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Reis J, Buguet A, Radomski M, Stella AB, Vásquez TC, Spencer PS. Neurological patients confronting climate change: A potential role for the glymphatic system and sleep. J Neurol Sci 2024; 458:122900. [PMID: 38310733 DOI: 10.1016/j.jns.2024.122900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/18/2024] [Accepted: 01/21/2024] [Indexed: 02/06/2024]
Abstract
Interest in the health consequences of climate change (global warming, heatwaves) has increased in the neurological community. This review addresses the impact of elevated ambient temperatures and heatwaves on patients with neurological and mental health disorders, including multiple sclerosis, synucleinopathies, dementia, epilepsies, mental health, and stroke. Patients with such conditions are highly vulnerable during heatwaves because of functional disorders affecting sleep, thermoregulation, autonomic system reactivity, mood, and cognitive ability. Several medications may also increase the risk of heatstroke. Special attention is devoted to the involvement of common underlying mechanisms, such as sleep and the glymphatic system. Disease prevention and patient care during heatwaves are major issues for caregivers. Beyond the usual recommendations for individuals, we favor artificially induced acclimation to heat, which provides preventive benefits with proven efficacy for healthy adults.
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Affiliation(s)
- Jacques Reis
- Department of Neurology, University Hospital of Strasbourg, 67000 Strasbourg, France; Association RISE, 3 rue du Loir, 67205 Oberhausbergen, France.
| | - Alain Buguet
- Malaria Research Unit, UMR 5246 CNRS, Claude-Bernard Lyon-1 University, 69622 Villeurbanne, France; 21 rue de Champfranc, 38630 Les Avenières Veyrins-Thuellin, France
| | - Manny Radomski
- Emeritus at the University of Toronto, Apt n° 2501, 2010 Islington Avenue, Toronto, ON M9P3S8, Canada
| | - Alex Buoite Stella
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital, University of Trieste, Trieste, Italy
| | - Teresa Corona Vásquez
- División de Estudios de Posgrado, Universidad Nacional Autónoma de México, Mexico City, Mexico; Clinical Neurodegenerative Diseases Laboratory, Instituto Nacional de Neurología y Neurocirugía, Manuel Velasco Suárez, Mexico City, Mexico
| | - Peter S Spencer
- Department of Neurology, School of Medicine, Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, OR 97239, USA
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Miziev S, Pawlak WA, Howard N. Comparative analysis of energy transfer mechanisms for neural implants. Front Neurosci 2024; 17:1320441. [PMID: 38292898 PMCID: PMC10825050 DOI: 10.3389/fnins.2023.1320441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 12/19/2023] [Indexed: 02/01/2024] Open
Abstract
As neural implant technologies advance rapidly, a nuanced understanding of their powering mechanisms becomes indispensable, especially given the long-term biocompatibility risks like oxidative stress and inflammation, which can be aggravated by recurrent surgeries, including battery replacements. This review delves into a comprehensive analysis, starting with biocompatibility considerations for both energy storage units and transfer methods. The review focuses on four main mechanisms for powering neural implants: Electromagnetic, Acoustic, Optical, and Direct Connection to the Body. Among these, Electromagnetic Methods include techniques such as Near-Field Communication (RF). Acoustic methods using high-frequency ultrasound offer advantages in power transmission efficiency and multi-node interrogation capabilities. Optical methods, although still in early development, show promising energy transmission efficiencies using Near-Infrared (NIR) light while avoiding electromagnetic interference. Direct connections, while efficient, pose substantial safety risks, including infection and micromotion disturbances within neural tissue. The review employs key metrics such as specific absorption rate (SAR) and energy transfer efficiency for a nuanced evaluation of these methods. It also discusses recent innovations like the Sectored-Multi Ring Ultrasonic Transducer (S-MRUT), Stentrode, and Neural Dust. Ultimately, this review aims to help researchers, clinicians, and engineers better understand the challenges of and potentially create new solutions for powering neural implants.
