Crisis neonatales: evaluacion, diagnostico y tratamiento / Neonatal seizures: evaluation, diagnosis, and treatment

Resumen Las crisis convulsivas tienen una alta incidencia en la etapa neonatal, representando la principal manifes tación de disfunción neurológica. Ciertas condiciones fisiológicas del cerebro neonatal facilitan su aparición. Su diagnóstico puede ser un reto debido a que su semio logía no es tan clara comparado con niños mayores, y además, es necesario la confirmación por medio de EEG continuo o aEEG. Su reconocimiento oportuno es muy importante para un adecuado tratamiento y así evitar un impacto negative en el pronóstico a largo plazo. En la siguiente revisión, recapitulamos la fisiopatología, las causas y la clasificación de las crisis convulsivas neo natales, además de su correcto abordaje y las mejores opciones terapéuticas para su tratamiento dependiendo de la causa.

Abstract Seizures have a high incidence in the neonatal stage, being the main manifestation of neurological dysfunc tion. Certain physiological conditions of the neonatal brain facilitate its appearance. Its diagnosis can be a challenging because its semiology is not as clear as in older children, furthermore, confirmation by either EEG or aEEG is necessary. Its timely recognition is very im portant for adequate treatment and thus avoid a nega tive impact on the long-term outcome. In the following review, we recapitulate the pathophysiology, causes, and classification of neonatal seizures, as well as their correct approach and the best therapeutic options for their treatment depending on the cause.

Correlation of Clinical Profile and Electroencephalographic Finding in Hypoxic-Ischemic Encephalopathy in a Tertiary Care Hospital: A Single-Center Experience from Bangladesh

Background: Perinatal asphyxia and resultant hypoxic-ischemic encephalopathy (HIE) is not an uncommon phenomenon in a developing country, like Bangladesh. Electroencephalogram (EEG) is regarded as an effective prognostic tool. Correlation of clinical profiles and EEG findings of HIE patients arenot commonly observed in Bangladesh. The aim of the study was to observe the clinical profile and EEG changes in different stages of hypoxic-ischemic encephalopathy and compare them in a tertiary care hospital.Material & Methods:This is a cross-sectional observational study conducted for a period of six months in Dhaka Medical College Hospital, Dhaka. Sarnat and Sarnat score was used to classify HIE. 20 asphyxiated neonates without HIE were selected as the control group (group II) while 30asphyxiated neonates with HIE, were selected as the case group (group I) by purposive sampling. Clinical profiles, EEG findings, and immediate outcomes were observed and compared between the two groups.Results:73.3% patients were delivered at term and 30% patients were delivered at home in group I. 70% patients’ delivery were conducted by doctor in group I and 75% in group II. 63.3% patients had meconium stain in group I and 25% in group II, which was found significant. 46.7% had prolong labor in group I and 20% in group II, 40% had premature ruptured membrane (PROM) in group I and 40% in group II. Hypothermia, weak primitive reflexes, hypotonia, lethargy and seizure were significantly higher in group I. Changes in EEG correlated between the two groups and was found significant. Also, patients in group I, needed prolong hospital stay.Conclusions:The clinical profiles and EEG changes in patients with hypoxic ischemic encephalopathy was concluded that there is significant association with meconium stain, seizure, hypothermia, weak primitive reflexes, lethargic, miosis, hypotonia, poor APGAR score, burst suppression & SET findings in EEG and prolonged hospital stay in prenatal asphyxia with hypoxic ischemic encephalopathy.

The effect of ladder approach on development of preterm low birth weight infants with HIE-2

Background: Premature infants with Peri-natal asphyxia leading to a hypoxic-ischemic encephalopathy (HIE) are at greater risk for cerebral palsy. HIE grade II infants have long term neurological complications due to maladaptive brain wiring during NICU stay. Ladder approach, with graded stimulation program is administered by Occupational therapist, plays a vital role to minimize the maladaptive responses to environment. Objective of this study was to effect of Ladder Approach on preterm low birth weight Infants with HIE-2 as compared to conventional treatment. Design of this study was to Prospective Block Randomized Convenient Sampling Control Trial, Experimental design study. The study was carried out in the NICU and PU ward of Tertiary care hospital in metropolitan city from April 2015 to October 2016. The study subjects included a convenient sample of 30 preterm Low birth weight HIE-2 infants randomly selected into study or control groups. Neonatal behavioural Assessment scale (NBAS), Infant Neurological International Battery (INFANIB).Methods: The preterm infants from study group who received Ladder Approach and control group who received routine conventional care only. Outcome measures NBAS was at baseline and first follow up. INFANIB was administered at second follow up to assess neurodevelopment.Results: Showed that the premature infants of the study had significant difference in neuro behavioral status with mean for all subcomponents from to post intervention mean 39.6 in experimental group and from baseline mean of 24.3 to post intervention mean score of 33.2 in control group on neurobehavioral scale. Further neurodevelopmental status showed similar results on INFANIB in experimental group.Conclusions: The premature Infants with HIE grade 2, receiving ladder approach have shown more mature responses resulting into well-organized Neurobehavioral status, and resulted in improved brain wiring as evident in INFANIB.

