F. A. Zeiler
Full Text Available Background. Tromethamine (THAM has been demonstrated to reduce intracranial pressure (ICP. Early consideration for THAM may reduce the need for other measures for ICP control. Objective. To describe 4 cases of early THAM therapy for ICP control and highlight the potential to avoid TH and paralytics and achieve reduction in sedation and hypertonic/hyperosmotic agent requirements. Methods. We reviewed the charts of 4 patients treated with early THAM for ICP control. Results. We identified 2 patients with aneurysmal subarachnoid hemorrhage (SAH and 2 with traumatic brain injury (TBI receiving early THAM for ICP control. The mean time to initiation of THAM therapy was 1.8 days, with a mean duration of 5.3 days. In all patients, after 6 to 12 hours of THAM administration, ICP stability was achieved, with reduction in requirements for hypertonic saline and hyperosmotic agents. There was a relative reduction in mean hourly hypertonic saline requirements of 89.1%, 96.1%, 82.4%, and 97.0% for cases 1, 2, 3, and 4, respectively, comparing pre- to post-THAM administration. Mannitol, therapeutic hypothermia, and paralytics were avoided in all patients. Conclusions. Early administration of THAM for ICP control could potentially lead to the avoidance of other ICP directed therapies. Prospective studies of early THAM administration are warranted.
Wilson, E; W. S. Waring
This article reports the time course and clinical features of acute ethanol poisoning in an elderly man who had previously abstained from alcohol. Several hours after ingestion, severe hypotension and hypothermia developed, and the consciousness level was reduced. Supportive measures were sufficient to allow the patient's blood pressure and temperature to recover by 24 h post ingestion. The clinical manifestations of ethanol toxicity are often confounded by coexistent drug ingestion and varia...
Carlin, Jesse Lea; Tosh, Dilip K; Xiao, Cuiying; Piñol, Ramón A; Chen, Zhoumou; Salvemini, Daniela; Gavrilova, Oksana; Jacobson, Kenneth A; Reitman, Marc L
Adenosine can induce hypothermia, as previously demonstrated for adenosine A1 receptor (A1AR) agonists. Here we use the potent, specific A3AR agonists MRS5698, MRS5841, and MRS5980 to show that adenosine also induces hypothermia via the A3AR. The hypothermic effect of A3AR agonists is independent of A1AR activation, as the effect was fully intact in mice lacking A1AR but abolished in mice lacking A3AR. A3AR agonist-induced hypothermia was attenuated by mast cell granule depletion, demonstrating that the A3AR hypothermia is mediated, at least in part, via mast cells. Central agonist dosing had no clear hypothermic effect, whereas peripheral dosing of a non-brain-penetrant agonist caused hypothermia, suggesting that peripheral A3AR-expressing cells drive the hypothermia. Mast cells release histamine, and blocking central histamine H1 (but not H2 or H4) receptors prevented the hypothermia. The hypothermia was preceded by hypometabolism and mice with hypothermia preferred a cooler environmental temperature, demonstrating that the hypothermic state is a coordinated physiologic response with a reduced body temperature set point. Importantly, hypothermia is not required for the analgesic effects of A3AR agonists, which occur with lower agonist doses. These results support a mechanistic model for hypothermia in which A3AR agonists act on peripheral mast cells, causing histamine release, which stimulates central histamine H1 receptors to induce hypothermia. This mechanism suggests that A3AR agonists will probably not be useful for clinical induction of hypothermia. PMID:26606937
Hulstijn, J.H.; de Marchena, E.
This article follows up on a study by Dagut and Laufer (1985), who found that Hebrew learners of English avoid phrasal verbs, such as ‘let down’, while preferring one-word verbs, such as ‘;disappoint’, since phrasal verbs do not exist in Hebrew. A corollary derived from Dagut and Laufer's study is that Dutch learners of English would tend not to avoid English phrasal verbs, since phrasal verbs also exist in Dutch. It was hypothesized, however, that Dutch learners of English as a second langua...
Kammersgaard, Trine S; Pedersen, Lene Juul; Jørgensen, Erik
data. The statistical variables were divided into blocks according to level (design and litter) and chronological order (prenatal, birth, perinatal, and thermoregulatory success at 2 h) before applying the graphical model to the data. Bayesian-Information-Criteria (BIC) was used for model selection...... 635 crossbred neonatal piglets, the aim of this study was to identify the links among different physiological and behavioral measures and their connections to the piglets’ ability to overcome initial postnatal hypothermia, with rectal temperature at 2 h as the response variable. The data included....... The BIC relates to maximum likelihood but introduces an additional penalty term for the number of parameters. The strength of an association between 2 variables is reported as the increase in BIC (BICinc) due to removing the link. Results indicate that at 2 h, 22.1% of the piglets had a rectal...
J.H. Hulstijn; E. Marchena
This article follows up on a study by Dagut and Laufer (1985), who found that Hebrew learners of English avoid phrasal verbs, such as ‘let down’, while preferring one-word verbs, such as ‘;disappoint’, since phrasal verbs do not exist in Hebrew. A corollary derived from Dagut and Laufer's study is t
Full Text Available Introduction. Pulmonary embolism as a possible cause of acute heart failure is a potentially fatal condition that can cause death in all age groups. Patients successfully resuscitated after cardiac arrest have a high risk of increased mortality and their poor longterm outcome is often associated with severe neurological complications. Case Outline. This is a case report of a 67yearold man after a successful cardiopulmonary resuscitation (CPR which was followed by therapeutic hypothermia (TH. The patient visited the dermatological outpatients’ department with clinical presentation of pain and swelling of the right leg, shortness of breath and chest pain. During examination the patient lost consciousness, stopped breathing and had cardiac arrest. ECG was done which registered asystole. We began CPR. After 59 minutes of resuscitation return of heartbeat was achieved. The patient was transported to the Emergency Department. On admission, after computerized tomography (CT of the chest confirmed massive pulmonary embolism (PE, the patient was administered thrombolytic therapy with Metalyse (tenecteplase and anticoagulation therapy (heparin. After stabilization, therapeutic hypothermia was applied. Combination of EMCOOLSpad on the chest and abdomen and cold Ringer lactate 500 ml at 4°C was flushed. Temperature was decreased to 33°C and kept stabile for 24 hours. After eight days the patient was conscious with a minimal neurological deficit. Conclusion. As shown in this case report, and according to the rich experience elsewhere, cooling therapy after outofhospital cardiac arrest and successful CRP may be useful in preventing neurological complications.
White, C W; Ambrose, E; Müller, A; Li, Y; Le, H; Thliveris, J; Arora, R C; Lee, T W; Dixon, I M C; Tian, G; Nagendran, J; Hryshko, L V; Freed, D H
The resuscitation of hearts donated after circulatory death (DCD) is gaining widespread interest; however, the method of initial reperfusion (IR) that optimizes functional recovery has not been elucidated. We sought to determine the impact of IR temperature on the recovery of myocardial function during ex vivo heart perfusion (EVHP). Eighteen pigs were anesthetized, mechanical ventilation was discontinued, and cardiac arrest ensued. A 15-min standoff period was observed and then hearts were reperfused for 3 min at three different temperatures (5°C; N = 6, 25°C; N = 5, and 35°C; N = 7) with a normokalemic adenosine-lidocaine crystalloid cardioplegia. Hearts then underwent normothermic EVHP for 6 h during which time myocardial function was assessed in a working mode. We found that IR coronary blood flow differed among treatment groups (5°C = 483 ± 53, 25°C = 722 ± 60, 35°C = 906 ± 36 mL/min, p < 0.01). During subsequent EVHP, less myocardial injury (troponin I: 5°C = 91 ± 6, 25°C = 64 ± 16, 35°C = 57 ± 7 pg/mL/g, p = 0.04) and greater preservation of endothelial cell integrity (electron microscopy injury score: 5°C = 3.2 ± 0.5, 25°C = 1.8 ± 0.2, 35°C = 1.7 ± 0.3, p = 0.01) were evident in hearts initially reperfused at warmer temperatures. IR under profoundly hypothermic conditions impaired the recovery of myocardial function (cardiac index: 5°C = 3.9 ± 0.8, 25°C = 6.2 ± 0.4, 35°C = 6.5 ± 0.6 mL/minute/g, p = 0.03) during EVHP. We conclude that the avoidance of profound hypothermia during IR minimizes injury and improves the functional recovery of DCD hearts. PMID:26780159
Basyuni, Shadi; Panayi, Andreana; Sharma, Valmiki; Santhanam, Vijay
Introduction We present the case of an overlooked scalp laceration in an 81-year-old lady who presented with polytrauma following a fall down stairs. Complications that developed required more extensive treatment compared to what would have sufficed with early identification. Presentation of case Imaging on admission to hospital showed multiple vertebrae and rib fractures as well as a large cranial subcutaneous haematoma with no intracerebral bleed. Before the laceration was identified, the patient developed acute anaemia requiring transfusion. Continued reduction in haemoglobin levels called for a more thorough examination of the scalp. Investigation, following copious irrigation, revealed a large laceration. The presence of infection and necrotic tissue necessitated a general anaesthetic for debridement and closure. Disscussion Diagnostic errors are more common in patients presenting with multiple or severe injuries. Initial management in trauma cases should focus on more evident or life threatening injuries However, it is important that reflections and recommendations are continually made to reduce diagnostic errors, which are higher in polytraumatised patients. Various factors including haemodynamic instability and patient positioning added to the elusive nature of this wound. Adequate examination of lacerations requires thorough cleaning as coagulated blood and other material may obscure findings. This is particularly important in scalp lacerations where the overlying hair can form a barrier that is effective at hiding the wound edges. Conclusion This case highlights the importance of a thorough secondary survey; an effective examination technique would have avoided the need for extensive treatment to manage the sequelae of the missed scalp laceration. PMID:27088847
Hypothermia is a serious medical condition that strikes during very cold weather or when people are chilled from rain, sweat, or cold water. Created: 11/1/2007 by Emergency Communications System. Date Released: 12/13/2007.
Full Text Available The politics and tax legislation being a manifestation of strict sovereignty of the State, the phenomenon of double taxation occursfrequently representing a difficult poison for the foreign trade activity, especially hindering investments abroad, technology transfer or proliferationoutside of the state of the companies’ branches. Therefore, international legal double taxation, by the repeated taxation of the income, it is anobstacle to the development of economic relations between states, reducing the revenue of the international operators and their interests in makinginvestment abroad. This paper presents the main causes that determine double taxation, its forms, i.e. the economic double taxation and theinternational legal double taxation, the need for eliminating the double taxation and avoidance methods.
Schulman, H.; Laufer, L.; Berginer, J.; Hertzanu, Y. [Department of Radiology, Soroka Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, P. O. Box 151, Beer-Sheva 84101 (Israel); Hershkowitz, E.; Berenstein, T.; Sofer, S. [Pediatric Intensive Care Unit, Soroka Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva (Israel); Maor, E. [Department of Pathology, Soroka Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva (Israel)
Background. Newborn infants are particularly prone to hypothermia, a condition with a high mortality. Objective. To study the CT brain patterns in infants with hypothermia and neurological symptoms. Materials and methods. We reviewed the brain CT of nine infants with neonatal hypothermia, multiple organ failure, seizures and coma. Results. Two infants had normal CT scans, acutely and at follow-up, and were clinically normal at follow-up. In seven infants, CT showed diffuse cerebral oedema, with reversal of the normal density relationship between grey and white matter and a relative increased density of the thalami, brainstem and cerebellum - the `reversal sign`. In six surviving infants with severe developmental delay, follow-up CT revealed cerebral atrophy with multicystic encephalomalacia. Conclusions. The `reversal sign` has been described in the abused child, birth asphyxia and anoxia due to drowning. Neonatal hypothermia is offered as a further cause. (orig.) With 6 figs., 1 tab., 13 refs.
Background. Newborn infants are particularly prone to hypothermia, a condition with a high mortality. Objective. To study the CT brain patterns in infants with hypothermia and neurological symptoms. Materials and methods. We reviewed the brain CT of nine infants with neonatal hypothermia, multiple organ failure, seizures and coma. Results. Two infants had normal CT scans, acutely and at follow-up, and were clinically normal at follow-up. In seven infants, CT showed diffuse cerebral oedema, with reversal of the normal density relationship between grey and white matter and a relative increased density of the thalami, brainstem and cerebellum - the 'reversal sign'. In six surviving infants with severe developmental delay, follow-up CT revealed cerebral atrophy with multicystic encephalomalacia. Conclusions. The 'reversal sign' has been described in the abused child, birth asphyxia and anoxia due to drowning. Neonatal hypothermia is offered as a further cause. (orig.)
Full Text Available Introduction. The single most important clinically relevant cause of global cerebral ischemia is cardiac arrest. The estimated rate of sudden cardiac arrest is between 40 and 130 cases per 100.000 people per year. Almost 80% of patients initially resuscitated from cardiac arrest remain comatose for more than one hour. One year after cardiac arrest only 10-30% of these patients survive with good neurological outcome. The ability to survive anoxic no-flow states is dramatically increased with protective and preservative hypothermia. The results of clinical studies show a marked neuroprotective effect of mild hypothermia in resuscitation. Material and Methods. In our clinic, 12 patients were treated with therapeutic hypothermia. A combination of intravascular and external method of cooling was used according to the ILCOR (International Liaison Committee on Resuscitation guidelines. The target temperature was 33oC, while the duration of cooling was 24 hours. After that, passive rewarming was allowed. All patients also received other necessary therapy. Results. Six patients (50% had a complete neurological recovery. Two patients (16.6% had partial neurological recovery. Four patients (33.3% remained comatose. Five patients (41.66% survived, while 7 (58.33% patients died. The main cause of cardiac arrest was acute myocardial infarction (91.6%. One patient had acute myocarditis. Conclusion. Mild resuscitative hypothermia after cardiac arrest improves neurological outcome and reduces mortality in comatose survivors. .
According to literature, therapeutic hypothermia has been applied for treating conditions that causes an interruption in the delivery of oxygen to the brain, giving the patient better chances of survival with a neurological recovery and without any irreversible damage to the brain. Hypothermia is also used during surgeries and circulatory arrest. In this article, the objective temperature of hypothermia is 32 °C, which is considered mild: 32–35 °C. Three techniques of hypothermia induction were considered: external blood cooling, endovascular cooling with a catheter insertion and water bath. Energy and exergy analyses were performed to determine the clinical effectiveness of these techniques and to evaluate the best test parameters, from which it was possible to calculate the body internal temperature, destroyed exergy and exergy efficiency. Moreover, it was proposed an exergy performance index, which takes into account the ability of a given technique to change the exergy of the body. Results indicate that therapeutic hypothermia takes the subject to a state of lower destroyed exergy and higher body exergy efficiency. The exergy performance index shows that lower rates of cooling lead to a better transformation of the exergy removed from the body into variation of the body exergy. - Highlights: • Thermodynamic study of the human body under mild hypothermia. • Energy and Exergy analysis were applied to the human thermal model. • Calculation of destroyed exergy, exergy efficiency. • Hypothermia led the body to a state of lower destroyed exergy. • EBC achieved higher values of destroyed exergy and exergy efficiency
Guido Luis Gomes Otto
Full Text Available Objective: to evaluate occurrence of avoidable-mortality causes on the waiting list of patients at the intensive care units. Methods: one thousand, two hundred and twelve enrollments of patients from all age groups were analyzed and classified according to the Brazilian Health System for causes of avoidable mortality. Descriptive statistics for simple, relative and mean frequency rates were employed for the comparative analysis of the variables. Results: cases of non-communicable diseases, among the avoidable-mortality causes, occupied more than 80.0% of intensive care unit´s beds. Hospitalizations comprised illnesses of the circulatory and respiratory apparatus, especially in patients over 40 years old, together with the external causes and consequences of pregnancy and puerperium with mortality rates within the 15-39 age group. Conclusion: the high proportion of patients with diseases from avoidable causes on the waiting list for intensive care units hospitalization suggest that improvements in the programs involved with the prevention of diseases, especially non-communicable diseases, are needed.
... fact, some older people can have a mild form of hypothermia if the temperature in their home is too cool. What Are The Signs Of Hypothermia? When you think about being cold, you probably think of shivering. That is one ...
Feist, Wolfgang; Born, Rolf
Thermal bridges increase the heat demand, affect the thermal comfort, facilitate mould cultures and cause structural damage. Many thermal bridges can be avoided by proper building construction details. At least the impact of thermal bridges can be avoided.
Protect yourself against hypothermia and frostbite during cold weather. Wear warm clothing that covers your skin and remove any wet clothing immediately. Created: 11/1/2007 by Emergency Communications System. Date Released: 12/13/2007.
Johansen, Maria E; Jensen, Jens-Ulrik; Bestle, Morten H;
trial; The Cooling And Surviving Septic shock (CASS) study. Patients suffering severe sepsis/septic shock are allocated to either mild induced hypothermia (cooling to 32-34°C for 24hours) or control (uncontrolled temperature). TRIAL REGISTRATION: NCT01455116. Thrombelastography (TEG) is performed three...
Bernard, S A
Out-of-hospital cardiac arrest is common and patients who are initially resuscitated by ambulance officers and transported to hospital are usually admitted to the intensive care unit (ICU). In the past, the treatment in the ICU consisted of supportive care only, and most patients remained unconscious due to the severe anoxic neurological injury. It was this neurological injury rather than cardiac complications that caused the high rate of morbidity and mortality. However, in the early 1990's, a series of animal experiments demonstrated convincingly that mild hypothermia induced after return of spontaneous circulation and maintained for several hours dramatically reduced the severity of the anoxic neurological injury. In the mid-1990's, preliminary human studies suggested that mild hypothermia could be induced and maintained in post-cardiac arrest patients without an increase in the rate of cardiac or other complications. In the late 1990's, two prospective, randomised, controlled trials were conducted and the results confirmed the animal data that mild hypothermia induced after resuscitation and maintained for 12 - 24 hours dramatically improved neurological and overall outcomes. On the basis of these studies, mild hypothermia was endorsed in 2003 by the International Liaison Committee on Resuscitation as a recommended treatment for comatose patients with an initial cardiac rhythm of ventricular fibrillation. However, the application of this therapy into routine clinical critical care practice has been slow. The reasons for this are uncertain, but may relate to the relative complexity of the treatment, unfamiliarity with the pathophysiology of hypothermia, lack of clear protocols and/or uncertainty of benefit in particular patients. Therefore, recent research in this area has focused on the development of feasible, inexpensive techniques for the early, rapid induction of mild hypothermia after cardiac arrest. Currently, the most promising strategy is a rapid
Brian A. Holden
Full Text Available In the late 1990s, two papers from very different parts of the world, Australia and India, highlighted the fact that uncorrected refractive error was a significant cause of blindness and the major cause of impaired vision.1,2 Since then, the World Health Organization (WHO and the International Agency for the Prevention of Blindness (IAPB, both separately and in their joint initiative, VISION 2020: The Right to Sight, have worked very hard to put uncorrected refractive error on the blindness prevention agenda and to develop strategies for the elimination of this most simple avoidable cause of vision loss. They have been joined in these efforts by international non-governmental development organisations with expertise or programmes in this field, such as the International Centre for Eyecare Education (ICEE, Sightsavers International (SSI, Christian Blind Mission (CBM, Helen Keller International (HKI, and the World Council of Optometry (WCO.
Full Text Available No abstract available. Article truncated after 150 words. Nielsen N, Wetterslev J, Cronberg T, et al. Targeted temperature management at 33°C versus 36°C after cardiac arrest. N Engl J Med. 2013;369(23:2197-206. Therapeutic hypothermia is recommended by international resuscitation guidelines for unconscious patients who regain spontaneous circulation after cardiac arrest (1. Two randomized controlled trials in 2002 demonstrated that mild therapeutic hypothermia significantly improved neurologic outcomes and survival among patients who experienced cardiac arrests due to an initial shockable rhythm (2,3. However, the optimal temperature target for therapeutic hypothermia has yet to be determined. The Target Temperature Management (TTM-36 study was an international randomized control trial that investigated the benefits and harms of two temperature targets, 33°C and 36°C, among 950 participants who experienced out-of-hospital cardiac arrest. Participants were randomly assigned to receive 24 hours of therapeutic hypothermia at a temperature of 33°C or 36°C. The primary outcome was all-cause mortality through the end of the trial (180 days …
Adorisio, Ottavio; De Peppo, Francesco; Rivosecchi, Massimo; Silveri, Massimiliano
Enterobius vermicularis may cause infections of the gastrointestinal tract and occurs approximately in 4% to 28% of children worldwide. It is most common in children aged 5 to 14 years.The most commonly reported symptoms are pruritus in the perianal region, abdominal pain, urinary tract infection, insomnia, irritability, salpingitis, and appendicitis, whereas intestinal obstruction is a very rare but would be considered to perform the right instrumental examination avoiding unnecessary surgical exploration.We report a case of an 8-year-old boy with an intestinal occlusion due to a colonic intussusception by Enterobius vermicularis managed conservatively. PMID:26196360
Sabiye Yılmaz; Mehmet Akif Çakar; Mehmet Bülent Vatan; Harun Kılıç; Nurgül Keser
Drowning is one of the fatal accidents frequently encountered during the summer and is the most common cause of accidental death in the world. Anoxia, hypothermia, and metabolic acidosis are mainly responsible for morbidty. Cardiovascular effects may occur secondary to hypoxia and hypothermia. Atrial fibrillation, sinus dysrhythmias (rarely requiring treatment), and, in serious cases, ventricular fibrillation or asystole may develop, showing as rhythm problems on electrocardiogram and Osborn ...
Settergren, Jennifer; Eiermann, Birgit; Mannheimer, Buster
Purpose To investigate the extent to which clinicians avoid well-established drug-drug interactions that cause statin-induced myopathy. We hypothesised that clinicians would avoid combining erythromycin or verapamil/diltiazem respectively with atorvastatin or simvastatin. In patients with statin-fibrate combination therapy, we hypothesised that gemfibrozil was avoided to the preference of bezafibrate or fenofibrate. When combined with verapamil/diltiazem or fibrates, we hypothesized that the ...
Full Text Available Drowning is one of the fatal accidents frequently encountered during the summer and is the most common cause of accidental death in the world. Anoxia, hypothermia, and metabolic acidosis are mainly responsible for morbidty. Cardiovascular effects may occur secondary to hypoxia and hypothermia. Atrial fibrillation, sinus dysrhythmias (rarely requiring treatment, and, in serious cases, ventricular fibrillation or asystole may develop, showing as rhythm problems on electrocardiogram and Osborn wave can be seen, especially during hypothermia. A 16-year-old male patient who was admitted to our hospital’s emergency service with drowning is presented in this article. In our case, ventricular fibrillation and giant J wave (Osborn wave associated with hypothermia developed after drowning was seen. We present this case as a reminder of ECG changes due to hypothermia that develop after drowning. Response to cardiopulmonary resuscitation after drowning and hypothermia is not very good. Mortality is very high, so early resuscitation and aggressive treatment of cardiovascular and respiratory problems are important for life.
朱帅; 闵昱源; 郑少华; 周艳楠; 张丽娜; 景桂霞
Objective To evaluate the effects of intraoperative warming with and without 1 hour of preoperative warming, in preventing intraoperative and postoperative hypothermia. Methods Thirty ASA physical status I and II female patients scheduled for elective abdominal surgery received standard general anesthesia. In 10 patients, no special precautions were taken ( Gl group ); 10 patients were submitted to preoperative and intraoperative active warming ( G2 group ); 10 patients were only warmed intraoperatively ( G3 group ). Temperatures were recorded at 30 min intervals. Results The patients in G2 had high skin and core temperatures than Gl group during two hours of anesthesia and the core temperatures were higher at 90 and 120 min than G3 group ( P <0.05 ). Patients in G2 and G3 were extubated early and none had shivering. In contrast, patients in Gl had low temperature and five patients shivered. Conclusion One hour of preoperative warning combined with intraoperative warming can prevent intra - or postoperative hypothermia and shivering and offer good conditions for early tracheal extubation.%目的 观察术中保暖联合或不联合术前1 h保暖,对全麻手术患者术中和术后低体温的影响.方法 收集30例美国麻醉师协会(ASA)分级I～Ⅱ级女性择期腹部手术常规全身麻醉患者.10例不给于保暖措施(G1组);10例术前1 h联合术中保暖(G2组);10例仅术中保暖(G3组).各组患者每30 min记录体温一次.结果 G2组患者手术2 h内体表和核心体均温高于G1组,其术中90 min和120 min核心体温高于G3组(P<0.05).G2和G3组术后拔管较早且无寒颤反应;G1组手术结束时体温较低且5例患者发生寒颤.结论 术前1 h联合术中保暖能避免全麻手术术中和术后低体温、寒颤发生,给拔管提供良好条件.
Olsen, Tom Skyhøj; Weber, Uno Jakob; Kammersgaard, Lars Peter
Experimental evidence and clinical experience show that hypothermia protects the brain from damage during ischaemia. There is a growing hope that the prevention of fever in stroke will improve outcome and that hypothermia may be a therapeutic option for the treatment of stroke. Body temperature is...... directly related to stroke severity and outcome, and fever after stroke is associated with substantial increases in morbidity and mortality. Normalisation of temperature in acute stroke by antipyretics is generally recommended, although there is no direct evidence to support this treatment. Despite its...... obvious therapeutic potential, hypothermia as a form of neuroprotection for stroke has been investigated in only a few very small studies. Therapeutic hypothermia is feasible in acute stroke but owing to serious side-effects--such as hypotension, cardiac arrhythmia, and pneumonia--it is still thought of...
Full Text Available Abstract Background Traumatic brain injury is a major cause of death and severe disability worldwide with 1,000,000 hospital admissions per annum throughout the European Union. Therapeutic hypothermia to reduce intracranial hypertension may improve patient outcome but key issues are length of hypothermia treatment and speed of re-warming. A recent meta-analysis showed improved outcome when hypothermia was continued for between 48 hours and 5 days and patients were re-warmed slowly (1°C/4 hours. Previous experience with cooling also appears to be important if complications, which may outweigh the benefits of hypothermia, are to be avoided. Methods/design This is a pragmatic, multi-centre randomised controlled trial examining the effects of hypothermia 32-35°C, titrated to reduce intracranial pressure Participants are randomised to either standard care or standard care with titrated therapeutic hypothermia. Hypothermia is initiated with 20-30 ml/kg of intravenous, refrigerated 0.9% saline and maintained using each centre's usual cooling technique. There is a guideline for detection and treatment of shivering in the intervention group. Hypothermia is maintained for at least 48 hours in the treatment group and continued for as long as is necessary to maintain intracranial pressure 20 mmHg in accordance with the Brain Trauma Foundation Guidelines, 2007. Discussion The Eurotherm3235Trial is the most important clinical trial in critical care ever conceived by European intensive care medicine, because it was launched and funded by the European Society of Intensive Care Medicine and will be the largest non-commercial randomised controlled trial due to the substantial number of centres required to deliver the target number of patients. It represents a new and fundamental step for intensive care medicine in Europe. Recruitment will continue until January 2013 and interested clinicians from intensive care units worldwide can still join this important
Knobel, B; Mikhlin, A
. Respiratory and metabolic, sometimes lactic, acidosis, lethargy and coma, hypercoagulopathy, hyperosmolar state, acute pancreatitis and renal and hepatic failure are frequent complications of hypothermia. Underlying predisposing causes of hypothermia are diabetic ketoacidosis, cerebrovascular disease, mental retardation, hypothyroidism, pituitary and adrenal insufficiency, malnutrition, acute alcoholism, liver damage, hypoglycemia, sepsis, hypothalamic dysfunction, sepsis and polypharmacy, and especially, the use of sedative and narcotic drugs. Our case demonstrates once again that CPR once begun should continue until the successful rewarming because "no one is dead until warm and dead". PMID:11759373
Higgins, Rosemary D.; Shankaran, Seetha
Hypothermia for hypoxic ischemic encephalopathy has recently permeated clinical practice for term infants. Speculation regarding a neuroprotective benefit of hypothermia for premature infants with HIE has been raised as a need for further research. Hypothermia for other indications including necrotizing enterocolitis with the hope of tissue preservation following injury is less well studied. A summary of evidence for hypothermia and premature infants is presented in this brief report.
