Cognitive function changes and their influential factors in patients with ischemic stroke and leukoaraiosis / 中国基层医药

Objective:To investigate cognitive function changes and their influential factors in patients with ischemic stroke and leukoaraiosis.Methods:A total of 500 patients with ischemic stroke who received treatment in Yiwu Central Hospital from January 2018 to October 2019 were included in this study. They were divided into simple ischemic stroke group ( n = 200) and ischemic stroke complicated by leukoaraiosis group (combination group, n = 300). The infarct location and the degree of leukoaraiosis in the combination group were analyzed. An additional 150 volunteers who concurrently underwent the Cognitive Function Test in the same hospital were selected as controls. Cognitive function was evaluated using the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). Patients in the combination group were divided into cognitive impairment group (MoCA score ≥ 26 points) and non-cognitive impairment group (MoCA score < 26 points) according to MoCA score. The risk factors of cognitive impairment in patients with ischemic stroke and leukoaraiosis were analyzed. Results:The scores of the MMSE, MoCA, Clock Drawing Test (CDT), Verbal Fluency Test (VFT), and Digit Span Test (DST) in the control group were (28.93 ± 2.70) points, (28.35 ± 2.74) points, (4.69 ± 1.14) points, (4.94 ± 0.42) points, and (14.33 ± 1.66) points respectively. They were (26.92 ± 2.18) points, (25.02 ± 3.52) points, (3.61 ± 1.60) points, (4.77 ± 0.46) points, and (11.73 ± 1.16) points, respectively in the simple ischemic stroke group and (24.91 ± 2.79) points, (20.70 ± 3.06) points, (2.87 ± 1.23) points, (4.07 ± 0.85) points, and (10.82 ± 0.93) points respectively in the combination group. There were significant differences in the scores of the MMSE, MoCA, CDT, VFT, and DST among the three groups ( F = 124.50, 318.50, 93.43, 112.60, 428.60, all P < 0.001). Significant differences in the scores of the MMSE, MoCA, CDT, VFT, and DST were observed between patients with different degrees of leukoaraiosis ( F = 69.09, 102.40, 20.98, 60.90, 57.00, all P < 0.001). Spearman correlation analysis results showed that the scores of the MMSE, MoCA, CDT, VFT, and DST were negatively correlated with the degree of leukoaraiosis ( r = -0.61, -0.69, -0.43, -0.56, -0.44, all P < 0.05). Logistic regression analysis results showed that age, history of smoking and drinking, history of diabetes, history of stroke, and infarct location were the independent risk factors for cognitive impairment in patients with ischemic stroke and leukoaraiosis. Education level was a protective factor against ischemic stroke and leukoaraiosis. Conclusion:The degree of cognitive impairment in patients with ischemic stroke and leukoaraiosis is related to the degree of leukoaraiosis. Age, history of smoking and drinking, history of diabetes, history of stroke, infarction location, and education level are the influential factors of cognitive impairment.

Leucoencefalopatia tóxica por inhalación de heroína "Chasing the Dragon": serie de casos / Toxic Leukoencephalopathy by inhaling heroin "Chasing the Dragon": case series

RESUMEN INTRODUCCIÓN: La leucoencefalopatia tóxica es una afección que compromete la sustancia blanca por exposición a sustancias tóxicas. La heroina es una de las implicadas en el desarrollo de la leucoencefalopatia con diferencias exclusivas que suceden con la inhalación según las diversas técnicas en comparación al uso intravenoso, bien sea de la heroína o de otras sustancias psicoactivas. En esta serie describimos cinco casos, de sexo masculino, que desarrollaron leucoencefalopatia espongiforme por heroína (LEH) posterior a la inhalación de vapores, en un hospital del sistema de salud público en la ciudad de Armenia, Colombia. OBJETIVO: El objetivo de este estudio es describir las características demográficas, clínicas, hallazgos de laboratorio e imágenes diagnósticas, así como la mortalidad asociada a LEH en la muestra estudiada. MÉTODOS: Recolección de datos de historias clinicas y búsqueda de imágenes registradas en el Hospital San Juan de Dios de Armenia durante el periodo 2017-2018. RESULTADOS: Se obtienen cinco casos clínicos de pacientes usuarios de vapores inhalados de heroina, quienes ingresan con signos neurológicos de predominio motores y extrapiramidales, con el signo radiológico clásico de "Chasing the Dragon" en estudios de TC cerebral simple en todos los casos. De los cinco casos se presenta un deceso, determinando una mortalidad de 20% comparado con un 25% de mortalidad reportado en la literatura. CONCLUSIONES: La LEH suele estar subdiagnosticada dado que suele confundirse con un trastorno neuropsiquiatríco o de la conducta asociada al consumo de sustancias psicoactivas (SPA), el diagnóstico se realizó con los hallazgos típicos en las imágenes de TC cerebral simple. Se debe tener en cuenta las estadísticas sobre consumo de heroína a la hora de realizar el abordaje de un paciente con historial de consumo de SPA y los signos neurológicos para relacionarlos con esta etiologia y dar un manejo integral a estos pacientes.