Studies on Pathophysiology and Possible Cause of Hie-Symptom ─Findings on Sublingual and Body Surface Temperature, Venous Gas Partial Pressure and the Effects of Oral Administration of PDE-5 Inhibitor Tadarafil─ / 日本温泉気候物理医学会雑誌

  Background and Purpose: Hie-symptom is more common in women, with complains of strong cold sensation of fingers and lower limbs during cold weather. From the cyanotic findings of hands and thighs and dark venous blood, blood stasis due to excessive peripheral vein contraction was suspected. Then we studied the changes of sublingual and body surface temperature, venous gas partial pressure in the warm and cold conditions. To examine the role of thermo-dilating effects of nitric oxide (NO), the effects oral administration PDE 5 inhibitor Tadarafil (TDF) were also studied.   Subjects and Methods: The subjects were 10 women (31 +- 8.8 yrs) with Hie-symptom and 7 women (26+-3.7 yrs) without Hie-symptom, BMI, blood pressure, heart rate,sublingual and peripheral body surface temperature (hand and lower limb), venous and arterial blood gas partial pressure, and fingertip arterial oxygen saturation were measured. The measurement was carried out at warm indoors (about 23°C) and cold outdoors (about 12°C). Then 10 mg TDF tablet was taken and all measurements were repeated again at the same time on the next day.   Results: There was no difference in fingertip arterial blood oxygen saturation in both groups either at indoor or outdoor conditions, and even after taking TDF. In the cold outdoor, the subjects with Hie-symptom, compared to without Hie-symptom, showed significantly lower body surface temperature and venous blood pO2, and increased pCO2. After taking TDF, although sublingual temperature and the decrease in body surface temperature outside the room improved in both groups, the improvement was greater in Hie-symptom.  Consideration and Conclusion: Because of normal fingertip arterial blood oxygen saturation, Hie-symptom is not considered to be a disorder of the cardiopulmonary/arterial system. From a significant decrease in peripheral body surface temperature, and peripheral venous blood pO2, and an increase in pCO2 of Hie-symptom in cold outdoors, it is considered that blood stasis by excessive constriction of peripheral veins or arteriovenous anastomosis (AVA) by the cold. The better effects of oral TDF, in Hie-symptom seems to predict the involvement of NO or cGMP in blood stasis.

Studies on Pathophysiology and Possible Cause of Hie-Symptom ─Findings on Sublingual and Body Surface Temperature, Venous Gas Partial Pressure and the Effects of Oral Administration of PDE-5 Inhibitor Tadarafil─ / 日本温泉気候物理医学会雑誌

  Background and Purpose: Hie-symptom is more common in women, with complains of strong cold sensation of fingers and lower limbs during cold weather. From the cyanotic findings of hands and thighs and dark venous blood, blood stasis due to excessive peripheral vein contraction was suspected. Then we studied the changes of sublingual and body surface temperature, venous gas partial pressure in the warm and cold conditions. To examine the role of thermo-dilating effects of nitric oxide (NO), the effects oral administration PDE 5 inhibitor Tadarafil (TDF) were also studied.   Subjects and Methods: The subjects were 10 women (31 +- 8.8 yrs) with Hie-symptom and 7 women (26+-3.7 yrs) without Hie-symptom, BMI, blood pressure, heart rate,sublingual and peripheral body surface temperature (hand and lower limb), venous and arterial blood gas partial pressure, and fingertip arterial oxygen saturation were measured. The measurement was carried out at warm indoors (about 23°C) and cold outdoors (about 12°C). Then 10 mg TDF tablet was taken and all measurements were repeated again at the same time on the next day.   Results: There was no difference in fingertip arterial blood oxygen saturation in both groups either at indoor or outdoor conditions, and even after taking TDF. In the cold outdoor, the subjects with Hie-symptom, compared to without Hie-symptom, showed significantly lower body surface temperature and venous blood pO2, and increased pCO2. After taking TDF, although sublingual temperature and the decrease in body surface temperature outside the room improved in both groups, the improvement was greater in Hie-symptom.  　Consideration and Conclusion: Because of normal fingertip arterial blood oxygen saturation, Hie-symptom is not considered to be a disorder of the cardiopulmonary/arterial system. From a significant decrease in peripheral body surface temperature, and peripheral venous blood pO2, and an increase in pCO2 of Hie-symptom in cold outdoors, it is considered that blood stasis by excessive constriction of peripheral veins or arteriovenous anastomosis (AVA) by the cold. The better effects of oral TDF, in Hie-symptom seems to predict the involvement of NO or cGMP in blood stasis.

Neuro developmental outcome of preterm babies with hypoxic ischemic encephalopathy

Background: Neonatal encephalopathy, following severe birth asphyxia or perinatal hypoxia is referred to as hypoxic ischemic encephalopathy (HIE). Cerebral ischemia occurs as a consequence of cerebral oedema and reduced cerebral perfusion due to myocardial dysfunction as a result of hypoxic cardiomyopathy. Sarnat stage I -100% recovery, HIE stage II - 80% normal and 20% mortality and HIE stage III - 50% mortality and 50% morbidity. Relatively few studies have been made on outcome in HIE affected preterm infants. The aims and objectives of this study was to find out the neurodevelopmental outcome in preterm infants with HIE.Methods: This study is an observational clinical study, undertaken in Kempegowda Institute of Medical sciences and research centre, Bangalore, India. Study was performed between November 2016 to September 2018. 31 preterm infants with HIE were included in the study. Regular follow-up was done at 3, 6, 9, 12.15, 18 months by using Trivandrum development screening chart (TDSC) to stage II HIE infants.Results: The incidence of abnormal neurological outcome was 12.9%. Out of 31 preterm babies, stage I were 24, stage II was 4 (100% morbidity) and stage III were 3 (100% mortality).Conclusions: In present study, stage II HIE had 100% morbidity and moderate disability, stage III 100% mortality. Thus at 3-5 months of age during follow-up, when authors identify developmental delay, it is an ideal time to start interventional therapy to improve long term outcome.

