- The Correlation Between a Short-term Conventional Electroencephalography in the First Day of Life and Brain Magnetic Resonance Imaging in Newborns Undergoing Hypothermia for Hypoxic-Ischemic Encephalopathy. [Journal Article]
- PNPediatr Neurol 2016 Nov 03
- CONCLUSIONS: Severity of electrographic findings on encephalograph in the first day of life during therapeutic hypothermia for hypoxic-ischemic encephalopathy correlated with the extent of injury on brain magnetic resonance imaging. This information may be useful for families and aid guide clinical decision making.
- EEG Monitoring Technique Influences the Management of Hypoxic-Ischemic Seizures in Neonates Undergoing Therapeutic Hypothermia. [Journal Article]
- DNDev Neurosci 2017 Jan 17
- Electroencephalogram (EEG) monitoring techniques for neonatal hypoxia-ischemia (HI) are evolving over time, and the specific type of EEG utilized could influence seizure diagnosis and management. We ...
Electroencephalogram (EEG) monitoring techniques for neonatal hypoxia-ischemia (HI) are evolving over time, and the specific type of EEG utilized could influence seizure diagnosis and management. We examined whether the type of EEG performed affected seizure treatment decisions (e.g., the choice and number of antiseizure drugs [ASDs]) in therapeutic hypothermia-treated neonates with HI from 2007 to 2015 in the Johns Hopkins Hospital Neonatal Intensive Care Unit. During this period, 3 different EEG monitoring protocols were utilized: Period 1 (2007-2009), single, brief conventional EEG (1 h duration) at a variable time during therapeutic hypothermia treatment, i.e., ordered when a seizure was suspected; Period 2 (2009-2013), single, brief conventional EEG followed by amplitude-integrated EEG for the duration of therapeutic hypothermia treatment and another brief conventional EEG after rewarming; and Period 3 (2014-2015), continuous video-EEG (cEEG) for the duration of therapeutic hypothermia treatment (72 h) plus for an additional 12 h during and after rewarming. One hundred and sixty-two newborns were included in this retrospective cohort study. As a function of the type and duration of EEG monitoring, we assessed the risk (likelihood) of receiving no ASD, at least 1 ASD, or ≥2 ASDs. We found that the risk of a neonate being prescribed an ASD was 46% less during Period 3 (cEEG) than during Period 1 (brief conventional EEG only) (95% CI 6-69%, p = 0.03). After adjusting for initial EEG and MRI results, compared with Period 1, there was a 38% lower risk of receiving an ASD during Period 2 (95% CI: 9-58%, p = 0.02) and a 67% lower risk during Period 3 (95% CI: 23-86%, p = 0.01). The risk ratio of receiving ≥2 ASDs was not significantly different across the 3 periods. In conclusion, in addition to the higher sensitivity and specificity of continuous video-EEG monitoring, fewer infants are prescribed an ASD when undergoing continuous forms of EEG monitoring (aEEG or cEEG) than those receiving conventional EEG. We recommend that use of continuous video-EEG be considered whenever possible, both to treat seizures more specifically and to avoid overtreatment.
- Cerebral modulation of the autonomic nervous system in term infants. [Journal Article]
- JPJ Perinatol 2017 Jan 12
- CONCLUSIONS: Our data support the notion that lateralized cerebral modulation of the ANS, specifically of its sympathetic component, is present in the term newborn, and suggest complex modulation of these tracts by components of the posterior fossa.Journal of Perinatology advance online publication, 12 January 2017; doi:10.1038/jp.2016.248.
- Closed Vitrification System as A Platform for Cryopreservation of Tissue Engineered Constructs. [Journal Article]
- CLCryo Letters 2016 Nov/Dec; 37(6):440-447
- CONCLUSIONS: Data demonstrate that this vitrification system can be used as a platform for development of effective protocols for cryopreservation of MSCs-based TECs.
- Glial fibrillary acidic protein plasma levels are correlated with degree of hypothermia during cardiopulmonary bypass in congenital heart disease surgery. [Journal Article]
- ICInteract Cardiovasc Thorac Surg 2016 Dec 31
- CONCLUSIONS: Hypothermia degree during CPB is correlated with GFAP plasma increase in children with biventricular heart defects undergoing surgical repair. Rewarming is the most critical CPB phase for GFAP increase. The implication of high plasma GFAP is still under evaluation. Follow-up studies are ongoing to assess the reliability of GFAP as a marker of brain injury and/or as a predictor of neurodevelopmental abnormalities.
- The 6-chromanol derivate SUL-109 enables prolonged hypothermic storage of adipose tissue-derived stem cells. [Journal Article]
- BBiomaterials 2017; 119:43-52
- Encouraging advances in cell therapy research with adipose derived stem cells (ASC) require an effective short-term preservation method that provides time for quality control and transport of cells f...