ABSTRACT IlNTRODUCTION: Toxic leukoencephalopathy is a condition that compromises the encephalic white matter due to exposure to toxic substances. Heroin is one of those involved in the development of leukoencephalopathy and there are certain differences that occur with its inhalation with the different techniques compared to intravenous use, either heroin or other psychoactive substances. In this serie, we describe five cases of male sex who developed heroin spongiform leukoencephalopathy (HSLE) after inhalation of vapors, in a Hospital of the public health system in the city of Armenia, Colombia. OBJECTIVES: The objective of this study is to describe the demographic and clinical characteristics, laboratory findings and diagnostic images, as well as the mortality associated with HSLE in the sample studied. METHODS: Collection of data from medical records and search of images registered at the San Juan de Dios Hospital in Armenia during the period 2017-2018. RESULTS: Five clinical cases were obtained of patients who were users of inhaled heroin vapors and were admitted to the hospital with predominantly motor and extrapyramidal neurological signs, with simple brain CT studies showing the classic radiological sign of "Chasing the Dragon" in all five cases. One death was presented, with a mortality of 20% compared to the 25% mortality that has been reported in the scientific literature. CONCLUSIONS: HSLE is usually underdiagnosed since it is often confused with a neuropsychiatric or behavioral disorder associated with the consumption of psychoactive substances (PAS). The diagnosis was made with the typical findings in simple brain CT images. Statistics on heroin use must be considered when approaching a patient with a history of PAS use and neurological signs, to relate them to this etiology and provide comprehensive management to these patients.

Rapid Cerebral Edema and Herniation in a 65-Year-Old Man With Balamuthia Mandrillaris.

This case describes a 65-year-old man with hepatocellular carcinoma as well as other medical comorbidities who developed rapidly progressive cerebral edema, nonconvulsive status epilepticus, and ultimately died. Postmortem examination revealed massive cerebral edema, widespread parenchymal necrosis, herniation, hemorrhage, and cerebral amebiasis. The causative agent was identified by the Center for Disease Control as Balamuthia mandrillaris.

Effect of propofol postconditoning on Rb-E2F1 signaling pathway in hippocampal neurons in a rat model of oxygen-glucose deprivation and restoration / 中华麻醉学杂志

Objective:To evaluate the effect of propofol postconditoning on retinoblastoma protein (Rb)-E2F1 signaling pathway in hippocampal neurons in a rat model of oxygen-glucose deprivation and restoration (OGD/R).Methods:Pregnant Wistar rats at 16-18 days of gestation were sacrificed, and the hippocampal neurons of fetal rats were obtained and primarily cultured for 7 days.The neurons were divided into 3 groups ( n=42 each) using a random number table method: control group (group C), OGD/R group (group O) and propofol postconditoning group (group P). In group O, the neurons were subjected to oxygen-glucose deprivation for 1 h, followed by restoration of oxygen-glucose.In group P, propofol (final concentration 1.2 μg/ml) was added immediately after restoration of oxygen and glucose, and the cells were cultured for 2 h and then the culture medium was replaced with plain culture medium.At 24 h of culture, the expression of p-Rb and E2F1 was determined by Western blot, and the cell cycle and apoposis rate were assessed by flow cytometry. Results:Compared with group C, the apoptosis rate was significantly increased, expression of p-Rb and E2F1 was up-regulated, the ratio of p-Rb nuclear/plasmosin protein and the proportion of neurons in G 0/G 1 phase were decreased, and the proportion of neurons in S and G 2/M phases was increased in O and P groups ( P<0.05). Compared with group O, the apoptosis rate was significantly decreased, expression of p-Rb and E2F1 was down-regulated, the ratio of p-Rb nuclear/plasmosin protein and the proportion of neurons in G 0/G 1 phase were increased, and the proportion of neurons in S and G 2/M phases was decreased in group P ( P<0.05). Conclusion:The mechanism by which propofol postconditioning decreases the apoptosis in hippocampal neurons is related to inhibiting Rb-E2F1 signaling pathway in a rat model of OGD/R.

Predictive value of early cerebral oxygen utilization combined with the bispectral index for delayed encephalopathy after acute carbon monoxide poisoning in elderly patients / 中华老年医学杂志