Assessment of epidemiological profile of neonatal seizure cases admitted to a tertiary health center of Odisha, India: a cross-sectional study

Background: Neonatal seizures are common manifestations of neurologic dysfunction in newborns. The incidence of' seizures in neonatal period is higher than any other period of life. It is one of the common causes of admission to special newborn care unit. Therefore, it has been decided to assess the epidemiological profile of neonatal seizure.Methods: A cross-sectional study was conducted from January2017 to June 2018, in the SNCU of MKCG Medical College and Hospital, Berhampur. A total of 300 neonates admitted to SNCU with clinically apparent seizure were the study population and convenient sampling method was used for selecting them. The approval was taken from IEC MKCG Medical College to carry out the study. The data was collected by using a pretested proforma from parents and hospital records. Verbal informed consent was taken from parents. The data so collected was analysed in the department of Pediatrics.Results: Out of the total 300 babies, 66% were males, 61.34% were early neonates,77% babies were of primi' mothers,76% of babies were outborn . 62.12% of babies were born by vaginal route. HIE was most common (88%) cause of seizure. Out of the all seizure types, subtle seizure was most common (87.67%), followed by clonic seizure (35.67%). Various maternal risk factors were present in 81.81 % of cases. Most common risk factor was anemia (50.57%).18.93% of cases were born with' history of obstructed labor/prolonged labor. Overall mortality was 8%.Conclusions: Neonatal seizures are important causes of morbidity and mortality in newborns. Prevention of HIE and maternal risk factors along with early use of an effective drug with minimum side effects are the ways to overcome this problem.

Neuroprotective effect of erythropoietin on rat model of hypoxic-ischemic encephalopathy / 中国比较医学杂志

Objective To study the protective effect of recombinant human erythropoietin (EPO) on brain and to explore the changes in the diversity of intestinal microbial flora in neonatal rats with hypoxic-ischemic encephalopathy (HIE) by establishing a neonatal rat model of HIE, and to provide an experimental basis for clinical application of EPO in the treatment of neonatal HIE. Methods The HIE model was established in 7-day-old neonatal SD rats. The rats were randomly divided into the HIE model group, EPO-treated group and control group. The changes of nestin expression were detected by immunohistochemistry. Feces of the rats were collected to detect the changes in intestinal microbial flora by 16s rRNA sequencing. Results The expressions of nestin at the same time point in each group were significantly different (P ＜0. 05). The nestin level in the control group was the lowest, that in the EPO-treated group was the highest, and the HIE model group in between. The Shannon-Wiener index of the HIE model group showed a tendency to decrease compared with the control group. Conclusions Exogenous EPO can promote the growth of neural cells in neonatal rats with HIE, indicating a certain protective effect. Meanwhile, the diversity of intestinal microbial flora of the HIE neonatal rats is also changed.

Preparation of a rat model of neonatal hypoxic-ischemic encephalopathy / 中国比较医学杂志

Objective To simulate the process of hypoxic?ischemic brain injury at high altitude in a simulated cabin with plateau low pressure environment, and to prepare a rat model of cerebral injuries at different high altitudes. Method Thirty?two 0?day?old neonatal SD rats were divided into four groups, namely group A ( control group) and three test groups:group B (2000 m group), group C (4000 m group), and group D (6000 m group). The rats of control group were reared in a barrier environment. The rats of test groups were placed in a simulated cabin with plateau low pressure environment, and to prepare neonatal cerebral ischemia?hypoxia model by sport activities. The sport movements were carried out in the cabin in a swimming groove 60 min/d, and not less than 20 hours a day at high altitude low pressure environment. Zea Longa 5 point scale standard was used to determine the behavioral scores at the 3 th 7 th 11 th 15 th days, and samples were collected on the 15th day to observe red blood cell morphology using HE and 2, 3, 5?triphenyltetrazolium chloride ( TTC ) staining and ultrastructure by scanning electron microscopy. Result ( 1 ) The neurological scores of the test groups A, B, C were significantly different from that of the control group (P<0?05), and the scores of test group D and control group were very significantly different ( P <0?01 ) . ( 2 ) The histopathological examination using HE staining showed inflammatory cell infiltration in all rats of the test groups, and the extent of inflammatory cell infiltration was positively correlated with the increase of altitude. ( 3 ) The histopathology with TTC staining revealed prominent ischemia in the cerebral cortex of rats in the plateau hypoxic environment. ( 4 ) Scanning electron microscopy showed that the rat erythrocytes were cap?like in the group B, irregular in the group C, and zigzag shape in the group D. Conclusions In this study, a rat model of neonatal hypoxic?ischemic encephalopathy ( HIE) is successfully established by hypoxic cabin combined with sport activity. This model is stable, reliable, more closely mimicking the pathogenesis and clinical manifestation of neonatal HIE than models prepared with other methods, therefore, may be used in related research.