Mesopelagic fishes occur in all the world’s oceans, but their abundance and consequently their ecological significance remains uncertain. The current global estimate based on net sampling prior to 1980 suggests a global abundance of one gigatonne (109 t) wet weight. Here we report novel evidence of efficient avoidance of such sampling by the most common myctophid fish in the Northern Atlantic, i.e. Benthosema glaciale. We reason that similar avoidance of nets may explain consistently higher acoustic abundance estimates of mesopelagic fish from different parts of the world’s oceans. It appears that mesopelagic fish abundance may be underestimated by one order of magnitude, suggesting that the role of mesopelagic fish in the oceans might need to be revised.
Olsen, Tom Skyhøj; Weber, Uno Jakob; Kammersgaard, Lars Peter
directly related to stroke severity and outcome, and fever after stroke is associated with substantial increases in morbidity and mortality. Normalisation of temperature in acute stroke by antipyretics is generally recommended, although there is no direct evidence to support this treatment. Despite its...... obvious therapeutic potential, hypothermia as a form of neuroprotection for stroke has been investigated in only a few very small studies. Therapeutic hypothermia is feasible in acute stroke but owing to serious side-effects--such as hypotension, cardiac arrhythmia, and pneumonia--it is still thought of...
Alsirafy, Samy A; Raheem, Ahmad A; Al-Zahrani, Abdullah S; Mohammed, Amrallah A; Sherisher, Mohamed A; El-Kashif, Amr T; Ghanem, Hafez M
Frequent emergency department visits (EDVs) by patients with terminal cancer indicates aggressive care. The pattern and causes of EDVs in 154 patients with terminal cancer were investigated. The EDVs that started during working hours and ended by home discharge were considered avoidable. During the last 3 months of life, 77% of patients had at least 1 EDV. In total, 309 EDVs were analyzed. The EDVs occurred out of hour in 67%, extended for an average of 3.6 hours, and ended by hospitalization in 52%. The most common chief complaints were pain (46%), dyspnea (13%), and vomiting (12%). The EDVs were considered avoidable in 19% of the visits. The majority of patients with terminal cancer visit the ED before death, mainly because of uncontrolled symptoms. A significant proportion of EDVs at the end of life is potentially avoidable. PMID:25877944
Electron terms in the field of two stationary Coulomb centres (TCCs) of charges Z and Z' separated by a distance R are a fundamental problem of quantum mechanics, presenting fascinating atomic physics: the terms show crossings and avoided crossings. In the latter situation, the electron has a much larger probability of tunnelling from one well to the other (i.e. of charge exchange) than in the absence of such degeneracy. These rich features of the TCC problem are also manifest in different areas of physics such as plasma spectroscopy. Recently it was shown experimentally that charge exchange, enhanced by the encounter of two TCC terms, can result in an unusual structure (a dip) in the spectral line profile emitted by a Z ion from a plasma consisting of both Z and Z' ions. In this paper we present a detailed quantitative theory of this phenomenon, in which its origin is directly traced to the avoided crossings of terms in the TCC problem. We show that our theory explains quantitatively all the results of the above experiment where such a dip was observed in a hydrogen line. We also consider in detail several prospective 'radiator-perturber' pairs for observing these signatures of charge exchange in lines of hydrogen-like ions. Further experimental studies of such dips would serve to produce not-yet-available fundamental data on charge exchange between multicharged ions, virtually inaccessible by other experimental methods. (author)
Full Text Available Microenvironment has been increasingly recognized as a critical regulator of cancer progression. In this study, we identified early changes in the microenvironment that contribute to malignant progression. Exposure of human bronchial epithelial cells (BEAS-2B to methylnitrosourea (MNU caused a reduction in cell toxicity and an increase in clonogenic capacity when the temperature was lowered from 37°C to 28°C. Hypothermia-incubated adipocyte media promoted proliferation in A549 cells. Although a hypothermic environment could increase urethane-induced tumor counts and Lewis lung cancer (LLC metastasis in lungs of three breeds of mice, an increase in tumor size could be discerned only in obese mice housed in hypothermia. Similarly, coinjections using differentiated adipocytes and A549 cells promoted tumor development in athymic nude mice when adipocytes were cultured at 28°C. Conversely, fat removal suppressed tumor growth in obese C57BL/6 mice inoculated with LLC cells. Further studies show hypothermia promotes a MNU-induced epithelial-mesenchymal transition (EMT and protects the tumor cell against immune control by TGF-β1 upregulation. We also found that activated adipocytes trigger tumor cell proliferation by increasing either TNF-α or VEGF levels. These results suggest that hypothermia activates adipocytes to stimulate tumor boost and play critical determinant roles in malignant progression.
Bahubali D Gane
Full Text Available Introduction: Perinatal asphyxia is a major cause for neonatal mortality and morbidity around the world. The reduction of O2results in the generation of reactive oxygen species which interact with nucleic acid and make alteration in the structure and functioning of the genome. We studied the effect of therapeutic hypothermia on chromosomes with karyotyping. Subjects and Methods: Babies in the hypothermia group were cooled for the first 72 h, using gel packs. Rectal temperature of 33–34°C was maintained. Blood sample was collected after completion of therapeutic hypothermia for Chromosomal analysis. It was done with IKAROS Karyotyping system, Metasystems, based on recommendations of International system of human cytogenetic nomenclature. Results: The median chromosomal aberration was lower in hypothermia [2(0-5] than control group [4(1-7] and chromatid breakage was commonest aberration seen. Chromosomal aberration was significantly higher in severe encephalopathy group than moderate encephalopathy group. Conclusion: We conclude that the TH significantly reduces DNA damage in perinatal asphyxia.
Scher, A T
The type and circumstances of injury to 14 rugby players with cervical spinal cord damage sustained during a tackle have been analysed. Two specific mechanisms of injury were evident. Four players were injured when their heads collided with fixed objects while they were attempting to tackle an opponent. Ten players were injured while being tackled and 5 of them were tackled around the neck. The risk of trauma to the cervical spine caused by the force applied to the neck in a high tackle is discussed. The susceptibility of the ligaments of the cervical spine to the rotational force exerted during a high tackle is stressed. An amendment to the rules of rugby, which would reduce cervical trauma, is suggested. PMID:694671
Yuan, Rui; Zhang, Zhi-cheng
Accidental hypothermia refers to a state of lowering of core body temperature down to 35 ℃induced by drowning, burial in snow and prolonged exposure to cold environment, etc. Hypothermia may affect the cardiovascular system, respiratory system, digestive system, etc. The triad consisting "hypothermia, acidosis and coagulopathy" is an important factor accelerating the death of patients. Early, timely application of rewarming measures is regarded as the basic principle in treatment of hypotherm...
Kandasamy, S.B.; Hunt, W.A.; Harris, A.H. (Armed Forces Radiobiology Research Institute, Bethesda, MD (USA))
The role of neurotensin in radiation-induced hypothermia was examined. Intracerebroventricular (ICV) administration of neurotensin produced dose-dependent hypothermia. Histamine appears to mediate neurotensin-induced hypothermia because the mast cell stabilizer disodium cromoglycate and antihistamines blocked the hypothermic effects of neurotensin. An ICV pretreatment with neurotensin antibody attenuated neurotensin-induced hypothermia, but did not attenuate radiation-induced hypothermia, suggesting that radiation-induced hypothermia was not mediated by neurotensin.
Full Text Available PURPOSE: To investigate the extent to which clinicians avoid well-established drug-drug interactions that cause statin-induced myopathy. We hypothesised that clinicians would avoid combining erythromycin or verapamil/diltiazem respectively with atorvastatin or simvastatin. In patients with statin-fibrate combination therapy, we hypothesised that gemfibrozil was avoided to the preference of bezafibrate or fenofibrate. When combined with verapamil/diltiazem or fibrates, we hypothesized that the dispensed doses of atorvastatin/simvastatin would be decreased. METHODS: Cross-sectional analysis of nationwide dispensing data. Odds ratios of interacting erythromycin, verapamil/diltiazem versus respective prevalence of comparator drugs doxycycline, amlodipine/felodipine in patients co-dispensed interacting statins simvastatin/atorvastatin versus patients unexposed (pravastatin/fluvastatin/rosuvastatin was calculated. For fibrates, OR of gemfibrozil versus fenofibrate/bezafibrate in patients co-dispensed any statin was assessed. RESULTS: OR of interacting erythromycin versus comparator doxycycline did not differ between patients on interacting and comparator statins either in patients dispensed high or low statin doses (adjusted OR 0.87; 95% CI 0.60-1.25 and 0.92; 95% CI 0.69-1.23. Interacting statins were less common among patients dispensed verapamil/diltiazem as compared to patients on amlodipine/felodipine (OR high dose 0.62; CI 0.56-0.68 and low dose 0.63; CI 0.58-0.68. Patients on any statin were to a lesser extent dispensed gemfibrozil compared to patients not dispensed a statin (OR high dose 0.65; CI 0.55-0.76 and low dose 0.70; CI 0.63-0.78. Mean DDD (SD for any statin was substantially higher in patients co-dispensed gemfibrozil 178 (149 compared to patients on statin monotherapy 127 (93, (p<0.001. CONCLUSIONS: Prescribers may to some extent avoid co-prescription of statins with calcium blockers and fibrates with an increased risk of myopathy
Full Text Available Accidental hypothermia refers to a state of lowering of core body temperature down to 35 ℃induced by drowning, burial in snow and prolonged exposure to cold environment, etc. Hypothermia may affect the cardiovascular system, respiratory system, digestive system, etc. The triad consisting "hypothermia, acidosis and coagulopathy" is an important factor accelerating the death of patients. Early, timely application of rewarming measures is regarded as the basic principle in treatment of hypothermia. A series of rewarming measures, such as infusion of warm fluids, inspiration of warm air, abdominal infusion of warm fluid, instruction of warm fluid into pleural cavity, intravenous infusion of warm fluid, rewarming through ECMO, etc. have been used recently. Advance in research on the classification of hypothermia, its impact to the body and the treatment methods are reviewed in present paper. DOI: 10.11855/j.issn.0577-7402.2016.04.15
Full Text Available Prostate cancer has been extensively studied, but cellular stress responses in healthy prostate tissue are rarely investigated. Hypothermia is known to cause alterations in mRNA and protein expressions and stability. The aim of this study was to use normal rat prostate as a model in order to find out consequences of cold exposure and rewarming on the expressions of genes which are either members or functionally/structurally related to erythroblastic leukemia viral oncogene B (ErbB signaling pathway. Relative mRNA expressions of amphiregulin (AMR, cyclin D1 (CyD1, cyclin-dependent kinase inhibitor 1A (p21, transmembrane form of the prostatic acid phosphatase (PAcP, thrombomodulin (TM and heat shock transcription factor 1 (HSF1 in rat ventral prostate were quantified in mild (2 or 4.5 h at room temperature and severe (2 or 4.5 h at +10°C hypothermia and in rewarming after cold exposure (2 h at +10°C followed by 2 h at room temperature or 3 h at +28°C. AMR protein level, apoptotic Bcl-2 associated X protein to B-cell CLL/lymphoma 2 (Bax/Bcl-2 mRNA ratio and proliferative index Ki-67 were determined. 4.5-h mild hypothermia, 2-h severe hypothermia and rewarming increased expression of all these genes. Elevated proliferation index Ki-67 could be seen in 2-h severe hypothermia, and the proliferation index had its highest value in longer rewarming with totally recovered normal body temperature. Pro-apoptotic tendency could be seen in 2-h mild hypothermia while anti-apoptosis was predominant in 4.5-h mild hypothermia and in shorter rewarming with only partly recovered body temperature. Hypothermia and following rewarming promote the proliferation of cells in healthy rat prostate tissue possibly via ErbB signaling pathway.
Sosnowski, Przemysław; Mikrut, Kinga; Krauss, Hanna
This review focuses on the physiological responses and pathophysiological changes induced by hypothermia. Normal body function depends on its ability to maintain thermal homeostasis. The human body can be divided arbitrarily into two thermal compartments: a core compartment (trunk and head), with precisely regulated temperature around 37°C, and a peripheral compartment (skin and extremities) with less strictly controlled temperature, and lower than the core temperature. Thermoregulatory processes occur in three phases: afferent thermal sensing, central regulation, mainly by the preoptic area of the anterior hypothalamus, and efferent response. Exposure to cold induces thermoregulatory responses including cutaneous vasoconstriction, shivering and non-shivering thermogenesis, and behavioral changes. Alterations of body temperature associated with impaired thermoregulation, decreased heat production or increased heat loss can lead to hypothermia. Hypothermia is defined as a core body temperature below 35ºC, and may be classified according to the origin as accidental (e.g. caused by exposure to a cold environment, drugs, or illness) or intentional (i.e. therapeutic), or by the degree of hypothermia as mild, moderate or severe. Classification by temperature is not universal. Lowering of body temperature disrupts the physiological processes at the molecular, cellular and system level, but hypothermia induced prior to cardiosurgical or neurosurgical procedures, by the decrease in tissue oxygen demand, can reduce the risk of cerebral or cardiac ischemic damage. Therapeutic hypothermia has been recommended as a clinical procedure in situations characterized by ischemia, such as cardiac arrest, stroke and brain injuries. PMID:25614675
Kim, Young-Min; Jeong, Ju-Hwan; Kyong, Yeon-Young; Kim, Han-Joon; Kim, Ji-Hoon; Park, Jeong-Ho; Park, Kyu-Nam
We report a case in which mild hypothermia was induced successfully using a cold intravenous fluid infusion in a 12-year-old boy who was comatose following 21 min of cardiac arrest caused by a lightning strike. PMID:18805616
Settergren, Jennifer; Eiermann, Birgit; Mannheimer, Buster
Purpose To investigate the extent to which clinicians avoid well-established drug-drug interactions that cause statin-induced myopathy. We hypothesised that clinicians would avoid combining erythromycin or verapamil/diltiazem respectively with atorvastatin or simvastatin. In patients with statin-fibrate combination therapy, we hypothesised that gemfibrozil was avoided to the preference of bezafibrate or fenofibrate. When combined with verapamil/diltiazem or fibrates, we hypothesized that the dispensed doses of atorvastatin/simvastatin would be decreased. Methods Cross-sectional analysis of nationwide dispensing data. Odds ratios of interacting erythromycin, verapamil/diltiazem versus respective prevalence of comparator drugs doxycycline, amlodipine/felodipine in patients co-dispensed interacting statins simvastatin/atorvastatin versus patients unexposed (pravastatin/fluvastatin/rosuvastatin) was calculated. For fibrates, OR of gemfibrozil versus fenofibrate/bezafibrate in patients co-dispensed any statin was assessed. Results OR of interacting erythromycin versus comparator doxycycline did not differ between patients on interacting and comparator statins either in patients dispensed high or low statin doses (adjusted OR 0.87; 95% CI 0.60–1.25 and 0.92; 95% CI 0.69–1.23). Interacting statins were less common among patients dispensed verapamil/diltiazem as compared to patients on amlodipine/felodipine (OR high dose 0.62; CI 0.56–0.68 and low dose 0.63; CI 0.58–0.68). Patients on any statin were to a lesser extent dispensed gemfibrozil compared to patients not dispensed a statin (OR high dose 0.65; CI 0.55–0.76 and low dose 0.70; CI 0.63–0.78). Mean DDD (SD) for any statin was substantially higher in patients co-dispensed gemfibrozil 178 (149) compared to patients on statin monotherapy 127 (93), (pgemfibrozil is paradoxically associated with a marked increased statin dose, further aggravating the risk for severe myopathy. PMID:23940522
During the treatment of stroke by local intra-arterial thrombolysis (LIT) it is frequently possible to pass the blood clot with a micro-catheter, allowing perfusion of brain tissue distally to the occlusion. This possibility allows for new early treatments of ischaemic brain tissue, even before the blood clot has been removed. One potential new approach to preserve brain tissue at risk may be locally induced endovascular hypothermia. Physical parameters such as the required micro-catheter input pressure, output velocity and flow rates, and a heat exchange model, applicable in the case of a micro-catheter placed within a guiding catheter, are presented. Also, a simple cerebral temperature model is derived that models the temperature response of the brain to the perfusion with coolant fluids. Based on this model, an expression has been derived for the time needed to reach a certain cerebral target temperature. Experimental in vitro measurements are presented that confirm the usability of standard commercially available micro-catheters to induce local hypothermia of the brain. If applied in vivo, the model predicts a local cooling rate of ischaemic brain tissue of 300 g of approximately 1 C in 1 min, which is up to a factor 30-times faster than the time-consuming systemic hypothermia via the skin. Systemic body temperature is only minimally affected by application of local hypothermia, thus avoiding many limitations and complications known in systemic hypothermia. (orig.)
Slotboom, J; Kiefer, C; Brekenfeld, C; Ozdoba, C; Remonda, L; Nedeltchev, K; Arnold, M; Mattle, H; Schroth, G
During the treatment of stroke by local intra-arterial thrombolysis (LIT) it is frequently possible to pass the blood clot with a micro-catheter, allowing perfusion of brain tissue distally to the occlusion. This possibility allows for new early treatments of ischaemic brain tissue, even before the blood clot has been removed. One potential new approach to preserve brain tissue at risk may be locally induced endovascular hypothermia. Physical parameters such as the required micro-catheter input pressure, output velocity and flow rates, and a heat exchange model, applicable in the case of a micro-catheter placed within a guiding catheter, are presented. Also, a simple cerebral temperature model is derived that models the temperature response of the brain to the perfusion with coolant fluids. Based on this model, an expression has been derived for the time needed to reach a certain cerebral target temperature. Experimental in vitro measurements are presented that confirm the usability of standard commercially available micro-catheters to induce local hypothermia of the brain. If applied in vivo, the model predicts a local cooling rate of ischaemic brain tissue of 300 g of approximately 1 degrees C in 1 min, which is up to a factor 30-times faster than the time-consuming systemic hypothermia via the skin. Systemic body temperature is only minimally affected by application of local hypothermia, thus avoiding many limitations and complications known in systemic hypothermia. PMID:15551092
... the wind and use a blanket to provide insulation from the cold ground. Cover the person's head ... Physician at FDR Medical Services/Millard Fillmore Suburban Hospital, Buffalo, NY. Also reviewed by David Zieve, MD, ...
... the size of our small blood vessels and shivering—to help us maintain a healthy body temperature,” ... and hands Puffy or swollen face Pale skin Shivering (although people with hypothermia don’t always shiver) ...
Zygielbaum, A. I.; Arkebauer, T. J.; Walter-Shea, E.
Vegetation photoprotective responses impact the reflected spectra in the visible or photosynthetically active (PAR) spectral region. Earlier, we presented a case that the increasing PAR reflectance which accompanies increasing water stress was due to one such response, chloroplast avoidance movement. This increasing reflectance has been reported in published papers for several decades and dismissed as operator error or a result of changes in leaf turgor or optical pathway. We showed, however, that such changes in the PAR region, which occurred with no significant change in chlorophyll content, were caused by decreasing absorption, not changes in light scatter. Further, we demonstrated that the changes in reflectance were correlated with changes in ambient light (downwelling radiance). To further refine the case that chloroplast movement is the basis of these observations, excised leaves were exposed separately to either red light or white light illumination of equal photon flux densities. The transmittance observed as these leaves dried increased in the leaves exposed to white light and remained constant in the leaves exposed to red light. Since chloroplast movement is driven by blue light, our conjecture is strengthened. We have also observed distinct morning vs. afternoon differences in reflectance spectra of greenhouse-grown plants; indices derived from these spectra also vary diurnally--leading us to coin the phase 'apparent chlorophyll'. All observations previously reported were the result of greenhouse experiments. We report herein on observations of leaf and canopy reflectances under field conditions and on the impact the increasing reflectance has on estimation of chlorophyll content using spectral indices. We also present evidence that increasing reflectance which is concomitant with increasing plant stress may not correlate with stress indications using the photochemical reflectance index (PRI) and discuss the implications of that observation.
Organ injury caused by ischaemia and anoxia during prolonged cardiac arrest is compounded by reperfusion injury that occurs when spontaneous circulation is restored. Mild hypothermia (32-35 degrees C) is neuroprotective through several mechanisms, including suppression of apoptosis, reduced production of excitotoxins and free radicals, and anti-inflammatory actions. Experimental studies show that hypothermia is more effective the earlier it is started after return of spontaneous circulation (ROSC). Two randomised clinical trials show improved survival and neurological outcome in adults who remained comatose after initial resuscitation from prehospital VF cardiac arrest, and who were cooled after ROSC. Different strategies can be used to induce hypothermia. Optimal timing of therapeutic hypothermia for cardiac ischaemia is unknown. In patients who failed to respond to standard cardiopulmonary resuscitation, intra-arrest cooling using ice-cold intravenous (i.v.) fluid improved the chance of survival. Recently, fasudil, a Rho kinase inhibitor, was reported to prevent cerebral ischaemia in vivo by increasing cerebral blood flow and inhibiting inflammatory responses. In future, two different kinds of protective therapies, BCL-2 overexpression and hypothermia,will both inhibit aspects of apoptotic cell death cascades, and that combination treatment can prolong the temporal "therapeutic window" for gene therapy. PMID:19069351
Full Text Available Organ injury caused by ischemia and anoxia during prolonged cardiac arrest is compounded by reperfusion injury that occurs when spontaneous circulation is restored. Mild hypothermia (32-35ºC is neuroprotective through several mechanisms, including suppression of apoptosis, reduced production of excitotoxins and free radicals, and anti-inflammatory actions. Experimental studies show that hypothermia is more effective the earlier it is started after return of spontaneous circulation (ROSC. Two randomized clinical trials show improved survival and neurological outcome in adults who remained comatose after initial resuscitation from prehospital VF cardiac arrest, and who were cooled after ROSC. Different strategies can be used to induce hypothermia. Optimal timing of therapeutic hypothermia for cardiac ischemia is unknown. In patients who failed to respond to standard cardiopulmonary resuscitation, intra-arrest cooling using ice-cold intravenous (i.v. fluid improved the chance of survival. Recently, fasudil, a Rho kinase inhibitor, was reported to prevent cerebral ischaemia in vivo by increasing cerebral blood flow and inhibiting inflammatory responses. In future, two different kinds of protective therapies, BCL-2 overexpression and hypothermia, will both inhibit aspects of apoptotic cell death cascades, and that combination treatment can prolong the temporal 'therapeutic window' for gene therapy.
Full Text Available Therapeutic hypothermia protects neurons after injury to the central nervous system (CNS. Microglia express toll-like receptors (TLRs that play significant roles in the pathogenesis of sterile CNS injury. To elucidate the possible mechanisms involved in the neuroprotective effect of therapeutic hypothermia, we examined the effects of hypothermic culture on TLR3-activated microglial release of interferon (IFN-β and nitric oxide (NO, which are known to be associated with neuronal cell death. When rat or mouse microglia were cultured under conditions of hypothermia (33°C and normothermia (37°C with a TLR3 agonist, polyinosinic-polycytidylic acid, the production of IFN-β and NO in TLR3-activated microglia at 48 h was decreased by hypothermia compared with that by normothermia. In addition, exposure to recombinant IFN-β and sodium nitroprusside, an NO donor, caused death of rat neuronal pheochromocytoma PC12 cells in a concentration-dependent manner after 24 h. Taken together, these results suggest that the attenuation of microglial production of IFN-β and NO by therapeutic hypothermia leads to the inhibition of neuronal cell death.
Zhang, Jian; Xue, Xiaodong; Xu, Yinli; Zhang, Yuji; Li, Zhi; Wang, Huishan
Hypothermia is widely used in neurosurgery and cardiac surgeries. However, little is known about the underlying molecular mechanisms. We previously reported that the transcriptome responses of cardiomyocyte exposed to hypothermia, "The transcriptome responses of cardiomyocyte exposed to hypothermia" . Herein, we provide the hypothermia inhibited proliferation of cardiomyocyte cells in vitro and the details of transcription factors in regulation of differentially expressed genes. PMID:27274530
Lindroth, A.; Vestin, P.; Sundqvist, E.; Mölder, M.; Bâth, A.; Hellström, M.; Klemedtsson, L.; Weslien, P.
just beside the clear-cut experiment. The CO2 fluxes from the forest were measured by eddy covariance method while soil CO2 and CH4 effluxes were measured by automatic chambers. The thinning was made in November/December 2008. Immediately after the thinning, we found significantly higher soil effluxes, probably due to increased decomposition of dead roots but the soil was still a sink of CH4. The stand level flux measurements showed no effect on total ecosystem respiration, probably because of reduced autotrophic respiration from canopy layer. Initially the GPP was slightly reduced as compared to the non-thinned sector but already after 6-7 months, no effect of the thinning on GPP could be detected. The results indicate that selective harvest such as thinning has the potential to avoid the emissions that occur after a heavy disturbance such as that caused by clear-cutting. Thus, more efforts should be made to study the long-term effects on the total GHG exchange by selective harvest methods as compared to clear-cut methods.
Tadayyon, Maedeh; Zarrinabadi, Nourollah; Ketabi, Saeed
Dealing with learners who prefer to take the back seat and avoid classroom participation can be every teacher's nightmare. This lack of participation may cause teacher frustration, and possibly the only way to reduce this lack of participation is to access the concept of avoidance strategy. Avoidance strategy is the abandonment of a classroom task…
G.J. van der Ploeg; J.C. Goslings; B.H. Walpoth; J.J.L.M. Bierens
Aim of the study: Accidental hypothermia (AH) is a complex and life threatening condition. Knowledge about epidemiology, rewarming treatments, complications and outcome is limited. This study was initiated to obtain data on causes, rewarming treatments and complications. Methods: A retrospective coh
Stravitz, R.T.; Larsen, Finn Stolze
transplantation or spontaneous liver regeneration follows in short order. To buy time, the induction of therapeutic hypothermia (core temperature 32 degrees C-35 degrees C) has been shown to effectively bridge patients to transplant. Similar to the experience in patients with cerebral edema after other neurologic...... of liver injury. Hypothermia has not been adequately studied for its safety and theoretically may increase the risk of infection, cardiac dysrhythmias, and bleeding, all complications independently associated with acute liver failure. Therefore, although an ample body of experimental and human data...
Macleod, Malcolm R; Petersson, Jesper; Norrving, Bo;
The European Hypothermia Stroke Research Workshop was held in January 2010, in response to the alarming prospects of a significant increase of stroke expected in the coming years globally. Considering that a minority of patients (around 10%) are currently eligible for thrombolytic treatment, ther...
Rami Darwazeh; Yi Yan
Besides local neuronal damage caused by the primary insult, central nervous system injuries may secondarily cause a progressive cascade of related events including brain edema, ischemia, oxida-tive stress, excitotoxicity, and dysregulation of calcium homeostasis. Hypothermia is a beneficial strategy in a variety of acute central nervous system injuries. Mild hypothermia can treat high intra-cranial pressure fol owing traumatic brain injuries in adults. It is a new treatment that increases sur-vival and quality of life for patients suffering from ischemic insults such as cardiac arrest, stroke, and neurogenic fever fol owing brain trauma. Therapeutic hypothermia decreases free radical produc-tion, inflammation, excitotoxicity and intracranial pressure, and improves cerebral metabolism after traumatic brain injury and cerebral ischemia, thus protecting against central nervous system dam-age. Although a series of pathological and physiological changes as wel as potential side effects are observed during hypothermia treatment, it remains a potential therapeutic strategy for central nervous system injuries and deserves further study.
Kang, In Sook; Fumiaki, Ikeno; Pyun, Wook Bum
Mild therapeutic hypothermia of 32–35℃ improved neurologic outcomes in outside hospital cardiac arrest survivor. Furthermore, in experimental studies on infarcted model and pilot studies on conscious patients with acute myocardial infarction, therapeutic hypothermia successfully reduced infarct size and microvascular resistance. Therefore, mild therapeutic hypothermia has received an attention as a promising solution for reduction of infarction size after acute myocardial infarction which are...
Full Text Available We report a case of inadvertent hypothermia leading to severe hypotension resistant to high dose vasopressors, which responded to temperature correction in a patient undergoing spinal instrumentation surgery. A 60-year-old female developed severe hypotension during spinal instrumentation surgery. After review of all factors it was found to be secondary to hypothermia. The patient did not respond to high dose vasopressors. However, when normothermia was restored she recovered uneventfully. Patients undergoing lengthy spinal procedures in prone position are vulnerable to develop hypothermia and consequent cardiovascular depression so adequate measures should be taken to prevent hypothermia.