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Doman M, Thy M, Dessajan J, Dlela M, Do Rego H, Cariou E, Ejzenberg M, Bouadma L, de Montmollin E, Timsit JF. Temperature control in sepsis. Front Med (Lausanne) 2023; 10:1292468. [PMID: 38020082 PMCID: PMC10644266 DOI: 10.3389/fmed.2023.1292468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Fever can be viewed as an adaptive response to infection. Temperature control in sepsis is aimed at preventing potential harms associated with high temperature (tachycardia, vasodilation, electrolyte and water loss) and therapeutic hypothermia may be aimed at slowing metabolic activities and protecting organs from inflammation. Although high fever (>39.5°C) control is usually performed in critically ill patients, available cohorts and randomized controlled trials do not support its use to improve sepsis prognosis. Finally, both spontaneous and therapeutic hypothermia are associated with poor outcomes in sepsis.
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Affiliation(s)
- Marc Doman
- Medical ICU, Paris Cité University– Bichat University Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Michael Thy
- Medical ICU, Paris Cité University– Bichat University Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France
- Inserm UMR 1137 – IAME Team 5 – Decision Sciences in Infectious Diseases, Control and Care INSERM/Paris Diderot, Sorbonne Paris Cité University, Paris, France
| | - Julien Dessajan
- Medical ICU, Paris Cité University– Bichat University Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Mariem Dlela
- Medical ICU, Paris Cité University– Bichat University Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Hermann Do Rego
- Medical ICU, Paris Cité University– Bichat University Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Erwann Cariou
- Medical ICU, Paris Cité University– Bichat University Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Michael Ejzenberg
- Medical ICU, Paris Cité University– Bichat University Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Lila Bouadma
- Medical ICU, Paris Cité University– Bichat University Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France
- Inserm UMR 1137 – IAME Team 5 – Decision Sciences in Infectious Diseases, Control and Care INSERM/Paris Diderot, Sorbonne Paris Cité University, Paris, France
| | - Etienne de Montmollin
- Medical ICU, Paris Cité University– Bichat University Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France
- Inserm UMR 1137 – IAME Team 5 – Decision Sciences in Infectious Diseases, Control and Care INSERM/Paris Diderot, Sorbonne Paris Cité University, Paris, France
| | - Jean-François Timsit
- Medical ICU, Paris Cité University– Bichat University Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France
- Inserm UMR 1137 – IAME Team 5 – Decision Sciences in Infectious Diseases, Control and Care INSERM/Paris Diderot, Sorbonne Paris Cité University, Paris, France
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He L, Li H, Zhang Z, Ge H, Wang H, Zhu M, Xu Z, Zhang J, Fang S, Hu C, Qian L, Xu H, Yao Y, Yuan S, Zhu J, Lu C, Zheng J, Li J, Jiang Q, Xu H, Chen L, Shang S, Chen Y. Factors associated with afebrile presentation and delayed defervescence of bacterial meningitis in children under 3 years of age: a multi-centre retrospective analysis. BMC Pediatr 2023; 23:470. [PMID: 37723538 PMCID: PMC10507889 DOI: 10.1186/s12887-023-04179-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 07/05/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND This multi-center study aimed to identify factors affecting fever and delayed defervescence in bacterial meningitis (BM) patients under 3 years of age because of the variability of fever in this patient population. METHODS Only BM patients under 3 years treated at 49 centers in China from November 2018 to end-April 2021 were included in the study. Univariate and multivariate logistic regression analyses were performed to determine factors associated with afebrile presentation and fever of delayed defervescence. RESULTS A total of 863 BM patients under 3 years were included in the study. Coagulase negative staphylococcus was associated with afebrile presentation (OR = 1.176), while septicaemia and ear-nose-throat infections were associated with fever (P < 0.05). The patients with fever were assigned into early and delayed defervescence groups based on defervescence time (less than and more than or equal to one week). Furthermore, Streptococcus agalactiae meningitis (OR = 1.124), concomitant gastrointestinal infection (OR = 1.276), encephalomalacia (or = 1.339), and subdural effusion (OR = 1.454) were independently associated with delayed defervescence (all P < 0.05). CONCLUSIONS The findings can aid in the efficient utilization of fever in auxiliary diagnosis and evaluating the condition of the disease.