Clinical utility of early amplitude integrated EEG in monitoring term newborns at risk of neurological injury / Utilidade clínica de um monitoramento por EEG de amplitude integrada precoce em recém-nascidos a termo com risco de lesão neurológica

OBJECTIVE: to test the clinical utility of an early amplitude-integrated electroencephalography (aEEG) to predict short-term neurological outcome in term newborns at risk of neurology injury. METHODS: this was a prospective, descriptive study. The inclusion criteria were neonatal encephalopathy, neurologic disturbances, and severe respiratory distress syndrome. Sensitivity, specificity, positive and negative predictive values, and likelihood ratio (LR) were calculated. Clinical and demographic data were analyzed. Neurological outcome was defined as the sum of clinical, electroimaging, and neuroimaging findings. RESULTS: ten of the 21 monitored infants (48%) presented altered short-term neurologic outcome. The aEEG had 90% sensitivity, 82% specificity, 82% positive predictive value, and 90% negative predictive value. The positive LR was 4.95, and the negative LR was 0.12. In three of 12 (25%) encephalopathic infants, the aEEG allowed for a better definition of the severity of their condition. Seizures were detected in eight infants (38%), all subclinical at baseline, and none had a normal aEEG background pattern. The status of three infants (43%) evolved and required two or more drugs for treatment. CONCLUSIONS: in infants with encephalopathy or other severe illness, aEEG disturbances occur frequently. aEEG provided a better classification of the severity of encephalopathy, detected early subclinical seizures, and allowed for monitoring of the response to treatment. aEEG was a useful tool at the neonatal intensive care unit for predicting poor short-term neurological outcomes for all sick newborn. .

OBJETIVO: testar a utilidade clínica do aEEG precoce em recém-nascidos a termo com risco delesão neurológica, para prever resultados neurológicos de curto prazo. MÉTODOS: estudo prospectivo e descritivo. Os critérios de inclusão foram encefalopatia neonatal, distúrbios neurológicos e bebês com SARA grave. Sensibilidade, especificidade, valor preditivo positivo e negativo e razão de verossimilhança foram calculados. Dados clínicos edemográficos foram analisados. O resultado neurológico foi definido como a soma de conclusões clínicas, de eletro e de neuroimagem. RESULTADOS: dentre os 21 neonatos monitorados, dez (48%) apresentaram resultado neurológico de curto prazo alterado. O aEEG apresentou sensibilidade de 90%, especificidade de 82%, valor preditivo positivo de 82% e valor preditivo negativo de 90%. A VR positiva foi de 4,95, e a RV negativa de 0,12. Em três dos 12 (25%) neonatos com encefalopatia foi possível definir melhora gravidade de sua condição pelo aEEG. Foram detectadas convulsões em oito neonatos (38%), todas subclínicas no início do estudo, e nenhum apresentou um padrão histórico normal no aEEG. O estado de três neonatos (43%) evoluiu e exigiu dois ou mais medicamentos para tratamento. CONCLUSÕES: em neonatos com encefalopatia ou outra doença grave, os distúrbios no aEEGocorrem com mais frequência. O aEEG forneceu uma classificação melhor da gravidade da encefalopatia, detectou convulsões subclínicas precoces e permitiu que fosse feito o monitoramento da resposta ao tratamento. O aEEG é uma ferramenta útil para prever resultados neurológicos de curto prazo em todos os bebês doentes na UTIN. .

Effects of Ontokyu (warm tube moxibustion) Medical Treatment on Young Women with Chilly Constitution (‘Hie’ Symptoms) / 日本温泉気候物理医学会雑誌

Objective: We examined the effects of ontokyu (warm tube moxibustion) medical treatment of GB33 and SP6 on young women with a chilly constitution (‘Hie’ symptoms). Methods: The subjects were 13 female university students (mean age: 20.7± 1.3years). They were assigned to either a GB33 group or an SP6 group in consideration of height for the determinate method by the discriminant analysis of Sakaguchi et al. After a one-week pre-observation period, 1 or 2 ontokyu treatments (Choan NEO, Yamasho) twice a week for four weeks were conducted. The follow-up period was two weeks. Effects of the therapy were evaluated using an original questionnaire (‘Hie’ diary), which consisted of six categorical scales of 14 symptoms and Visual Analogue Scale (VAS) of the severity of ‘Hie’. Results: Three subjects dropped out before 1st week therapy among the 13 subjects, so the number of subjects in both groups became five. There was no significant difference between the 2 groups in terms of age, height, weight, BMI, VAS, and total score for 14 symptoms at the baseline. There was no interaction between the groups for VAS or total score for the 14 symptoms. For both groups, no significant changes could be found in VAS during the intervention period and follow-up period compared with that during the pre-observation period. Although the total score for the 14 symptoms in both groups decreased gradually from the start of intervention for the GB33 group, it significantly decreased in after the 3rd and 4th weeks therapy compared with that in the pre-observation period. For the SP6 group, it significantly decreased in after the 4th week therapy and the 2nd week after finished therapy. For each item of the 14 symptoms, the GB33 group showed significant differences in stiff neck and shoulders and feeling thirsty when their scores between the pre-observation period and the intervention period were compared. In addition, the SP6 group showed a significant difference in stiff neck and shoulders, feeling thirsty, and nervousness when their scores between the pre-observation period and the intervention period were compared. Specifically, stiff neck and shoulders for the GB33 group was significantly reduced in the 1st and 2nd weeks after finished therapy, and feeling thirsty showed significant reduction in after the 3rd and 4th weeks therapy. On the other hand, for the SP6 group, stiff neck and shoulders significantly decreased in after the 2nd and 4th weeks therapy and the 1st and 2nd after finished therapy, as did feeling thirsty in the 4th week therapy and in the 2nd week after finished therapy, as well as becoming nervous in after the 1st, 2nd and 4th weeks therapy. Conclusion: It was suggested that ontokyu medical treatment to GB33 and SP6 for young women with a chilly constitution did not appear to exacerbate the severity of ‘Hie’ after reductions in air temperature, while improving the total score for 14 symptoms similarly.

