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[PMID]: 29474879
[Au] Autor:Moon HK; Jang J; Park KN; Kim SH; Lee BK; Oh SH; Jeung KW; Choi SP; Cho IS; Youn CS
[Ad] Address:Department of Emergency Medicine, Seoul St. Mary Hospital, College of Medicine, College of Medicine, The Catholic University of Korea, Seoul 137-701, South Korea.
[Ti] Title:Quantitative analysis of relative volume of low apparent diffusion coefficient value can predict neurologic outcome after cardiac arrest.
[So] Source:Resuscitation;126:36-42, 2018 Feb 21.
[Is] ISSN:1873-1570
[Cp] Country of publication:Ireland
[La] Language:eng
[Ab] Abstract:INTRODUCTION: Predicting neurologic outcomes after cardiac arrest (CA) is challenging. This study tested the hypothesis that a quantitative analysis of diffusion weighted imaging (DWI) using the FMRIB Software Library (FSL) can predict neurologic outcomes after CA and can clarify the optimal apparent diffusion coefficient (ADC) thresholds for predicting poor neurologic outcomes. METHODS: Out-of-hospital CA patients treated with targeted temperature management (TTM) who underwent DWI were included in this study. Voxel-based analysis was performed to calculate the mean ADC value. ADC thresholds (750, 700, 650, 600, 550, 500, 450 and 400) and brain volumes below each threshold were also analyzed for their correlation with outcomes. The patients were divided into early (within 48 h after return of spontaneous circulation (ROSC)) and late group (between 48 h and 7 days after ROSC) according to the DWI scan time. The primary outcome was a poor neurologic outcome at 6 months after CA, defined as a cerebral performance category (CPC) of 3-5. RESULTS: One hundred ten DWIs were analyzed. The mean ADC values were 789.0 (761.5-826.5)  10 mm /s for the good neurologic outcome group and 715.2 (663.1-778.4)  10 mm /s for the poor neurologic outcome group (p < 0.001). All the ADC thresholds could differentiate patients with good versus poor outcomes. The ADC threshold of 400  10 mm /s had the highest odds ratio (4.648 in the early group and 11.283 in the late group) after adjusting for initial rhythm and anoxic time. To achieve 100% specificity using an ADC threshold of 400  10 mm /s, the sensitivity was 64% (cutoff value; >2.5% ADC threshold of 400  10 mm /s) in the early group and 79.2% (cutoff value; >1.66% ADC threshold of 400  10 mm /s) in the late group. CONCLUSIONS: Voxel-based analysis using FSL software can predict neurologic outcomes after CA. The ADC threshold of 400  10 mm /s had the highest OR for predicting a poor neurologic outcome.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180310
[Lr] Last revision date:180310
[St] Status:Publisher

  2 / 37095 MEDLINE  
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[PMID]: 29454009
[Au] Autor:Fink EL; Clark RSB; Berger RP; Fabio A; Angus DC; Watson RS; Gianakas JJ; Panigrahy A; Callaway CW; Bell MJ; Kochanek PM
[Ad] Address:Critical Care Medicine, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA; Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; Safar Center for Resuscitation Research, Pittsburgh, PA, USA; Clinical Research, Investigation, and Systems Modeling of Acute
[Ti] Title:24 vs. 72 hours of hypothermia for pediatric cardiac arrest: A pilot, randomized controlled trial.
[So] Source:Resuscitation;126:14-20, 2018 Feb 14.
[Is] ISSN:1873-1570
[Cp] Country of publication:Ireland
[La] Language:eng
[Ab] Abstract:AIM: Children surviving cardiac arrest (CA) lack proven neuroprotective therapies. The role of biomarkers in assessing response to interventions is unknown. We hypothesized that 72 versus 24 h of hypothermia (HT) would produce more favorable biomarker profiles after pediatric CA. METHODS: This single center pilot randomized trial tested HT (33  1 C) for 24 vs. 72 h in 34 children with CA. Children comatose after return of circulation aged 1 week to 17 years and treated with HT by their physician were eligible. Serum was collected twice daily on days 1-4 and once on day 7. Mortality was assessed at 6 months. RESULTS: Patient characteristics, baseline biomarker concentrations, and adverse events were similar between groups. Eight (47%) and 4 (24%) children died in the 24 h and 72 h groups, p = .3. Serum neuron specific enolase (NSE) concentration was increased in the 24 vs. 72 h group at 84 h-96 h (median [interquartile range] 47.7 [3.9, 79.9] vs. 1.4 [0.0, 11.1] ng/ml, p = .02) and on day 7 (18.2 [3.2, 74.0] vs. 2.6 [0.0, 12.8] ng/ml, p = .047). Serum S100b was increased in the 24 h vs. 72 h group at 12 h-24 h, 36 h-84 h, and on day 7, all p < 0.05. HT duration was associated with S100b (but not NSE or MBP) concentration on day 7 in multivariate analyses. CONCLUSION: Serum biomarkers show promise as theragnostic tools in pediatric CA. Our biomarker and safety data also suggest that 72 h duration after pediatric CA warrants additional exploration.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180310
[Lr] Last revision date:180310
[St] Status:Publisher