Objective:To investigate clinical value of early cerebral oxygen utilization(O 2UCc)combined with the bispectral index(BIS)for monitoring delayed encephalopathy after acute carbon monoxide poisoning(DEACMP)in elderly patients. Methods:This was a retrospective analysis.A total of 90 elderly patients with acute severe carbon monoxide poisoning(ASCMP)treated in Harrison International Peace Hospital from Nov.2018 to Jan.2020 were considered as research objects.Patients were divided into the DEACMP group(n=25)and the good prognosis group(n=65)according to their prognosis.Oxygen quantity absorbed into UCC(O 2UCc)and Bispectral index(BIS)at different times in the early stages were compared between the two groups.Correlations of O 2UCc and BIS with the occurrence of DEACMP were analyzed.Clinical significance of O 2UCc or BIS alone and of the two parameters in combination for the prediction of DEACMP was investigated. Results:O 2UCc was higher and BIS was lower in the DEACMP group than in the good prognosis group at 0 h, 6 h, 12 h, and 24 h after admission(all P<0.01). Pearson correlation analysis showed that O 2UCc was negatively correlated with DEACMP( r0 h=-0.482, r6 h=-0.534, r12 h=-0.587, r24 h=-0.514, all P<0.01), BIS was positively correlated with DEACMP( r0 h=0.348, r6 h=0.583, r12 h=0.679, r24 h=0.489, all P<0.01), and the correlation was the strongest at 12h after admission.ROC curve analysis was performed with O2UCc, BIS and the combined predictors at 12 h, and the results showed that the areas under the ROC curve of O 2UCc, BIS and the two in combination for DEACMP prediction were 0.845, 0.850 and 0.909, respectively, the sensitivities were 78.5%, 90.8% and 96.9% and the specificities were 80.0%, 76.0% and 84.0%, respectively. Conclusions:Early detection of O 2UCc or BIS has a good clinical value for predicting the development of ASCMP to DEACMP, and their combined value is even better.

Research progresses of neonatal cerebral network reorganization following hypoxic ischemic injury / 中国医学影像技术

Hypoxic ischemia (HI) is a fatal cause of neonatal encephalopathy and death. The developing brain can adjust the structures and function of brain according to different states due to neural plasticity. Understanding the pathophysiological process and cerebral network reorganization of neural damage after HI is very important for early diagnosis and intervention of disease. The research progresses of mechanism of neonatal cerebral network reorganization following HI were reviewed in this article.

Multiple Victims of Carbon Monoxide Poisoning in the Aftermath of a Wildfire: A Case Series.

INTRODUCTION: Carbon monoxide poisoning may occur in several contexts. MATERIAL AND METHODS: Retrospective of 37 carbon monoxide poisoning cases that underwent hyperbaric oxygen during wildfires in Funchal in August 2016. RESULTS: The studied sample included 37 patients, mean age of 38 years, 78% males. Ten were firefighters, four children and two pregnant victims. Neurological symptoms were the most reported. Median carboxyhemoglobin level was 3.7% (IQR 2.7). All received high-flow oxygen from admission to delivery of hyperbaric oxygen. Persistence of symptoms was the main indication for hyperbaric oxygen. Median time to hyperbaric oxygen was 4.8 hours (IQR 9.5), at 2.5 ATA for 90 minutes, without major complications. Discharge in less than 24 hours occurred in 92% of the cases. Thirty days follow-up: five patients presented clinical symptoms of late neurological syndrome; twelve patients were lost to follow-up. Carboxyhemoglobin levels on admission and mean time to hyperbaric oxygen were no different between those who did and did not develop the syndrome at 30 days (p = 0.44 and p = 0.58, respectively). DISCUSSION: Late neurological syndrome at 30 days occurred in 20% and no new cases were reported at 12 months. CONCLUSION: Use of hyperbaric oxygen appears to have reduced the incidence of the syndrome. This seems to be the first Portuguese series reporting use of hyperbaric oxygen in carbon monoxide poisoning due to wildfires. The authors intend to alert to the importance of referral of these patients because the indications and benefits of this treatment are well documented. This is especially important given the ever-growing issue of wildfires in Portugal.

Introdução: A intoxicação por monóxido de carbono pode ocorrer em diversos contextos. Material e Métodos: Retrospectiva de 37 casos de intoxicação por monóxido de carbono submetidos a oxigenoterapia hiperbárica nos fogos do Funchal de agosto de 2016. Resultados: Foram analisados 37 doentes, com média de 38 anos e 78% do sexo masculino; o universo de casos analisados incluiu 10 bombeiros, quatro crianças e duas grávidas; 80% reportaram sintomas neurológicos. O nível mediano de carboxihemoglobina foi de 3,7%. Todos receberam oxigénio alto débito até iniciarem oxigenoterapia hiperbárica. A persistência de sintomas foi a principal indicação para oxigenoterapia hiperbárica. O tempo mediano para oxigenoterapia hiperbárica foi 4,8 horas, a 2,5 ATA durante 90 minutos, sem intercorrências relevantes. O tempo até alta foi inferior a 24 horas em 92% dos casos. Follow-up 30 dias: cinco doentes apresentavam sinais clínicos de síndrome neurológico tardio; doze foram perdidos no follow-up. Os níveis de carboxihemoglobina durante a admissão e tempo médio até oxigenoterapia hiperbárica não diferiram entre os doentes que desenvolveram a síndrome a 30 dias e os restantes (p = 0,44 e p = 0,58, respetivamente). Discussão: A ocorrência de síndrome neurológico tardio a 30 dias ocorreu em 20% dos doentes, não se tendo verificado novos casos ao fim de 12 meses. Conclusão: A oxigenoterapia hiperbárica parece ter permitido reduzir a incidência de síndrome neurológico tardio. Esta é a primeira série de casos portuguesa que reporta exclusivamente a utilização de oxigenoterapia hiperbárica na intoxicação por monóxido de carbono por fogos florestais. Os autores pretendem alertar para importância destes doentes, cuja indicação terapêutica e benefício clínico deste tratamento está bem documentada, sobretudo atendendo à crescente problemática dos incêndios florestais em Portugal.