Scaramuzzo, Rosa T; Giampietri, Matteo; Fiorentini, Erika; Bartalena, Laura; Fiori, Simona; Guzzetta, Andrea; Ciampi, Mariella; Boldrini, Antonio; Ghirri, Paolo
Birth asphyxia is a cause of neonatal death or adverse neurological sequelae. Biomarkers can be useful to clinicians in order to optimize intensive care management and communication of prognosis to parents. During perinatal adverse events, increased cortisol secretion is due to hypothalamo-pituitary-adrenal axis activation. We aimed to investigate if cortisol variations during therapeutic hypothermia are associated with neurodevelopmental outcome. We compared 18 cases (neonates with birth asphyxia) with 18 controls (healthy term newborns) and confirmed increased serum cortisol concentrations following the peri-partum adverse event. Among cases, we stratified patients according to neurological outcome at 18 months (group A - good; group B - adverse) and found that after 24 h of therapeutic hypothermia serum cortisol concentration was significantly lower in group A vs group B (28.7 ng/mL vs 344 ng/mL, *p = 0.01). In group B serum, cortisol concentration decreased more gradually during therapeutic hypothermia. We conclude that monitoring serum cortisol concentration during neonatal therapeutic hypothermia can add information to clinical evaluation of neonates with birth asphyxia; cortisol values after the first 24 h of hypothermia can be a biomarker associated with neurodevelopmental outcome at 18 months of age. PMID:25394684
Johansen, Flemming Fryd; Jørgensen, Henrik Stig; Reith, Jakob
In experimental and human stroke, hypothermia is strongly related to a favorable outcome. Previous attempts to manipulate the core temperature in focal cerebral ischemia have been based on mechanical cooling. The purpose of the study is to establish a model for long-term drug-induced hypothermia in...
Dai, Hai-bin; Ji, Xiangjun; Zhu, Si-Hai; Hu, Yi-min; Zhang, Li-dong; Miao, Xiao-lei; Ma, Ru-Meng; Duan, Man-lin; Li, Wei-Yan
Background Both hydrogen sulphide (H2S) and mild hypothermia have been reported to prevent brain damage caused by reperfusion assault through regulating the N-methyl-D-aspartate receptor (NMDAR). However, the relationship between the two treatments and how they exert neuro-protective effects through NMDARs remain to be elucidated. Methods Transient cerebral ischemia was induced using the Pulsinelli four-vessel occlusion method. We used sodium hydrosulphide (NaHS) as the H2S donor. We randomly...
Cheng-You Wang; Yong Ni; Yan Liu; Zhi-Heng Huang; Min-Jie Zhang; Yong-Qiang Zhan; Hai-Bin Gao
AIM: To determine whether mild hypothermia could protect liver against ischemia and reperfusion injury in pigs. METHODS: Twenty-four healthy pigs were randomly divided into normothermia, mild hypothermia and normal control groups. The experimental procedure consisted of temporary interruption of blood flow to total hepatic lobe for different lengths of time and subsequent reperfusion. Hepatic tissue oxygen pressure (PtiO2) and aspartate aminotransferase (AST) values were evaluated, and ultrastructural analysis was carried out for all samples.RESULTS: Serum AST was significantly lower, and hepatic P,O2 values were significantly higher in the mild hypothermia group than in the normothermia group during liver ischemiareperfusion periods (P = 0.032, P = 0.028). Meanwhile, the histopathologic injury of liver induced by ischemiareperfusion was significantly improved in the mild hypothermia group, compared with that in the normothermia group. CONCLUSION: Mild hypothermia can protect the liver from ischemia-reperfusion injury in pigs.
Abstract: Hypothermia is a key symptom of sepsis and the mechanism(s) leading to hypothermia during sepsis is largely unknown. To investigate a potential mechanism and find an effective treatment for hypothermia in sepsis, we induced hypothermia in mice by lipopolysaccharide (LP...
Gaizauskiene, A.; Gurevicius, R
STUDY OBJECTIVE--The study aimed to analyse avoidable mortality in Lithuania as an index of the quality of health care and to assess trends in avoidable mortality from 1970-90. SETTING AND PARTICIPANTS--All deaths of Lithuanian residents aged between 0 and 64 years between 1970 and 1990 were analysed. MEASUREMENTS AND MAIN RESULTS--Twenty seven per cent of all deaths in this age group were avoidable. Avoidable deaths were grouped into preventable and treatable ones. Treatable causes of death ...
Radiation-induced tinnitus is a side effect of radiotherapy in the inner ear for cancers of the head and neck. Effective dose constraints for protecting the cochlea are under-reported. The aim of this study is to determine the cochlea dose limitation to avoid causing tinnitus after head-and-neck cancer (HNC) intensity-modulated radiation therapy (IMRT). In total 211 patients with HNC were included; the side effects of radiotherapy were investigated for 422 inner ears in the cohort. Forty-nine of the four hundred and twenty-two samples (11.6 %) developed grade 2+ tinnitus symptoms after IMRT, as diagnosed by a clinician. The Late Effects of Normal Tissues–Subjective, Objective, Management, Analytic (LENT-SOMA) criteria were used for tinnitus evaluation. The logistic and Lyman-Kutcher-Burman (LKB) normal tissue complication probability (NTCP) models were used for the analyses. The NTCP-fitted parameters were TD50 = 46.31 Gy (95 % CI, 41.46–52.50), γ50 = 1.27 (95 % CI, 1.02–1.55), and TD50 = 46.52 Gy (95 % CI, 41.91–53.43), m = 0.35 (95 % CI, 0.30–0.42) for the logistic and LKB models, respectively. The suggested guideline TD20 for the tolerance dose to produce a 20 % complication rate within a specific period of time was TD20 = 33.62 Gy (95 % CI, 30.15–38.27) (logistic) and TD20 = 32.82 Gy (95 % CI, 29.58–37.69) (LKB). To maintain the incidence of grade 2+ tinnitus toxicity <20 % in IMRT, we suggest that the mean dose to the cochlea should be <32 Gy. However, models should not be extrapolated to other patient populations without further verification and should first be confirmed before clinical implementation
Van der Pals Jesper
Full Text Available Abstract Background In experimentally induced myocardial infarction, mild hypothermia (33–35°C is beneficial if applied prior to ischemia or reperfusion. Hypothermia, when applied after reperfusion seems to confer little or no benefit. The mechanism by which hypothermia exerts its cell-protective effect during cardiac ischemia remains unclear. It has been hypothesized that hypothermia reduces the reperfusion damage; the additional damage incurred upon the myocardium during reperfusion. Reperfusion results in a massive increase in blood flow, reactive hyperemia, which may contribute to reperfusion damage. We postulated that hypothermia could attenuate the post-ischemic reactive hyperemia. Methods Sixteen 25–30 kg pigs, in a closed chest model, were anesthetized and temperature was established in all pigs at 37°C using an intravascular cooling catheter. The 16 pigs were then randomized to hypothermia (34°C or control (37°C. The left main coronary artery was then catheterized with a PCI guiding catheter. A Doppler flow wire was placed in the mid part of the LAD and a PCI balloon was then positioned proximal to the Doppler wire but distal to the first diagonal branch. The LAD was then occluded for ten minutes in all pigs. Coronary blood flow was measured before, during and after ischemia/reperfusion. Results The peak flow seen during post-ischemic reactive hyperemia (during the first minutes of reperfusion was significantly reduced by 43 % (p Conclusion Mild hypothermia significantly reduces post-ischemic hyperemia in a closed chest pig model. The reduction of reactive hyperemia during reperfusion may have an impact on cardiac reperfusion injury.
扁虱是莱姆关节炎的罪魁祸首。研究人员为了弄明白何处扁虱最猖獗, 不惜以身作饵,他们发现:The ticks were all over the log surface。因此告诫人 们:Avoid sitting on logs。
Liu, Kaiyin; Khan, Hajra; Geng, Xiaokun; Zhang, Jun; Ding, Yuchuan
Mild physical hypothermia after stroke has been associated with positive outcomes. Despite the well-studied beneficial effects of hypothermia in the treatment of stroke, lack of precise temperature control, intolerance for the patient, and immunosuppression are some of the reasons which limit its clinical translation. Pharmacologically induced hypothermia has been explored as a possible treatment option following stroke in animal models. Currently, there are eight classes of pharmacological agents/agonists with hypothermic effects affecting a multitude of systems including cannabinoid, opioid, transient receptor potential vanilloid 1 (TRPV1), neurotensin, thyroxine derivatives, dopamine, gas, and adenosine derivatives. Interestingly, drugs in the TRPV1, neurotensin, and thyroxine families have been shown to have effects in thermoregulatory control in decreasing the compensatory hypothermic response during cooling. This review will briefly present drugs in the eight classes by summarizing their proposed mechanisms of action as well as side effects. Reported thermoregulatory effects of the drugs will also be presented. This review offers the opinion that these agents may be useful in combination therapies with physical hypothermia to achieve faster and more stable temperature control in hypothermia. PMID:27320243
Li, Minheng; Miao, Peng; Zhu, Yisheng; Tong, Shanbao
Hypothermia can unintentionally occur in daily life, e.g., in cardiovascular surgery or applied as therapeutics in the neurosciences critical care unit. So far, the temperature-induced spatiotemporal responses of the neural function have not been fully understood. In this study, we investigated the functional change in cerebral blood flow (CBF), accompanied with neuronal activation, by laser speckle imaging (LSI) during hypothermia. Laser speckle images from Sprague-Dawley rats (n = 8, male) were acquired under normothermia (37°C) and moderate hypothermia (32°C). For each animal, 10 trials of electrical hindpaw stimulation were delivered under both temperatures. Using registered laser speckle contrast analysis and temporal clustering analysis (TCA), we found a delayed response peak and a prolonged response window under hypothermia. Hypothermia also decreased the activation area and the amplitude of the peak CBF. The combination of LSI and TCA is a high-resolution functional imaging method to investigate the spatiotemporal neurovascular coupling in both normal and pathological brain functions.
Schmitt, Katharina R. L.; Boato, Francesco; Diestel, Antje; Hechler, Daniel; Kruglov, Andrei; Berger, Felix; HENDRIX, Sven
Systemic or brain-selective hypothermia is a well-established method for neuroprotection after brain trauma. There is increasing evidence that hypothermia exerts beneficial effects on the brain and may also support regenerative responses after brain damage. Here, we have investigated whether hypothermia influences neurite outgrowth in vitro via modulation of the post-injury cytokine milieu. Organotypic brain slices were incubated: deep hypothermia (2 h at 17 degrees C), rewarming (2 h up to 3...
Denes, Eric; Amaniou, Monique; Rogez, Jean-Philippe; Weinbreck, Pierre; Merle, Louis
Hypothermia is an uncommon side effect of acetaminophen. We report 4 cases of HIV-infected patients who developed hypothermia after intravenous injection of propacetamol (the parenteral formulation of acetaminophen). The mechanism of this hypothermia is unknown. AIDS-induced changes in the metabolism of acetaminophen, could be an explanation. AIDS-associated opportunistic diseases may account for part of the mechanism. These hypothermias occur within 6 hours after the injection, are well tolerated and regress spontaneously. PMID:12486392
Shkesters, A P; Utno, L Ia; Girgensone, M Ia
Alongside anti-hypoxia activity, the method of deep hypothermia causes discoordination of metabolism in the heart. This is due to increased secretion of catecholamines in the process of cooling, to activation in free radical generation and lipid peroxidation. Pantethine and alpha-tocopherol were used. Pantethine reduced lipid peroxidation, preserved reaction activity of catalyzing resyntheses and transport of high energetic compounds in the heart, while alpha-tocopherol prevented lipid peroxidation activation and decrease in SOD. Simultaneous use of pantethine and alpha-tocopherol caused increase in SOD and normalization of heart metabolism. Thus, for protection of the heart against excessive free radical generation under deep hypothermia simultaneous use of antioxidants like pantethine and alpha-tocopherol is necessary. PMID:1893178
Johansen, Flemming F; Hasseldam, Henrik; Rasmussen, Rune Skovgaard; Bisgård, Anne Sofie; Bonfils, Peter Kramshøj; Poulsen, Steen Seier; Hansen-Schwartz, Jacob
Objectives: Hypothermia is still unproven as beneficial treatment in human stroke, although in animal models, conditioning the brain with hypothermia has induced tolerance to insults. Here, we delineate the feasibility of drug-induced mild hypothermia in reducing ischemic brain damage when...
Kammersgaard, L P; Rasmussen, B H; Jørgensen, Henrik Stig;
Hypothermia reduces neuronal damage in animal stroke models. Whether hypothermia is neuroprotective in patients with acute stroke remains to be clarified. In this case-control study, we evaluated the feasibility and safety of inducing modest hypothermia by a surface cooling method in awake patients...
C. Schwiebert; R. Huhn; A. Heinen; N.C. Weber; M.W. Hollmann; W. Schlack; B. Preckel
Background and objective Hypothermia protects against myocardial reperfusion injury. However, inducing hypothermia takes time, which makes it unsuitable as an emergency treatment. Combining mild hypothermia with low-dose xenon, applied either simultaneously or one after the other, protects the neona
Quock, R.M.; Panek, R.W.; Kouchich, F.J.; Rosenthal, M.A.
Exposure of rats to high levels of nitrous oxide (N2O) in oxygen reduced body temperature in a concentration-related manner. The hypothermia was partly reversed by pretreatment with naloxone but not naltrexone. But in rats rendered tolerant to morphine by pellet implantation, exposure to 75% N2O/25% O2 evoked a marked hypothermia similar to that observed in morphine-naive animals. In another experiment, the hypothermic effect of chloral hydrate was also sensitive to antagonism by pretreatment with naloxone but not naltrexone. These observations lead the authors to suspect that N2O-induced hypothermia in rats is possibly not mediated by opiate receptors. The thermotropic activity of N2O may result from some non-opioid action of N2O. Its selective antagonism by naloxone (but not naltrexone) may be due to a unique non-opioid analeptic action of naloxone. 32 references, 4 figures.
De Robertis, E; Kozek-Langenecker, S A; Tufano, R; Romano, G M; Piazza, O; Zito Marinosci, G
Acidosis, hypothermia and hypocalcaemia are determinants for morbidity and mortality during massive hemorrhages. However, precise pathological mechanisms of these environmental factors and their potential additive or synergistic anticoagulant and/or antiplatelet effects are not fully elucidated and are at least in part controversial. Best available evidences from experimental trials indicate that acidosis and hypothermia progressively impair platelet aggregability and clot formation. Considering the cell-based model of coagulation physiology, hypothermia predominantly prolongs the initiation phase, while acidosis prolongs the propagation phase of thrombin generation. Acidosis increases fibrinogen breakdown while hypothermia impairs its synthesis. Acidosis and hypothermia have additive effects. The effect of hypocalcaemia on coagulopathy is less investigated but it appears that below the cut-off of 0.9 mmol/L, several enzymatic steps in the plasmatic coagulation system are blocked while above that cut-off effects remain without clinical sequalae. The impact of environmental factor on hemostasis is underestimated in clinical practice due to our current practice of using routine coagulation laboratory tests such as partial thromboplastin time or prothrombin time, which are performed at standardized test temperature, after pH correction, and upon recalcification. Temperature-adjustments are feasible in viscoelastic point-of-care tests such as thrombelastography and thromboelastometry which may permit quantification of hypothermia-induced coagulopathy. Rewarming hypothermic bleeding patients is highly recommended because it improves patient outcome. Despite the absence of high-quality evidence, calcium supplementation is clinical routine in bleeding management. Buffer administration may not reverse acidosis-induced coagulopathy but may be essential for the efficacy of coagulation factor concentrates such as recombinant activated factor VII. PMID:24608516
Xiao-yan Xia; Yi-xin Xia
Objective To investigate the effect of graded hypothermia on neuropathologic alteratiors of neonatal rat brain after exposed to hypoxic-ischemic insult at 37℃, 33℃, 31℃, and 28℃, respectively, and to observe the effect of hypothermia on 72-kDa heat shock protein (HSP72) expression after hypoxic-ischemic insult. Methods Seven days old Wistar rats were subjected to unilateral common carotid artery ligation followed by exposure to hypoxia in 8％ oxygen for 2 hours at 37℃, 33℃, 31℃, and 28℃, respectively. The brain temperature was monitored indirectly by inserting a mini-thermocouple probe into the temporal muscle during hypoxia. After hypoxia-ischemia their mortality was assessed. Neuronal damage was assessed with HE staining 72 hours after hypoxia. HSP72 expression at 0.5, 24, and 72 hours of recovery was immunohistochemically assessed using a monoclonal antibody to HSP72. Results Hypoxia-ischemia caused 10.5％ (2/19) of mortality in rat of 37℃ group, but no death occurred in 33℃, 31℃ or 28℃ groups. HE staining showed neuropathologic damage was extensive in rats exposed to hypoxia-ischemia at 37℃ (more than 80.0％). The incidence of severe brain damage was significantly decreased in 33℃ (53.3％) and 31℃ groups (44.4％), and no histologic injury was seen in the 28℃ group of rats. Expression of HSP72 was manifest and persistent in the rat brain of 37℃ group, but minimum in the rat brain of 28℃ group. Conclusion Mild and moderate hypothermia might prevent cerebral visible neuropathologic damage associated with hypoxic-ischemic injury by decreasing stress response.
Full Text Available Abstract Background The use of mechanical/physical devices for applying mild therapeutic hypothermia is the only proven neuroprotective treatment for survivors of out of hospital cardiac arrest. However, this type of therapy is cumbersome and associated with several side-effects. We investigated the feasibility of using a transient receptor potential vanilloid type 1 (TRPV1 agonist for obtaining drug-induced sustainable mild hypothermia. Methods First, we screened a heterogeneous group of TRPV1 agonists and secondly we tested the hypothermic properties of a selected candidate by dose-response studies. Finally we tested the hypothermic properties in a large animal. The screening was in conscious rats, the dose-response experiments in conscious rats and in cynomologus monkeys, and the finally we tested the hypothermic properties in conscious young cattle (calves with a body weight as an adult human. The investigated TRPV1 agonists were administered by continuous intravenous infusion. Results Screening: Dihydrocapsaicin (DHC, a component of chili pepper, displayed a desirable hypothermic profile with regards to the duration, depth and control in conscious rats. Dose-response experiments: In both rats and cynomologus monkeys DHC caused a dose-dependent and immediate decrease in body temperature. Thus in rats, infusion of DHC at doses of 0.125, 0.25, 0.50, and 0.75 mg/kg/h caused a maximal ΔT (°C as compared to vehicle control of -0.9, -1.5, -2.0, and -4.2 within approximately 1 hour until the 6 hour infusion was stopped. Finally, in calves the intravenous infusion of DHC was able to maintain mild hypothermia with ΔT > -3°C for more than 12 hours. Conclusions Our data support the hypothesis that infusion of dihydrocapsaicin is a candidate for testing as a primary or adjunct method of inducing and maintaining therapeutic hypothermia.
... anxieties over social pressure or legitimate fears of violence at school. Let him know that school attendance is required ... to the classroom. If a problem like a school bully or an unreasonable teacher is the cause of your child's anxiety, become an advocate for ...
Full Text Available Introduction & Objective: Hypoxic-ischemic encephalopathy is one of the most important causes of permanent damage to brain tissue that redound to mortality and/or late sequelae such as cerebral palsy or delayed neural development. 15-20 percent of Hypoxic-ischemic encephalopathy (HIE cases die during neonatal period and 25-30 percent of those who survive suffer from neural development problems such as cerebral palsy and mental retardation. Hypothermia or lowering temperature of brain or total body is a new and promising treatment. The present study was done to assess therapeutic effects of induced local hypothermia in hypoxic-ischemic encephalopathy (HIE among neonates admitted to Fatemieh and Beset hospitals of Hamadan city.Materials & Method: The present study was performed as a randomized clinical trial upon 36 neonates who had inclusion criteria to be imported into the study. In the first 6 hours after birth, the neonates were randomly classified into two 18 person groups. In the control group the neonates were managed with routine treatments consisted of preservative measures and anti-convulsive treatments, if necessary. In the case group the neonates received induced local hypothermia for 6 hours in addition to routine therapeutic managements. The data were analyzed using SPSS Version 13.Results: 72.7% of the neonates of the case and control groups were male. There was no significant difference between the case and control groups in sex, birth weight, gestational age and perinatal obstetric complications. The mean duration of admission was 7.72±4.23 days in the case group and 10.06±5.99 days in the control group with no significant difference between the two groups (P=0.199. The mean time of starting oral feeding was 3.44±3.11 days and 4.53±2.74 days in the control and case groups respectively and this difference was not statistically significant either (P=0.737.The mean time of regaining consciousness was 3.72±3.19 days in the case
Hale, F A; Anthony, J M
While thermally supported cats experienced a drop in body temperature during dental procedures, the drop was significantly greater in cats without thermal support. As cats are at risk of developing clinical hypothermia during dental procedures, steps should be taken to minimize the loss of body heat.
Bro-Jeppesen, John; Kjaergaard, Jesper; Søholm, Helle;
AIM: Inducing therapeutic hypothermia (TH) in Out-of-Hospital Cardiac Arrest (OHCA) can be challenging due to its impact on central hemodynamics and vasopressors are frequently used to maintain adequate organ perfusion. The aim of this study was to assess the association between level of vasopres...
Kochanek Ashley R
Full Text Available Abstract The induction of hypothermia for cellular protection is well established in several clinical settings. Its role in trauma patients, however, is controversial. This review discusses the benefits and complications of induced hypothermia--emphasizing the current state of knowledge and potential applications in bleeding patients. Extensive pre-clinical data suggest that in advanced stages of shock, rapid cooling can protect cells during ischemia and reperfusion, decrease organ damage, and improve survival. Yet hypothermia is a double edged sword; unless carefully managed, its induction can be associated with a number of complications. Appropriate patient selection requires a thorough understanding of the pre-clinical literature. Clinicians must also appreciate the enormous influence that temperature modulation exerts on various cellular mechanisms. This manuscript aims to provide a balanced view of the published literature on this topic. While many of the advantageous molecular and physiological effects of induced hypothermia have been outlined in animal models, rigorous clinical investigations are needed to translate these promising findings into clinical practice.
裘五四; 刘伟国; 沈宏; 王卫民; 章志量; 张瑛; 江素君; 杨小锋
Objective: To investigate the therapeutic effect of mild hypothermia on severe traumatic brain injury.Methods: Eighty-six in-patients with severe traumatic brain injury treated ordinarily were consecutively randomized into two groups: a hypothermia group (n=43) and a normothermia group (the control group, n=43). In the hypothermia group, the core temperature (i.e., nasopharyngeal or brain temperature) of the patient was reduced to and maintained at 33-35℃ with a systemic cooling blanket. Natural rewarming began after 3-5 days (mean: 4.3 days) of hypothermia treatment. In the control group, the patient received no hypothermia treatment. The vital sign, extradural pressure and serum superoxide dismutase were observed and measured during treatment, and the complications as well as the Glasgow outcome scale were evaluated at 2 years after injury.Results: The mean extradural pressure in the hypothermia group (27.38 mm Hg±4.88 mm Hg at 24 hours, 29.40 mm Hg±4.50 mm Hg at 48 hours and 26.40 mm Hg±4.13 mm Hg at 72 hours after injury) was much lower than that in the control group (32.63 mm Hg±3.00 mm Hg, 34.80 mm Hg±6.00 mm Hg and 31.81 mm Hg±4.50 mm Hg respectively at 24, 48 and 72 hours, P<0.05). The mean serum superoxide dismutase levels in the hypothermia group on days 3 and 7 (583.7 μg/L±99.6 μg/L and 699.4 μg/L±217.3 μg/L, respectively) were much higher than those in the control group at the same time period (446.6 μg/L±79.5 μg/L and 497.1 μg/L±101.2 μg/L, respectively, P<0.01). The recovery rates at 2 years after injury were 65.1% in the hypothermia group and 37.2% in the control group (P<0.05). The mortality rates were 25.6% in the hypothermia group and 51.2% in the control group (P<0.05). The complications, including pulmonary infections, thrombocytopenia (platelet count <100×109/L), hemorrhage in the digestive tract, electrolyte disorders and renal malfunction, were managed without severe sequelae .Conclusions: Mild hypothermia is a safe and
Excitotoxic median raphe lesions aggravate working memory storage performance deficits caused by scopolamine infusion into the dentate gyrus of the hippocampus in the inhibitory avoidance task in rats
Full Text Available The interactions between the median raphe nucleus (MRN serotonergic system and the septohippocampal muscarinic cholinergic system in the modulation of immediate working memory storage performance were investigated. Rats with sham or ibotenic acid lesions of the MRN were bilaterally implanted with cannulae in the dentate gyrus of the hippocampus and tested in a light/dark step-through inhibitory avoidance task in which response latency to enter the dark compartment immediately after the shock served as a measure of immediate working memory storage. MRN lesion per se did not alter response latency. Post-training intrahippocampal scopolamine infusion (2 and 4 µg/side produced a more marked reduction in response latencies in the lesioned animals compared to the sham-lesioned rats. Results suggest that the immediate working memory storage performance is modulated by synergistic interactions between serotonergic projections of the MRN and the muscarinic cholinergic system of the hippocampus.
李晓南; 邓静云; 徐柏荣; 巴凌昊
【目的】明确江苏省儿童可避免死亡指标，为制定我省儿童死亡率的卫生政策和医疗保健措施提供 一定的理论依据。【方法】根据Rutstein等提出的可避免死亡指标，采用江苏省与美国、本省农村和城市儿童死因 死亡率对比，计算相对危险度。【结果】江苏省儿童可避免主要死因为败血症、肺炎、腹泻、脑膜炎、营养不良、意外 窒息。可避免死因占全省总死亡的51.6％。【结论】要降低我省儿童死亡率，应加强可避免死因疾病的控制。%【 Objective】 In order to determine avoidable death indication among of Jiangsu Province and to reduce mortality of children under five. 【Methods】 We measured relative risk(RR) of mortality in children between the US and Jiangsu,rural and urban areas of Jiangsu to determine avoidable death indicators among Jiangsu Province. 【 Results】 Septicemia, pneumonia, diar rhea,meningitis,malnutrition,accident suffocation, drowing were considered as avoidable death causes of children in Jiangsu, which ac count for 51.6% of all death causes of children under five. 【 Conclusions】 Avoidable causes of death mortality among children under five in Jiangsu should be controlled by medical intervention.
Wintermark, Pia [Children' s Hospital Boston, Division of Newborn Medicine, Boston, MA (United States); Children' s Hospital Boston, Department of Radiology, Boston, MA (United States); Montreal Children' s Hospital, Division of Newborn Medicine, Montreal, QC (Canada); Labrecque, Michelle; Hansen, Anne [Children' s Hospital Boston, Division of Newborn Medicine, Boston, MA (United States); Warfield, Simon K.; DeHart, Stephanie [Children' s Hospital Boston, Department of Radiology, Boston, MA (United States)
Until now, brain MRIs in asphyxiated neonates who are receiving therapeutic hypothermia have been performed after treatment is complete. However, there is increasing interest in utilizing early brain MRI while hypothermia is still being provided to rapidly understand the degree of brain injury and possibly refine neuroprotective strategies. This study was designed to assess whether therapeutic hypothermia can be maintained while performing a brain MRI. Twenty MRI scans were obtained in 12 asphyxiated neonates while they were treated with hypothermia. The median difference between esophageal temperature on NICU departure and return was 0.1 C (range: -0.8 to 0.8 C). We found that therapeutic hypothermia can be safely and reproducibly maintained during a brain MRI. Hypothermia treatment should not prevent obtaining an early brain MRI if clinically indicated. (orig.)
Carr, Jennie M.; Lima, Steven L.
Many birds use regulated drops in night-time body temperature (Tb) to conserve energy critical to winter survival. However, a significant degree of hypothermia may limit a bird's ability to respond to predatory attack. Despite this likely energy–predation trade-off, the behavioural costs of avian hypothermia have yet to be examined. We thus monitored the nocturnal hypothermia of mourning doves (Zenaida macroura) in a laboratory setting in response to food deprivation. Nocturnal flight tests w...
