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[PMID]:29505526
[Au] Autor:Li X; Zhao Z; Liu X; Ma G; Zhu MJ
[Ad] Endereço:Department of Critical Care Medicine.
[Ti] Título:Encephalopathy associated with propofol infusion syndrome: A case report.
[So] Source:Medicine (Baltimore);97(1):e9521, 2018 Jan.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Propofol infusion syndrome (PRIS) is a rare but potentially fatal complication of propofol infusion. It is clinically characterized by metabolic acidosis, refractory bradycardia, rhabdomyolysis, renal failure, hyperlipidemia, and hepatomegaly. Brain lesion was only reported once in a pediatric patient. We present the 1st adult case with colon polyp and cancer who was diagnosed with PRIS. Her brain magnetic resonance imaging (MRI) and computed tomography (CT) scans reveal prominent bilateral brain lesions, matching with the proposed pathophysiologic mechanism of the syndrome. The patient received prompt acidosis correction and cardiorespiratory support. At last, she died from refractory circulatory failure. CONCLUSION: It may be necessary to order a prompt neuroimaging examination in patients suspected with PRIS to judge whether brain lesions exist or not.
[Mh] Termos MeSH primário: Encefalopatias/etiologia
Síndrome da Infusão de Propofol/complicações
[Mh] Termos MeSH secundário: Adulto
Encefalopatias/diagnóstico por imagem
Imagem de Difusão por Ressonância Magnética
Evolução Fatal
Feminino
Seres Humanos
Neuroimagem
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180306
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009521


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[PMID]:29400038
[Au] Autor:Podeur P; Okhremchuk I; Morvan JB; Vatin L; Rivière D; de Faria A; Joubert C; Dagain A
[Ti] Título:[Multiple intracranial epidermoid cysts: Case report].
[So] Source:Rev Laryngol Otol Rhinol (Bord);136(4):159-62, 2015.
[Is] ISSN:0035-1334
[Cp] País de publicação:France
[La] Idioma:fre
[Ab] Resumo:Epidermoid cyst is a benign and rare tumor, that evolves slowly. We describe the case of a 55 years-old woman, who came to our consultation for atypical trigeminal neuralgia of left V1 and V2 nerves. Brain MRI found two tumors: T1W hypointense with no appreciable enhancement after gadolinium injection and T2W and diffusion hyperintense. This last feature was in favour of an epidermoid cyst, but the multiplicity of cerebral lesions was definitely not in favor of such a diagnos­tic. They were located behind the right eye and in the left Meckel's cave (trigeminal cave). The surgical strategy consis­ted in removal the retro orbital tumor witch was the most acces­si­ble of both the diagnostic of epidermoid cyst was retaned thanks to the anatomopathology report. As these lesions had the exact same characteristics, we concluded that they were simi­lar. The second epidermoid cyst was not removed because of surgical risk, its benign nature and low evolutionary potential.
[Mh] Termos MeSH primário: Encefalopatias/diagnóstico por imagem
Fossa Craniana Posterior/diagnóstico por imagem
Cisto Epidérmico/diagnóstico por imagem
Doenças Orbitárias/diagnóstico por imagem
[Mh] Termos MeSH secundário: Encefalopatias/patologia
Fossa Craniana Posterior/patologia
Cisto Epidérmico/patologia
Cisto Epidérmico/cirurgia
Feminino
Seres Humanos
Imagem por Ressonância Magnética
Meia-Idade
Doenças Orbitárias/patologia
Doenças Orbitárias/cirurgia
Neuralgia do Trigêmeo/etiologia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180206
[St] Status:MEDLINE


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[PMID]:29302033
[Au] Autor:Ignatenko O; Chilov D; Paetau I; de Miguel E; Jackson CB; Capin G; Paetau A; Terzioglu M; Euro L; Suomalainen A
[Ad] Endereço:Research Programs Unit, Molecular Neurology, Biomedicum Helsinki, Haartmaninkatu 8, University of Helsinki, Helsinki, 00014, Finland.
[Ti] Título:Loss of mtDNA activates astrocytes and leads to spongiotic encephalopathy.
[So] Source:Nat Commun;9(1):70, 2018 01 04.