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Affiliation(s)
- Lin He
- Department of Infectious Diseases, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center For Child Health, Hangzhou, China
- Zhejiang University School of Medicine, Hangzhou, China
| | - Haijing Li
- Department of Pediatric, Shaoxing Maternity and Child Health Care Hospital, Shaoxing, China
| | - Zhigang Zhang
- Department of Pediatric, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, China
| | - Hejia Ge
- Department of Pediatric, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Hongwei Wang
- Department of Pediatric, Shaoxing Keqiao Women and Children's Hospital, Shaoxing, China
| | - Mengquan Zhu
- Department of Pediatric, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhiwei Xu
- Department of Pediatric, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jiening Zhang
- Department of Pediatric, Jiaxing Maternity and Child Health Care Hospital, Jiaxing, China
| | - Sheng Fang
- Department of Pediatric, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Chuanze Hu
- Department of Pediatric, Jinhua Maternal and Child Health Care Hospital, Jinhua, China
| | - Lijun Qian
- Department of Pediatric, Lishui Central Hospital and Fifth Affiliated Hospital of Wenzhou Medical College, Lishui, China
| | - Huifang Xu
- Department of Pediatric, Lanxi People's Hospital, Lanxi, China
| | - Yinna Yao
- Department of Pediatric, Zhuji People's Hospital of Zhejiang Province, Zhuji, China
| | - Shengfu Yuan
- Department of Pediatric, Yuyao People's Hospital, Yuyao, China
| | - Jiajun Zhu
- Division of Neonatology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chaosheng Lu
- Department of Pediatric, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jishan Zheng
- Department of Pediatric, Ningbo Women and Children Hospital, Ningbo, China
| | - Junsheng Li
- Department of Pediatric, Lishui Maternity and Child Health Care Hospital, Lishui, China
| | - Qi Jiang
- Department of Pediatric, Huzhou Maternity and Child Health Care Hospital, Huzhou, China
| | - Huiqing Xu
- Department of Pediatric, Ningbo Women and Children Hospital, Ningbo, China
| | - Lihua Chen
- Division of Neonatology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center For Child Health, Hangzhou, China
| | - Shiqiang Shang
- Department of Clinical Laboratory, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center For Child Health, Hangzhou, China.
| | - Yinghu Chen
- Department of Infectious Diseases, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center For Child Health, Hangzhou, China.
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McGlennen KM, Jannotta GE, Livesay SL. Nursing Management of Temperature in a Patient with Stroke. Crit Care Nurs Clin North Am 2023; 35:39-52. [PMID: 36774006 DOI: 10.1016/j.cnc.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Fever is common in patients with stroke and is associated with worse outcomes. Studies in brain injury informed interventions commonly termed therapeutic temperature management (TTM) to improve the monitoring and management of fever. While the role and benefit of TTM in stroke patients has not been well studied, the nurse and healthcare team must extrapolate existing data to determine how to best monitor and apply TTM after stroke. Nurses should be knowledgeable about interventions to monitor and manage complications of TTM (eg, shivering), the studies underway to quantify the impact of fever treatment and emerging technology expected to improve TTM.