邱靜雯; Yau, Ching-man
Hypothermia at birth is strongly associated with mortality and morbidity in preterm infants. Unfortunately, infants are prone to hypothermia immediately after birth. A large proportion of preterm infants, especially those of gestational age at less than 30 weeks, experience different levels of hypothermia. A frequently used possible preventive measure is the application of an occlusive wrap immediately after birth. However, no systematic review on this preventive measure supports its translat...
Talakoub, Sedigheh; Shahbazifard, Zahra; Armanian, Amir Mohamad; Ghazavi, Zohreh
Background: After the umbilical cord is cut, premature neonates face numerous problems including hypothermia. With regard to serious complications of hypothermia and incapability of conventional methods in preservation of neonates’ temperature after admission, the researcher decided to conduct a study on the effects of two polyethylene covers in prevention of hypothermia among premature neonates. Materials and Methods: This clinical trial was conducted on 96 neonates aged 28–32 weeks that ran...
Charles Patrick Gilman
Full Text Available Super-refractory status epilepticus is status epilepticus that continues beyond 24 hours and includes those cases in which epilepsy is recurrent upon reduction or withdrawal of treatment. We describe the presentation and successful management of a male patient with super-refractory status epilepticus using the inhaled anesthetic, isoflurane, and mild hypothermia (HT. The potential utility of combined HT and volatile anesthesia is discussed.
Charles Patrick Gilman
Super-refractory status epilepticus is status epilepticus that continues beyond 24 hours and includes those cases in which epilepsy is recurrent upon reduction or withdrawal of treatment. We describe the presentation and successful management of a male patient with super-refractory status epilepticus using the inhaled anesthetic, isoflurane, and mild hypothermia (HT). The potential utility of combined HT and volatile anesthesia is discussed.
Full Text Available Background: Post injection sciatic nerve injury is a common cause of sciatic nerve mononeuropathy in the developing world largely due to inadequate health care facilites in the rural regions. Objective: The study was conducted to analyse the pattern of this nerve lesion in clinical and electrophysiological parameters and also to study the outcome in a conservatively treated cohort. Materials and Methods: One hundred and six patients who underwent evaluation at our laboratory from 2000 to 2006 for post injection sciatic neuropathy formed the study population. Twenty two of these were followed up (mean 6.6 months for the outcome. Results: In the cases with full data, common peroneal division of the sciatic nerve was affected alone or predominantly. On follow up, 72% cases showed little or partial recovery. Thirty two percent patients had residual trophic changes and causalgia at their last visit. Conclusion: The majority of cases of postinjection sciatic nerve injury have poor prognosis on conservative treatment.
Honda, Mitsuru; Yokota, Kyosuke; Ichibayashi, Ryo; Yoshihara, Katsunori; Masuda, Hiroyuki; Uekusa, Hiroyuki; Seiki, Yoshikatsu; NOMOTO, Jun; Nagao, Takeki; Kishi, Taichi; Sase, Shigeru
Aims: Neurointensive care has reduced the mortality and improved the outcome of patients for severe brain damage, over recent decades, and made it possible to perform this therapy in safety. However, we have to understand the complications of this therapy well. The purpose of our study was to determine the systemic circulation disturbance during the initiation of therapeutic hypothermia by using this continuous neurointensive monitoring system. Materials and Methods: Ten severe brain damage p...
Spencer, Jeremy M.
Hypothermia within the United States has seldom been studied from a geographic perspective. This dissertation assessed the following aspects of hypothermia: 1) A cataloging of Internet web pages containing hypothermia-related guidance, with a summary of the information contained within. The summarized hypothermia information was assessed for scientific validity through an extensive assessment of the peer-reviewed medical literature; 2) the spatio-temporal distribution of hypothermia deaths in U.S. Combined Statistical areas for the years 1979-2004, and their association with National Weather Service windchill advisory and warning thresholds; 3) the spatio-temporal distribution of hypothermia morbidity in the State of New York from 1991-1992 to 2005-2006 and its association with Spatial Synoptic Classification weather types. The results indicate that web-based hypothermia information has generally poor content not supported by the scientific literature, and there are many prominent omissions of well-established hypothermia information. A total of 9,185 hypothermia fatalities attributable to cold exposure occurred in 89 metro areas from 1979 to 2004. The southeastern US had the greatest vulnerability to hypothermia, with high rates of deaths occurring at higher temperatures than northern states. Median windchill temperature associated with deaths was generally latitudinal, with southern deaths occurring at higher temperatures. For all regions, hypothermia deaths occurred at temperatures considerably higher than windchill advisory criteria. Hypothermia morbidity within New York State was associated with long-lasting polar weather types. There are a number of findings common to these three papers. Information about hypothermia tends to be under-communicated (no central location for wind chill alerts, unsupported statements on many websites). Hypothermia deaths and hospitalizations increase when locally cold and long-lasting weather types occur, which fits in with what
Kieboom, J. K.; Verkade, H. J.; Burgerhof, J. G.; Bierens, J. J.; van Rheenen, P. F.; Kneyber, M. C.; Albers, M. J.
OBJECTIVES To evaluate the outcome of drowned children with cardiac arrest and hypothermia, and to determine distinct criteria for termination of cardiopulmonary resuscitation in drowned children with hypothermia and absence of spontaneous circulation. DESIGN Nationwide retrospective cohort study. S
Choi, Sang-Sik; Kim, Won Young; Kim, Won; Lim, Kyung-Su
Central diabetes insipidus (DI), characterized by unexpected fatal hypernatremia, is a rare complication after successful cardiopulmonary resuscitation with therapeutic hypothermia, but may be potentially fatal if recognition is delayed. We describe here a patient who experienced cardiac arrest due to a pulmonary embolism, followed by successful resuscitation after induction of therapeutic hypothermia. The patient, however, suddenly developed unexpected hypernatremia with increased urine outp...
Full Text Available Objetivo: Los indicadores de mortalidad podrían reflejar el efecto de las intervenciones sanitarias sobre la salud de la población, aunque no hay acuerdo sobre el más adecuado. El objetivo del trabajo fue obtener una lista de causas de mortalidad evitable que pueda ser de uso común en España. Métodos: Se ha realizado un proceso de consenso entre médicos asistenciales, elaboradores y usuarios de indicadores sanitarios, basado en las publicaciones sobre el tema y las aportaciones de los expertos participantes. Se ha valorado el grado de acuerdo obtenido en los distintos ítems. Resultados: Se han consensuado 34 causas de mortalidad evitable, así como el tipo de intervenciones que podrían evitar la muerte. El consenso fue medio o alto en la mayor parte de causas e intervenciones (sólo en 4 fue bajo, así como para el conjunto de la lista y sublistas (de servicios sanitarios y de políticas intersectoriales elaboradas. El consenso fue mayor en relación a la evitabilidad de las causas de muerte que al tipo de intervenciones que la pueden evitar. La discrepancia fue mayor en las intervenciones del ámbito asistencial que en las de políticas intersectoriales. Conclusiones: La reflexión y la discusión a que ha sido sometida esta lista de mortalidad evitable, así como la publicitación de los criterios y del procedimiento seguido, supone un valor añadido. La lista mejora la comparabilidad de los datos y de los resultados entre los distintos sistemas de salud del territorio, por lo cual se recomienda su utilización en el contexto español.Objective: Mortality indicators could reflect the effect of health services interventions on the population's health, although there is no agreement about which indicator would be the most appropriate. The objective of this study was to obtain a consensus list of causes of avoidable mortality that could be used as a reference in Spain. Methods: Based on existing publications and participants' knowledge
Francesca Del Balzo; Stella Maiolo; Paola Papoff; Luigi Giannini; Corrado Moretti; Enrico Properzi; Alberto Spalice
Hypoxic-ischemic encephalopathy (HIE) is an important cause of acute neurological damage in newborns at (or near) term. Several trials in recent years have shown that moderate hypothermia by total body cooling or selective head is an effective intervention to reduce mortality and major disability in infants survived a perinatal hypoxic-ischemic attack. Follow-up in these patients is very important to establish neurodevelopmental outcome, and specific markers can lead us to detect predicting s...
Van Poucke, Sven; Stevens, Kris; Kicken, Cécile; Simons, Antoine; Marcus, Abraham; Lancé, Marcus
Alterations in platelet function are a common finding in surgical procedures involving cardiopulmonary bypass and hypothermia. Although the combined impact of hypothermia and artificial circulation on platelets has been studied before, the ultimate strategy to safely minimize the risk for bleeding and thrombosis is yet unknown. The aim of this study was to evaluate the use of a mock circulation loop to study the impact of hypothermia for platelet-related hemostatic changes. Venous blood was collected from healthy adult humans (n = 3). Closed mock circulation loops were assembled, each consisting of a centrifugal pump, an oxygenator with integrated heat exchanger, and a hardshell venous reservoir. The experiment started with the mock circulation temperature set at 37°C (T0 [0 h]). Cooling was then initiated at T1 (+2 h), where temperature was adjusted from 37°C to 32°C. Hypothermia was maintained from T2 (+4 h) to T3 (+28 h). From that point in time, rewarming from 32°C to 37°C was initiated with similar speed as cooling. From time point T4 (+30 h), normothermia (37°C) was maintained until the experiment ended at T5 (+32 h). Blood samples were analyzed in standard hematological tests: light transmission aggregometry (LTA) (arachidonic acid [AA], adenosine diphosphate [ADP], collagen [COL], thrombin-receptor-activating-peptide-14 [TRAP]), multiple electrode aggregometry (MEA) (AA, ADP, COL, TRAP), and rotational thromboelastometry (ROTEM) (EXTEM, FIBTEM, PLTEM). Hemoglobin, hematocrit, and platelet count decrease more substantially during temperature drop (37-32°C) than during hypothermia maintenance. Hb and Hct continue to follow this trend during active rewarming (32-37°C). PC increase from the moment active rewarming was initiated. None of the values return to the initial values. LTA values demonstrate a similar decrease in aggregation after stimulation with the platelet agonists between the start of the mock circulation and the start of
Full Text Available Deep hypothermia, which is used during thoracic aortic surgery for neuroprotection, is associated with coagulation abnormalities in animal and in vitro models. However, there is a paucity of data regarding the impact of deep hypothermia duration on perioperative bleeding. The objective of the current study was to examine the relationship between the duration of deep hypothermia and perioperative bleeding. A retrospective review of 507 consecutive thoracic aortic surgery patients who had surgery with deep hypothermic circulatory arrest was performed. The degree of bleeding and coagulopathy was estimated using perioperative transfusion. Log linear modeling with Poisson regression was used to analyze the relationship between deep hypothermia duration and perioperative bleeding, while controlling for other preselected variables. There was a significant association between deep hypothermia duration and RBC transfusion (P = 0.001. There was no significant association between deep hypothermia duration and FFP and platelet transfusion (P = 0.18 and P = 0.06. The association between deep hypothermia duration and the amount of bleeding (RBC transfusion was dependent on total CPB time. In general, for shorter CPB times (approximately 120 to 180 minutes there was an upward sloping line or positive relationship between deep hypothermia duration and bleeding. However, for cases with longer CPB times (300 to 360 minutes, there was no such relationship. The relationship between deep hypothermia duration and perioperative bleeding is dependent on CPB time. For surgeries with short CPB times (120 to 180 minutes, prolonged deep hypothermia is associated with increased post-operative bleeding, as estimated by RBC transfusion. For cases with longer CPB times (300 to 360 minutes, there appears to be no relationship.
Method is given for employing hvdc transmission as a power source for cathodic protection against corrosion of nearby underground metallic structures such as pipelines; the method consists of connecting metallic structures with auxiliary electrodes buried in soil.
María Nélida Conejo Pérez
Full Text Available Recent studies have demonstrated therapeutic mild hypothermia improves neurological outcome of patients after suffering an out-of-hospital cardiac arrest.Other studies in animals suggest that the sooner hypothermia is started after return of spontaneous circulation, the lower neurological symptoms are suffered by patients.The aim of this work is to know the efficiency of the therapeutic moderated hipotermia after the cardiopulmonar resuscitation realized extra hospitable.Methods: We made a literature search in Medline (Pubmed, Cinahl, Cuiden, Cochrane Library and the Joanna Briggs Institute, combining mesh and free terms; and searched in the journals Circulation, Resuscitation and Emergency Medicine Journal manually last year. We selected systematic reviews and randomized and nonrandomized clinical trials which had contrasted in-hospital and out-of-hospital TMH with over 18 years patients.Results: Only 5 articles met the inclusion criteria of the 35 selected: four randomized clinical trials and one nonrandomized. They were then subjected to a critical methodological evaluation (CASPe and statistic evaluation (IDIPaz.Conclusions: Pre hospital TMH is an effective and safe technique in comatose patients after being resuscitated from cardiac arrest, improving the neurological status at hospital discharge.
Talwar, A.; Fahim, Mohammad
Haemodynamic responses to hypothermia were studied at normal haematocrit and following the induction of acute normovolaemic haemodilution. Experiments were performed on 20 cats anaesthetized with a mixture of chloralose and urethane in two groups. In one group (n=10) the effects of hypothermia on various haemodynamic variables were studied at normal haematocrit (41.0+/-1.7%) and in the second group of cats (n=10) the effects of hypothermia on various haemodynamic variables were studied after the induction of acute normovolaemic haemodilution (14.0+/-1.0%). The haemodynamic variables left ventricular pressure, left ventricular contractility, arterial blood pressure, heart rate and right atrial pressure were recorded on a polygraph. Cardiac output was measured using a cardiac output computer. In both groups hypothermia was induced by surface cooling with the help of ice. Cardiovascular variables were recorded at each 1° C fall in body temperature. Hypothermia produced a significant (P<0.05) drop in heart rate, cardiac output, arterial blood pressure and left ventricular contractility in both groups. However, the percentage decrease in these variables in response to hypothermia was significantly (P<0.05) higher in cats with low haematocrit than in those with normal haematocrit. The severity of hypothermia - induced cardiovascular effects is evident from the drastic decrease in heart rate, cardiac output, arterial blood pressure and myocardial contractility in cats with low haematocrit, indicating a higher risk of circulatory failure under anaemic conditions at low temperatures.
Wu, Zhou; Zhu, Shu-Zhen; Hu, Ya-Fang; Gu, Yong; Wang, Sheng-Nan; Lin, Zhen-Zhou; Xie, Zuo-Shan; Pan, Su-Yue
In order to evaluate whether glibenclamide can extend the therapeutic window during which induced hypothermia can protect against stroke, we subjected adult male Sprague-Dawley rats to middle cerebral artery occlusion (MCAO). We first verified the protective effects of hypothermia induced at 0, 2, 4 or 6h after MCAO onset, and then we assessed the effects of the combination of glibenclamide and hypothermia at 6, 8 or 10h after MCAO onset. At 24h after MCAO, we assessed brain edema, infarct volume, modified neurological severity score, Evans Blue leakage and expression of Sulfonylurea receptor 1 (SUR1) protein and pro-inflammatory factors. No protective effects were observed when hypothermia was induced too long after MCAO. At 6h after MCAO onset, hypothermia alone failed to decrease cerebral edema and infarct volume, but the combination of glibenclamide and hypothermia decreased both. The combination also improved neurological outcome, ameliorated blood-brain barrier damage and decreased levels of COX-2, TNF-α and IL-1β. These results suggest that glibenclamide enhances and extends the therapeutic effects of delayed hypothermia against ischemia stroke, potentially by ameliorating blood-brain barrier damage and declining levels of pro-inflammatory factors. PMID:27134036
LeClerq Steven C
Full Text Available Abstract Background Neonatal hypothermia is associated with an increased mortality risk for 28 days. There are few community-based data on specific risk factors for neonatal hypothermia. Estimates of association between neonatal hypothermia in the community and risk factors are needed to guide the design of interventions to reduce exposure. Methods A cohort of 23,240 babies in rural southern Nepal was visited at home by field workers who measured axillary temperatures for 28 days (213,316 temperature measurements. The cumulative incidence of hypothermia (defined as Results Ten percent of the babies (n = 2342 were observed with temperatures of 2500 g. Risk varied inversely along the entire weight spectrum: for every 100 g decrement hypothermia risk increased by 7.4%, 13.5% and 31.3%% for babies between 3000 g and 2500 g, 2500 g and 2000 g and Conclusions In addition to season in which the babies were born, weight is an important risk factor for hypothermia. Smaller babies are at higher relative risk of hypothermia during the warm period and do not receive the protective seasonal benefit apparent among larger babies. The need for year-round thermal care, early breastfeeding and maternal thermal care should be emphasized. Further work is needed to quantify the benefits of other simple neonatal thermal care practices.
Kämäräinen, Antti; Hoppu, Sanna; Silfvast, Tom; Virkkunen, Ilkka
Therapeutic hypothermia has been shown to improve survival and neurological outcome after prehospital cardiac arrest. Existing experimental and clinical evidence supports the notion that delayed cooling results in lesser benefit compared to early induction of mild hypothermia soon after return of spontaneous circulation. Therefore a practical approach would be to initiate cooling already in the prehospital setting. The purpose of this review was to evaluate current clinical studies on prehospital induction of mild hypothermia after cardiac arrest. Most reported studies present data on cooling rates, safety and feasibility of different methods, but are inconclusive as regarding to outcome effects. PMID:19821967
Full Text Available Abstract Therapeutic hypothermia has been shown to improve survival and neurological outcome after prehospital cardiac arrest. Existing experimental and clinical evidence supports the notion that delayed cooling results in lesser benefit compared to early induction of mild hypothermia soon after return of spontaneous circulation. Therefore a practical approach would be to initiate cooling already in the prehospital setting. The purpose of this review was to evaluate current clinical studies on prehospital induction of mild hypothermia after cardiac arrest. Most reported studies present data on cooling rates, safety and feasibility of different methods, but are inconclusive as regarding to outcome effects.
Kämäräinen, Antti; Hoppu, Sanna; Silfvast, Tom; Virkkunen, Ilkka
Therapeutic hypothermia has been shown to improve survival and neurological outcome after prehospital cardiac arrest. Existing experimental and clinical evidence supports the notion that delayed cooling results in lesser benefit compared to early induction of mild hypothermia soon after return of spontaneous circulation. Therefore a practical approach would be to initiate cooling already in the prehospital setting. The purpose of this review was to evaluate current clinical studies on prehospital induction of mild hypothermia after cardiac arrest. Most reported studies present data on cooling rates, safety and feasibility of different methods, but are inconclusive as regarding to outcome effects. PMID:19821967
Full Text Available Neonatal encephalopathy following birth asphyxia is a major predictor of long-term neurological impairment. Therapeutic hypothermia is currently the standard of care to prevent brain injury in asphyxiated newborns but is not protective in all cases. More robust and versatile treatment options are needed. Angiogenesis is a demonstrated therapeutic target in adult stroke. However, no systematic study examines the expression of angiogenesis-related markers following birth asphyxia in human newborns.This study aimed to evaluate the expression of angiogenesis-related protein markers in asphyxiated newborns developing and not developing brain injury compared to healthy control newborns.Twelve asphyxiated newborns treated with hypothermia were prospectively enrolled; six developed eventual brain injury and six did not. Four healthy control newborns were also included. We used Rules-Based Medicine multi-analyte profiling and protein array technologies to study the plasma concentration of 49 angiogenesis-related proteins. Mean protein concentrations were compared between each group of newborns.Compared to healthy newborns, asphyxiated newborns not developing brain injury showed up-regulation of pro-angiogenic proteins, including fatty acid binding protein-4, glucose-6-phosphate isomerase, neuropilin-1, and receptor tyrosine-protein kinase erbB-3; this up-regulation was not evident in asphyxiated newborns eventually developing brain injury. Also, asphyxiated newborns developing brain injury showed a decreased expression of anti-angiogenic proteins, including insulin-growth factor binding proteins -1, -4, and -6, compared to healthy newborns.These findings suggest that angiogenesis pathways are dysregulated following birth asphyxia and are putatively involved in brain injury pathology and recovery.
Anesthetics and body temperature alterations are both known to alter parameters of sensory-evoked responses. However few studies have quantitatively assessed the contributions of hypothermia to anesthetic-induced changes. Two experiments were performed. In the first, chronically ...
Musacchia, X. J.
A study was made of the effects of acclimation of hamsters to high (34-35 C) and low (4-5 C) temperatures for periods up to 6 weeks on the induction of hypothermia in hamsters. Hypothermia was achieved by exposing hamsters to a helox mixture of 80% helium and 20% oxygen at 0 C. Hypothermic induction was most rapid (2-3 hr) in heat-acclimated hamsters and slowest (6-12 hr) in cold-acclimated hamsters. The induction period was intermediate (5-8 hr) in room temperature nonacclimated animals (controls). Survival time in hypothermia was relatable to previous temperature acclimations. The hypothesis that thermogenesis in cold-acclimated hamsters would accentuate resistance to induction of hypothermia was substantiated.
Chlorpyrifos (CHP), an anticholinesterase organophosphate (OP) pesticide, induces acute hypothermia in adult and developing rats. Previously we demonstrated that thermoregulation in preweanling pups is markedly more sensitive to the neurotoxic effects of CHP than in adults. The c...
Peng Yang; Limin Zhang; Yunhe Zhang; Xifeng Zou; Qunxi Li; Yun Li; Jun Zhu; Jianmin Li; Aijun Fu; Qingjun Liu; Tong Chen; Zelin Sun; Zhiyong Zhang
The influence of mild hypothermia on neural cell apoptosis remains poorly understood. Therefore, the present study established rat models of diffuse axonal injury (DAI) at 33 °C. Morris water maze results demonstrated significantly better learning and memory functions in DAI rats with hypothermia compared with DAI rats with normothermia. Expression of apoptotic protease activating factor-1 in the hippocampal CA1 region was significantly lower in the DAI hypothermia group compared with the DAI normothermia group. Expression of apoptotic protease activating factor-1 positively correlated with latency, but negatively correlated with platform location times and time of swimming in the quadrant area. Results suggested that post-traumatic mild hypothermia in a rat model of DAI could provide cerebral protection by attenuating expression of apoptotic protease activating factor-1.
Over the past two decades there has been considerable interest in the use of hypothermia in the management of severe traumatic brain injury. However despite promising experimental evidence, results from clinical studies have failed to demonstrate benefit. Indeed recent studies have shown a tendency to worse outcomes in those patients randomised to therapeutic hypothermia. In this narrative review the pathophysiological rationale behind hypothermia and the clinical evidence for efficacy are examined. There would still appear to be a role for hypothermia in the management of intractable intracranial hypertension. However optimising therapeutic time frames and better management of strategies for complications will be required if experimental evidence for neuroprotection is to be translated into clinical benefit. PMID:26928159
Tomohiro Matsui; Yukari Motoki; Yusuke Yoshida
Therapeutic hypothermia protects neurons after injury to the central nervous system (CNS). Microglia express toll-like receptors (TLRs) that play significant roles in the pathogenesis of sterile CNS injury. To elucidate the possible mechanisms involved in the neuroprotective effect of therapeutic hypothermia, we examined the effects of hypothermic culture on TLR3-activated microglial release of interferon (IFN)- β and nitric oxide (NO), which are known to be associated with neuronal cell deat...
Karlsen, Anders M; Thomassen, Øyvind; Vikenes, Bjarne H.; Brattebø, Guttorm
Introduction Hypothermia is associated with increased morbidity and mortality in trauma patients and poses a challenge in pre-hospital treatment. The aim of this study was to identify equipment to prevent, diagnose, and treat hypothermia in Norwegian pre-hospital services. Method In the period of April-August 2011, we conducted a survey of 42 respondents representing a total of 543 pre-hospital units, which included all the national ground ambulance services, the fixed wing and helicopter air...
Jin, Yichao; Lin, Yingying; Feng, Jun-feng; Jia, Feng; Gao, Guo-yi; Jiang, Ji-yao
Here, we evaluated changes in autophagy after post-traumatic brain injury (TBI) followed by moderate hypothermia in rats. Adult male Sprague-Dawley rats were randomly divided into four groups: sham injury with normothermia group (37 °C); sham injury with hypothermia group (32 °C); TBI with normothermia group (TNG; 37 °C); and TBI with hypothermia group (THG; 32 °C). Injury was induced by a fluid percussion TBI device. Moderate hypothermia (32 °C) was achieved by partial immersion in a water bath (0 °C) under general anesthesia for 4 h. All rats were killed at 24 h after fluid percussion TBI. The ipsilateral hippocampus in all rats was analyzed with hematoxylin and eosin staining; terminal deoxynucleoitidyl transferase-mediated nick end labeling staining was used to determine cell death in ipsilateral hippocampus. Immunohistochemistry and western blotting of microtubule-associated protein light chain 3 (LC3), Beclin-1, as well as transmission electron microscopy performed to assess changes in autophagy. At 24 h after TBI, the cell death index was 27.90 ± 2.36% in TNG and 14.90 ± 1.52% in THG. Expression level of LC3 and Beclin-1 were significantly increased after TBI and were further up-regulated after post-TBI hypothermia. Further, ultrastructural observations showed that there was a marked increase of autophagosomes and autolysosomes in ipsilateral hippocampus after post-TBI hypothermia. Our data demonstrated that moderate hypothermia significantly attenuated cell death and increased autophagy in ipsilateral hippocampus after fluid percussion TBI. In conclusion, autophagy pathway may participate in the neuroprotective effect of post-TBI hypothermia. PMID:25942484
Hoppu Sanna; Kämäräinen Antti; Silfvast Tom; Virkkunen Ilkka
Abstract Therapeutic hypothermia has been shown to improve survival and neurological outcome after prehospital cardiac arrest. Existing experimental and clinical evidence supports the notion that delayed cooling results in lesser benefit compared to early induction of mild hypothermia soon after return of spontaneous circulation. Therefore a practical approach would be to initiate cooling already in the prehospital setting. The purpose of this review was to evaluate current clinical studies o...
Noirhomme, Quentin; Lehembre, Rémy; Lugo, Zulay; Lesenfants, Damien; Luxen, André; Laureys, Steven; Oddo, Mauro; Rossetti, Andrea
Visual analysis of electroencephalography (EEG) background and reactivity during therapeutic hypothermia provides important outcome information, but is time-consuming and not always consistent between reviewers. Automated EEG analysis may help quantify the brain damage. Forty-six comatose patients in therapeutic hypothermia, after cardiac arrest, were included in the study. EEG background was quantified with burst-suppression ratio (BSR) and approximate entropy, both used to monitor anesthesi...
Astudillo Ley, Rafael
Thirty-nine pediatric and 82 adult patients were studied during cardiac surgery with cardio pulmonary bypass (CPB) performed with moderate hypothermia or with deep hypothermia and circulatory arrest (DHCA) with or-without retrograde cerebral perfusion (RCP). Cerebral blood flow (CBF) was estimated from Doppler measurements of the blood velocity in the middle cerebral artery (MCAv). Arterio-venous (jugular bulb) differences of blood lactate and oxygen were used to study cereb...
Kim, Chang-Yeon; Bae, Myung Hwan; Kim, Nam Kyun; Yang, Young Ae; Kim, Kyu Yeun; Lee, Jang Hoon; Eun, Jung Su; Cho, Yongkeun
Therapeutic hypothermia (TH) has been used to protect neurological functions in cardiac arrest patient. Although Osborn wave is not pathognomonic of hypothermia, it is a well-known electrocardiogram finding of hypothermic patients. The cellular and ionic mechanisms of the Osborn wave have been suggested, and its relationship to tachyarrhythmias, such as ventricular tachycardia and ventricular fibrillation, is being explored. This case highlights the arrhythmogenic potential of Osborn wave and individual difference in response of TH. PMID:25653709
Kim, Chang-Yeon; Bae, Myung Hwan; Kim, Nam Kyun; Yang, Young Ae; Kim, Kyu Yeun; Lee, Jang Hoon; Eun, Jung Su; Cho, Yongkeun
Therapeutic hypothermia (TH) has been used to protect neurological functions in cardiac arrest patient. Although Osborn wave is not pathognomonic of hypothermia, it is a well-known electrocardiogram finding of hypothermic patients. The cellular and ionic mechanisms of the Osborn wave have been suggested, and its relationship to tachyarrhythmias, such as ventricular tachycardia and ventricular fibrillation, is being explored. This case highlights the arrhythmogenic potential of Osborn wave and...