DOES THE ANESTHESIA TECHNIQUE AFFECT ARTERIAL PRESSURE AND REGIONAL CEREBRAL OXYGEN SATURATION DURING SHOULDER ARTHROSCOPY IN THE BEACH CHAIR POSITION?

- This study aimed to investigate the impact of posture and anesthesia techniques on blood pressure changes, heart rate and regional cerebral oxygen saturation during shoulder arthroscopy in the beach chair position (BCP). Sixty patients were included in this prospective cohort study: 30 patients mechanically ventilated and subjected to general anesthesia (GA) and 30 patients subjected to interscalene block (ISB) without mechanical ventilation. Noninvasive blood pressure, heart rate (HR), peripheral blood oxygen saturation and regional oxygen saturation of the brain were measured in twelve predefined points during perioperative period. The GA group patients had significantly lower mean arterial pressure and heart rate values compared to patients in ISB group during BCP (p<0.001). There was a significant difference in regional cerebral saturation between the groups measured only in points of induction and emergence from anesthesia in favor of GA group when receiving 100% oxygen (p<0.001). Changes in the mean arterial pressure and regional cerebral oxygen saturation for both brain hemispheres correlated only at the 10th minute after setting up BCP in GA patients (right, p=0.004 and left, p=0.003). This correlation did not exist in the ISB group patients at any of the points measured. Cerebral desaturation events recorded in both groups were not statistically significantly different. Results of this study demonstrated that GA preserved regional cerebral oxygenation in a safe range during BCP despite changes in the arterial blood pressure and heart rate in comparison to ISB.

From Dental to Mental Institutions: Asylum-Bound Dentist Zacheus Rogers Oxygenates Nitrous Oxide.

American dentist Zacheus Rogers taught surgeon Edmund Andrews-and indirectly anesthesia pioneers SJ Hayes and FW Hewitt-to oxygenate anesthetics. Ironically, Rogers may have himself suffered neurologic damage by failing to oxygenate the nitrous oxide that he is speculated to have abused personally.

Hipotermia neuroprotetora tardia / Late hypothermic neuroprotection

A parada cardiorrespiratória é um evento de alta mortalidade. A isquemia cerebral difusa relacionada ao hipofluxo cerebral frequentemente leva à injúria neurológica grave e ao desenvolvimento de estado vegetativo persistente. A hipotermia terapêutica representa um importante avanço no tratamento da encefalopatia anóxica pós-parada cardíaca. Seus efeitos neuroprotetores têm sido amplamente demonstrados em várias situações de isquemia neuronal. Apesar de ser um procedimento associado com redução de mortalidade nestes pacientes, a hipotermia ainda é um tratamento subutilizado no manejo da síndrome pós-ressuscitação. Nosso objetivo foi demonstrar que a hipotermia neuroprotetora tem efeito benéfico mesmo realizada tardiamente naqueles pacientes comprovadamente encefalopatas como consequência de baixo fluxo cerebral devido à parada cardiorrespiratória que mantém um nível neurológico baixo (Glasgow abaixo de 8). Este fato é demonstrado pelo não uso de substâncias neurodepressoras nas últimas 48 horas, e o ganho para o paciente seria maior que os prováveis riscos que a hipotermia pode ocasionar. Este relato mostra os efeitos benéficos no paciente submetido ao tratamento da hipotermia neuroprotetora tardiamente, evoluindo satisfatoriamente, visto que foi devolvido à sociedade em Glasgow 14 e com independência suficiente para atender suas necessidades humanas básicas. Era um paciente do sexo masculino, 25 anos, pardo, solteiro, imigrante ilegal oriundo da Bolívia, auxiliar de costura, com história de mal súbito enquanto praticava futebol com amigos em quadra ao ar livre. Deu entrada no pronto-socorro em parada cardiorrespiratória por taquicardia ventricular. Foram realizadas manobras de reanimação com cardioversão elétrica e massagem cardíaca e não houve relato do tempo de parada cardíaca. Foi transferido para a unidade de terapia intensiva adulto com hipótese diagnóstica de encefalopatia anóxica pós-parada cardiorrespiratória sem uso de drogas vasoativas em Glasgow 6.(AU)