  3 / 37095 MEDLINE  
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[PMID]: 29522447
[Au] Autor:Camici M; Garcia-Gil M; Tozzi MG
[Ad] Address:Dipartimento di Biologia, Unit di Biochimica, Via San Zeno 51, 56127 Pisa, Italy. marcella.camici@unipi.it.
[Ti] Title:The Inside Story of Adenosine.
[So] Source:Int J Mol Sci;19(3), 2018 Mar 09.
[Is] ISSN:1422-0067
[Cp] Country of publication:Switzerland
[La] Language:eng
[Ab] Abstract:Several physiological functions of adenosine (Ado) appear to be mediated by four G protein-coupled Ado receptors. Ado is produced extracellularly from the catabolism of the excreted ATP, or intracellularly from AMP, and then released through its transporter. High level of intracellular Ado occurs only at low energy charge, as an intermediate of ATP breakdown, leading to hypoxanthine production. AMP, the direct precursor of Ado, is now considered as an important stress signal inside cell triggering metabolic regulation through activation of a specific AMP-dependent protein kinase. Intracellular Ado produced from AMP by allosterically regulated nucleotidases can be regarded as a stress signal as well. To study the receptor-independent effects of Ado, several experimental approaches have been proposed, such as inhibition or silencing of key enzymes of Ado metabolism, knockdown of Ado receptors in animals, the use of antagonists, or cell treatment with deoxyadenosine, which is substrate of the enzymes acting on Ado, but is unable to interact with Ado receptors. In this way, it was demonstrated that, among other functions, intracellular Ado modulates angiogenesis by regulating promoter methylation, induces hypothermia, promotes apoptosis in sympathetic neurons, and, in the case of oxygen and glucose deprivation, exerts a cytoprotective effect by replenishing the ATP pool.
[Pt] Publication type:JOURNAL ARTICLE; REVIEW
[Em] Entry month:1803
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[St] Status:In-Process

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[PMID]: 29438845
[Au] Autor:Muzik O; Reilly KT; Diwadkar VA
[Ad] Address:Departments of Pediatrics, Wayne State University School of Medicine, Detroit, MI 48201, USA; Departments of Radiology, Wayne State University School of Medicine, Detroit, MI 48201, USA. Electronic address: otto@pet.wayne.edu.
[Ti] Title:"Brain over body"-A study on the willful regulation of autonomic function during cold exposure.
[So] Source:Neuroimage;172:632-641, 2018 Feb 10.
[Is] ISSN:1095-9572
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:The defense of body temperature against environmental thermal challenges is a core objective of homeostatic regulation governed by the autonomic nervous system. Autonomous mechanisms of thermoregulation are only weakly affected by top-down modulation, allowing only transient tolerance for extreme cold. There is however, anecdotal evidence of a unique set of individuals known for extreme cold tolerance. Here we present a case study of a 57-year old Dutch national, Wim Hof, the so-called "Iceman", with the ability to withstand frequent prolonged periods of extreme cold exposure based on the practice of a self-developed technique involving a combination of forced breathing, cold exposure and meditation (collectively referred to as the Wim Hof Method, henceforth "WHM"). The relative contributions of the brain and the periphery that endow the Iceman with these capabilities is unknown. To investigate this, we conducted multi-modal imaging assessments of the brain and the periphery using a combination of fMRI and PET/CT imaging. Thermoregulatory defense was evoked by subjecting the Iceman (and a cohort of typical controls) to a fMRI paradigm designed to generate periods of mild hypothermia interspersed by periods of return to basal core body temperature. fMRI was acquired in two separate sessions: in a typical (passive) state and following the practice of WHM. In addition, the Iceman also underwent a whole body PET/CT imaging session using the tracers C11-hydroxyephedrine (HED) and 18F-fluorodeoxyglucose (FDG) during both thermoneutral and prolonged mild cold conditions. This acquisition allowed us to determine changes in sympathetic innervation (HED) and glucose consumption (FDG) in muscle and fat tissues in the absence of the WHM. fMRI analyses indicated that the WHM activates primary control centers for descending pain/cold stimuli modulation in the periaqueductal gray (PAG), possibly initiating a stress-induced analgesic response. In addition, the WHM also engages higher-order cortical areas (left anterior and right middle insula) that are uniquely associated with self-reflection, and which facilitate both internal focus and sustained attention in the presence of averse (e.g. cold) external stimuli. However, the activation of brown adipose tissue (BAT) was unremarkable. Finally, forceful respiration results in increased sympathetic innervation and glucose consumption in intercostal muscle, generating heat that dissipates to lung tissue and warms circulating blood in the pulmonary capillaries. Our results provide compelling evidence for the primacy of the brain (CNS) rather than the body (peripheral mechanisms) in mediating the Iceman's responses to cold exposure. They also suggest the compelling possibility that the WHM might allow practitioners to develop higher level of control over key components of the autonomous system, with implications for lifestyle interventions that might ameliorate multiple clinical syndromes.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[St] Status:Publisher

