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Application of artificial hibernation technology in acute brain injury

Neural Regeneration Research 2024年第9期19卷 1940-1946页

作者： Xiaoni Wang Shulian Chen Xiaoyu Wang Zhen Song Ziqi Wang Xiaofei Niu Xiaochu Chen Xuyi Chen Graduate School of Tianjin University of Traditional Chinese Medicine TianjinChina Characteristic Medical Center of People’s Armed Police Forces TianjinChina

Controlling intracranial pressure,nerve cell regeneration,and microenvironment regulation are the key issues in reducing mortality and disability in acute brain injury.There is currently a lack of effective treatment methods.Hibernation has the characteristics of low temperature,low metabolism,and hibernation rhythm,as well as protective effects on the nervous,cardiovascular,and motor systems.Artificial hibernation technology is a new technology that can effectively treat acute brain injury by altering the body’s metabolism,lowering the body’s core temperature,and allowing the body to enter a state similar to hibernation.This review introduces artificial hibernation technology,including mild hypothermia treatment technology,central nervous system regulation technology,and artificial hibernation-inducer technology.Upon summarizing the relevant research on artificial hibernation technology in acute brain injury,the research results show that artificial hibernation technology has neuroprotective,anti-inflammatory,and oxidative stress-resistance effects,indicating that it has therapeutic significance in acute brain injury.Furthermore,artificial hibernation technology can alleviate the damage of ischemic stroke,traumatic brain injury,cerebral hemorrhage,cerebral infarction,and other diseases,providing new strategies for treating acute brain injury.However,artificial hibernation technology is currently in its infancy and has some complications,such as electrolyte imbalance and coagulation disorders,which limit its use.Further research is needed for its clinical application.

关键词： cute brain injury artificial hibernation hypothermia low metabolism mild hypothermia

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The future of artificial hibernation medicine:protection of nerves and organs after spinal cord injury

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Neural Regeneration Research 2024年第1期19卷 22-28页

作者： Caiyun Liu Haixin Yu Zhengchao Li Shulian Chen Xiaoyin Li Xuyi Chen Bo Chen School of Acupuncture&Moxibustion and Tuina Tianjin University of Traditional Chinese MedicineTianjinChina Research Center of Experimental Acupucture Science Tianjin University of Traditional Chinese MedicineTianjinChina Characteristic Medical Center of Chinese People’s Armed Police Force TianjinChina Binhai New Area Hospital of TCM TianjinChina Fourth Teaching Hospital of Tianjin University of TCM TianjinChina

Spinal cord injury is a serious disease of the central nervous system involving irreversible nerve injury and various organ system injuries.At present,no effective clinical treatment exists.As one of the artificial hibernation techniques,mild hypothermia has preliminarily confirmed its clinical effect on spinal cord injury.However,its technical defects and barriers,along with serious clinical side effects,restrict its clinical application for spinal cord injury.Artificial hibernation is a futureoriented disruptive technology for human life support.It involves endogenous hibernation inducers and hibernation-related central neuromodulation that activate particular neurons,reduce the central constant temperature setting point,disrupt the normal constant body temperature,make the body adapt"to the external cold environment,and reduce the physiological resistance to cold stimulation.Thus,studying the artificial hibernation mechanism may help develop new treatment strategies more suitable for clinical use than the cooling method of mild hypothermia technology.This review introduces artificial hibernation technologies,including mild hypothermia technology,hibernation inducers,and hibernation-related central neuromodulation technology.It summarizes the relevant research on hypothermia and hibernation for organ and nerve protection.These studies show that artificial hibernation technologies have therapeutic significance on nerve injury after spinal co rd injury through inflammatory inhibition,immunosuppression,oxidative defense,and possible central protection.It also promotes the repair and protection of res pirato ry and digestive,cardiovascular,locomoto r,urinary,and endocrine systems.This review provides new insights for the clinical treatment of nerve and multiple organ protection after spinal cord injury thanks to artificial hibernation.At present,artificial hibernation technology is not mature,and research fa ces various challenges.Neve rtheless,the effort is wo rthwhile for the future development of medicine.