Cardiac arrest is a high-mortality event. Brain hypoflow-related diffuse cerebral ischemia often leads to severe neurological injury, and to the development of a persistent vegetative state. Therapeutic hypothermia is an important advance in the treatment of anoxic encephalopathy after cardiac arrest. Its neuroprotective effects have been widely demonstrated in several situations of neuronal ischemia. Although the procedure is associated with reduced mortality, hypothermia is still an underused treatment in the management of post-resuscitation syndrome. Our goal was to demonstrate that neuroprotective hypothermia is effective even when performed late in patients with encephalopathies from brain hypoflow due to cardiac arrest with a low neurological level (Glasgow below 8). This is demonstrated by the lack of neurodepressant substances in the previous 48 hours, and patient benefit would be higher than the probable risks that hypothermia could cause. This report shows the beneficial effects in the patient undergoing delayed neuroprotective hypothermia, who progressed satisfactorily, since taken back to Glasgow 13 with sufficient independence to meet basic human needs. The patient was a male of 25 years old, dark-skinned, single, an illegal immigrant from Bolivia, sewing assistant, with a history of sudden cardiac arrest, which occured while playing soccer outdoors. He was admitted to the emergency room in cardiopulmonary arrest (CPA) due to ventricular tachycardia. Resuscitation maneuvers with electrical cardioversion and cardiac massage were performed, and there is no reported time of cardiac arrest. He was transferred to the Adult Intensive Care Unit with a diagnosis hypothesis of anoxic encephalopathy after cardiac arrest, with no use of vasoactive drugs in Glasgow 6.(AU)

[Effect of neuroglobin on oxygen-glucose deprivation and reoxygenation induced autophagy in a human neuroblastoma cell line].

Objective: To investigate the effect of neuroglobin on oxygen-glucose deprivation and reoxygenation (OGD/R) induced autophagy in a human neuroblastoma cell line (SH-SY5Y). Methods: SH-SY5Y cells were transfected with plasmids (or vector) to establish a stable cell line of NGB overexpression (OE). After treated with OGD/R, cells were collected for the analyses of mRNA (Atg5, Atg7, BECN1 and FUNDC1) and protein levels of LC3. Furthermore, mitochondrial and cytosolic fractions were isolated for protein levels of PINK1 and Parkin. Results: Treatment of OGD/R significantly increased the levels of mRNA of Atg5, Atg7, BECN1 and FUNDC1 (peak levels were 4.90±0.71, 6.72±0.75, 2.71±0.39 and 3.96±0.78 fold, all P<0.05). The protein level of Parkin increased in mitochondria and decreased in cytoplasm after the treatment. Compared with the vector group, Ngb OE group showed a significant higher level of FUNDC1 mRNA (3.96±0.78 versus 6.86±0.63 fold, P<0.05), while Atg5, Atg7 and BECN1 mRNA levels showed no significant difference. Moreover, the mitochondrial or cytosolic protein levels of PINK1 or Parkin showed no significant difference between Ngb OE and vector group. Conclusions: Overexpression of Ngb can not affect autophagy or mitohpagy in OGD/R treated SH-SY5Y cells. Overexpression of Ngb can increase the mRNA level of FUNDC1 and the mechanism needs further study.

[Risk factors associated with the development of perinatal asphyxia in neonates at the Hospital Universitario del Valle, Cali, Colombia, 2010-2011].

INTRODUCTION: Perinatal asphyxia is one of the main causes of perinatal mortality and morbidity worldwide and it generates high costs for health systems; however, it has modifiable risk factors. OBJECTIVE: To identify the risk factors associated with the development of perinatal asphyxia in newborns at Hospital Universitario del Valle, Cali, Colombia. MATERIALS AND METHODS: Incident cases and concurrent controls were examined. Cases were defined as newborns with moderate to severe perinatal asphyxia who were older than or equal to 36 weeks of gestational age, needed advanced resuscitation and presented one of the following: early neurological disorders, multi-organ commitment or a sentinel event. The controls were newborns without asphyxia who were born one week apart from the case at the most and had a comparable gestational age. Patients with major congenital malformations and syndromes were excluded. RESULTS: Fifty-six cases and 168 controls were examined. Premature placental abruption (OR=41.09; 95%CI: 4.61-366.56), labor with a prolonged expulsive phase (OR=31.76; 95%CI: 8.33-121.19), lack of oxytocin use (OR=2.57; 95% CI: 1.08 - 6.13) and mothers without a partner (OR=2.56; 95% CI: 1.21-5.41) were risk factors for the development of perinatal asphyxia in the study population. Social difficulties were found in a greater proportion among the mothers of cases. CONCLUSIONS: Proper control and monitoring of labor, development of a thorough partograph, and active searches are recommended to ensure that all pregnant women have adequate prenatal care with the provision of social support to reduce the frequency and negative impact of perinatal asphyxia.

Risk factors associated with the development of perinatal asphyxia in neonates at the Hospital Universitario del Valle, Cali, Colombia, 2010-2011 / Factores de riesgo asociados con el desarrollo de asfixia perinatal en neonatos en el Hospital Universitario del Valle, Cali, Colombia, 2010-2011