[Is] ISSN:2041-1723
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Mitochondrial dysfunction manifests as different neurological diseases, but the mechanisms underlying the clinical variability remain poorly understood. To clarify whether different brain cells have differential sensitivity to mitochondrial dysfunction, we induced mitochondrial DNA (mtDNA) depletion in either neurons or astrocytes of mice, by inactivating Twinkle (TwKO), the replicative mtDNA helicase. Here we show that astrocytes, the most abundant cerebral cell type, are chronically activated upon mtDNA loss, leading to early-onset spongiotic degeneration of brain parenchyma, microgliosis and secondary neurodegeneration. Neuronal mtDNA loss does not, however, cause symptoms until 8 months of age. Findings in astrocyte-TwKO mimic neuropathology of Alpers syndrome, infantile-onset mitochondrial spongiotic encephalopathy caused by mtDNA maintenance defects. Our evidence indicates that (1) astrocytes are dependent on mtDNA integrity; (2) mitochondrial metabolism contributes to their activation; (3) chronic astrocyte activation has devastating consequences, underlying spongiotic encephalopathy; and that (4) astrocytes are a potential target for interventions.
[Mh] Termos MeSH primário: Astrócitos/metabolismo
Encefalopatias/genética
DNA Mitocondrial/genética
Doenças Mitocondriais/genética
[Mh] Termos MeSH secundário: Animais
Encéfalo/metabolismo
Encéfalo/ultraestrutura
DNA Helicases/genética
DNA Helicases/metabolismo
DNA Mitocondrial/metabolismo
Camundongos Knockout
Microscopia Eletrônica
Proteínas Mitocondriais/genética
Proteínas Mitocondriais/metabolismo
Mutação
Neurônios/metabolismo
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (DNA, Mitochondrial); 0 (Mitochondrial Proteins); EC 3.6.1.- (Peo1 protein, mouse); EC 3.6.4.- (DNA Helicases)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180106
[St] Status:MEDLINE
[do] DOI:10.1038/s41467-017-01859-9


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[PMID]:29381921
[Au] Autor:Li J; Wang C; Chen N; Song J; Sun Y; Yao Q; Yan L; Yang J
[Ad] Endereço:Department of Liver Surgery and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University.
[Ti] Título:Immediate postoperative tracheal extubation in a liver transplant recipient with encephalopathy and the Mayo end-stage liver disease score of 41: A CARE-compliant case report revealed meaningful challenge in recovery after surgery (ERAS) for liver transplantation.
[So] Source:Medicine (Baltimore);96(47):e8467, 2017 Nov.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Immediate postoperative tracheal extubation (IPTE) is one of the most important subject in recovery after surgery (ERAS) for liver transplantation. However, the criteria for IPTE is not uniform at present. PATIENT CONCERNS: We reported a successful IPTE in a liver transplant recipient with encephalopathy and a high Mayo end-stage liver disease (MELD) score of 41, which beyond the so-called criteria reported in the literature. The patient was 48-year-old man, admitted in September 2016 for end-stage liver cirrhosis secondary to hepatitis B. DIAGNOSES: End-stage liver cirrhosis secondary to hepatitis B with encephalopathy and a high MELD score of 41. INTERVENTIONS: He was involved in our ERAS project and was extubated at the end of the liver transplantation in the operating room. OUTCOMES: As a result, the patient was not reintubated and had an excellent postoperative recovery, staying in intensive care unit (ICU) for just 2 days and discharged home on day 10. LESSONS: We believed IPTE in liver transplant recipients with severe liver dysfunction is a meaningful challenge in ERAS for liver transplantation. Our case and literature review suggest 3 things: IPTE in liver transplantation is generally feasible and safe; the encephalopathy or high MELD score should not be the only limiting factor; and a more systematic predicting system for IPTE in liver transplantation should be addressed in future studies.
[Mh] Termos MeSH primário: Extubação/métodos
Encefalopatias/etiologia
Doença Hepática Terminal/complicações
Doença Hepática Terminal/cirurgia
Transplante de Fígado/métodos
[Mh] Termos MeSH secundário: Doença Hepática Terminal/etiologia
Hepatite B/complicações
Seres Humanos
Masculino
Meia-Idade
Fatores de Tempo
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180220
[Lr] Data última revisão:
180220
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180201
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008467


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[PMID]:28458341
[Au] Autor:Ikeda-Matsuo Y
[Ad] Endereço:Laboratory of Pharmacology, Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Hokuriku University.