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Affiliation(s)
| | - Gemi E Jannotta
- Department of Anesthesia and Pain Medicine, University of Washington
| | - Sarah L Livesay
- Department of Anesthesia and Pain Medicine, University of Washington, Rush University College of Nursing
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Fujita M, Oda Y, Kaneda K, Kaneko T, Suehiro E, Dohi K, Kuroda Y, Kobata H, Tsuruta R, Maekawa T. Temperature difference between jugular bulb and pulmonary artery is associated with neurological outcome in patients with severe traumatic brain injury: A post hoc analysis of a brain hypothermia study. PLoS One 2023; 18:e0285525. [PMID: 37155613 PMCID: PMC10166477 DOI: 10.1371/journal.pone.0285525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 04/26/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND The purpose of this study was to examine whether the temperature difference between the jugular bulb and pulmonary artery (ΔTjb-pa) is associated with the neurological outcome of patients with severe traumatic brain injury (TBI). METHODS We conducted a post hoc analysis of a multicenter randomized controlled trial of mild therapeutic hypothermia (TH, 32.0-34.0°C) or fever control (FC, 35.5-37.0°C) for the patients with severe TBI. ΔTjb-pa averaged every 12 h and the variation in ΔTjb-pa were compared between patients with favorable (n = 39) and unfavorable (n = 37) neurological outcomes. These values were also compared in the TH and FC subgroups. RESULTS The average ΔTjb-pa values in patients with favorable and unfavorable outcomes were 0.24 ± 0.23 and 0.06 ± 0.36°C, respectively (P < 0.001). ΔTjb-pa trended significantly higher in the favorable outcome patients than in the unfavorable outcome patients throughout the 120 h after onset of severe TBI (P < 0.001). The variation in ΔTjb-pa from 0 to 72 h was significantly lower in the favorable outcome patients than in the unfavorable outcome patients (0.8 ± 0.8 vs 1.8 ± 2.5°C, respectively, P = 0.013). From 72 to 120 h, there was no significant difference in the variation in ΔTjb-pa. Significant differences between patients with favorable and unfavorable outcomes in ΔTjb-pa and the variation in ΔTjb-pa were similar in the TH subgroup, but not evident in the FC subgroup. CONCLUSIONS A reduction in ΔTjb-pa and greater variation in ΔTjb-pa were associated with an unfavorable outcome in patients with severe TBI, especially those treated with TH. When treating severe TBI patients, it is important to understand that there will be differences in temperature reflecting the brain environment and the systemic temperature, depending on the severity and outcome of TBI during TH.
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Affiliation(s)
- Motoki Fujita
- Acute and General Medicine, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Yasutaka Oda
- Acute and General Medicine, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Kotaro Kaneda
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Ube, Japan
| | - Tadashi Kaneko
- Department of Emergency and Disaster Medicine, Mie University Graduate School of Medicine, Tsu, Japan
| | - Eiichi Suehiro
- Department of Neurosurgery, International University of Health and Welfare School of Medicine, Narita, Japan
| | - Kenji Dohi
- Department of Emergency and Critical Care Medicine, Showa University Hospital, Tokyo, Japan
| | - Yasuhiro Kuroda
- Department of Emergency, Disaster, and Critical Care Medicine, Kagawa University Hospital, Kagawa, Japan
| | - Hitoshi Kobata
- Department of Emergency and Critical Care Medicine/Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Ryosuke Tsuruta
- Acute and General Medicine, Yamaguchi University Graduate School of Medicine, Ube, Japan
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Ube, Japan
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Chorostecki JR, Schneider NJ, Stutzman SE, Olson DM. A Case Series of Clinical Limitations to the Clinical Course of Neurogenic Fever. Ther Hypothermia Temp Manag 2022. [PMID: 36099203 DOI: 10.1089/ther.2022.0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Nurses play a vital role in the care of neurocritical patients. Fever is a common and dangerous occurrence, and there is a substantial lack of consistency in how to maintain normothermia in these patients. We present five cases in which patients were confirmed to have neurogenic fever (NF) and the documented interventions. In all five cases, temperature and interventions were not documented consistently, making it difficult to assess how nurses acted to avoid hyperthermia in these patients. Additional research is needed to determine interventions, processes, procedures, and documentation of NF in neurocritical patients.