关键词： artificial hibernation central thermostatic-resista nt regulation hypothermia multi-system protection neuroprotection organ protection spinal cord injury synthetic torpor

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hypothermia selectively protects the anterior forebrain mesocircuit during global cerebral ischemia

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Neural Regeneration Research 2022年第7期17卷 1512-1517页

作者： Xiao-Hua Wang Wei Jiang Si-Yuan Zhang Bin-Bin Nie Yi Zheng Feng Yan Jian-Feng Lei Tian-Long Wang Department of Anesthesiology Xuanwu HospitalCapital Medical UniversityBeijingChina National Clinical Research Center for Geriatric Disorders BeijingChina Department of Anesthesiology Third Medical Center of People’s Liberation Army General HospitalBeijingChina Daxing Hospital Affiliated to Capital Medical University BeijingChina Beijing Engineering Research Center of Radiographic Techniques and Equipment Institute of High Energy PhysicsChinese Academy of SciencesBeijingChina School of Nuclear Science and Technology University of Chinese Academy of SciencesBeijingChina Neuroprotection Research Laboratory Departments of Radiology and NeurologyMassachusetts General Hospital and Harvard Medical SchoolCharlestownMAUSA Cerebrovascular Research Center Xuanwu HospitalCapital Medical UniversityBeijingChina

hypothermia is an important protective strategy against global cerebral ischemia following cardiac arrest.However,the mechanisms of hypothermia underlying the changes in different regions and connections of the brain have not been fully elucidated.This study aims to identify the metabolic nodes and connection integrity of specific brain regions in rats with global cerebral ischemia that are most affected by hypothermia treatment.18F-fluorodeoxyglucose positron emission tomography was used to quantitatively determine glucose metabolism in different brain regions in a rat model of global cerebral ischemia established at 31–33℃.Diffusion tensor imaging was also used to reconstruct and explore the brain connections involved.The results showed that,compared with the model rats established at 37–37.5℃,the rat models of global cerebral ischemia established at 31–33℃had smaller hypometabolic regions in the thalamus and primary sensory areas and sustained no obvious thalamic injury.hypothermia selectively preserved the integrity of the anterior forebrain mesocircuit,exhibiting protective effects on the brain during the global cerebral ischemia.The study was approved by the Institutional Animal Care and Use Committee at Capital Medical University(approval No.XW-AD318-97-019)on December 15,2019.

关键词： anterior forebrain mesocircuit cardiac arrest corpus callosum global cerebral ischemia hypometabolic areas hypothermia magnetic resonance imaging positron emission tomography prefrontal cortex rats thalamus

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Histopathological,histochemical and biochemical postmortem changes in induced fatal hypothermia in rats

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Forensic Sciences Research 2022年第2期7卷 211-227页

作者： Mahrous Abdelbasset Ibrahim Sally Salem Mohammed Hany Goda Tammam Rehab Ibrahim Abdel-Karim Medhat Mohammed Farag Forensic Medicine&Clinical Toxicology College of MedicineJouf UniversitySakakahSaudi Arabia Forensic Medicine&Clinical Toxicology Department Faculty of MedicineSuez Canal UniversityIsmailiaEgypt Histology and Cell Biology Department Faculty of MedicineSuez Canal UniversityIsmailiaEgypt Forensic Medicine and Clinical Toxicology Department Faculty of MedicineAl-Azhar UniversityCairoEgypt Medical biochemistry Department College of MedicineShaqra UniversityShaqraaSaudi Arabia Medical Biochemistry&Molecular Biology Department Faculty of MedicineBenha UniversityBenhaEgypt