Strasser, Ruth H; Wunderlich, Carsten; Gildemeister, Ramona; Diewok, Claudia; Ziegs, Enrico; Simonis, Gregor; Flemming, Kerstin
Objective: Hypothermia has been shown to reduce neurologic deficits in patients after cardiopulmonary resuscitation (CPR). It was not clear if intravascular cooling is superior to standard external cooling in inducing hypothermia. Goal of this study was to compare intravascular cooling with an automated cooling device with external cooling in everyday practice on a cardiac-care ICU (intensive care unit). Methods: Patients after successful CPR for unwitnessed cardiac arrest were subjected to c...
Full Text Available John J Kim,1,2 Nathan Buchbinder,1,† Simon Ammanuel,1,4,5,† Robert Kim,1,† Erika Moore,1 Neil O'Donnell,1 Jennifer K Lee,3 Ewa Kulikowicz,3 Soumyadipta Acharya,1 Robert H Allen,1,9 Ryan W Lee,6,7 Michael V Johnston4–81Department of Biomedical Engineering, Whiting School of Engineering, The Johns Hopkins University, 2The James Buchanan Brady Urological Institute, Department of Urology, The Johns Hopkins University School of Medicine, 3Department of Anesthesia and Critical Care Medicine, Johns Hopkins University, 4Kennedy Krieger Institute, 5Hugo W Moser Research Institute, 6Department of Neurology, 7Department of Pediatrics, 8Department of Physical Medicine and Rehabilitation Johns Hopkins University School of Medicine, Baltimore, MD; 9Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA†These authors contributed equally to this workAbstract: Despite recent advances in neonatal care and monitoring, asphyxia globally accounts for 23% of the 4 million annual deaths of newborns, and leads to hypoxic-ischemic encephalopathy (HIE. Occurring in five of 1000 live-born infants globally and even more in developing countries, HIE is a serious problem that causes death in 25%–50% of affected neonates and neurological disability to at least 25% of survivors. In order to prevent the damage caused by HIE, our invention provides an effective whole-body cooling of the neonates by utilizing evaporation and an endothermic reaction. Our device is composed of basic electronics, clay pots, sand, and urea-based instant cold pack powder. A larger clay pot, lined with nearly 5 cm of sand, contains a smaller pot, where the neonate will be placed for therapeutic treatment. When the sand is mixed with instant cold pack urea powder and wetted with water, the device can extract heat from inside to outside and maintain the inner pot at 17°C for more than 24 hours with monitoring by LED lights and thermistors
Orban, Jean-Christophe; Cattet, Florian; Lefrant, Jean-Yves; Leone, Marc; Jaber, Samir; Constantin, Jean-Michel; Allaouchiche, Bernard; Ichai, Carole
Aims Cardiac arrest is a major health concern worldwide accounting for 375,000 cases per year in Europe with a survival rate of <10%. Therapeutic hypothermia has been shown to improve patients’ neurological outcome and is recommended by scientific societies. Despite these guidelines, different surveys report a heterogeneous application of this treatment. The aim of the present study was to evaluate the clinical practice of therapeutic hypothermia in cardiac arrest patients. Methods This self-declarative web based survey was proposed to all registered French adult intensive care units (ICUs) (n = 357). Paediatrics and neurosurgery ICUs were excluded. The different questions addressed the structure, the practical modalities of therapeutic hypothermia and the use of prognostic factors in patients admitted after cardiac arrest. Results One hundred and thirty-two out of 357 ICUs (37%) answered the questionnaire. Adherence to recommendations regarding the targeted temperature and hypothermia duration were 98% and 94% respectively. Both guidelines were followed in 92% ICUs. During therapeutic hypothermia, sedative drugs were given in 99% ICUs, mostly midazolam (77%) and sufentanil (59%). Neuromuscular blocking agents (NMBA) were used in 97% ICUs, mainly cisatracurium (77%). Numerous prognostic factors were used after cardiac arrest such as clinical factors (95%), biomarkers (53%), electroencephalography (78%) and evoked potentials (35%). Conclusions In France, adherence to recommendations for therapeutic hypothermia after cardiac arrest is higher than those previously reported in other countries. Numerous prognostic factors are widely used even if their reliability remains controversial. PMID:23049783
Wu, Tai-Wei; McLean, Claire; Friedlich, Philippe; Seri, Istvan [Children' s Hospital Los Angeles, Center for Fetal and Neonatal Medicine and the USC Division of Neonatal Medicine, Department of Pediatrics, Los Angeles, CA (United States); University of Southern California, LAC/USC Medical Center, Keck School of Medicine, Los Angeles, CA (United States); Grimm, John; Bluml, Stefan [University of Southern California, LAC/USC Medical Center, Keck School of Medicine, Los Angeles, CA (United States); Children' s Hospital Los Angeles, Department of Radiology, Los Angeles, CA (United States)
Therapeutic hypothermia has become standard treatment for neonatal hypoxic-ischemic encephalopathy (HIE), with brain MRI commonly performed after the child has been rewarmed. However, early imaging during hypothermia might provide information important in designing clinical trials that refine and personalize therapeutic hypothermia. We tested a protocol to ensure safety and maintenance of hypothermia during in-hospital transport and MRI. MRI during therapeutic hypothermia was performed in 13 newborns on the 2nd-3rd postnatal days. Mean one-way transport time was 20.0 ± 3.3 min. Mean rectal temperatures ( C) leaving the unit, upon arrival at the MR suite, during MRI scan and upon return to the unit were 33.5 ± 0.3 C, 33.3 ± 0.3 C, 33.1 ± 0.4 C and 33.4 ± 0.3 C, respectively. Using our protocol therapeutic hypothermia was safely and effectively continued during in-hospital transport and MRI without adverse effects. (orig.)
Transient Receptor Potential Channel Opening Releases Endogenous Acetylcholine, which Contributes to Endothelium-Dependent Relaxation Induced by Mild Hypothermia in Spontaneously Hypertensive Rat but Not Wistar-Kyoto Rat Arteries.
Zou, Q; Leung, S W S; Vanhoutte, P M
Mild hypothermia causes endothelium-dependent relaxations, which are reduced by the muscarinic receptor antagonist atropine. The present study investigated whether endothelial endogenous acetylcholine contributes to these relaxations. Aortic rings of spontaneously hypertensive rats (SHRs) and normotensive Wistar-Kyoto (WKY) rats were contracted with prostaglandin F2 α and exposed to progressive mild hypothermia (from 37 to 31°C). Hypothermia induced endothelium-dependent, Nω-nitro-l-arginine methyl ester-sensitive relaxations, which were reduced by atropine, but not by mecamylamine, in SHR but not in WKY rat aortae. The responses in SHR aortae were also reduced by acetylcholinesterase (the enzyme responsible for acetylcholine degradation), bromoacetylcholine (inhibitor of acetylcholine synthesis), hemicholinium-3 (inhibitor of choline uptake), and vesamicol (inhibitor of acetylcholine release). The mild hypothermia-induced relaxations in both SHR and WKY rat aortae were inhibited by AMTB [N-(3-aminopropyl)-2-[(3-methylphenyl)methoxy]-N-(2-thienylmethyl)-benzamide; the transient receptor potential (TRP) M8 inhibitor]; only those in SHR aortae were inhibited by HC-067047 [2-methyl-1-[3-(4-morpholinyl)propyl]-5-phenyl-N-[3-(trifluoromethyl)phenyl]-1H-pyrrole-3-carboxamide; TRPV4 antagonist] while those in WKY rat aortae were reduced by HC-030031 [2-(1,3-dimethyl-2,6-dioxo-1,2,3,6-tetrahydro-7H-purin-7-yl)-N-(4-isopropylphenyl)acetamide; TRPA1 antagonist]. The endothelial uptake of extracellular choline and release of cyclic guanosine monophosphate was enhanced by mild hypothermia and inhibited by HC-067047 in SHR but not in WKY rat aortae. Compared with WKY rats, the SHR preparations expressed similar levels of acetylcholinesterase and choline acetyltransferase, but a lesser amount of vesicular acetylcholine transporter, located mainly in the endothelium. Thus, mild hypothermia causes nitric oxide-dependent relaxations by opening TRPA1 channels in WKY rat aortae
Kang, Xiaoxu; Jia, Xiaofeng; Geocadin, Romergryko G.; Thakor, Nitish V.; Maybhate, Anil
Neurological complications after cardiac arrest (CA) can be fatal. Although hypothermia has been shown to be beneficial, understanding the mechanism and establishing neurological outcomes remains challenging because effects of CA and hypothermia are not well characterized. This paper aims to analyze EEG (and the α-rhythms) using multiscale entropy (MSE) to demonstrate the ability of MSE in tracking changes due to hypothermia and compare MSE during early recovery with long-term neurological ex...
Erlinge David; Högberg Carl; Braun Oscar Ö
Abstract Background Mild hypothermia is currently standard of care for cardiac arrest patients in many hospitals and a common belief is that hypothermia attenuates platelet aggregation. We wanted to examine the effects of clopidogrel on platelet aggregation during hypothermia. Methods Platelet reactivity at 37°C and 33°C was evaluated by light transmission aggregometry and vasodilator-stimulated phosphoprotein (VASP) in blood from healthy volunteers before, and 24 hours after, a 600 mg loadin...
Full Text Available Inadvertent intraoperative hypothermia (core temperature 2 h (OR = 3.44, 95% CI 1.90-6.22,, and intravenous un-warmed fluid (OR = 2.45, 95% CI 1.45-4.12 significantly increased the risk of hypothermia.The incidence of inadvertent intraoperative hypothermia in Beijing is high, and the rate of active warming of patients during operation is low. Concern for the development of intraoperative hypothermia should be especially high in patients undergoing major operations, requiring long periods of anesthesia, and receiving un-warmed intravenous fluids.
Yi, Jie; Xiang, Ziyong; Deng, Xiaoming; Fan, Ting; Fu, Runqiao; Geng, Wanming; Guo, Ruihong; He, Nong; Li, Chenghui; Li, Lei; Li, Min; Li, Tianzuo; Tian, Ming; Wang, Geng; Wang, Lei
Background/Objective Inadvertent intraoperative hypothermia (core temperature 2 h (OR = 3.44, 95% CI 1.90–6.22,), and intravenous un-warmed fluid (OR = 2.45, 95% CI 1.45–4.12) significantly increased the risk of hypothermia. Conclusions The incidence of inadvertent intraoperative hypothermia in Beijing is high, and the rate of active warming of patients during operation is low. Concern for the development of intraoperative hypothermia should be especially high in patients undergoing major ope...
Dietz, R M; Deng, G; Orfila, J E; Hui, X; Traystman, R J; Herson, P S
Pediatric cardiac arrest (CA) often leads to poor neurologic outcomes, including deficits in learning and memory. The only approved treatment for CA is therapeutic hypothermia, although its utility in the pediatric population remains unclear. This study analyzed the effect of mild therapeutic hypothermia after CA in juvenile mice on hippocampal neuronal injury and the cellular model of learning and memory, termed long-term potentiation (LTP). Juvenile mice were subjected to cardiac arrest and cardiopulmonary resuscitation (CA/CPR) followed by normothermia (37°C) and hypothermia (30°C, 32°C). Histological injury of hippocampal CA1 neurons was performed 3days after resuscitation using hematoxylin and eosin (H&E) staining. Field excitatory post-synaptic potentials (fEPSPs) were recorded from acute hippocampal slices 7days after CA/CPR to determine LTP. Synaptic function was impaired 7days after CA/CPR. Mice exposed to hypothermia showed equivalent neuroprotection, but exhibited sexually dimorphic protection against ischemia-induced impairment of LTP. Hypothermia (32°C) protects synaptic plasticity more effectively in females, with males requiring a deeper level of hypothermia (30°C) for equivalent protection. In conclusion, male and female juvenile mice exhibit equivalent neuronal injury following CA/CPR and hypothermia protects both males and females. We made the surprising finding that juvenile mice have a sexually dimorphic response to mild therapeutic hypothermia protection of synaptic function, where males may need a deeper level of hypothermia for equivalent synaptic protection. PMID:27033251
... Names Personality disorder - avoidant References American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Publishing. 2013. ...
Full Text Available Aims: To study the impact of hypothermia upon admission to the Intensive Care Unit (ICU on early and late mortality and to develop a prediction model for late mortality in severely injured trauma patients. Materials and Methods: A multicenter retrospective cohort study was performed in adult trauma patients admitted to the ICU of two Level-1 trauma centers between 2007 and 2012. Hypothermia was defined as a core body temperature of ≤35° Celsius. Logistic regression analyses were performed to quantify the effect of hypothermia on 24-hour and 28-day mortality and to develop a prediction model. Results: A total of 953 patients were included, of which 354 patients had hypothermia (37% upon ICU admission. Patients were divided into a normothermic or hypothermic group. Hypothermia was associated with a significantly increased mortality at 24 hours and 28 days (OR 2.72 (1.18-6.29 and OR 2.82 (1.83-4.35 resp.. The variables included in the final prediction model were hypothermia, age, APACHE II score (corrected for temperature, INR, platelet count, traumatic brain injury and Injury Severity Score. The final prediction model discriminated between survivors and non-survivors with high accuracy (AUC = 0.871, 95% CI 0.844-0.898. Conclusions: Hypothermia, defined as a temperature ≤35° Celsius, is common in critically ill trauma patients and is one of the most important physiological predictors for early and late mortality in trauma patients. Trauma patients admitted to the ICU may be at high risk for late mortality if the patient is hypothermic, coagulopathic, severely injured and has traumatic brain injury or an advanced age.
Balvers, Kirsten; Van der Horst, Marjolein; Graumans, Maarten; Boer, Christa; Binnekade, Jan M.; Goslings, J. Carel; Juffermans, Nicole P.
Aims: To study the impact of hypothermia upon admission to the Intensive Care Unit (ICU) on early and late mortality and to develop a prediction model for late mortality in severely injured trauma patients. Materials and Methods: A multicenter retrospective cohort study was performed in adult trauma patients admitted to the ICU of two Level-1 trauma centers between 2007 and 2012. Hypothermia was defined as a core body temperature of ≤35° Celsius. Logistic regression analyses were performed to quantify the effect of hypothermia on 24-hour and 28-day mortality and to develop a prediction model. Results: A total of 953 patients were included, of which 354 patients had hypothermia (37%) upon ICU admission. Patients were divided into a normothermic or hypothermic group. Hypothermia was associated with a significantly increased mortality at 24 hours and 28 days (OR 2.72 (1.18-6.29 and OR 2.82 (1.83-4.35) resp.). The variables included in the final prediction model were hypothermia, age, APACHE II score (corrected for temperature), INR, platelet count, traumatic brain injury and Injury Severity Score. The final prediction model discriminated between survivors and non-survivors with high accuracy (AUC = 0.871, 95% CI 0.844-0.898). Conclusions: Hypothermia, defined as a temperature ≤35° Celsius, is common in critically ill trauma patients and is one of the most important physiological predictors for early and late mortality in trauma patients. Trauma patients admitted to the ICU may be at high risk for late mortality if the patient is hypothermic, coagulopathic, severely injured and has traumatic brain injury or an advanced age. PMID:27512330
Objective: To observe the changes of evoked pote ntials after severe brain injury and the effect of mild hypothermia on acute sev ere brain injury. Methods: A total of 44 patients with severe closed head injury (GCS 3-8, admitted within 10 hours from injury) admitted from May 1998 to March 1999 were selected for this study. All patients were admitted into the intensiv e care unit and divided into 2 groups, Group A (GCS 3-5) and Group B (GCS 6 -8). Patients were also randomly assigned to either normothermia or hypothermia subgroups. Patients in the hypothermia group were cooled to 32-34℃. Median nerve short-latency somatosensory evoked potentials (SLSEP) and brain stem aud itory evoked potentials (BAEP) were recorded before cooling and 4, 24, 48, 72, 9 6 and 120 hours, respectively after cooling and temperature resuming. SLSEP and BAEP were measured at the same time in the normothermia group (control group). T he changes of evoked potentials (EP) were analyzed by statistical methods. Results: In the Group B, N20 amplitudes in SLSEP and I/V amplitudes in BAEP after mild hypothermia treatment in the hypothermia group dif fered significantly from those in the control group (P<0.05). However, in the Group A, no significant difference in all paramet ers was found. Conclusions: These results demonstrate that mild hypothermia tr eatment (32-34℃) in the Group B has a significant neuroelectrophysiological effect on severe brain injury. Nevertheless, the effect of mild hypothermia in t he Group A is not apparent and needs further studying.
Full Text Available Abstract Background Anaesthesia is commonly employed prior to surgical investigations and to permit icv injections in rodents. Indeed it is standard practise in many studies examining the subsequent actions of hormones and growth factors on the brain. Recent evidence that the basal activity of specific intracellular signalling proteins can be affected by anaesthesia prompted us to examine the effect of anaesthesia not only on the basal activity but also the insulin sensitivity of the major insulin signalling pathways. Results We find that urethane- and ketamine-induced anaesthesia results in rapid activation of the phosphatidylinositol (PI 3-kinase-protein kinase B (PKB signalling pathway in the brain, increases tau phosphorylation while at the same time reducing basal activity of the Ras-ERK pathway. Subsequent injection of insulin does not alter the activity of either the PI 3-kinase or ERK signalling pathways, indicating a degree of neuronal molecular insulin resistance. However, if body temperature is maintained during anaesthesia then there is no alteration in the basal activity of these signalling molecules. Subsequent response of both pathways to insulin injection is restored. Conclusion The data is consistent with a hypothermia related alteration in neuronal signalling following anaesthesia, and emphasises the importance of maintaining the body temperature of rodents when monitoring insulin (or growth factor/neurotrophic agent action in the brain of anesthetised rodents.
Full Text Available Introduction: Cardiopulmonary bypass is associated with higher risk of mortality and morbidity, thus it should be investigated regarding the major risk factors. Temperature management have a significant role in postoperative cerebral and neurological complications; however the optimum temperature during cardiopulmonary surgery is not certainly detected. This systematic review has investigated the differences between hypothermia and normothermia regarding postoperative mortality. Method: PubMed was searched for the relevant articles. Only English language articles were included with no time limitation. Data regarding in-hospital patient deaths provided in each article mostly within 30 days after the surgery, were extracted and compared based on relative risk reduction (RRR, absolute risk reduction (ARR, and number needed to treat (NNT.Result: Totally, 28 articles were retrieved and extracted. The mortality rate was zero in hypothermic and normotehrmic groups of 8/28 included studies, thus the RRR, ARR, and NNT could not be calculated. There were no significant differences between investigated groups of each included studies regarding the patients’ age, gender, and preoperative conditions.Conclusions: No significant difference was obtained between two studied groups. Similar prevalence of death observed between hypothermic and normothermic groups might be due to the sample size of studies, or the subsequent cares performed in intensive care units that assist to reduce the postoperative mortality rate. According to the obtained results, both of these procedures might be similarly safe regarding mortality rate.
Ferreira, V.S.; Slevc, L.R.; Rogers, E.S.
Three experiments assessed how speakers avoid linguistically and nonlinguistically ambiguous expressions. Speakers described target objects (a flying mammal, bat) in contexts including foil objects that caused linguistic (a baseball bat) and nonlinguistic (a larger flying mammal) ambiguity. Speakers sometimes avoided linguistic-ambiguity, and they…
Lee, Jin Hwan; Wei, Ling; Gu, Xiaohuan; Won, Soonmi; Wei, Zheng Zachory; Dix, Thomas A.
Background and Purpose— Therapeutic hypothermia is a promising strategy for treatment of acute stroke. Clinical translation of therapeutic hypothermia, however, has been hindered because of the lack of efficiency and adverse effects. We sought to enhance the clinical potential of therapeutic hypothermia by combining physical cooling (PC) with pharmacologically induced hypothermia after ischemic stroke. Methods— Wistar rats were subjected to 90-minute middle cerebral artery occlusion by insertion of an intraluminal filament. Mild-to-moderate hypothermia was induced 120 minutes after the onset of stroke by PC alone, a neurotensin receptor 1 (NTR1) agonist HPI-201 (formally ABS-201) alone or the combination of both. The outcomes of stroke were evaluated at 3 and 21 days after stroke. Results— PC or HPI-201 each showed hypothermic effect and neuroprotection in stroke rats. The combination of PC and HPI-201 exhibited synergistic effects in cooling process, reduced infarct formation, cell death, and blood-brain barrier damages and improved functional recovery after stroke. Importantly, coapplied HPI-201 completely inhibited PC-associated shivering and tachycardia. Conclusions— The centrally acting hypothermic drug HPI-201 greatly enhanced the efficiency and efficacy of conventional PC; this combined cooling therapy may facilitate clinical translation of hypothermic treatment for stroke. PMID:27301934
Nuckton, T J; Claman, D M; Goldreich, D; Wendt, F C; Nuckton, J G
To determine whether or not participants in open water swim events experience hypothermia and afterdrop, rectal temperature was measured for up to 45 minutes in 11 subjects following the New Year's Day Alcatraz Swim. This event was held in open water (11.7 degrees C [53.0 degrees F]) in the San Francisco Bay, and participants did not wear wetsuits or other protective clothing. Biophysical parameters, including surfacelvolume ratio, body mass index, and percent body fat were measured before the swim, and statistical analysis was done to determine predictors of temperature decrease and afterdrop duration. Applying the American Heart Association definition of hypothermia (less than 36.0 C [96.8 degrees F]), hypothermia was seen in 5 of the 11 subjects. Using a more rigorous and traditional definition (less than 35.0 degrees C [95.0 degrees F]), hypothermia was seen in only one subject. Afterdrop, defined as continued cooling following removal from cold stress, was seen in 10 of the 11 subjects. Surface/volume ratio (S/V) and body mass index (BMI) predicted the lowest recorded temperatures (P < .05; r(S/V) = -.71, r(BMI) = .72) and afterdrop duration (P < .05; r(SN) = -.75, r(BMI) = .69). These results suggest that hypothermia and afterdrop can occur commonly after recreational open water swimming, and that participants should be observed for signs of temperature decrease following removal from cold stress. PMID:11043627
Lin Zhang; Pixing Zhang; Yinming Zeng; Qun Chen
BACKGROUND: Hypothermia plays a protective role in cerebral ischemia/reperfusion injury. Dose combination with batroxobin, an active drug for treating cerebrovascular disease, will enhance its protection? OBJECTIVE: To explore the effects of hypothermia, batroxobin, hypothermia combined with batroxobin on complete cerebral ischemia/reperfusion injury in gerbils.DESIGN: A randomized block comparison observation. SETTING: Jiangsu Key Lab of Anesthesiology. MATERIALS: Experimental animal: Sixty Mongolia gerbils weighing 50-80 g, male or female, were provided by the Animals Center of Xuzhou Medical College. Drugs and agents: Batroxobin was provided by Dongling Phar maceutical Industry Organization (Japan). Superoxide dismutase (SOD) and malondiadehyde (MDA) kits were offered by Nanjing Jiancheng Bioengineering Institute. Other reagents were all import or national analytical pure grade. HITACHI R22A refrigerated high-speed centrifuge, and HARRIS ultra-hypothermia refrigerator were used.METHODS: The experiments were completed in Jiangsu Key Lab of Anesthesiology from May 2004 to January 2005. ① The animals were divided into 6 groups by random member table method: sham-operated group (n =6), ischemia control group (n =6), normothermia group (n =12), hypothermia group (n =12), batroxobin group (n =12) and hypothermia+batroxobin group (n =12). Gerbil rats were abdominally anesthetized with sodium pentobarbital. The neck skin was incised to separate bilateral common carotid arteries. Complete cerebral ischemia models were established by occluding bilateral common carotid arteries with artery clamp for 10 minutes, then the clamp was loosened to perfuse the arteries. Iso-electric level of brain electric wave showed the models were established successfully. The gerbils in the batroxobin group and hypothermia+batroxobin group were abdominally injected with batroxobin (8 BU/kg) while reperfusion, and isovolumetric saline was administered to the gerbils in the other groups
Full Text Available Neurologic outcomes following pediatric cardiac arrest are consistently poor. Early initiation of cardiopulmonary resuscitation has been shown to have positive effects on both survival to hospital discharge, and improved neurological outcomes after cardiac arrest. Additionally, the use of therapeutic hypothermia may improve survival in pediatric cardiac arrest patients admitted to the intensive care unit. We report a child with congenital hypertrophic obstructive cardiomyopathy and an out-of-hospital cardiac arrest, in whom the early initiation of effective prolonged cardiopulmonary resuscitation and subsequent administration of therapeutic hypothermia contributed to a positive outcome with no gross neurologic sequelae. Continuing efforts should be made to promote and employ high-quality cardiopulmonary resuscitation, which likely contributed to the positive outcome of this case. Further research will be necessary to develop and solidify national guidelines for the implementation of therapeutic hypothermia in selected subpopulations of children with OHCA.
Marin, N; Valverde, E; Cabañas, F
'Skin-to-skin' in healthy newborn infants is currently routine practice in Spanish maternity wards. This practice has shown benefits in increasing the duration of breast-feeding and maternal bonding behaviour with no significant adverse events. Early sudden deaths and severe apparent life-threatening events (ALTE) during the first 24 hours of life are infrequent, but well recognised. Risk factors during 'skin to skin' have been established. These events can lead to high neonatal morbidity and mortality. Hypothermia is now the standard of care for moderate to severe hypoxic-ischaemic encephalopathy and has shown to reduce mortality and neurological morbidity in children with hypoxic-ischaemic brain injury. Although there are no clinical trials that evaluate hypothermia after a severe ALTE, neonates who suffer it should be considered for this treatment. We present a case of a healthy newborn who had an ALTE during skin-to-skin with his mother and was treated with hypothermia. PMID:24051185
王维平; 任海军; 池京洋; 徐福林; 全勇
Objective: To study the effects of mild hypothermia therapy on severe brain-injured patients whose intracranial pressure (ICP) could be maintained below 25 mm Hg.Methods: Forty severe brain-injured patients with ICP below 25 mm Hg were divided randomly into one treatment group (n=20, mild hypothermia therapy) and one control group (n=20, normothermia therapy) to observe the changes of the concentration of excitatory amino acids (glutamate and glycine) and cytokines (interleukin-1β and interleukin-6). Results: There were no significant differences in the daily changes of the concentration of excitatory amino acid and cytokines between two groups. The outcome of two groups had no significant differences. Conclusions: Mild hypothermia has no additional beneficial effects on severe brain-injured patients compared with normothermia therapy if ICP can be maintained below 25 mm Hg by using conventional therapy.
Full Text Available The primary choice of treating refractory status epilepticus (RSE is intravenous anesthetics, but the seizures of some patients can not get a good control. Thus, other therapies must be combined. Hypothermia not only can terminate seizures, but also play a part in brain protection. Though combined use of intravenous anesthetics and hypothermia is not a regular clinical scheme, the favorable effect has been proved by a lot of clinical research. This paper mainly focuses on the dose of intravenous anesthetics, the time, temperature and procedure of hypothermia, the indications and contraindications of combined therapy, and so on. DOI: 10.3969/j.issn.1672-6731.2015.11.006
Radiation-induced hypothermia was examined in guinea pigs. Exposure to the head alone or whole-body irradiation induced hypothermia, whereas exposure of the body alone produced a small insignificant response. Systemic injection of disodium cromoglycate (a mast cell stabilizer) and cimetidine (H2-receptor antagonist) had no effect on radiation-induced hypothermia, whereas systemic and central administration of mepyramine (H1-receptor antagonist) or central administration of disodium cromoglycate or cimetidine attenuated it, indicating the involvement of central histamine through both H1 and H2 receptors in this response. Serotonin is not involved, since the serotonin antagonist methysergide had no effect on radiation-induced hypothermia. These results indicate that central histaminergic systems may be involved in radiation-induced hypothermia. 34 references, 5 figures, 2 tables
Guan Wang; Jian-ning Zhang; Jia-kui Guo; Ying Cai; Hong-sheng Sun; Kun Dong; Cheng-gang Wu
Cold-inducible RNA-binding protein (CIRP), a key regulatory protein, could be facilitated by mild hypothermia in the brain, heart and liver. This study observed the effects of mild hypothermia at 31 ± 0.5°C on traumatic brain injury in rats. Results demonstrated that mild hypothermia suppressed apoptosis in the cortex, hippocampus and hypothalamus, facilitated CIRP mRNA and protein expression in these regions, especially in the hypothalamus. The anti-apoptotic effect of mild hypothermia disappeared after CIRP silencing. There was no correlation between mitogen-activated extracellular signal-regulated kinase activation and CIRP silencing. CIRP silencing inhibited extracellular signal-regulated kinase-1/2 activation. These indicate that CIRP inhibits apoptosis by affecting extracellular signal-regulated kinase-1/2 activation, and exerts a neuroprotective effect during mild hypothermia for traumatic brain injury.