Abstract Introduction: Perinatal asphyxia is one of the main causes of perinatal mortality and morbidity worldwide and it generates high costs for health systems; however, it has modifiable risk factors. Objective: To identify the risk factors associated with the development of perinatal asphyxia in newborns at Hospital Universitario del Valle, Cali, Colombia. Materials and methods: Incident cases and concurrent controls were examined. Cases were defined as newborns with moderate to severe perinatal asphyxia who were older than or equal to 36 weeks of gestational age, needed advanced resuscitation and presented one of the following: early neurological disorders, multi-organ commitment or a sentinel event. The controls were newborns without asphyxia who were born one week apart from the case at the most and had a comparable gestational age. Patients with major congenital malformations and syndromes were excluded. Results: Fifty-six cases and 168 controls were examined. Premature placental abruption (OR=41.09; 95%CI: 4.61-366.56), labor with a prolonged expulsive phase (OR=31.76; 95%CI: 8.33-121.19), lack of oxytocin use (OR=2.57; 95% CI: 1.08 - 6.13) and mothers without a partner (OR=2.56; 95% CI: 1.21-5.41) were risk factors for the development of perinatal asphyxia in the study population. Social difficulties were found in a greater proportion among the mothers of cases. Conclusions: Proper control and monitoring of labor, development of a thorough partograph, and active searches are recommended to ensure that all pregnant women have adequate prenatal care with the provision of social support to reduce the frequency and negative impact of perinatal asphyxia.

Resumen Introducción: La asfixia perinatal constituye una de las principales causas de morbilidad y mortalidad perinatal en el mundo, tiene factores de riesgo modificables y genera altos costos para los sistemas de salud. Objetivo: Determinar los factores de riesgo asociados al desarrollo de asfixia perinatal en recién nacidos en el Hospital Universitario del Valle, Cali, Colombia. Materiales y métodos: Se llevó a cabo un estudio de casos incidentes y controles concurrentes. Los casos se definieron como neonatos con asfixia perinatal moderada a grave, de edad de gestación mayor o igual a 36 semanas, que requirieron reanimación avanzada y presentaron, al menos, una de las siguientes condiciones: alteraciones neurológicas tempranas, falla orgánica múltiple o aparición de un evento centinela. Los controles se definieron como neonatos sin diagnóstico de asfixia, nacidos hasta con una semana de diferencia con respecto al caso y de edad de gestación comparable. Se excluyeron los pacientes con malformaciones congénitas mayores y síndromes. Resultados: Se estudiaron 56 casos y 168 controles. El desprendimiento prematuro de la placenta (odds ratio, OR=41,09; IC95% 4,61-366,56), un trabajo de parto con fase expulsiva prolongada (OR=31,76; IC95% 8,33-121,19), no usar oxitocina (OR=2,57; IC95% 1,08-6,13) y ser madre soltera (OR=2,56; IC95% 1,21-5,41) fueron factores de riesgo para el desarrollo de asfixia perinatal en la población bajo estudio. En las madres de los casos se encontraron dificultades sociales en mayor proporción. Conclusiones: Se recomienda un control adecuado y una vigilancia apropiada del trabajo de parto, hacer un estricto partograma, y una búsqueda activa, de manera que cada mujer embarazada tenga un adecuado control prenatal y reciba apoyo social.

Mortality and Outcome Comparison Between Brain Tissue Oxygen Combined with Intracranial Pressure/Cerebral Perfusion Pressure-Guided Therapy and Intracranial Pressure/Cerebral Perfusion Pressure-Guided Therapy in Traumatic Brain Injury: A Meta-Analysis.

BACKGROUND: The combination of brain tissue oxygen and standard intracranial pressure (ICP)/cerebral perfusion pressure (CPP)-guided therapy is thought to improve traumatic brain injury (TBI) prognosis compared with standard ICP/CPP-guided therapy. However, related results of previous observational studies and recently published cohort studies and randomized controlled trials (RCTs) remain controversial. The objective of this study was to compare the effect of the combined therapy with that of standard ICP/CPP-guided therapy on mortality rate, favorable outcome, ICP/CPP, and length of stay (LOS). METHODS: We systematically searched PubMed, Embase, Cochrane Library, ClinicalTrials.gov, and Web of Science in July 2016 for studies comparing the combined therapy and standard ICP/CPP-guided therapy. Random-effect and fixed-effect models were used for pooled analyses. RESULTS: After screening 362 studies, 8 cohort studies and 1 RCT were included. Primary outcomes were mortality and favorable outcome. The overall mortality risk ratio showed no obvious advantages between the 2 groups (risk ratio [RR], 0.76; 95% confidence interval [CI], 0.54-1.06) and discharge mortality (RR, 1.01; 95% CI, 0.80-1.26) and 3-month mortality (RR, 0.77; 95% CI, 0.53-1.12). Compared with the ICP/CPP group, the combined group was more likely to achieve better outcome during the 6 months after TBI (RR, 1.26; 95% CI, 1.04-1.52) or exactly at 6 months (RR, 1.34; 95% CI, 1.07-1.68), whereas ICP (standardized mean difference [SMD], -0.19; 95% CI, -0.43 to 0.05), CPP (SMD, 0.13; 95% CI, -0.09 to 0.35), and LOS (SMD, 0.13; 95% CI, -0.11 to 0.37) showed no obvious differences. CONCLUSIONS: Compared with standard ICP/CPP-guided therapy, brain tissue oxygen combined with ICP/CPP-guided therapy improved long-term outcomes without any effects on mortality, ICP/CPP, or LOS.

Brain injury after moderate drowning: subtle alterations detected by functional magnetic resonance imaging.