Reaching a postmortem diagnosis of hypothermia is challenging in forensic practice.Therefore,this study was conducted to detect the histopathological,histochemical and biochemical changes that occur in adult albino rats following exposure to induced fatal hypothermia.Twenty-four adult albino rats were divided into the negative control,moderate hypothermia,severe hypothermia and hypoxia groups.Rats in the control group were euthanized when those in the moderate hypothermic group died.Blood samples were collected via heart puncture,and the cerebrum,heart,suprarenal gland,kidney,liver and skeletal muscle were removed to investigate the biochemical,histochemical and histopathological changes.Postmortem assessment depicted significant changes in lipid peroxidation,represented by increased malondialdehyde levels in the studied organs of the rats in hypothermic and hypoxia groups.Histopathological examination of the rats’organs revealed degeneration and necrosis in the hypothermia and hypoxia groups.Sections taken from the severe hypothermic rats revealed a loss of normal cardiac tissue architecture,necrotic changes in the pyramidal cells in the cerebral cortex,and massive necrosis,mainly in the tubules of the renal cortex and medulla.These findings suggest that histological changes might be used as biochemical markers for postmortem diagnosing of fatal hypothermia,particularly in severe hypothermic conditions.

关键词： Forensic sciences forensic medicine legal medicine autopsy forensic pathology histochemical hypothermia

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Comparison between forced-air and air-free warming on perioperative hypothermia in patients undergoing elective surgery

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Chinese Medical Journal 2022年第19期135卷 2363-2365页

作者： Bin Ji Mengxue He Hang Chen Yu Chen Siyuan Wang Lyucheng Yang Weihong Xu Nanping Shen Department of Anesthesiology Shanghai Children's Medical CenterSchool of MedicineShanghai Jiao Tong UniversityShanghai 200030China Department of Hematology&Oncology Center Shanghai Children's Medical CenterSchol of MedicineShanghai Jjao Tong UniversityShanghai 200030China Department of Nursing Shanghai Chidren's Medical CenterSchool of MedicineShanghai Jiao Tong UniversityShanghai 200030China.

To the Editor:hypothermia is described as a state in which the core temperature of a patient is decreased to equal to or30 min during the surgical procedure has been found to reduce the risk of perioperative hypotherm... 详细信息

To the Editor:hypothermia is described as a state in which the core temperature of a patient is decreased to equal to orhypothermia is associated withan increased riskof severaladverse events including postoperative shivering,surgical site infection,increased blood loss,and a longerlength of hospitalization.21Active warming for>30 min during the surgical procedure has been found to reduce the risk of perioperative hypothermia.Thus,more and more attention has been paid to how effectively prevent perioperative hypothermia,and many intraoperative active warming strategies have therefore been applied in,clinical practice,such as forced-air warming technology,_prewarming technology before anesthesia,resistive-polymer system,circulating water mattresses,and self-warming blanket.

关键词： hypothermia patients anesthesia

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Dual-sized hollow particle incorporated fibroin thermal insulating coatings on catheter for cerebral therapeutic hypothermia

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Bioactive Materials 2023年第8期26卷 116-127页

作者： Ming Li Yuan Gao Miaowen Jiang Hongkang Zhang Yang Zhang Yan Wu Wenhao Zhou Di Wu Chuanjie Wu Longfei Wu Luzi Bao Xiaoxiao Ge Zhengfei Qi Ming Wei Ang Li Yuchuan Ding Jicheng Zhang Guangzhen Pan Yu Wu Yan Cheng Yufeng Zheng Xunming Ji China-America Institute of Neuroscience and Beijing Institute of Geriatrics Xuanwu HospitalCapital Medical UniversityBeijing100053China School of Instrumentation and Optoelectronic Engineering Beihang UniversityBeijing100191China Beijing Institute for Brain Disorders Capital Medical UniversityBeijing100069China School of Materials Science and Engineering Peking UniversityBeijing100871China Shaanxi Key Laboratory of Biomedical Metallic Materials Northwest Institute for Nonferrous Metal ResearchXi’an710016China Department of Biomedical Engineering Columbia UniversityNew York CityNY10027USA Department of Neurosurgery Wayne State University School of MedicineDetroitMI48201USA Gong Yi Van-research Innovation Composite Material Co.Ltd Zheng Zhou451299China Department of Neurosurgery Xuanwu HospitalCapital Medical UniversityBeijing100053China