[Ti] Título:The Role of mPGES-1 in Inflammatory Brain Diseases.
[So] Source:Biol Pharm Bull;40(5):557-563, 2017.
[Is] ISSN:1347-5215
[Cp] País de publicação:Japan
[La] Idioma:eng
[Ab] Resumo:Prostaglandin E (PGE ) has been thought to be an important mediator of inflammation in peripheral tissues, but recent studies clearly show the involvement of PGE in inflammatory brain diseases. In some animal models of brain disease, the genetic disruption and chemical inhibition of cyclooxygenase (COX)-2 resulted in the reduction of PGE and amelioration of symptoms, and it had been thought that PGE produced by COX-2 may be involved in the progression of injuries. However, COX-2 produces not only PGE , but also some other prostanoids, and thus the protective effects of COX-2 inhibition, as well as severe side effects, may be caused by the inhibition of prostanoids other than PGE . Therefore, to elucidate the role of PGE , studies of microsomal prostaglandin E synthase-1 (mPGES-1), an inducible terminal enzyme for PGE synthesis, have recently been an active area of research. Studies from mPGES-1 deficient mice provide compelling evidence for its role in a variety of inflammatory brain diseases, such as ischemic stroke, Alzheimer's disease and epilepsy, and clues for developing new therapeutic treatments for brain diseases by targeting mPGES-1. Considering that COX inhibitors may non-selectively suppress the production of many types of prostanoids that are essential for normal physiological functioning of the brain and peripheral tissues, as well as induce gastro-intestinal, renal and cardiovascular complications, mPGES-1 inhibitors are expected to be injury-selective and have fewer side-effects when treating human brain diseases. Thus, this paper focuses on recent studies that have demonstrated the involvement of mPGES-1 in pathological brain diseases.
[Mh] Termos MeSH primário: Encefalopatias/genética
Dinoprostona/metabolismo
Encefalite/genética
Prostaglandina-E Sintases/genética
[Mh] Termos MeSH secundário: Animais
Encefalopatias/enzimologia
Encefalopatias/patologia
Encefalite/enzimologia
Encefalite/patologia
Seres Humanos
Doenças do Sistema Nervoso/enzimologia
Doenças do Sistema Nervoso/genética
Doenças do Sistema Nervoso/patologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
EC 5.3.99.3 (PTGES protein, human); EC 5.3.99.3 (Prostaglandin-E Synthases); K7Q1JQR04M (Dinoprostone)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180212
[Lr] Data última revisão:
180212
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170502
[St] Status:MEDLINE
[do] DOI:10.1248/bpb.b16-01026


  6 / 45190 MEDLINE  
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[PMID]:28458340
[Au] Autor:Kume T
[Ad] Endereço:Department of Pharmacology, Graduate School of Pharmaceutical Sciences, Kyoto University.
[Ti] Título:Therapeutic Potential of the Activators of the Nuclear Factor Erythroid 2-Related Factor 2-Antioxidant Response Element Pathway in Brain Disorders.
[So] Source:Biol Pharm Bull;40(5):553-556, 2017.
[Is] ISSN:1347-5215
[Cp] País de publicação:Japan
[La] Idioma:eng
[Ab] Resumo:Oxidative stress is recognized as an important mediator of brain disorders. Nevertheless, there are few antioxidants approved for brain diseases. There are two types of mechanisms as antioxidant systems in vivo, antioxidants and antioxidant enzymes. Antioxidants are consumed by the reaction with reactive oxygen species. Thus, it is important to maintain high concentrations at the requisite site. On the other hand, antioxidant capacity is maintained for around a half-day to one day once antioxidant enzymes are induced. Therefore, low molecular-weight compounds that could induce antioxidant enzymes are considered to be suitable for the treatment and prevention of brain diseases. The nuclear factor erythroid 2-related factor 2 (Nrf2)-antioxidant response element (ARE) pathway is known as a system for inducing these antioxidant enzymes. Here, the potential for low molecular-weight compounds capable of activating the Nrf2-ARE pathway to become therapeutic agents for brain diseases is discussed.