Effects of <i>Ontokyu</i> (warm tube moxibustion) Medical Treatment on Young Women with Chilly Constitution (‘Hie’ Symptoms) / 日本温泉気候物理医学会雑誌

<b>Objective:</b> We examined the effects of <i>ontokyu</i> (warm tube moxibustion) medical treatment of GB33 and SP6 on young women with a chilly constitution (‘Hie’ symptoms).<BR><b>Methods:</b> The subjects were 13 female university students (mean age: 20.7± 1.3years). They were assigned to either a GB33 group or an SP6 group in consideration of height for the determinate method by the discriminant analysis of Sakaguchi et al. After a one-week pre-observation period, 1 or 2 <i>ontokyu </i>treatments (Choan NEO, Yamasho) twice a week for four weeks were conducted. The follow-up period was two weeks. Effects of the therapy were evaluated using an original questionnaire (‘Hie’ diary), which consisted of six categorical scales of 14 symptoms and Visual Analogue Scale (VAS) of the severity of ‘Hie’.<BR><b>Results:</b> Three subjects dropped out before 1^st week therapy among the 13 subjects, so the number of subjects in both groups became five. There was no significant difference between the 2 groups in terms of age, height, weight, BMI, VAS, and total score for 14 symptoms at the baseline. There was no interaction between the groups for VAS or total score for the 14 symptoms. For both groups, no significant changes could be found in VAS during the intervention period and follow-up period compared with that during the pre-observation period. Although the total score for the 14 symptoms in both groups decreased gradually from the start of intervention for the GB33 group, it significantly decreased in after the 3^rd and 4^th weeks therapy compared with that in the pre-observation period. For the SP6 group, it significantly decreased in after the 4^th week therapy and the 2^nd week after finished therapy. For each item of the 14 symptoms, the GB33 group showed significant differences in stiff neck and shoulders and feeling thirsty when their scores between the pre-observation period and the intervention period were compared. In addition, the SP6 group showed a significant difference in stiff neck and shoulders, feeling thirsty, and nervousness when their scores between the pre-observation period and the intervention period were compared. Specifically, stiff neck and shoulders for the GB33 group was significantly reduced in the 1^st and 2^nd weeks after finished therapy, and feeling thirsty showed significant reduction in after the 3^rd and 4^th weeks therapy. On the other hand, for the SP6 group, stiff neck and shoulders significantly decreased in after the 2^nd and 4^th weeks therapy and the 1^st and 2^nd after finished therapy, as did feeling thirsty in the 4^th week therapy and in the 2^nd week after finished therapy, as well as becoming nervous in after the 1^st, 2^nd and 4^th weeks therapy.<BR><b>Conclusion:</b> It was suggested that <i>ontokyu </i>medical treatment to GB33 and SP6 for young women with a chilly constitution did not appear to exacerbate the severity of ‘Hie’ after reductions in air temperature, while improving the total score for 14 symptoms similarly.

XDS-I Gateway Development for HIE Connectivity with Legacy PACS at Gil Hospital / 대한의료정보학회지

OBJECTIVES: The ability to support healthcare document sharing is imperative in a health information exchange (HIE). Sharing imaging documents or images, however, can be challenging, especially when they are stored in a picture archiving and communication system (PACS) archive that does not support document sharing via standard HIE protocols. This research proposes a standard-compliant imaging gateway that enables connectivity between a legacy PACS and the entire HIE. METHODS: Investigation of the PACS solutions used at Gil Hospital was conducted. An imaging gateway application was then developed using a Java technology stack. Imaging document sharing capability enabled by the gateway was tested by integrating it into Gil Hospital's order communication system and its HIE infrastructure. RESULTS: The gateway can acquire radiology images from a PACS storage system, provide and register the images to Gil Hospital's HIE for document sharing purposes, and make the images retrievable by a cross-enterprise document sharing document viewer. CONCLUSIONS: Development of an imaging gateway that mediates communication between a PACS and an HIE can be considered a viable option when the PACS does not support the standard protocol for cross-enterprise document sharing for imaging. Furthermore, the availability of common HIE standards expedites the development and integration of the imaging gateway with an HIE.