Selective endovascular hypothermia has been used to provide cooling-induced cerebral neuroprotection,but current catheters do not support thermally-insulated transfer of cold infusate,which results in an increased exit temperature,causes hemodilution,and limits its cooling efficiency.Herein,air-sprayed fibroin/silica-based coatings combined with chemical vapor deposited parylene-C capping film was prepared on catheter.This coating features in dual-sized-hollow-microparticle incorporated structures with low thermal conductivity.The infusate exit temperature is tunable by adjusting the coating thickness and infusion rate.No peeling or cracking was observed on the coatings under bending and rotational scenarios in the vascular models.Its efficiency was verified in a swine model,and the outlet temperature of coated catheter(75μm thickness)was 1.8-2.0◦C lower than that of the uncoated one.This pioneering work on catheter thermal insulation coatings may facilitate the clinical translation of selective endovascular hypothermia for neuroprotection in patients with acute ischemic stroke.

关键词： Silk fibroin Thermal insulation coating Catheter Stroke hypothermia

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Clinical application of multidisciplinary team-and evidence-based practice project in gynecological patients with perioperative hypothermia

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World Journal of Psychiatry 2023年第11期13卷 848-861页

作者： Qing-Yan Liu Tong-Yang You Dai-Ying Zhang Juan Wang The Operating Room The Affiliated Hospital of Southwest Medical UniversityLuzhou 646000Sichuan ProvinceChina

BACKGROUND Perioperative hypothermia(PH)negatively affects the physical and mental health of patients to varying degrees.Currently,there is no effective multidisciplinary team(MDT)intervention for gynecological patients with PH.AIM To apply the best evidence on the prevention and management of PH in gynecological patients,improve the quality of perioperative evidence-based care based on treatment by an MDT for gynecological patients and analyze the effect of MDT-and evidence-based practice(EBP)projects on the psychological status and cognitive function of gynecological patients with PH.METHODS Under the guidance of knowledge translation and combined with the opinions of involved stakeholders and clinical experts,the best evidence for PH prevention and management in gynecological patients was selected and adjusted to suit the practice setting.Based on the evidence,the practice plan was developed,and the MDT intervention was carried out in the preoperative ward,the preoperative preparation room,the intraoperative operating room,the postanesthesia care unit,and the 24-hour postoperative gynecological ward through the EBP program.The incidence of hypothermia,the nurses’awareness,the implementation rate of examination indicators,and the thermal comfort level,psychological status and cognitive function of patients were compared before and after the implementation of the program.RESULTS The incidence of PH in gynecological patients decreased from 43.33%to 13.33%after the implementation of the scheme.The implementation rate of examination indicators 6-10,12,14,16-18,21,and 22 reached 100%,and that of other indicators was above 90%,except for examination indicators 5 and 13,which was 66.67%;the indices were significantly improved compared with the baseline(before evidence application)(P<0.05).The score of nurses'awareness of PH prevention and management in gynecological patients increased from 60.96±9.70 to 88.08±8.96,and the difference was statistically significant(P<0.001).The total score of the perioperative thermal co

关键词： hypothermia Gynecology Evidence-based care Knowledge translation Multidisciplinary team

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Ondansetron and hypothermia Induced Cardiac Arrest in a 97-Year-Old Woman: A Case Report

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Cardiovascular Innovations and Applications 2022年第3期7卷 66-72页

