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Neural Regeneration Research 2017年第3期12卷 341-350页

作者： Jin Hwan Lee James Zhang Shan Ping Yu Department of Anesthesiology Emory University School of MedicineAtlantaGAUSA Veteran's Affair Medical Center Center for Visual and Neurocognitive RehabilitationAtlantaGAUSA

Stroke is a leading cause of disability and death,yet effective treatments for acute stroke has been very *** far,tissue plasminogen activator has been the only FDA-approved drug for thrombolytic treatment of ischemic stroke patients,yet its application is only applicable to less than 4–5% of stroke patients due to the narrow therapeutic window（〈 4.5 hours after the onset of stroke） and the high risk of hemorrhagic *** evidence from basic and clinical studies has shown that therapeutic hypothermia,also known as targeted temperature management,can be a promising therapy for patients with different types of ***,the success in animal models using pharmacologically induced hypothermia（PIH） has gained increasing momentum for clinical translation of hypothermic *** review provides an updated overview of the mechanisms and protective effects of therapeutic hypothermia,as well as the recent development and findings behind PIH *** is expected that a safe and effective hypothermic therapy has a high translational potential for clinical treatment of patients with stroke and other CNS injuries.

关键词： stroke therapeutic hypothermia drug-induced hypothermia ischemia cell death inflammation

The utility of therapeutic hypothermia on cerebral autoregulation

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Journal of Intensive Medicine 2023年第1期3卷 27-37页

作者： Haiyan Liu Min Zhou Neurocritical Care Unit The First Affiliated Hospital of USTCDivision of Life Sciences and MedicineUniversity of Science and Technology of ChinaHefeiAnhui 230036China

Cerebral autoregulation(CA)dysfunction is a strong predictor of clinical outcome in patients with acute brain injury(ABI).CA dysfunction is a potential pathologic defect that may lead to secondary injury and worse functional *** therapeutic hypothermia(TH)in patients with ABI is *** factors,including patient selection,timing,treatment depth,duration,and rewarming strategy,impact its clinical ***,optimizing the benefit of TH is an important *** paper reviews the state of current research on the impact of TH on CA function,which may provide the basis and direction for CA-oriented target temperature management.

关键词： Brain injury therapeutic hypothermia Cerebral autoregulation Review

Temporal dynamics of neonatal hypoxic-ischemic encephalopathy injuries on magnetic resonance imaging

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Neural Regeneration Research 2025年第11期20卷 3144-3150页

作者： Holly Flyger Samantha J.Holdsworth Alistair J.Gunn Laura Bennet Hamid Abbasi Mātai Medical Research Institute Tairāwhiti GisborneNew Zealand Department of Anatomy&Medical Imaging Faculty of Medical and Health SciencesThe University of AucklandAucklandNew Zealand Center for Brain Research The University of AucklandAucklandNew Zealand Auckland Bioengineering Institute The University of AucklandAucklandNew Zealand

Moderate to severe perinatal hypoxic-ischemic encephalopathy occurs in~1 to 3/1000 live births in high-income countries and is associated with a significant risk of death or neurodevelopmental *** assessment is important to help identify highrisk infants,to help families,and to support appropriate interventions.A wide range of monitoring tools is available to assess changes over time,including urine and blood biomarkers,neurological examination,and *** present,magnetic resonance imaging is unique as although it is expensive and not suited to monitoring the early evolution of hypoxic-ischemic encephalopathy by a week of life it can provide direct insight into the anatomical changes in the brain after hypoxic-ischemic encephalopathy and so offers strong prognostic information on the long-term outcome after hypoxic-ischemic *** review investigated the temporal dynamics of neonatal hypoxic-ischemic encephalopathy injuries,with a particular emphasis on exploring the correlation between the prognostic implications of magnetic resonance imaging scans in the first week of life and their relationship to long-term outcome prediction,particularly for infants treated with therapeutic hypothermia.A comprehensive literature search,from 2016 to 2024,identified 20 pertinent *** review highlights that while the optimal timing of magnetic resonance imaging scans is not clear,overall,it suggests that magnetic resonance imaging within the first week of life provides strong prognostic *** challenges limit the timing consistency,particularly the need for intensive care and clinical ***,although most reports examined the prognostic value of scans taken between 4 and 10 days after birth,there is evidence from small numbers of cases that,at times,brain injury may continue to evolve for weeks after *** suggests that in the future it will be important to explore a wider range of times after hypo