Encouraging advances in cell therapy research with adipose derived stem cells (ASC) require an effective short-term preservation method that provides time for quality control and transport of cells from their manufacturing facility to their clinical destination. Hypothermic storage of cells in their specific growth media offers an alternative and simple preservation method to liquid nitrogen cryopreservation or commercial preservation fluids for short-term storage and transport. However, accumulation of cell damage during hypothermia may result in cell injury and death upon rewarming through the production of excess reactive oxygen species (ROS). Here, the ability of the cell culture medium additive SUL-109, a modified 6-chromanol, to protect ASC from hypothermia and rewarming damage is examined. SUL-109 conveys protective effects against cold-induced damage in ASC as is observed by preservation of cell viability, adhesion properties and growth potential. SUL-109 does not reduce the multilineage differentiation capacity of ASC. SUL-109 conveys its protection against hypothermic damage by the preservation of the mitochondrial membrane potential through the activation of mitochondrial membrane complexes I and IV, and increases maximal oxygen consumption in FCCP uncoupled mitochondria. Consequently, SUL-109 alleviates mitochondrial ROS production and preserves ATP production. In summary, here we describe the generation of a single molecule cell preservation agent that protects ASC from hypothermic damage associated with short-term cell preservation that does not affect the differentiation capacity of ASC.
- Autonomic disturbances including impaired hand thermoregulation in multiple system atrophy and Parkinson's disease. [Journal Article]
- JNJ Neural Transm (Vienna) 2016 Dec 21
- Autonomic dysfunction in multiple system atrophy (MSA) comprises cardinal symptoms of orthostatic hypotension (OH) and urinary incontinence. Additionally, cardiovagal and sudomotor abnormalities can ...
Autonomic dysfunction in multiple system atrophy (MSA) comprises cardinal symptoms of orthostatic hypotension (OH) and urinary incontinence. Additionally, cardiovagal and sudomotor abnormalities can be present. Previous studies compared hand skin temperature and its response to cooling in subjects with probable MSA and Parkinson's disease (PD). Significant differences were found indicating that disturbed thermoregulation belongs to MSA autonomic features and could be helpful in differentiation of MSA from PD. The objective of this study was to improve our knowledge about impaired thermoregulation of distal extremities in MSA with parkinsonian features (MSA-P) and PD and to assess the possible interrelations for the different subtypes of autonomic dysfunction in a large cohort of MSA-P, PD and control patients. The patients underwent a standard cooling-rewarming procedure, termed ice test (IT). Electroneurography, heart rate variability, sympathetic skin response and orthostatic tests were performed for the subdivision of the patients. The prevalence of pathological IT was slightly increased in MSA compared with PD and control groups. The presence of pathological IT was related with older patient's age in PD and control groups significantly (p < 0.05). This relation was absent for the MSA patients, who themselves were significantly younger (p = 0.001). Significant association between the presence of pathological IT and OH was determined (p < 0.001). Defective thermoregulation of distal extremities seems to be more severe in the MSA patients. The dysfunction of preganglionic sympathetic neurons might be involved in impaired response to cooling for MSA. The results suggest pathophysiological affinity of impaired sympathetic neurovascular regulation between pathological IT and OH.
- Effects of acute cold exposure on oxidative balance and total antioxidant capacity in juvenile Chinese soft-shelled turtle, Pelodiscus sinensis. [Journal Article]
- IZIntegr Zool 2016 Dec 19
- Acute cold exposure may disturb physiological homeostasis of the body in ectotherms. By now, there is no information about the effects of cold exposure on homeostasis of reactive oxygen species (ROS)...
Acute cold exposure may disturb physiological homeostasis of the body in ectotherms. By now, there is no information about the effects of cold exposure on homeostasis of reactive oxygen species (ROS) or antioxidant defense response in the Chinese soft-shelled turtle, Pelodiscus sinensis. In this study, P.sinensis juveniles were acclimated at 28 °C, transferred to 8 °C as cold exposure for 12 hours, moved back to 28 °C rewarming for 24 hours. We measured ROS level and total antioxidant capacity (TAC) in the brain, liver, kidney and spleen at 2 hours, 12 hours cold exposure, and the end of rewarming. Malonaldehyde (MDA) and carbonyl protein were used as marker of oxidative damage. Turtles being maintained simultaneously at 28°C all the time were used as the control group. Cold exposure did not disturb ROS balance in all four tissues, while rewarming raised ROS level in the brain and kidney of P. sinensis. Cold exposure and rewarming decreased TAC in the brain, liver and spleen while didn't change TAC in the kidney. MDA and carbonyl protein levels did not increase during the treatment, indicating no oxidative damage in all four tissues of P. sinensis. Our results indicated that a harsh cold exposure did not break the inner oxidative balance of P. sinensis, but more ROS produced during rewarming. P. sinensis showed good tolerance to the harsh temperature change by effective protection of its antioxidant defense system to oxidative damage. This study provides basic data to stress biology of P. sinensis. This article is protected by copyright. All rights reserved.