To describe cerebral (structural and functional MRI) and neuropsychological long term changes in moderate drowning victim's compared to healthy volunteers in working memory and motor domains. We studied 15 adult drowning victim's in chronic stage (DV - out of 157 eligible cases of sea water rescues with moderate drowning classification) paired to 18 healthy controls (HC). All participants were investigated using intelligence, memory, and attention neuropsychological standard tests and underwent functional (motor and working memory tasks) and structural magnetic resonance imaging (MRI) in a 3 T system. All images were preprocessed for head movement correction and quantitative analysis was performed using FSL and freesurfer software packages. We found no between group differences in neuropsychological assessments. No MRI brain lesion was observed in patients, neither difference on morphometric parameters in any cortical or subcortical brain structure. In constrast, functional MRI revealed that patients showed increased brain response in the motor (left putamen and insula) and memory (left cuneus and lingual gyrus - not the classical memory network) tasks. Functional brain changes in motor and visual brain regions in victims of moderate drowning may indicate reduced brain reserve, despite the lack of structural and behavior alterations. More attention should be given to investigate ageing effects in this nonfatal drowning group.

Hypoxia preconditioning may protect focal cerebral ischemia in rats by downregulation of glycogen synthase kinase 3β, phosphorylated signal transducer and activator of transcription 3 / 国际脑血管病杂志

Objective To investigate the roles of phosphorylated glycogen synthase kinase 3β (pGSK3β) and phosphorylated signal transducer and activator of transcription 3 (pSTAT3) in hypoxic preconditioning-induced neuroprotection against ischemic brain injury in rats.Methods Sixty SD rats were randomly divided into a sham operation group,a cerebral ischemia group,and a hypoxia preconditioning group (n =20 in each group).A model of middle cerebral artery occlusion (MCAO) was induced by the modified suture method.Before the preparation of MCAO model,the rats in the hypoxia preconditioning group were put into a hypobaric oxygen chamber at a simulated altitude of 5 000 m (pressure:0.53 × 105 kPa;partial pressure of oxygen:81 mmHg;1 mmHg =0.133 kPa),3 h a day for 5 days.At 24 h after MCAO modeling,the rats were subjected to neurobehavioral score (n =6) and cerebral infarction volume measurement (n =6).Immunohistochemical staining was used to detect the expression levels of neuronal nuclei (NeuN) and pGSK3β (Ser9) (n=7).Western blot was used to detect the expression levels of pGSK3 β (Ser9) and pSTAT3 (Tyr705) in the ischemic cortex (n =7).Results The neurological deficit score (1.833 ±0.408 vs.2.667 ± 0.516;t =3.101,P=0.011) and cerebral infarction volume (18.137％ ± 0.801％ vs.24.125％ ± 0.694％;t =13.840,P＜ 0.001) in the hypoxia preconditioning group were significantly lower or smaller than those in the cerebral ischemia group.Immunohistochemical staining showed that the numbers of NeuN positive cells in the cerebral ischemia group and the hypoxia preconditioning group were significantly less than that in the sham operation group (48.000 ± 1.414/high power field [HPF],124.833 ± 3.061/HPF,and 213.500 ± 2.429/HPF;F =7 150.550,P ＜ 0.001),the hypoxia preconditioning group was significantly more than the ischemia group (P ＜0.001);the numbers of pSTAT3 positive cells in the cerebral ischemia group and the hypoxia preconditioning group were significantly higher than that in the sham operation group (57.667 ± 1.366/HPF,29.167 ± 1.941/HPF and 3.500 ± 1.049/HPF;F =1 962.649,P ＜0.001),and the hypoxia preconditioning group was significantly less than the ischemia group (P ＜0.001).Western blot analysis showed that the expression levels of ischemic cortical pGSK3β and pSTAT3 in the cerebral ischemia group and the hypoxia preconditioning group were significantly higher than those of the sham operation group (pGSK3 β:2.336 ± 0.102,0.876 ± 0.196 and 0.440 ± 0.012;F =1 610.826,P ＜ 0.001;pSTAT3:8.368± 0.230,4.883± 0.123 and 0.595± 0.138;F=4018.051,P＜0.001),the hypoxia preconditioning group were significantly lower than the ischemia group (all P ＜0.001).Conclusions Hypoxia preconditioning has neuroprotective effect for ischemic brain injury in rats.It may be associated with the down-regulation of the expressions of pGSK3 and pSTAT3.