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Affiliation(s)
- Jessica R Chorostecki
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Nathan J Schneider
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Sonja E Stutzman
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - DaiWai M Olson
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Mertin V, Most P, Busch M, Trojan S, Tapking C, Haug V, Kneser U, Hundeshagen G. Current understanding of thermo(dys)regulation in severe burn injury and the pathophysiological influence of hypermetabolism, adrenergic stress and hypothalamic regulation—a systematic review. BURNS & TRAUMA 2022; 10:tkac031. [PMID: 36168403 PMCID: PMC9501704 DOI: 10.1093/burnst/tkac031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 04/08/2022] [Indexed: 11/25/2022]
Abstract
Background In this systematic review, we summarize the aetiology as well as the current knowledge regarding thermo(dys)regulation and hypothermia after severe burn trauma and aim to present key concepts of pathophysiology and treatment options. Severe burn injuries with >20% total body surface area (TBSA) affected commonly leave the patient requiring several surgical procedures, prolonged hospital stays and cause substantial changes to body composition and metabolism in the acute and long-term phase. Particularly in severely burned patients, the loss of intact skin and the dysregulation of peripheral and central thermoregulatory processes may lead to substantial complications. Methods A systematic and protocol-based search for suitable publications was conducted following the PRISMA guidelines. Articles were screened and included if deemed eligible. This encompasses animal-based in vivo studies as well as clinical studies examining the control-loops of thermoregulation and metabolic stability within burn patients Results Both experimental animal studies and clinical studies examining thermoregulation and metabolic functions within burn patients have produced a general understanding of core concepts which are, nonetheless, lacking in detail. We describe the wide range of pathophysiological alterations observed after severe burn trauma and highlight the association between thermoregulation and hypermetabolism as well as the interactions between nearly all organ systems. Lastly, the current clinical standards of mitigating the negative effects of thermodysregulation and hypothermia are summarized, as a comprehensive understanding and implementation of the key concepts is critical for patient survival and long-term well-being. Conclusions The available in vivo animal models have provided many insights into the interwoven pathophysiology of severe burn injury, especially concerning thermoregulation. We offer an outlook on concepts of altered central thermoregulation from non-burn research as potential areas of future research interest and aim to provide an overview of the clinical implications of temperature management in burn patients.
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Affiliation(s)
- Viktoria Mertin
- University of Heidelberg Department of Hand, Plastic and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, , 67071 Ludwigshafen am Rhein, Germany
| | - Patrick Most
- Department of Internal Medicine III University Hospital Heidelberg Division of Molecular and Translational Cardiology, , 69120 Heidelberg, Germany
- Deutsches Zentrum für Herz- und Kreislaufforschung (GCCR) , Partner site Heidelberg/Mannheim, Germany
| | - Martin Busch
- Department of Internal Medicine III University Hospital Heidelberg Division of Molecular and Translational Cardiology, , 69120 Heidelberg, Germany
- Deutsches Zentrum für Herz- und Kreislaufforschung (GCCR) , Partner site Heidelberg/Mannheim, Germany
| | - Stefan Trojan
- University of Witten/Herdecke Department of Anesthesiology and Intensive Care Medicine, Merheim Medical Center, Hospitals of Cologne, , 51109 Cologne, Germany
| | - Christian Tapking
- University of Heidelberg Department of Hand, Plastic and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, , 67071 Ludwigshafen am Rhein, Germany
| | - Valentin Haug
- University of Heidelberg Department of Hand, Plastic and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, , 67071 Ludwigshafen am Rhein, Germany
| | - Ulrich Kneser
- University of Heidelberg Department of Hand, Plastic and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, , 67071 Ludwigshafen am Rhein, Germany
| | - Gabriel Hundeshagen
- University of Heidelberg Department of Hand, Plastic and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, , 67071 Ludwigshafen am Rhein, Germany