[Mh] Termos MeSH primário: Antioxidantes/metabolismo
Encefalopatias/tratamento farmacológico
Fator 2 Relacionado a NF-E2/agonistas
Elementos de Resposta/efeitos dos fármacos
[Mh] Termos MeSH secundário: Animais
Encefalopatias/genética
Seres Humanos
Fator 2 Relacionado a NF-E2/genética
Transdução de Sinais/efeitos dos fármacos
Transdução de Sinais/genética
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Antioxidants); 0 (NF-E2-Related Factor 2); 0 (NFE2L2 protein, human)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180212
[Lr] Data última revisão:
180212
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170502
[St] Status:MEDLINE
[do] DOI:10.1248/bpb.b17-00091


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[PMID]:27774876
[Au] Autor:Lu S; Qiu X; Shi J; Li N; Lu ZH; Chen P; Yang MM; Liu FY; Jia WJ; Zhang Y
[Ti] Título:A Pathological Brain Detection System based on Extreme Learning Machine Optimized by Bat Algorithm.
[So] Source:CNS Neurol Disord Drug Targets;16(1):23-29, 2017.
[Is] ISSN:1996-3181
[Cp] País de publicação:United Arab Emirates
[La] Idioma:eng
[Ab] Resumo:AIM: It is beneficial to classify brain images as healthy or pathological automatically, because 3D brain images can generate so much information which is time consuming and tedious for manual analysis. Among various 3D brain imaging techniques, magnetic resonance (MR) imaging is the most suitable for brain, and it is now widely applied in hospitals, because it is helpful in the four ways of diagnosis, prognosis, pre-surgical, and postsurgical procedures. There are automatic detection methods; however they suffer from low accuracy. METHOD: Therefore, we proposed a novel approach which employed 2D discrete wavelet transform (DWT), and calculated the entropies of the subbands as features. Then, a bat algorithm optimized extreme learning machine (BA-ELM) was trained to identify pathological brains from healthy controls. A 10x10-fold cross validation was performed to evaluate the out-of-sample performance. RESULT: The method achieved a sensitivity of 99.04%, a specificity of 93.89%, and an overall accuracy of 98.33% over 132 MR brain images. CONCLUSION: The experimental results suggest that the proposed approach is accurate and robust in pathological brain detection.
[Mh] Termos MeSH primário: Algoritmos
Encefalopatias/diagnóstico por imagem
Encéfalo/diagnóstico por imagem
Aprendizado de Máquina
[Mh] Termos MeSH secundário: Automação
Encéfalo/patologia
Encefalopatias/patologia
Entropia
Seres Humanos
Processamento de Imagem Assistida por Computador
Imagem Tridimensional
Imagem por Ressonância Magnética
Neuroimagem
Reconhecimento Automatizado de Padrão
Reprodutibilidade dos Testes
Análise de Ondaletas
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180209
[Lr] Data última revisão:
180209
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161025
[St] Status:MEDLINE
[do] DOI:10.2174/1871527315666161019153259


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[PMID]:29381971
[Au] Autor:Yang X; Liu J; Ren Y; Richard SA; Zhang Y
[Ad] Endereço:Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
[Ti] Título:Isolated intracranial Rosai-Dorfman disease mimicking petroclival meningioma in a child: Case report and review of the literature.
[So] Source:Medicine (Baltimore);96(47):e8754, 2017 Nov.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Rosai -Dorfman disease (RDD) is a rare, idiopathic, and non-neoplastic histioproliferative disease with distinctive entity of unknown etiology. Central nervous system (CNS) RDD is uncommon, hence, isolated intracranial RDD is extremely rare. So far only 6 cases of CNS RDD with the lesions originating from petroclival region have been reported. We present a case of isolated intracranial RDD mimicking petroclival meningioma. PATIENT CONCERNS: A 14-year-old girl was admitted at our hospital with a 3-month history of dizziness, slowly progressing headache, and 2-month history of instability in walking. Cranial nerve deficits, including left facial paralysis, left facial numbness and left hearing loss, were evident on examination. DIAGNOSES: Initial diagnosis of petroclival meningioma was made according to preoperative magnetic resonance imaging. INTERVENTIONS: The lesion was resected subtotally and pathology confirmed RDD. The patient received gamma-knife treatment for the residual lesion. OUTCOMES: The patient recovered well and the residual lesion significantly retrogressed on follow-up images. LESSONS: Preoperative diagnosis of petroclival RDD is full of challenges. Although surgical resection of lesions is an effective treatment option, total resection is not highly recommended because the surgery-related defect must be minimal. Patient with residual lesion can be put on steroid therapy and/or radiotherapy, especially for IgG4 positive subset of RDD.