- Brief Rewarming Blunts Hypothermia-Induced Alterations in Sensation, Motor Drive and Cognition. [Journal Article]
- FPFront Physiol 2016; 7:592
- Background: It is well known that cold exposure experienced during occupational or recreational activities may adversely affect motor, cognitive performance, and health. Most research has used prolon...
Background: It is well known that cold exposure experienced during occupational or recreational activities may adversely affect motor, cognitive performance, and health. Most research has used prolonged passive external rewarming modalities and focused on the direct effects on the kinetics of physiological and psychological responses in hypothermic subjects. However, the brief whole body rewarming effects on physiological and psychological responses in parallel with functional consequences on cognitive and neurophysiological functions have not been investigated. This study explores these effects in 12 healthy young men. Methods: Subjects (20 ± 1 years) participated in 4 randomized trials, which were designed to compare the effects of whole-body brief (5-min) rewarming in 37°C water with rewarming for the same duration in 24°C (air) thermoneutral environment in mildly hypothermic subjects. After each rewarming, indicators of neuromuscular function (reflexes, central activation ratio, electromyography of exercising muscle, and contractile properties of calf muscles) and cognitive function (attention, simple motor speed, and information processing speed) were assessed. Results: Compared to rewarming in thermoneutral environment, after brief rewarming in 37°C water, significantly lower metabolic heat production (MHP) (206 ± 33.4 vs. 121.9 ± 24.3 W·m(2), P < 0.01), heart rate (76 ± 16 vs. 60 ± 12 b·min(-1), P < 0.01), cold strain (6.4 ± 3.1 vs. 5.3 ± 2.7, P < 0.01), improved thermal comfort and induced cessation of shivering were found. Electrically induced maximum torque amplitudes increased (P100, 102.8 ± 21.3 vs. 109.2 ± 17.5 Nm and PTT100, 83.1 ± 17.1 vs. 92.7 ± 16.0 Nm, P < 0.05), contraction half-relaxation time decreased (599.0 ± 53.8 vs. 589.0 ± 56.3 ms, P < 0.05), and Mmax-wave latency shortened (17.5 ± 2.2 vs. 15.6 ± 2.0 ms, P < 0.05) after 37°C water rewarming. Unlike rewarming in thermoneutral environment, 37°C water rewarming blunted the hypothermia-induced alterations in neural drive transmission (4.3 ± 0.5 vs. 3.4 ± 0.8 mV H-reflex and 4.9 ± 0.2 vs. 4.4 ± 0.4 mV V-wave, P < 0.05), which increased central fatigue during a 2-min maximum load (P < 0.05). Furthermore, only in brief warm water rewarming cerebral alterations were restored to the control level and it was indicated by shortened reaction times (P < 0.05). Conclusions: Brief rewarming in warm water rather than the same duration rewarming in thermoneutral environment blunted the hypothermia-induced alterations for sensation, motor drive, and cognition, despite the fact that rectal and deep muscle temperature remained lowered.
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- Burst Suppression in Hypothermia After Cardiac Arrest Because of Drowning Treated with Targeted Temperature Management: A Case Report. [Journal Article]
- THTher Hypothermia Temp Manag 2016 Dec 16
- Outcomes of cardiac arrest (CA) because of drowning in children are generally poor, but some reports show that cases with post-CA hypothermia because of drowning exhibit good recovery when treated wi...
Outcomes of cardiac arrest (CA) because of drowning in children are generally poor, but some reports show that cases with post-CA hypothermia because of drowning exhibit good recovery when treated with targeted temperature management (TTM). However, because electroencephalogram (EEG) findings are not reported in those cases, a complete examination of brain damage has not been performed during TTM. Here we report a case of a 15-month-old boy with post-CA hypothermia recovery after treating with TTM, along with EEG findings. The initial clinical and laboratory data and resuscitation history in the current case strongly indicated an unfavorable outcome. However, the return of normal EEG findings after 36 hours postadmission may indicate favorable neurological outcomes. Although reliable evidence has not been established, we recommend maintained mild therapeutic hypothermia using TTM, followed by slow rewarming in patients with post-CA hypothermia because of drowning, based on the observations in the current case and in other studies.