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Deng D, Liang H. Silencing MEG3 protects PC12 cells from hypoxic injury by targeting miR-21. ARTIFICIAL CELLS NANOMEDICINE AND BIOTECHNOLOGY 2020; 48:610-619. [PMID: 32050796 DOI: 10.1080/21691401.2020.1725533] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Increasing number of literatures highlighted lncRNA maternally expressed gene 3 (MEG3) as an emerging target for hypoxic-ischaemic brain damage (HIBD). This study attempted to assess the role of MEG3 in a cell model of HIBD. Expression of MEG3 in PC12 cells was suppressed by siRNA-mediated transfection, after which the cells were subjected to hypoxia. Cell viability, apoptosis, migration and the expression of related proteins were assessed. Furthermore, the downstream gene of MEG3 and its downstream signalling pathways were explored. We found that, down-regulation of MEG3 prevented hypoxic injury in PC12 cells, as hypoxia induced viability loss, apoptosis and migration repression were attenuated by transfection with MEG3 siRNA. Meanwhile, MEG3 acted as a miR-21 sponge. The neuroprotective functions of MEG3 silence were flattened when miR-21 was suppressed. Moreover, the deactivation of PI3K/AKT pathway and the activation of NF-κB pathway induced by hypoxia were attenuated by MEG3 silence. As expected, the effects of MEG3 silence on these two signalling were via miR-21. In conclusion, the neuroprotective effects of MEG3 silence on PC12 cells injured by hypoxia were observed in this study. Mechanistically, the neuroprotective effects of MEG3 silence on PC12 cells were via sponging miR-21 and thus regulating PI3K/AKT and NF-κB pathways.HIGHLIGHTSMEG3 is highly expressed in PC12 cells following hypoxic injury;Silence of MEG3 prevents hypoxia-induced cell damage in PC12 cells;MEG3 acts as a miR-21 sponge;MEG3 sponges miR-21 to regulate PI3K/AKT and NF-κB pathways.
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Affiliation(s)
- Dan Deng
- Department of Neurology, Daqing Oilfield General Hospital, Daqing, China
| | - Hui Liang
- Department of Neurology, Hainan General Hospital, Haikou, China
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Darkwah Oppong M, Bastias MJ, Pierscianek D, Droste L, Dinger TF, Ahmadipour Y, Rauschenbach L, Quesada C, Chihi M, Dammann P, Forsting M, Wrede KH, Sure U, Jabbarli R. Seizures at the onset of aneurysmal SAH: epiphenomenon or valuable predictor? J Neurol 2020; 268:493-501. [PMID: 32852577 PMCID: PMC7880934 DOI: 10.1007/s00415-020-10173-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/12/2020] [Accepted: 08/17/2020] [Indexed: 11/30/2022]
Abstract
Objective Seizures at the onset (SAO) of aneurysmal subarachnoid hemorrhage (aSAH) occur in up to one of every five cases. To date, there is no consensus on causal background and clinical value of these early bleeding-related seizures. This study aimed to analyze the predictors and the impact of SAO in aSAH. Methods All aSAH patients from the institutional observational cohort (01/2003–06/2016) were retrospectively reviewed. Patients’ charts and emergency protocols from first responders were screened for the occurrence of seizures in the first 24 h after aSAH. Patients’ baseline characteristics and occurrence of post-hemorrhagic complications were analyzed. Outcome endpoints included in-hospital mortality and poor outcome at 6-month follow-up (modified Rankin Scale > 3). Results Of 984 patients included in the final analysis, SAO occurred in 93 cases (9.5%) and were independently associated with younger age (< 51 years, p < 0.001), WFNS grade ≥ 4 (p < 0.001), aneurysm characteristics (location at the proximal branch of the anterior cerebral artery [p = 0.037] and irregular sac [p = 0.019]) and admission body temperature > 38.3 ℃ (p = 0.008). There was an association between SAO and early complications (early infarcts [p = 0.004] and primary decompressive craniectomy [p = 0.024]). Only in the subgroup analysis restricted to the younger individuals, SAO independently predicted poor outcome of aSAH (p = 0.002). Significance Onset seizures following aSAH are rare and most likely related to the severity of early brain injury. Particularly, younger individuals are not only at higher risk for SAO, but are also prone to poor outcome in case of aSAH accompanied with SAO. Trial registration number German clinical trial registry (DRKS, unique identifier: DRKS00008749, 06/09/2015)
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Affiliation(s)
- Marvin Darkwah Oppong
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany.
