), phosphorylated axonal neurofilament subunit H (pNfH) and visinin-like protein 1 (VILIP-1) were investigated in 30 patients undergoing elective off-pump coronary artery bypass grafting. Blood samples were collected at the start and end of a surgery as well as 24 h postoperatively. Associations between the studied biomarkers’ perioperative expression and type 2 neurological complications were analyzed. PD was associated with postoperative expression of GFAP; ePOCD was associated with postoperative expression of microRNA-21-5p and GFAP as well as intraoperative expression of NSP. The predictive accuracy of these molecules was found acceptable, with all their areas under the curve (AUC) values above 0.7. Multivariable regression indicated that microRNA-21-5p, GFAP and NSP were the only significant predictors of ePOCD. Evaluation of a multi-marker model including these three molecules revealed its outstanding predictive accuracy for ePOCD (AUC = 0.95). The use of microRNA-21-5p, GFAP and NSP for monitoring postoperative recovery warrants further research considering their potential to predict PD and ePOCD.

Background: Neonatal sepsis, a severe infection in newborns, remains one of the leading causes of morbidity and mortality among preterm infants. This study aimed to investigate the distribution of pathogens responsible for early-onset sepsis (EOS) and late-onset sepsis (LOS), the annual variability of pathogens responsible for each type of infection, and potential trends in their profiles in preterm infants from a tertiary care neonatal intensive care unit over a ten-year period. Methods: We analyzed 177 episodes of confirmed bloodstream infection between 1 January 2014 and 31 December 2023. An episode of confirmed bloodstream infection was defined by the growth of a single potential pathogen in the blood of an infant who met four criteria: showing clinical symptoms of infection, having abnormal hematologic parameters, receiving appropriate antibiotics for less than 5 days, and being born before 37 weeks of gestation. Pathogens were isolated from aseptically collected blood samples, processed within 2 h, incubated using the BACTEC system, and identified by Gram stains and selective media cultures. Pathogen identification was performed using standardized biochemical tests or MALDI-TOF MS. Sepsis was classified as EOS if it occurred within the first 72 h of life and as LOS if it occurred after 72 h. Results: Among the confirmed bloodstream infections, EOS accounted for 31 cases, while LOS accounted for 146 cases. Escherichia coli was identified as the primary pathogen responsible for early-onset sepsis (EOS), while Coagulase-negative Staphylococcus (CoNS) was most commonly associated with late-onset sepsis (LOS). The differences in the prevalence of these bacteria between EOS and LOS were statistically significant. However, no significant differences were found in the distribution of pathogens across different years, nor were there significant trends in their frequency over the study period. Our results demonstrate significant stability in the distribution of pathogens causing sepsis over the ten-year observation period, even during the COVID-19 pandemic. Conclusions: Understanding the temporal distribution of pathogens in neonatal sepsis can help prevent the overuse of antibiotics and support the implementation of screening programs, empiric therapy, and strategies to prevent healthcare-associated infections.

Introduction Neurological injuries remain a major concern following coronary artery bypass grafting (CABG) that offsets survival benefit of CABG over percutaneous coronary interventions. Among numerous efforts to combat this issue is the development of off-pump CABG (OPCABG) that obviates the need for extracorporeal circulation and is associated with improved neurological outcomes. The objective of this study is to examine whether the neuroprotective effect of OPCABG can be further pronounced by the use of two state-of-the-art operating techniques. Methods and analysis In this randomised, controlled, investigator and patient blinded single-centre superiority trial with three parallel arms, a total of 360 patients will be recruited. They will be allocated in a 1:1:1 ratio to two treatment arms and one control arm. Treatment arms undergoing either aortic no-touch OPCABG or OPCABG with partial clamp applying carbon dioxide surgical field flooding will be compared against control arm undergoing OPCABG with partial clamp. The primary endpoint will be the appearance of new lesions on control brain MRI 3 days after surgery. Secondary endpoints will include the prevalence of new focal neurological deficits in the first 7 days after surgery, the occurrence of postoperative cognitive dysfunction at either 1 week or 3 months after surgery and the incidence of delirium in the first 7 days after surgery. Data will be analysed on intention-to-treat principles and a per protocol basis. Ethics and dissemination Ethical approval has been granted for this study. Results will be disseminated through peer-reviewed media. Trial registration number NCT03074604; Pre-results. Date and version identifier 10-Mar-2017 Original