作者： Keith Sai Kit Leung Faareaha Ahmad Amun Mahmood Yuki Ka Ling Shum Ekta Punj Azam Majeed Riad Hosein Anna Hong Muzaffar Hashmi Faculty of Health and Life Sciences Aston UniversityBirmingham B47ETUnited Kingdom Emergency Department Queen Elizabeth Hospital BirminghamUniversity Hospitals Birmingham NHS Foundation TrustBirmingham B152THUnited Kingdom

Background:Ondansetron and hypothermia are both known to induce bradycardia or QT interval prolongation,thus placing affected patients at risk of cardiac arrest.Case Report:Herein,we report the case of a 97-year-old woman who initially presented with confusion and hypothermia,and experienced severe bradycardia and asystolic cardiac arrest after a 4 mg intravenous ondansetron bolus injection.Conclusion:Ondansetron is associated with bradycardia and QTc prolongation,both of which might be further exacerbated by hypothermia.Clinicians should be aware that administering ondansetron in patients with hypothermia might further increase the risk of adverse cardiac events and eventual cardiac arrest.

关键词： Ondansetron hypothermia Bradycardia QT prolongation Cardiac Arrest

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hypothermia ameliorates gastrointestinal ischemic injury sustained in a porcine cardiac arrest model

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Chinese Medical Journal 2012年第24期125卷 4406-4411页

作者： LU Yi WANG Shuo LI Chun-sheng Department of Emergency Medicine Beijing Chaoyang Hospital Capital Medical University Beijing 100020 China

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 4℃ 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 4℃ saline, can rapidly reduce internal body temperature, improve energy metabolism, and ameliorate injury to the gastrointestinal mucosa after CPR.

关键词： cardiac arrest cardiopulmonary resuscitation gastrointestinal tract hypothermia ischemic injury

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Intraoperative body temperature and emergence delirium in elderly patients after non-cardiac surgery:A secondary analysis of a prospective observational study

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Chinese Medical Journal 2023年第19期136卷 2330-2339页

作者： Guojun Wang Shuting He Mengyao Yu Yan Zhang Dongliang Mu Dongxin Wang Department of Anesthesiology Peking University First HospitalBeijing 100034China Department of Anesthesiology Peking University Cancer HospitalBeijing 100142China

Background:Emergence delirium(ED)is a kind of delirium that occured in the immediate post-anesthesia period.Lower body temperature on post-anesthesia care unit(PACU)admission was an independent risk factor of ED.The present study was designed to investigate the association between intraoperative body temperature and ED in elderly patients undergoing non-cardiac surgery.Methods:This study was a secondary analysis of a prospective observational study.Taking baseline body temperature as a reference,intraoperative absolute and relative temperature changes were calculated.The relative change was defined as the amplitude between intraoperative lowest/highest temperature and baseline reference.ED was assessed with the confusion assessment method for intensive care unit at 10 and 30 min after PACU admission and before PACU discharge.Results:A total of 874 patients were analyzed with a mean age of 71.8±5.3 years.The incidence of ED was 38.4%(336/874).When taking 36.0°C,35.5°C,and 35.0°C as thresholds,the incidences of absolute hypothermia were 76.7%(670/874),38.4%(336/874),and 17.5%(153/874),respectively.In multivariable logistic regression analysis,absolute hypothermia(lowest valuehypothermia(decrement>1.0°C from baseline)and its cumulative duration were also associated with an increased risk of ED,respectively.When taking the relative increment>0.5°C as a threshold,the incidence of relative hyperthermia was 21.7%(190/874)and it was associated with a decreased risk of ED after adjusting above confounders.Conclusions:In the present study,we found that intraoperative hypothermia,defined as either absolute or relative hypothermia,was associated with an increased risk of ED in elderly patients after non-cardiac surgery.Relative hyper

关键词： hypothermia Hyperthermia Emergence delirium Pain measurement Cognitive dysfunction Non-cardiac surgery Aged Post-anesthesia care unit

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