| | - Marcela Jara Bastias
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany
| | - Daniela Pierscianek
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany
| | - Leonie Droste
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany
| | - Thiemo F Dinger
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany
| | - Yahya Ahmadipour
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany
| | - Laurèl Rauschenbach
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany
| | - Carlos Quesada
- Clinic for Neurology, University Hospital, Essen University of Duisburg-Essen, Essen, Germany
| | - Mehdi Chihi
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany
| | - Philipp Dammann
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany
| | - Michael Forsting
- Institute for Diagnostic and Interventional Radiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Karsten H Wrede
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany
| | - Ulrich Sure
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany
| | - Ramazan Jabbarli
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany
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Badjatia N, Gupta N, Sanchez S, Haymore J, Tripathi H, Shah R, Hannan C, Tandri H. Safety and Feasibility of a Novel Transnasal Cooling Device to Induce Normothermia in Febrile Cerebrovascular Patients. Neurocrit Care 2020; 34:500-507. [PMID: 32666372 DOI: 10.1007/s12028-020-01044-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Inducing normothermia with surface cooling temperature modulating devices (TMDs) is cumbersome and often associated with significant shivering. We tested the safety and feasibility of a novel transnasal evaporative cooling device to induce and maintain normothermia in febrile patients following ischemic and hemorrhagic stroke. METHODS A single-center study utilizing the CoolStat® transnasal cooling device was used to achieve core temperature reduction in mechanically ventilated stroke patients with fever (T ≥ 38.3 C) refractory to acetaminophen by inducing an evaporative cooling energy exchange in the nasal turbinates thru a high flow of dehumidified air into the nasal cavity and out through the mouth. Continuous temperature measurements were obtained from tympanic and core (esophageal or bladder) temperature monitors. Safety assessments included continuous monitoring for hypertension, tachycardia, and raised intracranial pressure (when monitored). Otolaryngology (ENT) evaluations were monitored for any device-related nasal mucosal injury with a pre- and post-visual examination. Shivering was assessed every 30 min using the Bedside Shivering Assessment Scale (BSAS). Duration of device use was limited to 8 h, at which time patients were transitioned to routine care for temperature management. RESULTS Ten subjects (median age: 54 years, BMI: 32.5 kg/m2, 60% men) were enrolled with normothermia achieved in 90% of subjects. One subject did not achieve normothermia and was later refractory to other TMDs. Median baseline temperature was 38.5 ± 0.1 C, with a reduction noted by 4 h (38.5 ± 0.1 vs 37.3 ± 0.8, P < 0.001) and sustained at 8 h (38.5 ± 0.1 vs 37.1 ± 0.7, P = 0.001). Time to normothermia was 2.6 ± 1.9 h. The median BSAS was 0 (range 0-1) with only 4 episodes necessitating meperidine across 76 h of study monitoring. No treatment was discontinued due to safety concerns. ENT evaluations noted no device-related adverse findings. CONCLUSIONS Inducing normothermia with a novel transnasal TMD appears to be safe, feasible and not associated with significant shivering. A multicenter trial testing the ability of the CoolStat to maintain normothermia for 24 h is currently underway.
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Affiliation(s)
- Neeraj Badjatia
- Program in Trauma, Department of Neurology, University of Maryland School of Medicine, Baltimore, USA.