关键词： magnetic resonance imaging neonatal hypoxic-ischemic encephalopathy neurodevelopmental outcomes prognostic biomarkers in neuroimaging scan timing therapeutic hypothermia

Challenges in developing therapeutic strategies for mild neonatal encephalopathy

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Neural Regeneration Research 2022年第2期17卷 277-282页

作者： Alice McDouall Guido Wassink Laura Bennet Alistair J.Gunn Joanne O.Davidson Department of Physiology The University of AucklandAucklandNew Zealand

There is increasing evidence that infants with mild neonatal encephalopathy(NE) have significant risks of mortality, brain injury and adverse neurodevelopmental outcomes. In the era of therapeutic hypothermia, infants need to be diagnosed within 6 hours of birth, corresponding with the window of opportunity for treatment of moderate to severe NE, compared to the retrospective grading over 2 to 3 days, typically with imaging and formal electroencephalographic assessment in the pre-hypothermia era. This shift in diagnosis may have increased the apparent prevalence of brain damage and poor neurological outcomes seen in infants with mild NE in the era of hypothermia. Abnormal short term outcomes observed in infants with mild NE include seizures, abnormal neurologic examination at discharge, abnormal brain magnetic resonance imaging and difficulty feeding. At 2 to 3 years of age, mild NE has been associated with an increased risk of autism, language and cognitive deficits. There are no approved treatment strategies for these infants as they were not included in the initial randomized controlled trials for therapeutic hypothermia. However, there is already therapeutic creep, with many centers treating infants with mild NE despite the limited evidence for its safety and efficacy. The optimal duration of treatment and therapeutic window of opportunity for effective treatment need to be specifically established for mild NE as the evolution of injury is likely to be slower, based on preclinical data. Randomized controlled trials of therapeutic hypothermia for infants with mild NE are urgently required to establish the safety and efficacy of treatment. This review will examine the evidence for adverse outcomes after mild NE and dissect some of the challenges in developing therapeutic strategies for mild NE, before analyzing the evidence for therapeutic hypothermia and other strategies for treatment of these infants.

关键词： asphyxia electroencephalogram erythropoietin mild hypoxic ischemic encephalopathy neonatal encephalopathy neurological examination neuroprotection Sarnat score therapeutic hypothermia

Modeling and Simulation of an Invasive Mild Hypothermic Blood Cooling System

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Chinese Journal of Mechanical Engineering 2021年第1期34卷 45-53页

作者： Na Wang Qinghua Liu Yan Shi Shijun Wang Xianzhi Zhang Chengwei Han Yixuan Wang Maolin Cai Xunming Ji Engineering Training Center Beihang UniversityBeijing 100191China School of Automation Science and Electrical Engineering Beihang UniversityBeijing 100191China School of Mechanical and Material Engineering North China University of TechnologyBeijing 100144China People's Hospital of Juye County Heze 274900China Department of Mechanical Engineering Kingston Univer sityLondonUK. Department of Neurosurgery and Cerebrovascular Diseases Research In stitute Xuanwu HospitalCapital Medical UniversityBeijingChina

Nowadays,mild hypothermia is widely used in the fields of post-cardiac arrest resuscitation,stroke,cerebral hemorrhage,large-scale cerebral infarction,and craniocerebral *** this paper,a locally mixed sub-low temperature device is designed,and the cold and hot water mixing experiment is used to simulate the human blood transfer *** set a foundation for the optimization of the heat transfer system,the static characteristics are analyzed by building the mathematic model and setting up the experimental *** addition,the affection of several key structure parameters is *** experimental and simulation studies,it can be concluded that,firstly,the mathematical model proved to be ***,the results of simulation experiments show that 14.52℃ refrigeration can reduce the original temperature of 33.42℃ to 32.02℃,and the temperature of refrigerated blood rises to 18.64℃,and the average error is about 0.3℃.Thirdly,as the thermal conductivity of the vascular sheath increases,the efficiency of the heat exchange system also increases ***,as the input cold blood flow rate increases,the mass increases and the temperature of the mixed blood temperature *** provides a research basis for subsequent research on local fixed-point sub-low temperature control technology.