Huang, Chien-Hua; Tsai, Min-Shan; Chiang, Chih-Yen; Su, Yu-Jen; Wang, Tzung-Dau; Chang, Wei-Tien; Chen, Huei-Wen; Chen, Wen-Jone
While therapeutic hypothermia improves the outcomes of individuals in cardiac arrest, the hemodynamic responses and mechanisms which underlie hypothermia-induced cardioprotection are not fully understood. Therefore, we investigated the mechanism by which induced hypothermia preserves cardiac function and protects against mitochondrial damage following cardiac arrest. Cardiac arrest was induced in adult male Wistar rats by asphyxiation for 8.5 min. Following resuscitation, the animals were randomly assigned to a hypothermia (32 °C) or normothermia (37 °C) group. Monitoring results showed that cardiac output at the fourth hour after resuscitation was significantly better in rats treated with hypothermia when compared to rats treated with normothermia (P < 0.01). Examinations by transmission electron microscopy showed that mitochondria in the left ventricle of rats in the hypothermia group were significantly less swollen compared to such mitochondria in the normothermia group (P < 0.001). Additionally, opening of mitochondrial permeability transition pores occurred less frequently in the hypothermic group. While complex I/III activity in the electron transport reaction was damaged after cardiac arrest and resuscitation, the degree of injury was ameliorated by hypothermia treatment (P < 0.05). The amount of STAT-3 phosphorylated at tyrosine 705 and its expression in mitochondria were significantly higher under hypothermia treatment compared to normothermia treatment. In vitro studies showed that inhibition STAT-3 activation abolished the ability of hypothermia to protect H9C2 cardiomyocytes against injury produced by simulated ischemia and reperfusion. Therapeutic hypothermia treatment can ameliorate cardiac dysfunction and help preserve both mitochondrial integrity and electron transport activity. PMID:26471891
Malone, Daniel T; Taylor, David A
It has been suggested that the dose of Δ9-tetrahydrocannabinol (Δ9-THC) that induces hypothermia in the rat increases the release of brain 5-hydroxytryptamine (5-HT). In light of this, we investigated the hypothermia produced by Δ9-THC, and the effect the selective serotonin reuptake inhibitor fluoxetine has on this response.A significant dose-dependent decrease in body temperature occurred after i.v. administration of 0.5 to 5 mg kg−1 Δ9-THC; maximum decreases being 0.8±0.2°C to 2.9±0.3°C. T...
Acute experiments on rats were made to study the effect of ether, chloral hydrate (400 mg/kg), sodium thiopental (60 mg/kg), sodium hydroxybutyrate (1500 mg/kg) and ethanol (3000 mg/kg) on rectal temperature under normothermia and the time of the onset of mild, moderate and deep hypothermia, which corresponds to the rectal temperature 33, 26 and 19 degrees C. The ratios of hypothermia development for the cooling stages under consideration and pair correlation coefficients were calculated and linear regression equations were derived.
The experimental hypothermia, by the deep modifications of the circulatory hemodynamic, which it drags, and by the huge reduction of the oxidative processes that it characterizes, represent a particular physiological state that must permit to specify physico-chemical mechanisms which order the exchanges of the partition of the blood in capillaries and notably electrolytes exchanges. To do this study we followed the distribution kinetics of the sodium 24 in the blood system of 30 rabbits that was either in hypothermia, either to normal temperature. (M.B.)
Yinghui Bao; Yumin Liang; Jiyao Jiang; Qizhong Luo; Yicheng Lu
BACKGROUND: Moderate hypothermia is one of the effective therapeutic methods for head injury in recent years, there are many mechanisms of moderate hypothermia for brain protection, and its influence on cerebral oxygenation is also one of them.OBJECTIVE: To observe the influence of moderate hypothermia on cerebral oxygenation of animals with acute intracranial hypertension, and further investigate the protective mechanism of moderate hypothermia. DESIGN: A randomized controlled trial.SETTING: Department of Neurosurgery, Renji Hospital affiliated to the Medical College of Shanghai Jiao Tong University.MATERIALS: Twenty healthy little pigs, either male or female, weighing 4.5 - 5.5 kg, were used. Neurotrend-typed multiparameter monitoring system (Diametrics Company, British); CMA/100micro-injection pump (Carnegie Company, Sweden).METHODS: The experiment was conducted in the Changzheng Hospital affiliated to the Second Military Medical University of Chinese PLA in November, 2001. The pigs were randomized into two groups: the normothermia group (control group, n =10) and moderate hypothermia group (n =10). ①Bilateral femoral arteries were separated, one was connected to pressometer for monitoring mean arterial pressure (MEP), and the other for analysis of blood gases [including peripheral blood Ph value, arterial partial pressure of carbon dioxide (PaCCh), arterial partial pressure of carbon dioxide (PaCO2), HCO3-].②Rectal temperature was monitored with mercurial thermometer.③Intracranial pressure was monitored using Camino optic ICP probe placed in the subdural space. ④Neurotrend multiparameter monitoring sensor was inserted into the white matter for about 4 cm to determine cerebral perfusion pressure (CPP, CPP=MAP(ICP), brain tissue partial oxygen pressure (PO2), partial pressure of carbon dioxide (PCCh), HCO3- and brain temperature. The rectal temperature of animals in the moderate hypothermia group was lowered to 34℃ using ice bags, and the body
Systemic or central administration of 2-deoxy-d-glucose (2DG), a competitive inhibitor of glucose utilization, induces hypothermia in awake animals and humans. This response is mediated by the central nervous system, though the neural mechanism involved is largely unknown. In this study, I examined possible involvement of the forebrain, which contains the hypothalamic thermoregulatory center, and the medullary rostral raphe/parapyramidal regions (rRPa/PPy), which mediate hypoxia-induced heat-loss responses, in 2DG-induced hypothermia in urethane-chloralose-anesthetized, neuromuscularly blocked, artificially ventilated rats. The intravenous injection of 2DG (250mgkg(-1)) elicited an increase in tail skin temperature and decreases in body core temperature and the respiratory exchange ratio, though it did not induce any significant change in the metabolic rate. These results indicate that the hypothermic response was caused by an increase in heat loss, but not by a decrease in heat production and that it was accompanied by a decrease in carbohydrate utilization and/or an increase in lipid utilization as energy substrates. Complete surgical transection of the brainstem between the hypothalamus and the midbrain had no effect on the 2DG-induced hypothermic responses, suggesting that the hindbrain, but not the forebrain, was sufficient for the responses. However, pretreatment of the rRPa/PPy with the GABAA receptor blocker bicuculline methiodide, but not with vehicle saline, greatly attenuated the 2DG-induced responses, suggesting that the 2DG-induced hypothermia was mediated, at least in part, by GABAergic neurons in the hindbrain and activation of GABAA receptors on cutaneous sympathetic premotor neurons in the rRPa/PPy. PMID:26146232
王晓丹; 李美清; 谢曼英; 马育璇; 谢文
目的 探讨保温措施下腹部手术婴幼儿术中低体温发生的影响因素.方法 对98例行腹部手术的婴幼儿术中实施保温措施,观察并记录婴幼儿的体温变化情况.分析腹部手术婴幼儿术中低体温发生的影响因素.结果 98例婴幼儿发生术中低体温42例,发生率为42.86％.体表面积、手术时间和术中输血是影响手术低体温发生的影响因素.结论 腹部手术婴幼儿术中低体温发生率较高.在保温措施的基础上做好术前保温工作有利于降低婴幼儿腹部手术中低体温的发生.%Objective To explore the factors leading to hypothermia during the abdominal surgery process in infants under comprehensive heat preservation measure. Methods Ninety eight infants undergoing abdominal surgery in our hospital from April 2009 to March 2011 were under comprehensive heat preservation measures. The core temprature were recorded continually. The factors causing hypothermia during the abdominal surgery for infants were analyzed. Results Among all the 98 infants, 42 cases experienced intraoperative hypothermia and the incidence was 42.86%. The factors leading to hypothermia were body size, duration of operation and blood transfusion. Conclusions The infants are prone to suffer from hypothermia intraoperative abdominal surgery. Effective preoperative intervention is helpful to prevent hypothermia during the infant abdominal surgery under comprehensive heat preservation measures intraoperative heat preservation.
Thomason, Timothy C.
Certain psychological treatments should be avoided, and a list of such treatments would provide valuable guidance for counselors, as well as potential clients. It is well established that some therapies are potentially dangerous, and some fringe therapies are highly unlikely to help clients beyond a placebo effect. This article provides an…
Follis, Rose M; Carter, Bruce D
In this issue of Neuron, Redmond et al. (2016) identify junction adhesion molecule 2 (JAM2) as an inhibitor of somatodendritic myelination in spinal cord neurons, thereby elucidating how myelin forms on axons but avoids dendrites and cell bodies. PMID:27537479
Knowledge of poisonous plants is extremely important for home owners, gardeners, farmers, hunters, hikers, and the rest of the general public. Among the most important plants to avoid in the Delta Region are poison ivy, bull nettle, eastern black nightshade, Queen Ann’s lace, jimsonweed, and trumpe...
LU Yi; WANG Shuo; LI Chun-sheng
Background During cardiac arrest,the gastrointestinal tract is sensitive to ischemia.Protection of the gastrointestinal tract is a critical factor in determining prognosis following cardiopulmonary resuscitation (CPR).This study seeks to determine the extent of gastrointestinal tract injury and the potential protective effect of inducing hypothermia following a porcine cardiac arrest model and CPR.Methods Ventricular fibrillation was induced by programmed electrical stimulation in 16 male domestic pigs (n=8 per group).Four minutes after ventricular fibrillation,CPR was performed.Pigs that successfully restored spontaneous circulation then received intravenous infusions of saline at either 4C or room temperature to produce hypothermic and control conditions respectively.Serum diamine oxidase and gastrointestinal adenosine triphosphate enzyme activity were determined and histopathology of the gastrointestinal tract was performed by light microscopy and electron microscopy.Results Significant injury of the gastrointestinal tract after CPR was found.Na+-K+ and Ca2+ adenosine triphosphate enzyme activity in the gastric tissue were significantly high in animals receiving hypothermia treatment compared to controls.Hypothermia also significantly reduced serum diamine oxidase after CPR compared to the control group.Moreover,severe injury sustained by the gastrointestinal tissue was significantly ameliorated under hypothermic conditions compared to controls.Conclusions Gastrointestinal injury and abnormal energy metabolism are strikingly evident following CPR.Hypothermia,which is induced by an infusion of 4C saline,can rapidly reduce internal body temperature,improve energy metabolism,and ameliorate injury to the gastrointestinal mucosa after CPR.
Pedersen, Lene Juul; Larsen, Mona Lilian Vestbjerg; Malmkvist, Jens
We investigated whether hypothermia in newborn piglets could be reduced by applying different thermal aids. The experiment was performed on 150 newborn piglets from 24 sows. Right after birth, the piglets were moved to a wire mesh cage for the first 2 h of life where they experienced 1 of 7...
Bro-Jeppesen, John; Kjaergaard, Jesper; Horsted, Tina I;
=0.01. No significant differences were found in long-term survival (57% vs. 56% alive at 30 months), MMSE, or SF-36. Therapeutic hypothermia (hazard ratio: 0.15, p=0.007) and bystander CPR (hazard ratio 0.19, p=0.002) were significantly related to survival in the intervention period. CONCLUSION: CPC...
Szeremeta, Michał; Petelska, Aneta Dorota; Kotyńska, Joanna; Pepiński, Witold; Naumowicz, Monika; Figaszewski, Zbigniew Artur; Niemcunowicz-Janica, Anna
The objective of this research was to evaluate postmortem changes concerning electric charge of human erythrocytes and thrombocytes in fatal accidental hypothermia. The surface charge density values were determined on the basis of the electrophoretic mobility measurements of the cells conducted at various pH values of electrolyte solution. The surface charge of erythrocyte membranes after fatal accidental hypothermia increased compared to the control group within whole range of experimental pH values. Moreover, a slight shift of the isoelectric point of erythrocyte membranes towards high pH values was observed. The surface charge of thrombocyte membranes in fatal accidental hypothermia decreased at low pH compared to the control group. However, at pH range 4-9, the values increased compared to the control group. The isoelectric point of thrombocyte membranes after fatal accidental hypothermia was slightly shifted towards low pH values compared to the control group. The observed changes are probably connected with the partial destruction and functional changes of the blood cell structure. PMID:26364031
Jia, Feng; Mao, Qing; Liang, Yu-Min; Jiang, Ji-Yao
Here we investigate the effect of hypothermia on the expression of apoptosis-regulating protein TIMP-3 after fluid percussion traumatic brain injury (TBI) in rats. We began with 210 adult male Sprague-Dawley rats and randomly assigned them to three groups: TBI with hypothermia treatment (32°C), TBI with normothermia (37°C), and sham-injured controls. TBI was induced by a fluid percussion TBI device. Mild hypothermia (32°C) was achieved by partial immersion in a water bath (0°C) under general anesthesia for 4 h. The rats were killed at 4, 6, 12, 24, 48, and 72 h and 1 week after TBI. The mRNA and protein level of TIMP-3 in both the injured and uninjured hemispheres of the brains from each group were measured using RT-PCR and Western blotting. In the normothermic group, TIMP-3 levels in both the injured and uninjured hemispheres were significantly increased after TBI compared with those of sham-injured animals (p percussion brain injury significantly upregulates TIMP-3 expression, and that this increase may be suppressed by hypothermia treatment. PMID:23256480
Thomsen, Jakob Hartvig; Hassager, Christian; Bro-Jeppesen, John;
BACKGROUND: Bradycardia is a common finding in patients undergoing therapeutic hypothermia (TH) following out-of-hospital cardiac arrest (OHCA), presumably as a normal physiological response to low body temperature. We hypothesized that a normal physiological response with sinus bradycardia (SB) ...
ZHANG Hong; ZHANG Jun-jian; MEI Yuan-wu; SUN Sheng-gang; TONG E-tang
Background The optimal time window for the administration of hypothermia following cerebral ischemia has been studied for decades,with disparity outcomes.In this study,the efficacy of mild brain hypothermia beginning at different time intervals on brain endogenous antioxidant enzyme and energy metabolites was investigated in a model of global cerebral ischemia.Methods Forty-eight male Sprague-Dawley rats were divided into a sham-operated group,a normothermia (37℃-38℃) ischemic group and a mild hypothermic (31℃-32℃) ischemia groups.Rats in the last group were subdivided into four groups:240 minutes of hypothermia,30 minutes of normothermia plus 210 minutes of hypothermia,60 minutes of normothermia plus 180 minutes of hypothermia and 90 minutes of normothermia plus 150 minutes of hypothermia (n=8).Global cerebral ischemia was established using the Pulsinelli four-vessel occlusion model for 20minutes and mild hypothermia was applied after 20 minutes of ischemia.Brain.tissue was collected following 20 minutes of cerebral ischemia and 240 minutes of reperfusion,and used to measure the levels of superoxide dismutase (SOD),glutathione peroxidase (GSH-Px),reduced glutathione (GSH) and adenosine triphosphate (ATP).Results Mild hypothermia that was started within 0 to 60 minutes delayed the consumption of SOD,GSH-Px,GSH,and ATP (P ＜0.05 or P ＜0.01) in ischemic tissue,as compared to a normothermic ischemia group.In contrast,mild hypothermia beginning at 90 minutes had little effect on the levels of SOD,GSH-Px,GSH,and ATP (P＞0.05).Conclusions Postischemic mild brain hypothermia can significantly delay the consumption of endogenous antioxidant enzymes and energy metabolites,which are critical to the process of cerebral protection by mild hypothermia.These results show that mild hypothermia limits ischemic injury if started within 60 minutes,but loses its protective effects when delayed until 90 minutes following cerebral ischemia.
This new utility patent is an active design that relies on the lung's role as an organic heat exchanger for providing deep body core heating of air. It is based on the fact that the greatest heat loss mechanism for an insulated human body immersed in a cold water environment is due to heat loss through respiration. This innovation successfully merges two existing technologies (cold immersion suit and existing valve technologies) to produce a new product that helps prevent against the onset of hypothermia at sea. During normal operations, a human maintains an approximate body temperature of [98.6 F (37 C)]. A mechanism was developed to recover the warm temperature from the body and reticulate it in a survival suit. The primary intention is to develop an encompassing systems design that can both easily and cost effectively be integrated in all existing currently manufactured cold water survival suits, and as such, it should be noted that the cold water immersion suit is only used as a framework or tool for laying out the required design elements. At the heart of the suit is the Warm Air Recovery (WAR) system, which relies on a single, large Main Purge Valve (MPV) and secondary Purge Valves (PV) to operate. The main purge valve has a thin membrane, which is normally closed, and acts as a one-way check valve. When warm air is expelled from the lungs, it causes the main purge valve to open. Air forced from the MPV is dumped directly into the suit, thereby providing warmth to the torso, legs, and arms. A slight positive over-pressure in the suit causes warm waste air (or water if the suit is punctured) to be safely vented into the sea through large PVs located at the bottom of each arm and leg. The secondary purge valves act to prevent the buildup of large concentrations of CO2 gas and help guard against asphyxia. It is noted that the MPV causes the inhalation and exhalation cycles to be completely isolated from one another in the current suit design.
Grindstaff, Terry L.; Saliba, Susan A.
Writing a scientific manuscript can be a consuming, but rewarding task with a number of intrinsic and extrinsic benefits. The ability to write a scientific manuscript is typically not an emphasized component of most entry‐level professional programs. The purpose of this overview is to provide authors with suggestions to improve manuscript quality and to provide mechanisms to avoid common manuscript mistakes that are often identified by journal reviewers and editors.
Within the next two decades Indonesia aspires to generate prosperity, avoid a middle-income trap and leave no one behind as it tries to catch up with high-income economies. These are ambitious goals. Realizing them requires sustained high growth and job creation, as well as reduced inequality. Can Indonesia achieve them? This report argues that the country has the potential to rise and bec...
Del Balzo, Francesca; Maiolo, Stella; Papoff, Paola; Giannini, Luigi; Moretti, Corrado; Properzi, Enrico; Spalice, Alberto
Hypoxic-ischemic encephalopathy (HIE) is an important cause of acute neurological damage in newborns at (or near) term. Several trials in recent years have shown that moderate hypothermia by total body cooling or selective head is an effective intervention to reduce mortality and major disability in infants survived a perinatal hypoxic-ischemic attack. Follow-up in these patients is very important to establish neurodevelopmental outcome, and specific markers can lead us to detect predicting sign for good or poor outcome. We reported a few cases of newborn with HIE treated with hypothermia, in whom the comparison between electroencephalogram (EEG) and magnetic resonance imaging (MRI) represents the first marker for neurodevelopment outcome prediction. The continuous EEG monitoring showed a depressed EEG activity with diffuse burst depression in 7 patients. No epileptic abnormalities were registered. In 10 out of 20 patients no abnormalities of the background activity and no epileptic abnormalities were observed. We found that a depressed EEG activity during the first 72 h of life and a diffused alteration of basal ganglia at MRI were correlated with a poor neurodevelopmental outcome at 18 months of follow-up. PMID:25635216
Francesca Del Balzo
Full Text Available Hypoxic-ischemic encephalopathy (HIE is an important cause of acute neurological damage in newborns at (or near term. Several trials in recent years have shown that moderate hypothermia by total body cooling or selective head is an effective intervention to reduce mortality and major disability in infants survived a perinatal hypoxic-ischemic attack. Follow-up in these patients is very important to establish neurodevelopmental outcome, and specific markers can lead us to detect predicting sign for good or poor outcome. We reported a few cases of newborn with HIE treated with hypothermia, in whom the comparison between electroencephalogram (EEG and magnetic resonance imaging (MRI represents the first marker for neurodevelopment outcome prediction. The continuous EEG monitoring showed a depressed EEG activity with diffuse burst depression in 7 patients. No epileptic abnormalities were registered. In 10 out of 20 patients no abnormalities of the background activity and no epileptic abnormalities were observed. We found that a depressed EEG activity during the first 72 h of life and a diffused alteration of basal ganglia at MRI were correlated with a poor neurodevelopmental outcome at 18 months of follow-up.
Cases of accidental profound hypothermia occur most frequently in cold, northern climates. We describe an atypical case, occurring in a temperate climate, where a hypothermic cardiac-arrested patient was successfully resuscitated using extracorporeal circulation (ECC).
Guojie Jing; Baoxin Ma; Xiaoteng Yao; Yiyi Li; Yituan Xie; Wangan Li; Kejun Liu; Yingchao Jing; Baisheng Li; Yifan Lv
Fractional anisotropy values in diffusion tensor imaging can quantitatively relfect the consistency of nerve ifbers after brain damage, where higher values generally indicate less damage to nerve ifbers. Therefore, we hypothesized that diffusion tensor imaging could be used to evaluate the effect of mild hypothermia on diffuse axonal injury. A total of 102 patients with diffuse axonal injury were randomly divided into two groups:normothermic and mild hypothermic treatment groups. Patient’s modiifed Rankin scale scores 2 months after mild hypothermia were signiifcant-ly lower than those for the normothermia group. The difference in average fractional anisotropy value for each region of interest before and after mild hypothermia was 1.32-1.36 times higher than the value in the normothermia group. Quantitative assessment of diffusion tensor imaging indicates that mild hypothermia therapy may be beneifcial for patients with diffuse axonal injury.
Wong, Lai-hung; 黃麗虹
Hypothermia is commonly found in injured victims who suffer from central nervous system injury, hypovolemic shock, exposure to environment, administration of anesthetic drugs and cold intravenous fluid. All these factors decrease the abilities of trauma victims to maintain normothermia and conserve body heat. Hypothermia in injured victim is a significant contributor to a well known cycle—triad of death and associated with increased mortality, morbidity and length of hospital stay. Hypothermi...
Objective: To explore the variant processes of c ell apoptosis and the inhibiting effect of moderate hypothermia on cell apoptosi s after diffuse brain injury. Methods: Models of diffuse brain injury were induced by the tra uma device reported by Marmarou.1 A total of 128 Wistar rats were divided into 4 groups: the uninjured group (Group A, n=8), the severely i njured group (Group B, n=60), the mildly injured group (Gr oup C, n=30) and the mild hypothermia group (Group D, n=30). In Group D, the severely injured rats were treated with moderate hypothermia to keep the rectal temperature at 32℃ (standard deviation for 0.1℃) for 6 hours. Then the morphosis, the characteristics and the qua ntity of apoptotic cells in the cerebral cortex and in the hippocampus regions a fter different severities of craniocerebral injuries were observed and compared under an electronic microscope, with terminal deoxynucleotidyl nick end labeling (TUNEL) in DNA fragmentation and with agarose gel electrophoresis. Results: TUNEL showed apoptotic cells increased according to t he injury severity, and they peaked at 48 hours after injury and then declined. In Group C, apoptosis was located in the CA2 and CA3 areas of the hippocampu s. And in Group B, apoptosis increased evidently, and located in the whole hippo campus and in the frontal and parietal cortex regions. The hypothermia-treated rats had some apoptotic cells, too. However, even at 24, 48 and 72 hours after i njury there were significantly fewer apoptotic cells in the cortex and in the hi ppocampus in Group D than that in the non-treated groups. Electron microscopy s howed that the apoptotic cells were round and shrunken in morphology and the nuc lei were round and condensed at 24 and 48 hours after injury. And the apoptosis at 48 hours was more severe than that at 24 hours. The hypothermia-treated rats had no apoptotic cells. Gel electrophoresis showed that characteristic DNA “la dders” were observed in the
Yan, Sherry H. F.; Xu, Yuexiao
Recently, Chen et al. derived the generating function for partitions avoiding right nestings and posed the problem of finding the generating function for partitions avoiding right crossings. In this paper, we derive the generating function for partitions avoiding right crossings via an intermediate structure of partial matchings avoiding 2-right crossings and right nestings. We show that there is a bijection between partial matchings avoiding 2-right crossing and right nestings and partitions...
This report describes the activity based costing method used to acquire variable (volume dependent or avoidable) waste management cost data for routine operations at Department of Energy (DOE) facilities. Waste volumes from environmental restoration, facility stabilization activities, and legacy waste were specifically excluded from this effort. A core team consisting of Idaho National Engineering Laboratory, Los Alamos National Laboratory, Rocky Flats Environmental Technology Site, and Oak Ridge Reservation developed and piloted the methodology, which can be used to determine avoidable waste management costs. The method developed to gather information was based on activity based costing, which is a common industrial engineering technique. Sites submitted separate flow diagrams that showed the progression of work from activity to activity for each waste type or treatability group. Each activity on a flow diagram was described in a narrative, which detailed the scope of the activity. Labor and material costs based on a unit quantity of waste being processed were then summed to generate a total cost for that flow diagram. Cross-complex values were calculated by determining a weighted average for each waste type or treatability group based on the volume generated. This study will provide DOE and contractors with a better understanding of waste management processes and their associated costs. Other potential benefits include providing cost data for sites to perform consistent cost/benefit analysis of waste minimization and pollution prevention (WMIN/PP) options identified during pollution prevention opportunity assessments and providing a means for prioritizing and allocating limited resources for WMIN/PP
Fisher, E R; Partin, K M
Although it might seem to be a simple task for scientists to avoid plagiarism and thereby an allegation of research misconduct, assessment of trainees in the Responsible Conduct of Research and recent findings from the National Science Foundation Office of Inspector General regarding plagiarism suggests otherwise. Our experiences at a land-grant academic institution in assisting researchers in avoiding plagiarism are described. We provide evidence from a university-wide multi-disciplinary course that understanding how to avoid plagiarism in scientific writing is more difficult than it might appear, and that a failure to learn the rules of appropriate citation may cause dire consequences. We suggest that new strategies to provide training in avoiding plagiarism are required. PMID:24785995
Kam Lun Hon
Full Text Available We report a term neonate with hypoxic ischemic encephalopathy who underwent a 72-hour therapeutic hypothermia. He developed unstable body temperature associated with coagulase negative staphylococcus septicemia 2 weeks later which was promptly treated with intravenous antibiotics and made a good recovery. PubMed (a service of the U.S. National Library of Medicine was searched for the terms “therapeutic hypothermia” and “septicemia,” with limits activated (humans, English, age 0–18 years. There were only 6 randomized controlled trials, 1 non-randomized controlled trial, 1 retrospective cohort, and 1 case-control trial, which showed no definite evidence of increased risk of septicemia or neutrophil dysfunction in infants following hypothermia therapy.
Johansen, Flemming Fryd; Hasseldam, Henrik; Nybro Smith, Matthias; Rasmussen, Rune Skovgaard
BACKGROUND: Drug-induced hypothermia reduces brain damage in animal stroke models and is an undiscovered potential in human stroke treatment. We studied hypothermia induced by the serotonergic agonists S14671 (1-[2-(2-thenoylamino)ethyl]-4[1-(7- methoxynaphtyl)]piperazine) and ipsapirone in a rat...... controls (P < .05). S14671 rats kept normothermic did not show infarct reduction (P > .05). The body temperature after stroke was reduced 1.0-3.0°C compared with controls for 20 hours with S14671 treatment and for 6 hours with ipsapirone treatment. In humans, ipsapirone reduced temperature in average with...... stroke model and in man by literature meta-analysis. METHODS: Rats had 60 minutes of middle cerebral artery occlusion (MCAO) and then 7 days of survival. Body temperatures were monitored for 22 hours. Thirty minutes after MCAO, 1 group (n = 9) received bolus of S14671 (.75 mg/kg) and continuous infusion...