| | - Nidhi Gupta
- Department of Otolaryngology, University of Maryland School of Medicine, Baltimore, USA
| | - Stephanie Sanchez
- Program in Trauma, Department of Neurology, University of Maryland School of Medicine, Baltimore, USA
| | | | - Hemantkumar Tripathi
- Program in Trauma, Department of Neurology, University of Maryland School of Medicine, Baltimore, USA
| | - Rushil Shah
- Department of Cardiology, The Johns Hopkins Hospital, Baltimore, USA
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Lundbye J, Badjatia N, Polderman KH, Lyden P. Current Advances in the Use of Therapeutic Hypothermia. Ther Hypothermia Temp Manag 2020; 10:2-5. [PMID: 31934833 DOI: 10.1089/ther.2019.29070.jjl] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Justin Lundbye
- The Greater Waterbury Health Network, Waterbury, Connecticut
| | - Neeraj Badjatia
- Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Kees H Polderman
- Basildon and Thurrock University Hospitals, Anglia Ruskin School of Medicine, London-Essex, United Kingdom
| | - Patrick Lyden
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California
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13
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Badjatia N, Nichol G, Gupta R, Andrews P. Studies Targeting Stroke. Ther Hypothermia Temp Manag 2020; 10:11-16. [PMID: 31928501 DOI: 10.1089/ther.2019.29069.njb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Neeraj Badjatia
- Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Graham Nichol
- University of Washington-Harborview Center for Prehospital Emergency Care, Seattle, Washington
| | - Rishi Gupta
- Cerebrovascular and Endovascular Neurosurgery, Wellstar Health System, Kennestone Hospital, Atlanta, Georgia
| | - Peter Andrews
- Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, Scotland
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Giaccari LG, Pace MC, Passavanti MB, Sansone P, Esposito V, Aurilio C, Pota V. Continuous intravenous low-dose diclofenac sodium to control a central fever after ischemic stroke in the intensive care unit: a case report and review of the literature. J Med Case Rep 2019; 13:373. [PMID: 31847889 PMCID: PMC6918553 DOI: 10.1186/s13256-019-2281-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 10/01/2019] [Indexed: 11/10/2022] Open
Abstract
Introduction Elevation in body temperature within the first 24 hours of ischemic stroke is fairly common and known to be associated with worse outcomes. Only after thoroughly ruling out infection and the noninfectious etiologies and in the appropriate clinical setting should the diagnosis of central fever be made. Acetaminophen and nonsteroidal anti-inflammatory drugs are typical therapeutic options. External cooling is frequently used when pharmacologic interventions are inadequate. However, reports have suggested that neurogenic fevers are somewhat resistant to traditional pharmacologic therapies. Case presentation We describe a case of a Caucasian patient with central fever after ischemic stroke not responsive to acetaminophen administration and external cooling. After an initial bolus of diclofenac sodium (0.2 mg/kg in 100 ml of saline solution for 30 minutes), a continuous infusion (75 mg in 50 ml of saline solution) was started. After 5 days of treatment, the patient’s body temperature was below 37.5 °C, and the diclofenac sodium infusion was stopped. Conclusions We observed that a low-dose diclofenac sodium infusion was effective in treating fever without systemic side effects. This treatment may be suggested as an alternative to conventional antipyretic drugs, but additional clinical trials are required.
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Affiliation(s)
- L G Giaccari
- Department of Women, Child, General and Specialistic Surgery, University of Campania "L. Vanvitelli", Piazza Miraglia 2, 80138, Naples, Italy
| | - M C Pace
- Department of Women, Child, General and Specialistic Surgery, University of Campania "L. Vanvitelli", Piazza Miraglia 2, 80138, Naples, Italy
| | - M B Passavanti
- Department of Women, Child, General and Specialistic Surgery, University of Campania "L. Vanvitelli", Piazza Miraglia 2, 80138, Naples, Italy
| | - P Sansone
- Department of Women, Child, General and Specialistic Surgery, University of Campania "L. Vanvitelli", Piazza Miraglia 2, 80138, Naples, Italy
| | - V Esposito
- Department of Women, Child, General and Specialistic Surgery, University of Campania "L. Vanvitelli", Piazza Miraglia 2, 80138, Naples, Italy
| | - C Aurilio
- Department of Women, Child, General and Specialistic Surgery, University of Campania "L. Vanvitelli", Piazza Miraglia 2, 80138, Naples, Italy
| | - V Pota
- Department of Women, Child, General and Specialistic Surgery, University of Campania "L. Vanvitelli", Piazza Miraglia 2, 80138, Naples, Italy.
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