关键词： therapeutic hypothermia Invasive blood cooling Static character Heat transfer

Neonatal infratentorial subdural hematoma contributing to obstructive hydrocephalus in the setting of therapeutic cooling: A case report

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World Journal of Radiology 2021年第9期13卷 307-313页

作者： Lee K Rousslang Elizabeth A Rooks Jaren T Meldrum Kristopher G Hooten Jonathan R Wood Department of Radiology Tripler Army Medical CenterMedical CenterHI 96859United States Department of Neuroscience Duke UniversityDurhamNC 27708United States Department of Radiology Alaska Native Medical CenterAnchorageAK 99508United States Department of Neurosurgery Tripler Army Medical CenterMedical CenterHI 96859United States

BACKGROUND Symptomatic neonatal subdural hematomas usually result from head trauma incurred during vaginal delivery,most commonly during instrument *** subdural hematomas are rare in C-section deliveries that were not preceded by assisted delivery *** the literature is inconclusive,another possible cause of subdural hematomas is therapeutic *** SUMMARY We present a case of a term neonate who underwent therapeutic whole-body cooling for hypoxic ischemic encephalopathy following an emergent C-section delivery for prolonged *** ultrasound on day of life 3 demonstrated a rounded mass in the posterior fossa.A follow-up brain magnetic resonance imaging confirmed hypoxic ischemic encephalopathy and clarified the subdural hematomas in the posterior fossa causing mass effect and obstructive *** The aim of this report is to highlight the rarity and importance of mass-like subdural hematomas causing obstructive hydrocephalus,particularly in the setting of hypoxic ischemic encephalopathy and therapeutic whole-body cooling.

关键词： Hypoxic ischemic encephalopathy Neonatal subdural hematoma therapeutic hypothermia Case report

Comments on"Neonatal infratentorial subdural hematoma contributing to obstructive hydrocephalus in the setting of therapeutic cooling:A case report"

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World Journal of Radiology 2022年第6期14卷 177-179页

作者： Ioannis Siasios Aggeliki Fotiadou Yulia Rud Neurosurgery Department Papageorgiou HospitalThessaloniki 56403Greece Department of Neurology General University Hospital of AlexandroupolisAlexandroupoli 68100Greece Department of Anesthesiology European Interbalkan Medical CenterThessaloniki 57001Greece

Although therapeutic hypothermia(TH)contributes significantly in the treatment of hypoxic ischemic encephalopathy(HIE),it could result in devastating complications such as intracranial *** examinations for possible coagulation disorders and early brain imaging can detect all these cases that are amenable to aggravation of HIE after the initiation of TH.

关键词： therapeutic hypothermia Hypoxic ischemic encephalopathy Hemostatic disorders Intracranial hemorrhage Magnetic resonance imaging

Mild hypothermia as a treatment for central nervous system injuries Positive or negative effects?

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Neural Regeneration Research 2013年第28期8卷 2677-2686页

作者： Rami Darwazeh Yi Yan Department of Neurosurgery the First Affiliated Hospital of Chongqing Medical University

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 in- tracranial pressure following traumatic brain injuries in adults. It is a new treatment that increases survival and quality of life for patients suffering from ischemic insults such as cardiac arrest, stroke, and neurogenic fever following brain trauma. therapeutic hypothermia decreases free radical pro- duction, inflammation, excitotoxicity and intracranial pressure, and improves cerebral metabolism after traumatic brain injury and cerebral ischemia, thus protecting against central nervous system damage. Although a series of pathological and physiological changes as well as potential side ef- fects are observed during hypothermia treatment, it remains a potential therapeutic strategy for central nervous system injuries and deserves further study.

关键词： neural regeneration reviews brain injury spinal cord injury central nervous system injury mildhypothermia therapeutic hypothermia traumatic brain injury neuroregeneration

Epileptic Seizures in Neonates Treated with hypothermia for Hypoxo-Ischemic Encephalopathy in Brazzaville, Congo: Types and Evolution

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Neuroscience & Medicine 2023年第4期14卷 63-75页

作者： Josué Euberma Diatewa Dinah Happhia Boubayi Motoula-Latou Benoîte Gracia Diatewa Gabrielle Ontsira Grâce Kadidja Cléona Nkounkou-Milandou Eliot Prince Galiéni Sounga-Banzouzi Ghislain Armel Mpandzou Jean Robert Mabiala-Babela Paul Macaire Ossou-Nguiet Neurology Department University Hospital of Brazzaville Brazzaville Republic of Congo Faculty of Health Sciences Marien Ngouabi University Brazzaville Republic of Congo Neonatology Department Blanche Gomez Mother and Child Hospital Brazzaville Republic of Congo Neonatology Department University Hospital of Brazzaville Brazzaville Republic of Congo Neurology Department Loandjili General Hospital Pointe Noire Republic of Congo