Horst, K.; Eschbach, D.; Pfeifer, R.; Relja, B; Sassen, M.; T. Steinfeldt; Wulf, H; N Vogt; Frink, M.; Ruchholtz, S.; Pape, H. C.; F. Hildebrand
Background Hypothermia has been discussed as playing a role in improving the early phase of systemic inflammation. However, information on the impact of hypothermia on the local inflammatory response is sparse. We therefore investigated the kinetics of local and systemic inflammation in the late posttraumatic phase after induction of hypothermia in an established porcine long-term model of combined trauma. Materials & Methods Male pigs (35 ± 5kg) were mechanically ventilated and monitored ove...
Kadan, Murat; Erol, Gokhan; Savas Oz, Bilgehan; Arslan, Mehmet
Summary Background We aimed to examine the effects of topical hypothermia on inflammatory markers in patients undergoing coronary artery bypass surgery. Methods Fifty patients undergoing isolated coronary artery bypass surgery were included the study. They were randomised to two groups. Mild hypothermic cardiopulmonary bypass (28–32°C) was performed on both groups using standardised anaesthesiology and surgical techniques. Furthermore, topical cooling with 4°C saline was performed on patients...
Zhumadilov, Agzam; Gilman, Charles P.; Viderman, Dmitriy
Super-refractory status epilepticus (SRSE) is defined as status epilepticus that continues 24 h or more after the onset of anesthesia, and includes those cases in which epilepsy is recurrent upon treatment reduction. We describe the presentation and successful management of a male patient with SRSE using the inhaled anesthetic isoflurane, and mild hypothermia (HT). The potential utility of combined HT and volatile anesthesia is discussed. PMID:25674075
Zhumadilov, Agzam; Gilman, Charles P.; Viderman, Dmitriy
Super-refractory status epilepticus (SRSE) is defined as status epilepticus that continues 24 h or more after the onset of anesthesia, and includes those cases in which epilepsy is recurrent upon treatment reduction. We describe the presentation and successful management of a male patient with SRSE using the inhaled anesthetic isoflurane, and mild hypothermia (HT). The potential utility of combined HT and volatile anesthesia is discussed.
Renata R. T. Castro; Fernanda SNS Mendes; Nobrega, Antonio Claudio L.
INTRODUCTION: There are no available data addressing the potential clinical risks of open-water swimming competitions. OBJECTIVE: Address the risks of hypothermia and hypoglycemia during a 10-km open-water swimming competition in order to alert physicians to the potential dangers of this recently-introduced Olympic event. METHODS: This was an observational cross-sectional study, conducted during a 10-km open-water event (water temperature 21ºC). The highest ranked elite open-water swimmers in...
Yu Gao; Kang-Li Hui; Yu-Jie Wang; Lin Wu; Man-Lin Duan; Jian-Guo Xu; De-Xin Li
Background:Therapeutic hypothermia has been recommended for the treatment of cardiac arrest patients who remain comatose after the return of spontaneous circulation.The aim of this study was to evaluate the effectiveness and safety of mild hypothermia on patients with cardiac arrest by conducting a meta-analysis.Methods:The relevant trials were searched in Cochrane Library,PubMed,Web of Science,Embase,CNKI and Wan Fang Data from the date of their establishment to October 2014.Thereafter,the studies retrieved were screened based on predefined inclusion and exclusion criteria.Data were extracted,and the quality of the included studies was evaluated.A meta-analysis was conducted using the Cochrane Collaboration Review Manager 5.2 software.Results:Six randomized controlled trials involving 531 cases were included,among which 273 cases were assigned to the treatment group and the other 258 cases to the control group.The meta-analysis indicated that mild hypothermia therapy after cardiac arrest produced significant differences in survival rate (relative risk [RR] =1.23,95％ confidence interval [CI]:1.02-1.48,P =0.03) and neurological function (RR =1.33,95％ CI:1.08-1.65,P =0.007) after 6 months compared with normothermia therapy.However,no significant differences were observed in the survival to the hospital discharge (RR =1.35,95％ CI:0.87-2.10,P =0.18),favorable neurological outcome at hospital discharge (RR =1.53,95％ CI:0.95-2.45,P =0.08) and adverse events.Conclusions:The meta-analysis demonstrated that mild hypothermia can improve the survival rate and neurological function of patients with cardiac arrest after 6 months.On the other hand,regarding the survival to hospital discharge,favorable neurological outcome at hospital discharge,and adverse events,our meta-analysis produced nonsignificant results.
Objective:To analyze the effect of mild hypothermia auxiliary therapy on recovery of patients with craniocerebral trauma after decompressive craniectomy.Methods: 110 cases of patients with craniocerebral trauma who received decompressive craniectomy in our hospital from November 2012 to November 2014 were selected as research subjects and randomly divided into observation group and control group according to different treatment methods, each group with 55 cases. Control group received decompressive craniectomy alone, observation group received decompressive craniectomy combined with mild hypothermia auxiliary therapy, and then differences in neural function, serum NSE, SOD, NO and ET levels, cerebral blood flow level as well as serum ADH, BNP and ACTH levels of two groups were compared.Results:CPC grading of observation group 1 week after mild hypothermia auxiliary therapy was lower than that of control group and scores of GOC and ESS were higher than those of control group (P<0.05); serum NSE, NO and ET levels of observation group 1 week after treatment were lower than those of control group and SOD level was higher than that of control group (P<0.05); Vs and Vm levels of observation group 1 week after treatment were higher than those of control group and PI level was lower than that of control group (P<0.05); serum ADH and ACTH levels of observation group 1 week after treatment were lower than those of control group and BNP level was higher than that of control group (P<0.05).Conclusions:Decompressive craniectomy combined with mild hypothermia auxiliary therapy for patients with craniocerebral trauma can effectively improve patients’ neural function, promote cerebral blood flow and optimize humoral-associated factor levels, and it has positive clinical significance.
Jing, Guojie; Yao, Xiaoteng; Li, Yiyi; Xie, Yituan; Li, Wang#x2019;an; LIU, Kejun; Jing, Yingchao; Li, Baisheng; Lv, Yifan; Ma, Baoxin
Fractional anisotropy values in diffusion tensor imaging can quantitatively reflect the consistency of nerve fibers after brain damage, where higher values generally indicate less damage to nerve fibers. Therefore, we hypothesized that diffusion tensor imaging could be used to evaluate the effect of mild hypothermia on diffuse axonal injury. A total of 102 patients with diffuse axonal injury were randomly divided into two groups: normothermic and mild hypothermic treatment groups. Patient's m...
Eric A. Lacey; O’Connell, Redmond G.; Shane M. O’Mara; Paul M. Dockree
Mild Induced hypothermia has come to be recognised as a successful method of providing neuro-protective treatment for patients suffering ischemic stroke, cardiac arrest and traumatic brain injury (TBI). Anti-inflammatory responses and the lowering of cerebral metabolic rates, leading to a reduction in neuronal apoptosis, are considered to be the main mechanisms by which this process benefits patients. Assessment of a new hydro based cooling device, which could potentially be used by emergency...
Kalamida, Dimitra; Karagounis, Ilias V.; Mitrakas, Achilleas; Kalamida, Sofia; Giatromanolaki, Alexandra; Koukourakis, Michael I.
Purpose The current study examines the effect of fever-range hyperthermia and mild hypothermia on human cancer cells focusing on cell viability, proliferation and HSP90 expression. Materials and Methods A549 and H1299 lung carcinoma, MCF7 breast adenocarcinoma, U87MG and T98G glioblastoma, DU145 and PC3 prostate carcinoma and MRC5 normal fetal lung fibroblasts cell lines were studied. After 3-day exposure to 34°C, 37°C and 40°C, cell viability was determined. Cell proliferation (ki67 index), apoptosis (Caspase 9) and HSP90 expression was studied by confocal microscopy. Results Viability/proliferation experiments demonstrated that MRC5 fibroblasts were extremely sensitive to hyperthermia, while they were the most resistant to hypothermia. T98G and A549 were thermo-tolerant, the remaining being thermo-sensitive to a varying degree. Nonetheless, as a universal effect, hypothermia reduced viability/proliferation in all cell lines. Hyperthermia sharply induced Caspase 9 in the U87MG most thermo-sensitive cell line. In T98G and A549 thermo-tolerant cell lines, the levels of Caspase 9 declined. Moreover, hyperthermia strongly induced the HSP90 levels in T98G, whilst a sharp decrease was recorded in the thermo-sensitive PC3 and U87MG cell lines. Hyperthermia sensitized thermo-sensitive cancer cell lines to cisplatin and temozolomide, whilst its sensitizing effect was diminished in thermo-tolerant cell lines. Conclusions The existence of thermo-tolerant and thermo-sensitive cancer cell lines was confirmed, which further encourages research to classify human tumor thermic predilection for patient stratification in clinical trials. Of interest, mild hypothermia had a universal suppressing effect on cancer cell proliferation, further supporting the radio-sensitization hypothesis through reduction of oxygen and metabolic demands. PMID:25635828
Strasser, Ruth H.
Full Text Available Objective: Hypothermia has been shown to reduce neurologic deficits in patients after cardiopulmonary resuscitation (CPR. It was not clear if intravascular cooling is superior to standard external cooling in inducing hypothermia. Goal of this study was to compare intravascular cooling with an automated cooling device with external cooling in everyday practice on a cardiac-care ICU (intensive care unit. Methods: Patients after successful CPR for unwitnessed cardiac arrest were subjected to cooling with an automated cooling system (CoolGard, Alsius after initial hemodynamic stabilization. Goal was to achieve a core temperature of 33°C. Monitored were the time intervals from admission to begin of cooling and from begin of cooling to target temperature. Data were compared retrospectively with those from patients subjected to external cooling. Results: 31 consecutive patients treated with intravascular cooling were analyzed. Cooling was initiated at a mean time of 58 min after admission, and the target temperature of 33°C was achieved after a mean of 3.48 hours after the begin of cooling. In contrast, 49 patients treated with external cooling achieved a minimum temperature of 34.8°C only 9.2 hours after admission. Conclusion: In everyday practice, intravascular cooling using an automated cooling system is superior for a rapid induction of hypothermia after cardiac arrest.
Full Text Available The effectiveness of hypothermia as a method of neuroprotection in brain damage has been proved in many studies, but a large number of complications requires development of further protocols of its management. The article presents experience of treatment of aneurismal subarachnoid hemorrhage under conditions of preventive hypothermia. 84 patients were examined. In 56 of them the efficacy of developed method on prevention and correction of hypocalaemia developed as a result of cold diuresis has been proposed. It has been found that decrease in plasma potassium occurs in parallel with decrease in body temperature regardless the technique of potassium chloride injection. Introduction of potassium chloride solution in physiological dose of 0.2 mmol/kg prevents hypocalaemia development during preventive hypothermia. Injection of potassium chloride in the physiological dose of 0.2 mmol/kg/h and after beginning of patient’s rewarming – 0.8 mmol/kg within the period of one postsurgery day prevents the development of postoperative hypocalaemia in the postoperative period; and after patient’s rewarming– 0.8. mmol/kg within the period of one postoperative day prevents development of postoperative cardiac complications in the perioperative period by 20%.
Kiley, J P; Eldridge, F L; Millhorn, D E
We studied respiration (phrenic nerve activity) during progressive hypothermia to as low as 30.5 degrees C in five anesthetized, paralyzed, glomectomized, and vagotomized cats. PCO2 was maintained at a constant level throughout the experiments. We confirmed the results of a previous study (J. P. Kiley, F. L. Eldridge, and D. E. Millhorn, J. Appl. Physiol. 58: 295-312, 1985) in which respiratory minute output decreased progressively with cooling and respiratory frequency decreased markedly. In addition we show that focal rewarming to normal temperature (37.5 degrees C) of the structures in the intermediate areas on the ventral surface of the medulla resulted in a significant reversal of the depressed respiratory minute activity observed with hypothermia. Respiratory frequency, however, was unaffected by intermediate area rewarming. We conclude that the decreased respiratory activity during hypothermia is due to a generalized interference with neural function. A major portion of these effects is due to cooling of the intermediate areas, but the slowing of respiratory frequency appears to be an independent effect. PMID:4066572
Quantitative analysis of normal tissue effects in the clinic (QUANTEC) guideline validation using quality of life questionnaire datasets for parotid gland constraints to avoid causing xerostomia during head-and-neck radiotherapy
effectively avoid xerostomia, and the QUANTEC 25-Gy guideline is justified for NPC cohorts
Homayoun, Seraji; Colbaugh, Richard; Glass, Kristin
Simple and direct control scheme enables redundant robot to avoid obstacles in workspace. In proposed scheme, called "configuration control", degrees of freedom used to configure robot to satisfy set of inequality constraints representing avoidance of obstacles, while simultaneously making end effector follow desired trajectory. Provides capability to avoid obstacles in dynamically varying environment where apriori planning of tasks not feasible.
Pedersen, L J; Larsen, M L V; Malmkvist, J
We investigated whether hypothermia in newborn piglets could be reduced by applying different thermal aids. The experiment was performed on 150 newborn piglets from 24 sows. Right after birth, the piglets were moved to a wire mesh cage for the first 2 h of life where they experienced 1 of 7 different combinations of flooring (solid vs. slatted) and treatments: control, with no additional thermal aids on a solid floor ( = 26) or a slatted floor ( = 26); built-in floor heating ( = 31) or floor heating as a radiant floor plate on solid floor (FloorPlate; = 19); radiant heater above a solid floor (RadiantC; = 22) or a slatted floor (RadiantSlat; = 18); and provision of straw on a solid floor (Straw; = 8). Piglets' rectal temperature was measured both continuously and manually every 10 min for the first 2 h after birth using a thermal sensor inserted in the rectum of the piglets. The rectal temperature curve was analyzed for differences in the slope of the drop in rectal temperature and the deflection tangent of the curve. Furthermore, differences in average rectal temperature, minimum rectal temperature, rectal temperature 2 h after birth, and time with rectal temperature below 35°C were analyzed. All statistical analyses were performed using a mixed model. All thermal aids/heat solutions resulted in a less steep drop in rectal temperature, a faster recovery, and, for the smaller piglets, also a greater average rectal temperature (except for built-in floor heating) and less time with rectal temperature below 35°C. The most efficient thermal aids to reduce hypothermia in newborn piglets were Straw and RadiantC. Furthermore, Straw, RadiantC, and FloorPlate also eliminated the effect of birth weight on some of these indicators of thermoregulatory success. Otherwise, FloorPlate and RadiantSlat showed an intermediate outcome for most measures. With no heating, piglets on a solid floor experienced more severe hypothermia than piglets on a slatted floor. In conclusion
Asteroid 2011 AG5 will impact on Earth in 2040. (See Donald K. Yoemans, ``Asteroid 2011 AG5 - A Reality Check,'' NASA-JPL, 2012) In 2011, The author say: the dark hole will take the dark comet to impact our solar system in 20 years, and give a systemic model between the sun and its companion-dark hole to explain why were there periodicity mass extinction on earth. (see Dayong Cao, BAPS.2011.CAL.C1.7, BAPS.2011.DFD.LA.24, BAPS.2012.APR.K1.78 and BAPS.2011.APR.K1.17) The dark Asteroid 2011 AG5 (as a dark comet) is made of the dark matter which has a space-time (as frequence-amplitude square) center- a different systemic model from solar systemic model. It can asborb the space-time and wave. So it is ``dark.'' When many dark matters hit on our earth, they can break our atom structure and our genetic code to trigger the Mass Extinction. In our experiments, consciousness can change the systematic model and code by a life-informational technology. So it can change the output signals of the solar cell. (see Dayong Cao, BAPS.2011.MAR.C1.286 and BAPS.2012.MAR.P33.14) So we will develop the genetic code of lives to evolution and sublimation, will use the dark matter to change the systemic model between dark hole and sun and will avoid next extinction.
Graduates of vocational students are in the face of increasingly severe employment situation,social environment in the face of reality induced by other factors,a large number of vocational school students are at a loss,anxiety,irritability.Often expressed as not to take the initiative,saying that the ＂other,rely on,to＂ dependency,passive evasion jobs,in order to better help students better understand this problem,the analysis of its causes and influencing factors at the same time,with staff the actual characteristics of students that the corresponding psychological adjustment measures.%中职生毕业生面对日趋严峻的就业形势,面对现实社会环境中诱发等多种因素,为数不少的职校生感到无所适从、忧心忡忡、烦躁不安。往往表现为不主动出击,抱着＂等、靠、要＂的依赖思想,消极逃避就业岗位。为了更好帮助毕业生更好地认识这问题,在分析其成因及影响因素的同时,结合职校学生实际特点指出相应的心理调适对策。
See, K C; Jamal, S J Syed; Chiam, M L
This analysis is a case-series to document the outcome of term newborns with hypoxic ischaemic encephalopathy (HIE), enrolled into total body hypothermia therapy, in a tertiary neonatal unit in Malaysia. The method used to achieve total body hypothermia is a novel method using just environmental temperature, without the need of expensive equipment. A total of 17 babies were eligible to be included in this study, from the 1st of January 2010 to the 31st of December 2010. 14 out of 15 babies who had Stage 2 HIE had no neurological deficit at follow-up. All Stage 3 HIE babies passed away. Allowing for the small sample size, we can conclude that total body hypothermia therapy is feasible and is a safe treatment modality for HIE Stage 2 babies in a Malaysian setting, by manipulating environmental temperature to achieve therapeutic hypothermia. Further work is needed to determine the long-term outcome of passive cooling total body hypothermia in Stage 2 HIE babies in Malaysia. PMID:23082414
Kang, Xiaoxu; Jia, Xiaofeng; Geocadin, Romergryko G; Thakor, Nitish V; Maybhate, Anil
Neurological complications after cardiac arrest (CA) can be fatal. Although hypothermia has been shown to be beneficial, understanding the mechanism and establishing neurological outcomes remains challenging because effects of CA and hypothermia are not well characterized. This paper aims to analyze EEG (and the alpha-rhythms) using multiscale entropy (MSE) to demonstrate the ability of MSE in tracking changes due to hypothermia and compare MSE during early recovery with long-term neurological examinations. Ten Wistar rats, upon post-CA resuscitation, were randomly subjected to hypothermia (32 degrees C-34 degrees C, N = 5) or normothermia (36.5 degrees C-37.5 degrees C, N = 5). EEG was recorded and analyzed using MSE during seven recovery phases for each experiment: baseline, CA, and five early recovery phases (R1-R5). Postresuscitation neurological examination was performed at 6, 24, 48, and 72 h to obtain neurological deficit scores (NDSs). Results showed MSE to be a sensitive marker of changes in alpha-rhythms. Significant difference (p < 0.05) was found between the MSE for two groups during recovery, suggesting that MSE can successfully reflect temperature modulation. A comparison of short-term MSE and long-term NDS suggested that MSE could be used for predicting favorability of long-term outcome. These experiments point to the role of cortical rhythms in reporting early neurological response to ischemia and therapeutic hypothermia. PMID:19174339
对重型颅脑损伤患者亚低温治疗期间寒战的原因、控制和护理进展进行阐述.虽然目前尚缺乏亚低温治疗期间寒战控制的最佳方案,但可指出寒战的控制及预防是涉及多环节的综合性治疗技术,只有将正确的防治方法与密切的观察护理紧密结合才可有效地防止亚低温期间寒战发生,使低温治疗顺利进行,确保亚低温治疗效果,提高患者生存率.%It expatiated the reason, treatment and nursing care of chill during the process of therapeutic hypothermia on traumatic brain injury patient. The control of shivering is a comprehensive treatment. Although there is not the best method to avoid shivering, the closed combination of the correct control methods and the close nursing can effectively prevent the shivering during hypothermia and promote patients recovery.
Bjerregaard, Peter; Juel, K
suicides and alcohol related diseases were high in the capital and East Greenland and low in West Greenlandic settlements. It is concluded that further studies on preventable diseases and causes of death, in particular certain infectious diseases, accidents and suicides, are needed.......The concept of avoidable deaths suggests that certain deaths ought not occur in a given society because it is possible to prevent or treat the disease or condition. A list of avoidable deaths is time and community specific as it reflects the socioeconomic conditions, professional medical capacity...... and political will of the society. A list of avoidable deaths is proposed for Greenland which includes, inter alia, meningitis, lung cancer, acute respiratory infections, suicides, boat accidents and alcohol related diseases and accidents. All were considerably more common in Greenland than in Denmark...
Gilson Soares Feitosa-Filho
out-of-hospital cardiac arrest. Considering its formal recommendation as a therapy, post-return of spontaneous circulation after cardiac arrest, the objective of this study was to review the clinical aspects of therapeutic hypothermia. Non-systematic review of articles using the keywords "cardiac arrest, cardiopulmonary resuscitation, cooling, hypothermia, post resuscitation syndrome" in the Med-Line database was performed. References of these articles were also reviewed. Unconscious adult patients with spontaneous circulation after out-of-hospital ventricular fibrillation or pulseless ventricular tachycardia should be cooled. Moreover, for any other rhythm or in the intra-hospital scenario, such cooling may also be beneficial. There are different ways of promoting hypothermia. The cooling system should be adjusted as soon as possible to the target temperature. Mild therapeutic hypothermia should be administered under close control, using neuromuscular blocking drugs to avoid shivering. The rewarming process should be slow, and reach 36º C, usually in no less then 8 hours. When temperature increases to more than 35º C, sedation, analgesia, and paralysis could be discontinued. The expected complications of hypothermia may be pneumonia, sepsis, cardiac arrhythmias, and coagulopathy. In spite of potential complications which require rigorous control, only six patients need to be treated to save one life.
Grefe, William Kevin
This thesis presents collision avoidance integrated with lane keeping and adaptive cruise control for a car. Collision avoidance is the ability to avoid obstacles that are in the vehicleâ s path, without causing damage to the obstacle or car. There are three types of collision avoidance controllers, passive, active, and semi-active. This thesis is designed using active collision avoidance controllers. There are two controllers developed for collision avoidance in this paper. They are ...
We introduce a self-avoiding walk model for which end-effects are completely eliminated. We enumerate the number of these walks for various lattices in dimensions two and three, and use these enumerations to study the properties of this model. We find that endless self-avoiding walks have the same connective constant as self-avoiding walks, and the same Flory exponent $\
Grigori, Laura; Moufawad, Sophie
In this paper we present a communication avoiding ILU0 preconditioner for solving large linear systems of equations by using iterative Krylov subspace methods. Recent research has focused on communication avoiding Krylov subspace methods based on so called s-step methods. However there is no communication avoiding preconditioner yet, and this represents a serious limitation of these methods. Our preconditioner allows to perform s iterations of the iterative method with no communication, throu...
Grimmett, Geoffrey R.; Holroyd, Alexander E; Peres, Yuval
The connective constant mu of a graph is the exponential growth rate of the number of n-step self-avoiding walks starting at a given vertex. A self-avoiding walk is said to be forward (respectively, backward) extendable if it may be extended forwards (respectively, backwards) to a singly infinite self-avoiding walk. It is called doubly extendable if it may be extended in both directions simultaneously to a doubly infinite self-avoiding walk. We prove that the connective constants for forward,...
Yue Tu; Xiao-mei Miao; Tai-long Yi; Xu-yi Chen; Hong-tao Sun; Shi-xiang Cheng; Sai Zhang
Bloodletting atJing points has been used to treat coma in traditional Chinese medicine. Mild induced hypothermia has also been shown to have neuroprotective effects. However, the therapeutic effects of bloodletting atJing points and mild induced hypothermia alone are limited. Therefore, we investigated whether combined treatment might have clinical effectiveness for the treatment of acute severe trau-matic brain injury. Using a rat model of traumatic brain injury, combined treatment substantially alleviated cerebral edema and blood-brain barrier dysfunction. Furthermore, neurological function was ameliorated, and cellular necrosis and the inlfammatory response were lessened. These ifndings suggest that the combined effects of bloodletting atJing points (20 µL, twice a day, for 2 days) and mild induced hypothermia (6 hours) are better than their individual effects alone. Their combined application may have marked neuroprotective effects in the clinical treatment of acute severe traumatic brain injury.
Fosgerau, Keld; Weber, Uno J; Gotfredsen, Jacob W;
feasibility of using a transient receptor potential vanilloid type 1 (TRPV1) agonist for obtaining drug-induced sustainable mild hypothermia. Methods First, we screened a heterogeneous group of TRPV1 agonists and secondly we tested the hypothermic properties of a selected candidate by dose-response studies......Background The use of mechanical/physical devices for applying mild therapeutic hypothermia is the only proven neuroprotective treatment for survivors of out of hospital cardiac arrest. However, this type of therapy is cumbersome and associated with several side-effects. We investigated the...... was stopped. Finally, in calves the intravenous infusion of DHC was able to maintain mild hypothermia with ΔT > -3°C for more than 12 hours. Conclusions Our data support the hypothesis that infusion of dihydrocapsaicin is a candidate for testing as a primary or adjunct method of inducing and...
Tu, Yue; Miao, Xiao-mei; Yi, Tai-long; Chen, Xu-yi; Sun, Hong-tao; Cheng, Shi-xiang; Zhang, Sai
Bloodletting at Jing points has been used to treat coma in traditional Chinese medicine. Mild induced hypothermia has also been shown to have neuroprotective effects. However, the therapeutic effects of bloodletting at Jing points and mild induced hypothermia alone are limited. Therefore, we investigated whether combined treatment might have clinical effectiveness for the treatment of acute severe traumatic brain injury. Using a rat model of traumatic brain injury, combined treatment substantially alleviated cerebral edema and blood-brain barrier dysfunction. Furthermore, neurological function was ameliorated, and cellular necrosis and the inflammatory response were lessened. These findings suggest that the combined effects of bloodletting at Jing points (20 μL, twice a day, for 2 days) and mild induced hypothermia (6 hours) are better than their individual effects alone. Their combined application may have marked neuroprotective effects in the clinical treatment of acute severe traumatic brain injury.
Walter José Gomes
Full Text Available O emprego da hipotermia profunda tem se constituído, atualmente, numa Importante estratégia para melhoria da qualidade técnica e resultados em cirurgia cardiovascular. A hipotermia reduz os danos teciduais induzidos pela isquemia por diminuir o metabolismo e preservar os fosfatos energéticos. A regulação do pH tecidual durante a hipotermia é fundamental para a manutenção da homeostasia celular, já que a hipotermia induz alterações desse pH pela mudança provocada na constante de dissociação da água. A questão do melhor manuseio dos gases sangüíneos durante a hipotermia induzida tem sido objeto de controvérsia. Duas abordagens têm sido preconizadas para o manejo das alterações iónicas durante a hipotermia. A regulção pH-stat envolve a manutenção do pH constante de 7,40 em todas as temperaturas com ajustes da PaCO2 e a regulação α-stat permite a variação do pH sangüíneo, que aumenta conforme a diminuição da temperatura e o conteúdo total corpóreo de CO2 é mantido constante. Nesta presente revisão a relação entre pH sangüíneo e intracelular e as alterações iónicas induzidas pela hipotermia são discutidas.Deep hypothermia is a usefull tool to improve technical results in cardiovascular surgery and is nowadays the major strategy used to reduce ischemic injury. Hypothermia reduces metabolism and preserves cellular stores of high-energy phosphates. The regulation of tissue pH during hypothermia is important for cellular homeostasis. Furthermore, hypothermia has important effects on pH by altering the dissociation constant of water and various metabolics intermediates and the question of optimal blood gas management during deliberate hypothermia has been subject of much controversy. Two approaches have been advocated for pH management during hypothermia, the first termed pH strategy, where blood pH is maintained constant at 7,40 at all temperatures with PaCO2 adjustment, and in the second type of
Qingyang Xu; Chuang Zhang; Ning Wang
The vessel collision accidents cause a great loss of lives and property. In order to reduce the human fault and greatly improve the safety of marine traffic, collision avoidance strategy optimization is proposed to achieve this. In the paper, a multiobjective optimization algorithm NSGA-II is adopted to search for the optimal collision avoidance strategy considering the safety as well as economy elements of collision avoidance. Ship domain and Arena are used to evaluate the collision risk in ...