[Mh] Termos MeSH primário: Encefalopatias/diagnóstico
Histiocitose Sinusal/diagnóstico
Neoplasias Meníngeas/diagnóstico
Meningioma/diagnóstico
[Mh] Termos MeSH secundário: Adolescente
Diagnóstico Diferencial
Feminino
Seres Humanos
Neoplasias da Base do Crânio/diagnóstico
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180208
[Lr] Data última revisão:
180208
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180201
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008754


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[PMID]:28457227
[Au] Autor:Ochocinska MJ; Zlokovic BV; Searson PC; Crowder AT; Kraig RP; Ljubimova JY; Mainprize TG; Banks WA; Warren RQ; Kindzelski A; Timmer W; Liu CH
[Ad] Endereço:National Heart, Lung, and Blood Institute, National Institutes of Health, 6701 Rockledge Dr., Room 9149, Bethesda, MD, 20892-7950, USA. Margaret.Ochocinska@nih.gov.
[Ti] Título:NIH workshop report on the trans-agency blood-brain interface workshop 2016: exploring key challenges and opportunities associated with the blood, brain and their interface.
[So] Source:Fluids Barriers CNS;14(1):12, 2017 May 01.
[Is] ISSN:2045-8118
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:A trans-agency workshop on the blood-brain interface (BBI), sponsored by the National Heart, Lung and Blood Institute, the National Cancer Institute and the Combat Casualty Care Research Program at the Department of Defense, was conducted in Bethesda MD on June 7-8, 2016. The workshop was structured into four sessions: (1) blood sciences; (2) exosome therapeutics; (3) next generation in vitro blood-brain barrier (BBB) models; and (4) BBB delivery and targeting. The first day of the workshop focused on the physiology of the blood and neuro-vascular unit, blood or biofluid-based molecular markers, extracellular vesicles associated with brain injury, and how these entities can be employed to better evaluate injury states and/or deliver therapeutics. The second day of the workshop focused on technical advances in in vitro models, BBB manipulations and nanoparticle-based drug carrier designs, with the goal of improving drug delivery to the central nervous system. The presentations and discussions underscored the role of the BBI in brain injury, as well as the role of the BBB as both a limiting factor and a potential conduit for drug delivery to the brain. At the conclusion of the meeting, the participants discussed challenges and opportunities confronting BBI translational researchers. In particular, the participants recommended using BBI translational research to stimulate advances in diagnostics, as well as targeted delivery approaches for detection and therapy of both brain injury and disease.
[Mh] Termos MeSH primário: Barreira Hematoencefálica/fisiopatologia
Encefalopatias/patologia
National Institutes of Health (U.S.)
Pesquisa Médica Translacional
[Mh] Termos MeSH secundário: Animais
Transporte Biológico
Barreira Hematoencefálica/diagnóstico por imagem
Barreira Hematoencefálica/patologia
Encefalopatias/diagnóstico por imagem
Encefalopatias/fisiopatologia
Seres Humanos
Imagem por Ressonância Magnética
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180203
[Lr] Data última revisão:
180203
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170502
[St] Status:MEDLINE
[do] DOI:10.1186/s12987-017-0061-6


  10 / 45190 MEDLINE  
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Registro de Ensaios Clínicos
Registro de Ensaios Clínicos
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[PMID]:28742911
[Au] Autor:Kirkegaard H; Søreide E; de Haas I; Pettilä V; Taccone FS; Arus U; Storm C; Hassager C; Nielsen JF; Sørensen CA; Ilkjær S; Jeppesen AN; Grejs AM; Duez CHV; Hjort J; Larsen AI; Toome V; Tiainen M; Hästbacka J; Laitio T; Skrifvars MB
[Ad] Endereço:Research Center for Emergency Medicine and Department of Anesthesiology and Intensive Care Medicine, Aarhus University Hospital and Aarhus University, Aarhus, Denmark.