  5 / 37095 MEDLINE  
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[PMID]: 29383556
[Au] Autor:He T; Li Z; Xie D; Sun Q; Xu Y; Ye Q; Ni J
[Ad] Address:Chongqing Key Laboratory of Soil Multiscale Interfacial Process, College of Resources and Environment, Southwest University, NO 2 Tiansheng Road, Beibei District, Chongqing, 400716, China.
[Ti] Title:Simultaneous nitrification and denitrification with different mixed nitrogen loads by a hypothermia aerobic bacterium.
[So] Source:Biodegradation;29(2):159-170, 2018 Apr.
[Is] ISSN:1572-9729
[Cp] Country of publication:Netherlands
[La] Language:eng
[Ab] Abstract:Microorganism with simultaneous nitrification and denitrification ability plays a significant role in nitrogen removal process, especially in the eutrophic waters with excessive nitrogen loads. The nitrogen removal capacity of microorganism may suffer from low temperature or nitrite nitrogen source. In this study, a hypothermia aerobic nitrite-denitrifying bacterium, Pseudomonas tolaasii strain Y-11, was selected to determine the simultaneous nitrification and denitrification ability with mixed nitrogen source at 15C. The sole nitrogen removal efficiencies of strain Y-11 in simulated wastewater were obtained. After 24h of incubation at 15C, the ammonium nitrogen fell below the detection limit from an initial value of 10.99mg/L. Approximately 88.00.33% of nitrate nitrogen was removed with the initial concentration of 11.78mg/L and the nitrite nitrogen was not detected with the initial concentration of 10.75mg/L after 48h of incubation at 15C. Additionally, the simultaneous nitrification and denitrification nitrogen removal ability of P. tolaasii strain Y-11 was evaluated using low concentration of mixed NH -N and NO -N/NO -N (about 5mg/L-N each) and high concentration of mixed NH -N and NO -N/NO -N (about 100mg/L-N each). There was no nitrite nitrogen accumulation at the time of evaluation. The results demonstrated that P. tolaasii strain Y-11 had higher simultaneous nitrification and denitrification capacity with low concentration of mixed inorganic nitrogen sources and may be applied in low temperature wastewater treatment.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180310
[Lr] Last revision date:180310
[St] Status:In-Data-Review
[do] DOI:10.1007/s10532-018-9820-6

