Hydrogen gas can ameliorate seizure burden during therapeutic hypothermia in asphyxiated newborn piglets.

BACKGROUND: We previously reported that hydrogen (H2) gas combined with therapeutic hypothermia (TH) improved short-term neurological outcomes in asphyxiated piglets. However, the effect on seizure burden was unclear. Using amplitude-integrated electroencephalography (aEEG), we compared TH + H2 with TH alone in piglets 24 h after hypoxic-ischemic (HI) insult. METHODS: After a 40-min insult and resuscitation, 36 piglets ≤24 h old were divided into three groups: normothermia (NT, n = 14), TH alone (33.5 ± 0.5 °C, 24 h, n = 13), and TH + H2 (2.1-2.7% H2 gas, 24 h, n = 9). aEEG was recorded for 24 h post-insult and its background pattern, status epilepticus (SE; recurrent seizures lasting >5 min), and seizure occurrence (Sz; occurring at least once but not fitting the definition of SE) were evaluated. Background findings with a continuous low voltage and burst suppression were considered abnormal. RESULTS: The percentage of piglets with an abnormal aEEG background (aEEG-BG), abnormal aEEG-BG+Sz and SE was lower with TH + H2 than with TH at 24 h after HI insult. The duration of SE was shorter with TH + H2 and significantly shorter than with NT. CONCLUSIONS: H2 gas combined with TH ameliorated seizure burden 24 h after HI insult. IMPACT: In this asphyxiated piglet model, there was a high percentage of animals with an abnormal amplitude-integrated electroencephalography background (aEEG-BG) after hypoxic-ischemic (HI) insult, which may correspond to moderate and severe hypoxic-ischemic encephalopathy (HIE). Therapeutic hypothermia (TH) was associated with a low percentage of piglets with EEG abnormalities up to 6 h after HI insult but this percentage increased greatly after 12 h, and TH was not effective in attenuating seizure development. H2 gas combined with TH was associated with a low percentage of piglets with an abnormal aEEG-BG and with a shorter duration of status epilepticus at 24 h after HI insult.

The Diagnosis of Trichobezoar Based on the Presence of Hypercholesterolemia: A Case Report.

Trichobezoar refers to the collection of ingested hair accumulating in the gastric mucosa folds, which are found in patients with trichotillomania and trichophagia. We present a case of a nine-year-old girl in Japan who was found to have hypercholesterolemia in the universal lipid screening as a part of the annual health checkups for the prevention of lifestyle-related diseases. Further examination revealed a palpable mass without any digestive symptoms. Imaging studies and the patient's history of pica indicated trichobezoar and upper gastrointestinal endoscopy revealed a large hairball occupying the entire lumen of the stomach. Thereafter, the large trichobezoar was removed by laparotomy and psychological support was provided to her to prevent its recurrence. Hypercholesterolemia improved after the removal of trichobezoar, which suggests an association between a large trichobezoar and cholesterol metabolism. Hypercholesterolemia may serve as a clue to the identification of trichobezoar.