Effects of Electro-Acupuncture Therapy (EAT) to the Lower Limbs of Young Women who Suffer from Chilly Constitution (‘Hie’symptoms)—As judged by bodily pain (BP) score of Medical Outcomes Study Short-Form-8 Survey (SF-8)— / 日本温泉気候物理医学会雑誌

Objective  We examined the effects of low frequency electro-acupuncture therapy (EAT) on young women who suffered from‘Hie’symptoms, which were judged according to the national normal value of bodily pain (BP) scores from a ”Medical Outcomes Study Short-Form-8 Survey“ (SF-8). Subjects and Methodology  The experimental subjects were 20 women (mean age: 21.2 years old; range: 18-26 years old) who exhibited symptoms of ‘Hie’ symptoms (vasomotor dysfunction) and whose toes’skin temperature increased or showed a different reaction between right and left during a postural change test. A stainless steel acupuncture needle (length: 40 mm; diameter: 0.2 mm) was inserted approximately 15 mm deep at SP6 (Sanyinjiao, Saninko). EAT using an active electrode (the needle) at SP6 and a reference electrode (surface electrode) at the lateral-anterior aspect of the lower leg was applied at a frequency of 1 Hz for 20 minutes. The therapy was provided one session per week for a total of five sessions. Effects of the therapy were evaluated by using an original questionnaire (‘Hie’diary), which consisted of six categorical of 14 symptoms (including of‘Hie’) and Visual Analogue Scale (VAS) of‘severity of Hie’. Moreover, changes in health-related quality of life (HRQOL) by acupuncture were evaluated by using the SF-8 Standard Edition. Results  Subjects were grouped according to their SF-8 BP scores before the therapy: 12 subjects (L group) whose scores were less than the national normal value (42.75 points), and eight subjects (H group) whose scores were more than the national normal value. For both groups VAS levels showed no statistically significant changes, but for the L group the total score of 14 symptoms significantly decreased after the second therapy session compared with scores before the therapy. Moreover, the statistically significant decrease in the total score lasted for one month after the therapy had been finished. Compared with before therapy, the score of ‘vitality’ (VT) significantly increased for the L group one month after the therapy, and those of BP and ‘mental health’ (MH) significantly increased for the L group just after and one month after the therapy. Conclusions  EAT at SP6 on young women with ‘Hie’ symptoms (vasomotor dysfunction) contributes to improvement in overall condition and health-related QOL, and it is occluded that the effect of the EAT was high, because HRQOL was low (the score of BP was low).

Effects of Electro-Acupuncture Therapy to Lower Limbs on Chilly Constitution (‘Hie’Symptoms) —Comparison by the presence or absence of vasomotor dysfunction— / 日本温泉気候物理医学会雑誌

Objective: We examined the effects of low frequency electro-acupuncture therapy (EAT) in young women with‘Hie’symptoms, which were classified according to the presence of the vasomotor dysfunction as determined by the postural change test. Subjects and Methods: Subjects were 43 women (mean age, 21.2 years) who exhibited‘Hie’symptoms. The postural change test was performed in five-minute-loads in a standing position after a rest period of 10 minutes in a spine position. The skin temperature in the lower limbs was measured before and after the test. A stainless steel acupuncture needle (length, 40 mm; diameter, 0.2 mm) was inserted approximately 15 mm in depth at SP6 (Sanyinjiao, Saninko). EAT using an active electrode (needle) at SP6 and a reference electrode (surface electrode) at the lateral-anterior aspect of the lower leg were carried out at a frequency of 1 Hz for 20 minutes. The therapy was provided in a total of 5 sessions, with 1 session per week, and the postural change test was performed after 5 sessions. Thermal images from the medial aspect of the foot to the tibial aspect of the lower leg were captured using a thermography device, and mean skin temperature was calculated in selected regions of the toes and tibial aspect of the lower leg. Effects of the therapy were also evaluated using an original questionnaire (‘Hie’diary) concerning‘Hie’symptoms, which consists of six categorical scales of 14 symptoms including‘Hie’and severity of‘Hie’on a Visual Analogue Scale (VAS) was used. Moreover, changes in health-related quality of life by acupuncture were evaluated using the SF-8 Standard Edition. Results: Subjects were classified according to the results of the postural change test: 23 people (no vasomotor dysfunction group; non-vd group) whose skin temperature in the toe decreased after the postural change and 20 people (vasomotor dysfunction group; vd group) whose skin temperature in the toe increased after the load or showed a different reaction between right and left. In the vd group, the total score of 14 symptoms in the‘Hie’diary was significantly higher, and subjective‘Hie’symptoms showed a more severe score than that in the non-vd group. The bodily pain score in the SF-8 in vd group was significantly lower than a national reference value. After an EAT session, the vd group’s skin temperature on the tibial aspect of the lower leg at 20 minutes after completion of the load was significantly higher than that before the load. Moreover, changes in the VAS score and SF-8 score showed no statistical significant in both groups, but the total score of 14 symptoms decreased significantly in the vd group. Conclusions: We suggested that normalization in the blood vessel reaction in lower limbs by EAT at SP6 contributed to the improvement in the systemic condition that was determined by the postural test. The issue of further investigation is to elucidate the pathogenesis andor establishment of the treatment in the subjects with‘Hie’symptom whose vasomotor function was within normal limits.