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[PMID]: 29521421
[Au] Autor:Barletta M; Ostenkamp SM; Taylor AC; Quandt J; Lascelles BDX; Messenger KM
[Ad] Address:Department of Large Animal Medicine, College of Veterinary Medicine, University of Georgia, Athens, GA, USA.
[Ti] Title:The pharmacokinetics and analgesic effects of extended-release buprenorphine administered subcutaneously in healthy dogs.
[So] Source:J Vet Pharmacol Ther;, 2018 Mar 09.
[Is] ISSN:1365-2885
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:Buprenorphine is a partial agonist opioid used for analgesia in dogs. An extended-release formulation (ER-buprenorphine) has been shown to provide effective analgesia for 72hr in rats and mice. Six healthy mongrel dogs were enrolled in a randomized, blinded crossover design to describe and compare the pharmacokinetics and pharmacodynamics of ER-buprenorphine administered subcutaneous at 0.2mg/kg (ER-B) and commercially available buprenorphine for injection intravenously at 0.02mg/kg (IV-B). After drug administration, serial blood samples were collected to measure plasma buprenorphine concentrations using liquid chromatography/mass spectrometry detection. Heart rate, respiratory rate, body temperature, sedation score, and thermal threshold latency were recorded throughout the study. Median (range) terminal half-life, time to maximum concentration, and maximum plasma concentration of ER-buprenorphine were 12.74hr (10.43-18.84hr), 8hr (4-36hr), and 5.00ng/ml (4.29-10.98ng/ml), respectively. Mild bradycardia, hypothermia, and inappetence were noted in both groups. Thermal threshold latency was significantly prolonged compared to baseline up to 12hr and up to 72hr in IV-B and ER-B, respectively. These results showed that ER-buprenorphine administered at a dose of 0.2mg/kg resulted in prolonged and sustained plasma concentrations and antinociceptive effects up to 72hr after drug administration.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[St] Status:Publisher
[do] DOI:10.1111/jvp.12497

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[PMID]: 29519539
[Au] Autor:Campbell H; Govindan RB; Kota S; Al-Shargabi T; Metzler M; Andescavage N; Chang T; Vezina G; du Plessis A; Massaro AN
[Ad] Address:Pediatric Residency Program, Children's National Health System, Washington, DC.
[Ti] Title:Autonomic Dysfunction in Neonates with Hypoxic Ischemic Encephalopathy Undergoing Therapeutic Hypothermia Impairs Physiological Responses to Routine Care Events.
[So] Source:J Pediatr;, 2018 Mar 06.
[Is] ISSN:1097-6833
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:OBJECTIVE: To evaluate whether infants with hypoxic-ischemic encephalopathy and evidence of autonomic dysfunction have aberrant physiological responses to care events that could contribute to evolving brain injury. STUDY DESIGN: Continuous tracings of heart rate (HR), blood pressure (BP), cerebral near infrared spectroscopy, and video electroencephalogram data were recorded from newborn infants with hypoxic-ischemic encephalopathy who were treated with hypothermia. Videos between 16 and 24 hours of age identified 99 distinct care events, including stimulating events (diaper changes, painful procedures), and vagal stimuli (endotracheal tube manipulations, pupil examinations). Pre-event HR variability was used to stratify patients into groups with impaired versus intact autonomic nervous system (ANS) function. Postevent physiological responses were compared between groups with the nearest mean classification approach. RESULTS: Infants with intact ANS had increases in HR/BP after stimulating events, whereas those with impaired ANS showed no change or decreased HR/BP. With vagal stimuli, the HR decreased in infants with intact ANS but changed minimally in those with impaired ANS. A pupil examination in infants with an intact ANS led to a stable or increased BP, whereas the BP decreased in the group with an impaired ANS. Near infrared spectroscopy measures of cerebral blood flow/blood volume increased after diaper changes in infants with an impaired ANS, but were stable or decreased in those with an intact ANS. CONCLUSION: HR variability metrics identified infants with impaired ANS function at risk for maladaptive responses to care events. These data support the potential use of HR variability as a real-time, continuous physiological biomarker to guide neuroprotective care in high-risk newborns.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[St] Status:Publisher

  8 / 37095 MEDLINE  
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[PMID]: 29518256
[Au] Autor:Prahlow SP; Prahlow JA
[Ad] Address:Florida State University, College of Social Sciences & Public Policy, Tallahassee, FL, 32306.
[Ti] Title:Homicide in a Horse Barn?
[So] Source:J Forensic Sci;, 2018 Mar 08.
[Is] ISSN:1556-4029
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:As forensic scientists and physicians, forensic pathologists are duty-bound to perform their examinations with integrity and professionalism. The practice of medicine requires knowledge regarding the history and presentation of the patient. In forensic pathology, the history includes scene and other investigative information, and the decedent's medical and social history. Such information is important for the correct certification of the cause and manner of death. Herein, the authors present a case originally thought by police and death investigators to represent a sexual-assault-related homicide, as an elderly female's body was found partially nude, and apparently beaten, on the muddy floor of her horse barn. At autopsy, some of the injuries were determined to be postmortem and caused by horses. Additionally, gastric Wishnewsky spots indicated hypothermia as a probable mechanism of death. Finally, an acute hip fracture was identified, which explained why she was incapable of moving from her potentially dangerous environment.
[Pt] Publication type:CASE REPORTS
[Em] Entry month:1803
[Cu] Class update date: 180308
[Lr] Last revision date:180308
[St] Status:Publisher
[do] DOI:10.1111/1556-4029.13774