Dietrich, W Dalton; Bramlett, Helen M
The use of therapeutic hypothermia (TH) and targeted temperature management (TTM) for severe traumatic brain injury (TBI) has been tested in a variety of preclinical and clinical situations. Early preclinical studies showed that mild reductions in brain temperature after moderate to severe TBI improved histopathological outcomes and reduced neurological deficits. Investigative studies have also reported that reductions in post-traumatic temperature attenuated multiple secondary injury mechanisms including excitotoxicity, free radical generation, apoptotic cell death, and inflammation. In addition, while elevations in post-traumatic temperature heightened secondary injury mechanisms, the successful implementation of TTM strategies in injured patients to reduce fever burden appear to be beneficial. While TH has been successfully tested in a number of single institutional clinical TBI studies, larger randomized multicenter trials have failed to demonstrate the benefits of therapeutic hypothermia. The use of TH and TTM for treating TBI continues to evolve and a number of factors including patient selection and the timing of the TH appear to be critical in successful trial design. Based on available data, it is apparent that TH and TTM strategies for treating severely injured patients is an important therapeutic consideration that requires more basic and clinical research. Current research involves the evaluation of alternative cooling strategies including pharmacologically-induced hypothermia and the combination of TH or TTM approaches with more selective neuroprotective or reparative treatments. This manuscript summarizes the preclinical and clinical literature emphasizing the importance of brain temperature in modifying secondary injury mechanisms and in improving traumatic outcomes in severely injured patients. This article is part of a Special Issue entitled SI:Brain injury and recovery. PMID:26746342
Renata R. T. Castro
Full Text Available INTRODUCTION: There are no available data addressing the potential clinical risks of open-water swimming competitions. OBJECTIVE: Address the risks of hypothermia and hypoglycemia during a 10-km open-water swimming competition in order to alert physicians to the potential dangers of this recently-introduced Olympic event. METHODS: This was an observational cross-sectional study, conducted during a 10-km open-water event (water temperature 21ºC. The highest ranked elite open-water swimmers in Brazil (7 men, 5 women; ages 21±7 years old were submitted to anthropometrical measurements on the day before competition. All but one athlete took maltodextrine ad libitum during the competition. Core temperature and capillary glycemia data were obtained before and immediately after the race. RESULTS: Most athletes (83% finished the race with mild to moderate hypothermia (core temperature <35ºC. The body temperature drop was more pronounced in female athletes (4.2±0.7ºC vs. male: 2.7±0.8ºC; p=0.040. When data from the athlete who did not take maltodextrine was excluded, capillary glycemia increased among athletes (pre 86.6±8.9 mg/dL; post 105.5±26.9 mg/dL; p=0.014. Time to complete the race was inversely related to pre- competition body temperature in men (r=-0.802; p=0.030, while it was inversely correlated with the change in capillary glycemia in women (r=-0.898; p=0.038. CONCLUSION: Hypothermia may occur during open-water swimming events even in elite athletes competing in relatively warm water. Thus, core temperature must be a chief concern of any physician during an open-water swim event. Capillary glycemia may have positive effects on performance. Further studies that include more athletes in a controlled setting are warranted.
Hoffman, Karin; Bromster, Therése; Hakansson, Stellan; van den Berg, Johannes
The purpose of this article was to study an infant who suffered from asphyxia undergoing induced hypothermia with regard to (1) describe the pain and stress as measured by physiological variables skin conductance algesimeter (SCA) and pain rating scales, (2) the correlation between SCA and pain rating scales, and (3) how temperature cycles in the cooling blanket affect the response of the sympathetic nervous system as measured by the SCA and physiological variables. A single prospective case study was used for this article. Data were recorded every 15 minutes for 96 hours. Each observation was categorized according to treatment phase: cooling 0 to 72 hours, rewarming, and controlled normal temperature up to 96 hours. Structured observations were carried out and all nursing care was documented. In addition, 5 periods with no other nursing interventions were identified in which data were recorded every minute for analysis. Skin conductance algimetry showed a variable response during treatment. During cooling, 68% of the 15-minute periods, signs of stress and pain were recorded. During rewarming, the corresponding figure was 83%. During the time sequences with normal temperature, 89% of the periods were associated with stress and pain. During 80% of the nursing procedures, the SCA showed stress and pain. There was no correlation between the pain-rating scales and SCA. When the cooling blanket temperature was lower than core temperature, the infant had more stress and pain according to SCA (P heart rate and blood pressure (P < .001). In infants during induced hypothermia, SCA seem to detect pain and stress. Future evaluation of SCA for the detection of pain and stress during hypothermia treatment is necessary. Pain-rating scales do not appear reliable in this case report. PMID:23912017
Hypoxia evokes a regulated decrease in the body core temperature (Tc) in a variety of animals. The neuronal mechanisms of this response include, at least in part, glutamatergic activation in the lateral preoptic area (LPO) of the hypothalamus. As the sympathetic premotor neurons in the medulla oblongata constitute a cardinal relay station in the descending neuronal pathway from the hypothalamus for thermoregulation, their inhibition can also be critically involved in the mechanisms of the hypoxia-induced hypothermia. Here, I examined the hypothesis that hypoxia-induced hypothermia is mediated by glutamate-responsive neurons in the LPO that activate GABAergic transmission in the rostral raphe pallidus (rRPa) and neighboring parapyramidal region (PPy) of the medulla oblongata in urethane-chloralose-anesthetized, neuromuscularly blocked, artificially ventilated rats. Unilateral microinjection of GABA (15nmol) into the rRPa and PPy regions elicited a prompt increase in tail skin temperature (Ts) and decreases in Tc, oxygen consumption rate (VO2), and heart rate. Next, when the GABAA receptor blocker bicuculline methiodide (bicuculline methiodide (BMI), 10pmol) alone was microinjected into the rRPa, it elicited unexpected contradictory responses: simultaneous increases in Ts, VO2 and heart rate and a decrease in Tc. Then, when BMI was microinjected bilaterally into the PPy, no direct effect on Ts was seen; and thermogenic and tachycardic responses were slight. However, pretreatment of the PPy with BMI, but not vehicle saline, greatly attenuated the hypothermic responses evoked by hypoxic (10%O2-90%N2, 5min) ventilation or bilateral microinjections of glutamate (5nmol, each side) into the LPO. The results suggest that hypoxia-induced hypothermia was mediated, at least in part, by the activation of GABAA receptors in the PPy. PMID:24607346
Lucy Anne Murtha
Full Text Available Stroke is predominantly a senescent disease, yet most preclinical studies investigate treatment in young animals. We recently demonstrated that short-duration hypothermia-treatment completely prevented the dramatic intracranial pressure (ICP rise seen post-stroke in young rats. Here, our aim was to investigate whether a similar ICP rise occurs in aged rats and to determine whether short-duration hypothermia is an effective treatment in aged animals. Experimental Middle Cerebral Artery occlusion (MCAo - 3 hour occlusion was performed on male Wistar rats aged 19-20 months. At one hour after stroke-onset, rats were randomized to 2.5 hours hypothermia-treatment (32.5 °C or normothermia (37 °C. ICP was monitored at baseline, for 3.5 hours post-occlusion, and at 24 hours post-stroke. Infarct and edema volumes were calculated from histology. Baseline pre-stroke ICP was 11.2 ± 3.3 mmHg across all animals. Twenty-four hours post-stroke, ICP was significantly higher in normothermic animals compared to hypothermia-treated animals (27.4 ± 18.2 mmHg vs. 8.0 ± 5.0 mmHg, p = 0.03. Infarct and edema volumes were not significantly different between groups. These data demonstrate ICP may also increase 24 hours post-stroke in aged rats, and that short-duration hypothermia treatment has a profound and sustained preventative effect. These findings may have important implications for the use of hypothermia in clinical trials of aged stroke patients.
Minzhong Wang; Xiaoyan Lin; Xueping Liu; Qingxi Fu; Suming Zhang
BACKGROUND:Matrix metalloproteinase-9(MMP-9)expression increases with intracerebral hemorrhage,and participates in the pathophysiological processes of secondary brain injury after intracerebral hemorrhage.OBJECTIVE:To investigate the effects of mild hypothermia on MMP-9 expression and brain edema in the perihematomal region of experimental intracerebral hemorrhage rats.DESIGN,TIME AND SETTING:The randomized,controlled experiment was performed at the Central Laboratory of Shandong Provincial Hospital between May and September 2007.MATERIALS:Seventy-two,Wistar,male rats,12-weeks old,were used for this study.Rabbit anti-MMP-9 primary antibody was purchased from Boster,China.METHODS:Wistar rats were equally and randomly divided into normothermia and mild hypothermia groups.The two groups each comprised control,6-hour intracerebral hemorrhage,24-hour intracerebral hemorrhage,48-hour intracerebral hemorrhage,72-hour intracerebral hemorrhage,and 1-week intracerebral hemorrhage subgroups,with six rats in each subgroup.Rat models of intracerebral hemorrhage were established by irtjecting 100 μL of autologous blood into the rat caudate nucleus.Rats in the mild hypothermia group received four hours of local mild hypothermia immediately following the injection.Intracerebral temperature was maintained at(33±0.5)℃.Subsequently,intracerebral temperature was spontaneously recovered at 25℃.Rats in the control subgroup were not injected with autologous blood and received only with intracerebral hemorrhage.MAIN OUTCOME MEASURES:Brain water content and MMP-9 expression surrounding the hematoma region.RESULTS:MMP-9 expression increased at 6 hours,and brain edema reached a peak at 48 hours after intracerebral hemorrhage.MMP-9 expression was significantly decreased in the mild hypothermia group compared with the normothermia group at each time point (P<0.05).CONCLUSION:Mild hypothermia can significantly inhibit MMP-9 overexpression and relieve brain edema following intracerebral
Full Text Available Background/Aim. Hypothermia in surgical patients can be the consequence of long duration of surgical intervention, general anaesthesia and low temperature in operating room. Postoperative hypothermia contributes to a number of postoperative complications such as arrhythmia, myocardial ischemia, hypertension, bleeding, wound infection, coagulopathy, and prolonged effect of muscle relaxants. External heating procedures are used to prevent this condition. The aim of this study was to evaluate the efficiency of external warming system in alleviation of cold stress and hypothermia in patients who underwent major surgical procedures. Methods. The study was conducted in the Military Medical Academy in Belgrade. A total of 30 patients of both genders underwent abdominal surgical procedures, randomly divided into two equal groups: the one was externally warmed using warm air mattress (W, while in the control group (C surgical procedure was performed in regular conditions, without additional warming. Oesophageal temperature (Te was used as indicator of changes in core temperature, during surgery and awakening postoperative period, and temperature of control sites on the right hand (Th and the right foot (Tf reflected the changes in skin temperatures during surgery. Te and skin temperatures were monitored during the intraoperative period, with continuous measurement of Te during the following 90 minutes of the postoperative period. Heart rates and blood pressures were monitored continuously during the intraoperative and awakening period. Results. In the W group, the average Te, Tf and Th did not change significantly during the intraoperative as well as the postoperative period. In the controls, the average Te significantly decreased during the intraoperative period (from 35.61 ± 0.35ºC at 0 minute to 33.86 ± 0.51ºC at 120th minute. Compared to the W group, Te in the C group was significantly lower in all the observed periods. Average values of Tf and
Tay, Stan; Lee, I-Lynn
Potassium levels are regularly used as a prognostic factor to cease resuscitation in significant hypothermia. In this case report, we highlight how survival is still possible with extreme hyperkalaemia in severe hypothermia. We present a case of a 65-year-old Caucasian man who presented with metformin associated lactic acidosis. On presentation he had potassium of 9.1 mmol/l and a temperature of 31.5°C. Cardiopulmonary resuscitation was commenced when he went into asystolic arrest. This prese...
Anthony J. Guttmann
Full Text Available We have produced extended series for prudent self-avoiding walks on the square lattice. These are subsets of self-avoiding walks. We conjecture the exact growth constant and critical exponent for the walks, and show that the (anisotropic generating function is almost certainly not differentiably-finite.
Guttmann, Anthony J.; Dethridge, John C.
We have produced extended series for prudent self-avoiding walks on the square lattice. These are subsets of self-avoiding walks. We conjecture the exact growth constant and critical exponent for the walks, and show that the (anisotropic) generating function is almost certainly not differentiably-finite.
Levine-MacCombie, Joyce; Koss, Mary P.
Determined that acknowledged and unacknowledged acquaintance rape victims and rape avoiders could be discriminated by situational variables and response strategies. Avoiders were less likely to have experienced passive or internalizing emotions at the time of the assault, perceived the assault as less violent, and were more likely to have utilized…
Morse, William I.
Inhibited sexual desire (ISD) is one of the most common sexual dysfunctions, especially in women. Family physicians have an opportunity to recognize ISD before the associated problems become entrenched, and to guide couples toward satisfactory resolution. A summary is presented of current thinking on ISD and its causes. Case reports and observations about frequency of and treatment for ISD are included. Much less has been written about sexual avoidance in the presence of desire. A definition ...
Full Text Available Abstract Background Patients having arthroscopic shoulder surgery frequently experience periods of inadvertent hypothermia. This common perioperative problem has been linked to adverse patient outcomes such as myocardial ischaemia, surgical site infection and coagulopathy. International perioperative guidelines recommend patient warming, using a forced air warming device, and the use of warmed intraoperative irrigation solutions for the prevention of hypothermia in at-risk patient groups. This trial will investigate the effect of these interventions on patients’ temperature, thermal comfort, and total recovery time. Method/Design The trial will employ a randomised 2 x 2 factorial design. Eligible patients will be stratified by anaesthetist and block randomised into one of four groups: Group one will receive preoperative warming with a forced air warming device; group two will receive warmed intraoperative irrigation solutions; group three will receive both preoperative warming and warmed intraoperative irrigation solutions; and group four will receive neither intervention. Participants in all four groups will receive active intraoperative warming with a forced air warming device. The primary outcome measures are postoperative temperature, thermal comfort, and total recovery time. Primary outcomes will undergo a two-way analysis of variance controlling for covariants such as operating room ambient temperature and volume of intraoperative irrigation solution. Discussion This trial is designed to confirm the effectiveness of these interventions at maintaining perioperative normothermia and to evaluate if this translates into improved patient outcomes. Australian New Zealand Clinical Trials Registry number ACTRN12610000591055
Masoumeh Kourosh Arami
Full Text Available Objective(s: Nucleus Raphe Magnus (NRM that is involved in the regulation of body temperature contains nitric oxide (NO synthase. Considering the effect of NO on skin blood flow control, in this study, we assessed its thermoregulatory role within the raphe magnus. Materials and Methods: To this end, tail blood flow of male Wistar rats was measured by laser doppler following the induction of hypothermia. Results: Intra-NRM injection of SNP (exogenous NO donor, 0.1- 0.2 μl, 0.2 nM increased the blood flow. Similarly, unilateral microinjection of glutamate (0.1- 0.2 μl, 2.3 nM into the nucleus increased the blood flow. This effectof L-glutamate was reduced by prior intra NRM administrationof NO synthase inhibitor NG-methyl-L-arginine or NG-nitro-L-argininemethyl ester (L-NAME, 0.1 µl, 100 nM. Conclusion: It is concluded that NO modulates the thermoregulatory response of NRM to hypothermia and may interactwith excitatory amino acids in central skin blood flow regulation.
Full Text Available Internal ribosome entry site (IRES-mediated translation is an essential replication step for certain viruses. As IRES-mediated translation is regulated differently from cap-dependent translation under various cellular conditions, we sought to investigate whether temperature influences efficiency of viral IRES-mediated translation initiation by using bicistronic reporter constructs containing an IRES element of encephalomyocarditis virus (EMCV, foot-and-mouth disease virus (FMDV, hepatitis C virus (HCV, human rhinovirus (HRV or poliovirus (PV. Under mild hypothermic conditions (30 and 35°C, we observed increases in the efficiency of translation initiation by HCV and HRV IRES elements compared to translation initiation at 37°C. The promotion of HRV IRES activity was observed as early as 2 hours after exposure to mild hypothermia. We also confirmed the promotion of translation initiation by HRV IRES under mild hypothermia in multiple cell lines. The expression levels and locations of polypyrimidine tract-binding protein (PTB and upstream of N-Ras (unr, the IRES trans-acting factors (ITAFs of HCV and HRV IRES elements, were not modulated by the temperature shift from 37°C to 30°C. Taken together, this study demonstrates that efficiency of translation initiation by some viral IRES elements is temperature dependent.
Noirhomme, Quentin; Lehembre, Rémy; Lugo, Zulay Del Rosario; Lesenfants, Damien; Luxen, André; Laureys, Steven; Oddo, Mauro; Rossetti, Andrea O
Visual analysis of electroencephalography (EEG) background and reactivity during therapeutic hypothermia provides important outcome information, but is time-consuming and not always consistent between reviewers. Automated EEG analysis may help quantify the brain damage. Forty-six comatose patients in therapeutic hypothermia, after cardiac arrest, were included in the study. EEG background was quantified with burst-suppression ratio (BSR) and approximate entropy, both used to monitor anesthesia. Reactivity was detected through change in the power spectrum of signal before and after stimulation. Automatic results obtained almost perfect agreement (discontinuity) to substantial agreement (background reactivity) with a visual score from EEG-certified neurologists. Burst-suppression ratio was more suited to distinguish continuous EEG background from burst-suppression than approximate entropy in this specific population. Automatic EEG background and reactivity measures were significantly related to good and poor outcome. We conclude that quantitative EEG measurements can provide promising information regarding current state of the patient and clinical outcome, but further work is needed before routine application in a clinical setting. PMID:24452769
Gordon, C J; Stead, A G
This study was designed to assess the effects of ethyl alcohol (ethanol) administration on behavioral and autonomic thermoregulation in mice subjected to severe hypothermia or hyperthermia. Male mice of the BALB/c strain were injected intraperitoneally with ethanol at dosages of 0, 0.3, 1.0, or 3.0 g/kg and then placed within a hot environmental chamber to raise their body temperature to 41 degrees C or, alternatively, within a cold chamber to lower it to 28 degrees C. Once the desired hypothermic or hyperthermic state was achieved, the mice were removed from the chamber and placed in either a temperature gradient to monitor behavioral thermoregulatory responses or in an environmental chamber thermostabilized at an ambient temperature (Ta) of 28 degrees C to monitor metabolic rate. The 3.0 g/kg dosage significantly affected behavioral thermoregulatory responses of the hyperthermic mice when initially placed in the temperature gradient. The ability to increase metabolic rate following hypothermia was significantly suppressed at 3.0 g/kg. Dosages of 1.0 and 3.0 g/kg inhibited metabolic rate of hyperthermic mice. Both hypothermic and hyperthermic mice given 3.0 g/kg of ethanol had colonic temperatures significantly below normal after placement in the temperature gradient and metabolic chamber. In conclusion, relatively large dosages of ethanol impair behavioral and autonomic thermoregulation and may lower the set-point for the control of body temperature in mice. PMID:3413196
Watanabe, C; Suzuki, T
The effect of sodium selenite (SS) on the body temperature of adult male ICR mice was examined. SS (10-60 mumol/kg) administered subcutaneously resulted in a transient and dose-dependent hypothermia at ambient temperatures (Ta) of 20 and 30 degrees C. Reduced oxygen consumption accompanied the changes in body temperature. In addition, SS-treated mice exhibited transient cold-seeking behavior in the thermogradient. This SS-induced hypothermia was very similar to those induced by ethanol, tetrahydrocannabinol, triethyltin, sulfolane, and chlordimeform in that these all were transient, dependent on Ta, and not counteracted by behavioral thermoregulation. From these results, involvement of neural afferent or integral pathways is suggested. Further, acute mortality of SS-injected mice was enhanced with the elevation of Ta, as in the case of the chemicals mentioned above. Considering the diverse chemical and pharmacological properties of these chemicals, these results may suggest a possible interrelation between the hypothermic response and the modification of toxicity. PMID:3787631
McLeod, David V; Day, Troy
Host resistance consists of defences that limit pathogen burden, and can be classified as either adaptations targeting recovery from infection or those focused upon infection avoidance. Conventional theory treats avoidance as a fixed strategy which does not vary from one interaction to the next. However, there is increasing empirical evidence that many avoidance strategies are triggered by external stimuli, and thus should be treated as phenotypically plastic responses. Here, we consider the implications of avoidance plasticity for host-pathogen coevolution. We uncover a number of predictions challenging current theory. First, in the absence of pathogen trade-offs, plasticity can restrain pathogen evolution; moreover, the pathogen exploits conditions in which the host would otherwise invest less in resistance, causing resistance escalation. Second, when transmission trades off with pathogen-induced mortality, plasticity encourages avirulence, resulting in a superior fitness outcome for both host and pathogen. Third, plasticity ensures the sterilizing effect of pathogens has consequences for pathogen evolution. When pathogens castrate hosts, selection forces them to minimize mortality virulence; moreover, when transmission trades off with sterility alone, resistance plasticity is sufficient to prevent pathogens from evolving to fully castrate. PMID:26336170
Erlinge, David; Götberg, Matthias; Noc, Marko;
intervention (PCI) within <6 hours after symptom onset were randomized to hypothermia induced by rapid infusion of 600-2000 mL cold saline combined with endovascular cooling or standard of care. Hypothermia was initiated before PCI and continued for 1-3 hours after reperfusion aiming at a target temperature of......=31% (40.5, 28.8-51.9 vs. 59.0, 45.0-67.8, p=0.01, median, IQR). There was no mortality in either group. The incidence of heart failure was reduced in the hypothermia group (2 vs. 11, p=0.009). Patients with large MaR (>30% of the left ventricle) exhibited significantly reduced IS/MaR in the...... hypothermia group (40.5, 27.0-57.6 vs. 55.1, 41.1-64.4, median, IQR; hypothermia n=42 vs. control n=37, p=0.03), while patients with MaR<30% did not show effect of hypothermia (35.8, 28.3-57.5 vs. 38.4, 27.4-59.7, median, IQR; hypothermia n=15 vs. control n=19, p=0.50). The prespecified pooled analysis of...
National Aeronautics and Space Administration — Using biologically-inspired neuromorphic optic flow algorithms is a novel approach in collision avoidance for UAS. Traditional computer vision algorithms rely on...
Ricardo W. Muotri
Full Text Available Objectives: 1 To identify whether patients with panic disorder in general and those with the respiratory subtype in particular actively avoid exercise; 2 to investigate physiological differences in cardiopulmonary function parameters in patients with panic disorder in general, patients with the respiratory subtype of panic disorder, and healthy controls upon exercise challenge. Methods: Patients with panic disorder were classified as having either the respiratory or the non-respiratory subtype. Both groups were compared to controls in terms of exercise avoidance patterns and performance on cardiopulmonary exercise testing. Results: Patients with panic disorder exhibited higher exercise avoidance scores and worse performance on cardiopulmonary exercise testing as compared with controls. No differences were found between patients with the respiratory and non-respiratory subtypes. Conclusions: Exercise avoidance is present in panic disorder and is associated with poorer performance on cardiopulmonary exercise testing. These findings are not limited to patients with the respiratory subtype of the disorder.
We introduce a self-avoiding walk model for which end-effects are completely eliminated. We enumerate the number of these walks for various lattices in dimensions two and three, and use these enumerations to study the properties of this model. We find that endless self-avoiding walks have the same connective constant as self-avoiding walks, and the same Flory exponent ν. However, there is no power law correction to the exponential number growth for this new model, i.e. the critical exponent γ = 1 exactly in any dimension. In addition, the number growth has no analytic corrections to scaling, and we have convincing numerical evidence to support the conjecture that the amplitude for the number growth is a universal quantity. The technique by which end-effects are eliminated may be generalized to other models of polymers such as interacting self-avoiding walks.
We introduce a self-avoiding walk model for which end-effects are completely eliminated. We enumerate the number of these walks for various lattices in dimensions two and three, and use these enumerations to study the properties of this model. We find that endless self-avoiding walks have the same connective constant as self-avoiding walks, and the same Flory exponent ν. However, there is no power law correction to the exponential number growth for this new model, i.e. the critical exponent γ = 1 exactly in any dimension. In addition, the number growth has no analytic corrections to scaling, and we have convincing numerical evidence to support the conjecture that the amplitude for the number growth is a universal quantity. The technique by which end-effects are eliminated may be generalized to other models of polymers such as interacting self-avoiding walks. (paper)
Failure of photovoltaic systems because of serious damage is an increasing phenomenon. Especially in older systems, faulty projecting and installation may have costly late effects. Insurance companies reckon that most cases of damage and failure could easily be avoided. (orig.)
Jia, Feng; Mao, Qing; Liang, Yu-Min; Jiang, Ji-Yao
In this investigation, we evaluated the effect of post-traumatic mild hypothermia on cell death in the hippocampus after fluid percussion traumatic brain injury (TBI) in rats. Adult male Sprague-Dawley rats were randomly divided into three groups (n = 40/group): TBI with hypothermia treatment (32 degrees C), TBI with normothermia (37 degrees C), and sham injury. The TBI model was induced by a fluid percussion TBI device. Mild hypothermia (32 degrees C) was achieved by partial immersion in a water bath (0 degrees C) under general anesthesia for 4h. All rats were killed at 24 or 72h after TBI. The ipsilateral hippocampal CA1 in all rats were analyzed by hematoxylin and eosin staining, terminal deoxynucleotidyl transferase-mediated 2'-deoxyuridine 5'-triphosphate-biotin nick end labeling (TUNEL), and 4',6-diamidino-2-phenylindole (DAPI) staining for determining cell death. Caspase-3 expression was examined by reverse transcription-polymerase chain reaction (RT-PCR) and Western blotting. At 24h, based on TUNEL and DAPI results, the cell death index was 28.80 +/- 2.60% and 32.10 +/- 1.40% in the normothermia TBI group, while reaching only 14.30 +/- 2.70% and 18.40 +/- 2.10% in the hypothermic TBI group (p percussion injury. Taken together with other studies, these observations support the premise that post-traumatic mild hypothermia can provide cerebral protection for patients with TBI. PMID:19236165
Full Text Available Abstract Background Neuron specific enolase (NSE has repeatedly been evaluated for neurological prognostication in patients after cardiac arrest. However, it is unclear whether current guidelines for NSE cutoff levels also apply to cardiac arrest patients treated with hypothermia. Thus, we investigated the prognostic significance of absolute NSE levels and NSE kinetics in cardiac arrest patients treated with hypothermia. Methods In a prospective study of 35 patients resuscitated from cardiac arrest, NSE was measured daily for four days following admission. Outcome was assessed at ICU discharge using the CPC score. All patients received hypothermia treatment for 24 hours at 33°C with a surface cooling device according to current guidelines. Results The cutoff for absolute NSE levels in patients with unfavourable outcome (CPC 3-5 72 hours after cardiac arrest was 57 μg/l with an area under the curve (AUC of 0.82 (sensitivity 47%, specificity 100%. The cutoff level for NSE kinetics in patients with unfavourable outcome (CPC 3-5 was an absolute increase of 7.9 μg/l (AUC 0.78, sensitivity 63%, specificity 100% and a relative increase of 33.1% (AUC 0.803, sensitivity 67%, specificity 100% at 48 hours compared to admission. Conclusion In cardiac arrest patients treated with hypothermia, prognostication of unfavourable outcome by NSE kinetics between admission and 48 hours after resuscitation may be superior to prognostication by absolute NSE levels.
A method for allowing a robot to avoid objects along a programmed path: first, a field of view for an electronic imager of the robot is established along a path where the electronic imager obtains the object location information within the field of view; second, a population coded control signal is then derived from the object location information and is transmitted to the robot; finally, the robot then responds to the control signal and avoids the detected object.
Camilleri, Elizabeth; Rohde, Peter P.; Twamley, Jason
Quantum walks exhibit many unique characteristics compared to classical random walks. In the classical setting, self-avoiding random walks have been studied as a variation on the usual classical random walk. Classical self-avoiding random walks have found numerous applications, most notably in the modeling of protein folding. We consider the analogous problem in the quantum setting. We complement a quantum walk with a memory register that records where the walker has previously resided. The w...
Alstadsæter, Annette; Jacob, Martin
This paper analyzes the sources of heterogeneity in legal tax avoidance strategies across individuals. Three conditions are required for a taxpayer to participate in tax avoidance: incentive, access, and awareness. Using rich Swedish administrative panel data with a unique link between corporate and individual tax returns, we analyze individual participation in legal tax planning around the 2006 Swedish tax reform. Our results suggest that closely held corporations are utilized to facilitate ...