Effects of Electro-Acupuncture Therapy (EAT) to the Lower Limbs of Young Women who Suffer from Chilly Constitution (‘<I>Hie</I>’symptoms)—As judged by bodily pain (BP) score of Medical Outcomes Study Short-Form-8 / 日本温泉気候物理医学会雑誌

<B>Objective</B><br> We examined the effects of low frequency electro-acupuncture therapy (EAT) on young women who suffered from‘<I>Hie</I>’symptoms, which were judged according to the national normal value of bodily pain (BP) scores from a ”Medical Outcomes Study Short-Form-8 Survey“ (SF-8).<br><B>Subjects and Methodology</B><br> The experimental subjects were 20 women (mean age: 21.2 years old; range: 18-26 years old) who exhibited symptoms of ‘<I>Hie</I>’ symptoms (vasomotor dysfunction) and whose toes’skin temperature increased or showed a different reaction between right and left during apostural change test. A stainless steel acupuncture needle (length: 40 mm; diameter: 0.2 mm) was inserted approximately 15 mm deep at SP6 (Sanyinjiao, Saninko). EAT using an active electrode (the needle) at SP6 and a reference electrode (surface electrode) at the lateral-anterior aspect of the lower leg was applied at a frequency of 1 Hz for 20 minutes. The therapy was provided one session per week for a total of five sessions. Effects of the therapy were evaluated by using an original questionnaire (‘<I>Hie</I>’diary), which consisted of six categorical of 14 symptoms (including of‘<I>Hie</I>’) and Visual Analogue Scale (VAS) of‘severity of <I>Hie</I>’. Moreover, changes in health-related quality of life (HRQOL) by acupuncture were evaluated by using the SF-8 Standard Edition.<br><B>Results</B><br> Subjects were grouped according to their SF-8 BP scores before the therapy: 12 subjects (L group) whose scores were less than the national normal value (42.75 points), and eight subjects (H group) whose scores were more than the national normal value. For both groups VAS levels showed no statistically significant changes, but for the L group the total score of 14 symptoms significantly decreased after the second therapy session compared with scores before the therapy. Moreover, the statistically significant decrease in the total score lasted for one month after the therapy had been finished. Compared with before therapy, the score of ‘vitality’ (VT) significantly increased for the L group one month after the therapy, and those of BP and ‘mental health’ (MH) significantly increased for the L group just after and one month after the therapy.<br><B>Conclusions</B><br> EAT at SP6 on young women with ‘<I>Hie</I>’ symptoms (vasomotor dysfunction) contributes to improvement in overall condition and health-related QOL, and it is occluded that the effect of the EAT was high, because HRQOL was low (the score of BP was low).

Effects of Electro-Acupuncture Therapy to Lower Limbs on Chilly Constitution (‘Hie’Symptoms) —Comparison by the presence or absence of vasomotor dysfunction— / 日本温泉気候物理医学会雑誌

<B>Objective:</B> We examined the effects of low frequency electro-acupuncture therapy (EAT) in young women with‘Hie’symptoms, which were classified according to the presence of the vasomotor dysfunction as determined by the postural change test.<br><B>Subjects and Methods:</B> Subjects were 43 women (mean age, 21.2 years) who exhibited‘Hie’symptoms. The postural change test was performed in five-minute-loads in a standing position after a rest period of 10 minutes in a spine position. The skin temperature in the lower limbs was measured before and after the test. A stainless steel acupuncture needle (length, 40 mm; diameter, 0.2 mm) was inserted approximately 15 mm in depth at SP6 (Sanyinjiao, Saninko). EAT using an active electrode (needle) at SP6 and a reference electrode (surface electrode) at the lateral-anterior aspect of the lower leg were carried out at a frequency of 1 Hz for 20 minutes. The therapy was provided in a total of 5 sessions, with 1 session per week, and the postural change test was performed after 5 sessions. Thermal images from the medial aspect of the foot to the tibial aspect of the lower leg were captured using a thermography device, and mean skin temperature was calculated in selected regions of the toes and tibial aspect of the lower leg. Effects of the therapy were also evaluated using an original questionnaire (‘Hie’diary) concerning‘Hie’symptoms, which consists of six categorical scales of 14 symptoms including‘Hie’and severity of‘Hie’on a Visual Analogue Scale (VAS) was used. Moreover, changes in health-related quality of life by acupuncture were evaluated using the SF-8 Standard Edition.<br><B>Results:</B> Subjects were classified according to the results of the postural change test: 23 people (no vasomotor dysfunction group; non-vd group) whose skin temperature in the toe decreased after the postural change and 20 people (vasomotor dysfunction group; vd group) whose skin temperature in the toe increased after the load or showed a different reaction between right and left. In the vd group, the total score of 14 symptoms in the‘Hie’diary was significantly higher, and subjective‘Hie’symptoms showed a more severe score than that in the non-vd group. The bodily pain score in the SF-8 in vd group was significantly lower than a national reference value. After an EAT session, the vd group’s skin temperature on the tibial aspect of the lower leg at 20 minutes after completion of the load was significantly higher than that before the load. Moreover, changes in the VAS score and SF-8 score showed no statistical significant in both groups, but the total score of 14 symptoms decreased significantly in the vd group.<br><B>Conclusions:</B> We suggested that normalization in the blood vessel reaction in lower limbs by EAT at SP6 contributed to the improvement in the systemic condition that was determined by the postural test. The issue of further investigation is to elucidate the pathogenesis andor establishment of the treatment in the subjects with‘Hie’symptom whose vasomotor function was within normal limits.