  9 / 37095 MEDLINE  
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[PMID]: 29484389
[Au] Autor:Yang GS; Zhou XY; An XF; Liu XJ; Zhang YJ; Yu D
[Ad] Address:Department of Neurology, Affiliated Haikou Hospital, Xiangya School of Medicine, Central South University, Haikou, Hainan 570208, P.R. China.
[Ti] Title:mTOR is involved in stroke-induced seizures and the anti-seizure effect of mild hypothermia.
[So] Source:Mol Med Rep;17(4):5821-5829, 2018 Apr.
[Is] ISSN:1791-3004
[Cp] Country of publication:Greece
[La] Language:eng
[Ab] Abstract:Stroke is considered an underlying etiology of the development of seizures. Stroke leads to glucose and oxygen deficiency in neurons, resulting in brain dysfunction and injury. Mild hypothermia is a therapeutic strategy to inhibit strokeinduced seizures, which may be associated with the regulation of energy metabolism of the brain. Mammalian target of rapamycin (mTOR) signaling and solute carrier family2, facilitated glucose transporter member (GLUT)1 are critical for energy metabolism. Furthermore, mTOR overactivation and GLUT1 deficiency are associated with genetically acquired seizures. It has been hypothesized that mTOR and GLUT1 may additionally be involved in seizures elicited by stroke. The present study established global cerebral ischemia(GCI) models of rats. Convulsive seizure behaviors frequently occurred during the first and the second days following GCI, which were accompanied with seizure discharge reflected in the EEG monitor. Expression of phosphor(p)mTOR and GLUT1 were upregulated in the cerebral cortex and hippocampus, as evidenced by immunohistochemistry and western blot analyses. Mild hypothermia and/or rapamycin (mTOR inhibitor) treatments reduced the number of epileptic attacks, seizure severity scores and seizure discharges, thereby alleviating seizures induced by GCI. Mild hypothermia and/or rapamycin treatments reduced phosphorylation levels of mTOR and the downstream effecter p70S6 in neurons, and the amount of GLUT1 in the cytomembrane of neurons. The present study revealed that mTOR is involved in strokeinduced seizures and the antiseizure effect of mild hypothermia. The role of GLUT1 in strokeelicited seizures appears to be different from the role in seizures induced by other reasons. Further studies are necessary in order to elucidate the exact function of GLUT-1 in strokeelicited seizures.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[St] Status:In-Process
[do] DOI:10.3892/mmr.2018.8629

  10 / 37095 MEDLINE  
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[PMID]: 29474273
[Au] Autor:Gilley M; Beno S
[Ad] Address:Division of Emergency Medicine, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
[Ti] Title:Damage control resuscitation in pediatric trauma.
[So] Source:Curr Opin Pediatr;, 2018 Mar 06.
[Is] ISSN:1531-698X
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:PURPOSE OF REVIEW: Damage control resuscitation is an overall management strategy used in trauma patients to rapidly restore physiologic stability, while mitigating hypothermia, coagulopathy and acidosis. We review the evidence and current practice of damage control resuscitation in pediatric trauma patients with a specific focus on fluid management. RECENT FINDINGS: There have been a number of studies over the last several years examining crystalloid fluid resuscitation, balanced blood product transfusion practice and hemostatic agents in pediatric trauma. Excessive fluid resuscitation has been linked to increased number of ICU days, ventilator days and mortality. Balanced massive transfusion (1 : 1 : 1 product ratio) has not yet been demonstrated to have the same mortality benefits in pediatric trauma patients as in adults. Similarly, tranexamic acid (TXA) has strong evidence to support its use in adult trauma and some evidence in pediatric trauma. SUMMARY: Attention to establishing rapid vascular access and correcting hypothermia and acidosis is essential. A judicious approach to crystalloid resuscitation in the bleeding pediatric trauma patient with early use of blood products in keeping with an organized approach to massive hemorrhage is recommended. The ideal crystalloid volumes and/or blood product ratios in pediatric trauma patients have yet to be determined.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[St] Status:Publisher
[do] DOI:10.1097/MOP.0000000000000617


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