Analysis of the risk factors of delayed neuropsychologic sequelae after acute carbon monoxide poisoning / 中国基层医药

Objective To explore the risk factors for the development of delayed neuropsychologic sequelae (DNS)and to characterize the clinical course following the development of DNS in acute CO poisoning cases. Methods This study included 79 cases of acute CO poisoning,and they were divided into two groups consisting of 13 cases who developed DNS and 66 cases who did not.The generally conditions of the two groups [including age, gender,exposure environment,the time of coma,whether through referral,the severity of disturbance of consciousness, computed tomography(CT)abnormal,first time to see a doctor if hyperbaric oxygen therapy]and laboratory index [carbon oxygen hemoglobin(COHb),WBC,creatine kinase (CK),creatine kinase isoenzyme (CK -MB),lactate dehydrogenase(LDH),hospitalization time,HBO]were analyzed by single factor variance analysis,Chi -square test and Mann Whitney U test.Results Compared with the non DNS group,in the DNS group,JCS score was significantly higher[(200.4 ±107.24)points vs.(94.55 ±52.71 )points,U =8.373,P <0.01 ],CT abnormal skull increased (76.9% vs.6.2%,χ2 =9.548,P <0.01),CK[(5976.33 ±4 371.92)IU /L vs.(2 384.67 ±650.86)IU /L,F =6.877],CK -MB[(51.22 ±33.28)IU /L vs.(23.47 ±15.66)IU /L,F =4.329],LDH[(395.80 ±270.04)IU /L vs.(221.87 ±101.95)IU /L,F =1.012]increased,there were statistically significant differences between the two groups by single factor analysis(all P <0.01 ).The patients with DNS had longer hospitalized time [(283.27 ± 251.08)d vs.(37.93 ±37.18)d,F =2.283]and HBO time[(51.62 ±16.69)d vs.(7.70 ±5.38)d,F =6.428], there were statistically significant differences between the two groups by single factor analysis (all P <0.01 ). Conclusion In patients with the characteristics identified in this study,administration of HBO therapy should be proactively considered after informing their family at initial stage,thus to decrease the risk of developing DNS.

Beneficial Role of Erythrocyte Adenosine A2B Receptor-Mediated AMP-Activated Protein Kinase Activation in High-Altitude Hypoxia.

BACKGROUND: High altitude is a challenging condition caused by insufficient oxygen supply. Inability to adjust to hypoxia may lead to pulmonary edema, stroke, cardiovascular dysfunction, and even death. Thus, understanding the molecular basis of adaptation to high altitude may reveal novel therapeutics to counteract the detrimental consequences of hypoxia. METHODS: Using high-throughput, unbiased metabolomic profiling, we report that the metabolic pathway responsible for production of erythrocyte 2,3-bisphosphoglycerate (2,3-BPG), a negative allosteric regulator of hemoglobin-O2 binding affinity, was significantly induced in 21 healthy humans within 2 hours of arrival at 5260 m and further increased after 16 days at 5260 m. RESULTS: This finding led us to discover that plasma adenosine concentrations and soluble CD73 activity rapidly increased at high altitude and were associated with elevated erythrocyte 2,3-BPG levels and O2 releasing capacity. Mouse genetic studies demonstrated that elevated CD73 contributed to hypoxia-induced adenosine accumulation and that elevated adenosine-mediated erythrocyte A2B adenosine receptor activation was beneficial by inducing 2,3-BPG production and triggering O2 release to prevent multiple tissue hypoxia, inflammation, and pulmonary vascular leakage. Mechanistically, we demonstrated that erythrocyte AMP-activated protein kinase was activated in humans at high altitude and that AMP-activated protein kinase is a key protein functioning downstream of the A2B adenosine receptor, phosphorylating and activating BPG mutase and thus inducing 2,3-BPG production and O2 release from erythrocytes. Significantly, preclinical studies demonstrated that activation of AMP-activated protein kinase enhanced BPG mutase activation, 2,3-BPG production, and O2 release capacity in CD73-deficient mice, in erythrocyte-specific A2B adenosine receptor knockouts, and in wild-type mice and in turn reduced tissue hypoxia and inflammation. CONCLUSIONS: Together, human and mouse studies reveal novel mechanisms of hypoxia adaptation and potential therapeutic approaches for counteracting hypoxia-induced tissue damage.

Effect of ketamine on mitochondrial function of rat neurons subjected to anoxia / 中华麻醉学杂志

Objective To investigate the effect of ketamine on the mitochondrial function of rat neurons subjected to anoxia. Methods Primarily cultured rat hippocampal neurons were seeded in culture dishes (35 mm in diameter) at the density of 5×105-1×106 cells∕ml, and divided into 3 groups (n=11 each) using a random number table: control group, anoxia group and ketamine group. The neurons were exposed to 90% N2 plus 10% CO2 50 ml∕min for 5 min in anoxia group. In ketamine group, ketamine was added to the culture medium with the final concentration of 20 μmol∕L at 1 h before anoxia, and then the neurons were exposed to 90% N2 plus 10% CO2 50 ml∕min for 5 min. After the end of treatment in each group, the dead neurons were detected using trypan blue staining, the ATP content was determined by ATP bioluminescence assay, and mitochondrial membrane potential was measured by rhodamine 123 staining. Results Compared with control group, the mortality rate of hippocampal neurons was significantly in?creased, and the ATP content and mitochondrial membrane potential were significantly decreased in anoxia group and ketamine group ( P<0.05) . Compared with anoxia group, the mortality rate of hippocampal neu?rons was significantly decreased, and the ATP content and mitochondrial membrane potential were signifi?cantly increased in ketamine group (P<0.05). Conclusion The mechanism by which ketamine amelio?rates anoxia?induced damage to rat neurons is related to improved mitochondrial function.