Clinical Profile of Birth Asphyxia in Dhulikhel Hospital: A Retrospective Study.

Introduction: Birth asphyxia is defined by the World Health Organization "the failure to initiate and sustain breathing at birth." The WHO has estimated that 4 million babies die during the neonatal period every year and 99% of these deaths occur in low-income and middle income countries. Three major causes account for over three quarters of these deaths, serious infection (28%) complication of preterm birth (26%) and birth asphyxia (23%). This estimation implies that birth asphyxia is the cause of around one million neonatal deaths each year. One of the present challenges is the lack of a gold standard for accurately defining birth asphyxia. Because of same reason the incidence of birth asphyxia is difficult to quantify. Objective: The aim of this study was to assess the prevalence of birth asphyxia, identify the common obstetric and neonatal risk factors, and study the cause of death. Methodology: All babies born in Dhulikhel Hospital (DH) from Jan 2007 to Oct 2009 with a diagnosis of birth asphyxia (5 min Apgar < 7 and those with no spontaneous respirations after birth) were included in the study (n=102). Clinical information was collected retrospectively from maternal records (maternal age, gravida, type of delivery, presence of meconium, induced or spontaneous labour, and pregnancy complications). The NICU records provided additional information about new born infant (birth asphyxia, stages of birth asphyxia, birth weight, sex and subsequent mortality). Results: Among the 3784 live births there were 102 babies with birth asphyxia prevalence of 26.9/1000 live births. Babies with Hypoxic ischemic encephalopathy (HIE) Stage 1 had a very good outcome but HIE III was associated with a poor outcome. Males, primipara and pregnancies with complications were associated with a higher rate of birth asphyxia. Septicaemia, necrotizing enterocolitis, preterm delivery, convulsion and, pneumothorax were associated with higher mortality and morbidity. Conclusion: Birth asphyxia was one of the commonest causes of admission and mortality in NICU. Babies with HIE Stage III had a very poor prognosis. Birth asphyxia combined with other morbidities was associated with a higher mortality. Sepsis is the commonest morbidity in cases of birth asphyxia. Maternal gravida, pregnancy complication with PROM, meconium, APH, emergency caesarean section, preterm and male sex were the risk factors for birth asphyxia.

Effects of Acupuncture Electrotherapy to Lower Limbs on Hie Symptom (Vasomotor Dysfunction) / 日本温泉気候物理医学会雑誌

<b>Objective</b><br> We examined the effects of acupuncture electrotherapy in young women with hie symptoms (excessive sensitivity to cold), presented in conjunction with vasomotor dysfunction as determined by the postural change test.<br><b>Subjects and Methods</b><br> Subjects comprised 20 women (mean age, 20.6 years; range, 18-26 years) who exhibited symptoms of hie, evaluated as toe skin temperature after standing for 5 mins or a temperature difference between the right and left toes as compared to before standing. A stainless steel acupuncture needle (length, 40 mm; diameter, 0.2 mm) was inserted approximately 15 mm in SP6 (Shangqui). Acupuncture electrotherapy connected an acupuncture electrode to SP6 and a non-feeling electrode to lateral of the tibial tuberosity, and was undertaken at a frequency of 1 Hz for 20 mins. Therapy was provided as a total of 5 sessions, with 1 session each week, and the postural change test was performed before and after therapy. Thermal images from the medial aspect of the foot to the tibial aspect of the lower leg were captured using a medical thermography device, and mean skin temperature was calculated in selected regions of the toes, metatarsals, ankle, and tibial aspect of the lower leg. Therapy was evaluated using a questionnaire with two originally designed scales: a categorical scale of 14 symptoms including hie; and degree of hie on a visual analogue scale (VAS). Subjects completed the questionnaire every day during a period from 1 week before therapy sessions began until 1 week after completion of all 5 sessions. Scores for hie symptoms were calculated as mean values from the total score of the 14 symptoms and VAS each week. Changes in health-related quality of life with acupuncture were evaluated using the SF-8 Standard Edition.<br><b>Results</b><br> Toe skin temperature just after standing was not significantly increased by therapy as compared to before standing. Skin temperature on the tibial aspect of the lower leg 20 mins after standing was significantly increased as compared to the adaptation period. In terms of hie, VAS and SF-8, no significant changes were seen before and after therapy, but total score for the 14 symptoms decreased significantly.<br><b>Conclusions</b><br> Acupuncture electrotherapy to SP 6 did not appear to exacerbate hie symptoms after reductions in air temperature, while normalizing the postural vascular reflex and improving hie-related symptoms.

The expressions of IGF-1 in HIE neonatal rabbits / 重庆医科大学学报

Objective:Searching after the regularity of the expressions the insulin-like growth factors(IGF-1) inside the neonatal rabbits with chronic intrauterine anoxemia give to brain Tissues and serums. Methods: Choosing 24 Zelanian rabbits that have been in afternoon pregnancy,we divide them into three stochastic contratest group by chance: the control group,the anoxic group and the group interfered with Chinese traditional medicine. Then we contrast the expressions and changes of these groups with IGF-1 in brain tissues and in serums. Results: Contrasting IGF-1 in brain tissues,checked up with ?2. In three different groups,we have found that the differences of their expressions have some statistical significance (P