Background: Moderate to severe hypoxic-ischemic encephalopathy (HIE) in neonates is often treated with hypothermia. However, some neonates may experience epileptic seizures during therapeutic hypothermia (TH). Data on the electrophysiologic and evolutionary aspects of these seizures are scarce in African countries. Objectives: To determine the types of epileptic seizures caused by HIE in neonates in Brazzaville;to describe the evolution of background EEG activities during TH and rewarming;to report the evolution of epileptic seizures. Methods: This was a cross-sectional, descriptive study conducted from January 2020 to July 2022. It took place in Brazzaville in the Neonatology Department of the Blanche Gomez Mother and Child Hospital. It focused on term neonates suffering from moderate or severe HIE. They were treated with hypothermia combined with phenobarbital for 72 hours. Results: Among 36 neonates meeting inclusion criteria, there were 18 boys and 18 girls. Thirty-one (86.1%) neonates had grade 2 and 5 (13.9%) grade 3 HIE. In our neonates, HIE had induced isolated electrographic seizures (n = 11;30.6%), electroclinical seizures (n = 25;69.4%), and 6 types of background EEG activity. During TH and rewarming, there were 52.8% of patients with improved background EEG activity, 41.7% of patients with unchanged background EEG activity, and 5.5% of patients with worsened background EEG activity. At the end of rewarming, only 9 (25%) patients still had seizures. Conclusion: Isolated electrographic and electroclinical seizures are the only pathological entities found in our studied population. In neonates with moderate HIE, the applied therapeutic strategy positively influences the evolution of both seizures and background EEG activity. On the other hand, in neonates with severe HIE, the same therapeutic strategy is ineffective. .

关键词： Epileptic Seizures Neonate Hypoxo-Ischemic Encephalopathy therapeutic hypothermia Antiepileptic Drugs Brazzaville

Unraveling quad fever:Severe hyperthermia after traumatic cervical spinal cord injury

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Chinese Journal of Traumatology 2023年第1期26卷 27-32页

作者： Carlton C.L.Watson Dooniya Shaikh Jody C.DiGiacomo Aaron C.Brown Raina Wallace Shridevi Singh Lisa Szydziaka Sara Cardozo-Stolberg LD.George Angus Department of Surgery Nassau University Medical CenterEast MeadowNY1155USA American University of the Caribbean School of Medicine Pembroke PinesFL33027USA

Purpose:There are many infectious and inflammatory causes for elevated core-body temperatures,though they rarely pass 40℃(104℉).The term"quad fever"is used for extreme hyperpyrexia in the setting of acute cervical spinal cord injuries(SCIs).The traditional methods of treating hyperpyrexia are often ineffective and reported morbidity and mortality rates approach 100%.This study aims to identify the incidence of elevated temperatures in SCIs at our institution and assess the effectiveness of using a non-invasive dry water temperature management system as a treatment modality with ***:A retrospective analysis of acute SCI patients requiring surgical intensive care unit admission who experienced fevers≥40℃(104℉)were compared to patients with maximum temperatures<40℃.Patients≥18 years old who sustained an acute traumatic SCI were included in this *** who expired in the emergency department;had a SCI without radiologic abnormality;had neuropraxia;were admitted to any location other than the surgical intensive care unit;or had positive blood cultures were *** 9.4 was used to conduct statistical ***:Over the 9-year study period,35 patients were admitted to the surgical intensive care unit with a verified *** patients experienced maximum temperatures of≥40℃.Six of those patients were treated with the dry water temperature management system with an overall mortality of 57.1%in this *** mortality rate for the 28 patients who experienced a maximum temperature of≤40℃was 21.4%(p=0.16).Conclusion:The diagnosis of quad fever should be considered in patients with cervical SCI in the presence of *** this study,there was no significant difference in mortality between quad fever patients treated with a dry water temperature management system versus SCI patients without quad *** early use of a dry water temperature management system appears to decrease the mortality rate of quad fever.

关键词： Spinal cord injuries Fever Quadriplegia therapeutic hypothermia