[Ti] Título:Targeted Temperature Management for 48 vs 24 Hours and Neurologic Outcome After Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial.
[So] Source:JAMA;318(4):341-350, 2017 07 25.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: International resuscitation guidelines recommend targeted temperature management (TTM) at 33°C to 36°C in unconscious patients with out-of-hospital cardiac arrest for at least 24 hours, but the optimal duration of TTM is uncertain. Objective: To determine whether TTM at 33°C for 48 hours results in better neurologic outcomes compared with currently recommended, standard, 24-hour TTM. Design, Setting, and Participants: This was an international, investigator-initiated, blinded-outcome-assessor, parallel, pragmatic, multicenter, randomized clinical superiority trial in 10 intensive care units (ICUs) at 10 university hospitals in 6 European countries. Three hundred fifty-five adult, unconscious patients with out-of-hospital cardiac arrest were enrolled from February 16, 2013, to June 1, 2016, with final follow-up on December 27, 2016. Interventions: Patients were randomized to TTM (33 ± 1°C) for 48 hours (n = 176) or 24 hours (n = 179), followed by gradual rewarming of 0.5°C per hour until reaching 37°C. Main Outcomes and Measures: The primary outcome was 6-month neurologic outcome, with a Cerebral Performance Categories (CPC) score of 1 or 2 used to define favorable outcome. Secondary outcomes included 6-month mortality, including time to death, the occurrence of adverse events, and intensive care unit resource use. Results: In 355 patients who were randomized (mean age, 60 years; 295 [83%] men), 351 (99%) completed the trial. Of these patients, 69% (120/175) in the 48-hour group had a favorable outcome at 6 months compared with 64% (112/176) in the 24-hour group (difference, 4.9%; 95% CI, -5% to 14.8%; relative risk [RR], 1.08; 95% CI, 0.93-1.25; P = .33). Six-month mortality was 27% (48/175) in the 48-hour group and 34% (60/177) in the 24-hour group (difference, -6.5%; 95% CI, -16.1% to 3.1%; RR, 0.81; 95% CI, 0.59-1.11; P = .19). There was no significant difference in the time to mortality between the 48-hour group and the 24-hour group (hazard ratio, 0.79; 95% CI, 0.54-1.15; P = .22). Adverse events were more common in the 48-hour group (97%) than in the 24-hour group (91%) (difference, 5.6%; 95% CI, 0.6%-10.6%; RR, 1.06; 95% CI, 1.01-1.12; P = .04). The median length of intensive care unit stay (151 vs 117 hours; P < .001), but not hospital stay (11 vs 12 days; P = .50), was longer in the 48-hour group than in the 24-hour group. Conclusions and Relevance: In unconscious survivors from out-of-hospital cardiac arrest admitted to the ICU, targeted temperature management at 33°C for 48 hours did not significantly improve 6-month neurologic outcome compared with targeted temperature management at 33°C for 24 hours. However, the study may have had limited power to detect clinically important differences, and further research may be warranted. Trial Registration: clinicaltrials.gov Identifier: NCT01689077.
[Mh] Termos MeSH primário: Hipotermia Induzida
Parada Cardíaca Extra-Hospitalar/terapia
[Mh] Termos MeSH secundário: Idoso
Temperatura Corporal
Encefalopatias/etiologia
Reanimação Cardiopulmonar/métodos
Feminino
Seres Humanos
Hipotermia Induzida/efeitos adversos
Masculino
Meia-Idade
Parada Cardíaca Extra-Hospitalar/complicações
Parada Cardíaca Extra-Hospitalar/mortalidade
Fatores de Tempo
Inconsciência/etiologia
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; MULTICENTER STUDY; PRAGMATIC CLINICAL TRIAL; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1707
[Cu] Atualização por classe:180124
[Lr] Data última revisão:
180124
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170726
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2017.8978



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