Synthetic MRI to Assess Neurological Injury in Recovered COVID-19 Patients / 中山大学学报(医学科学版)

ObjectiveTo assess the microstructural involvement of gray matter in recovered COVID-19 patients using Synthetic MRI. MethodsThis study was conducted in 29 recovered COVID-19 patients， including severe group （SG， n=11） and ordinary group （OG， n=18）. Healthy volunteers matched by age， sex， BMI and years of education were selected as a healthy control group （HC=23 cases）. Each subject underwent synthetic MRI to generate quantitative T1 and T2 maps， and the T1 and T2 maps were segmented into 90 regions of interest （ROIs） using automatic anatomical labeling （AAL） mapping. T1 and T2 values for each ROI were obtained by averaging all voxels within the ROIs. The T1 and T2 values of the 90 brain regions between the three groups were compared. ResultsRelative to HC， the SG had significantly higher T2 values in bilateral orbital superior frontal gyrus， bilateral parahippocampal gyrus， bilateral putamen， bilateral middle temporal gyrus， bilateral Inferior temporal gyrus， left orbital superior frontal gyrus， left orbital inferior frontal gyrus， left gyrus rectus， left anterior cingulate and paracingulate gyri， right median cingulate and paracingulate gyri， left posterior cingulate gyrus， and left supramarginal gyrus （P＜0.05）； Relative to OG， SG showed significantly increased T2 values in the left rectus gyrus， left parahippocampal gyrus， bilateral middle temporal gyrus， and bilateral inferior temporal gyrus （P＜0.05）. Relative to HC， the T1 values of SG were significantly increased in bilateral orbital superior frontal gyrus， left rectus gyrus， left anterior cingulate and paracingulate gyri， right posterior cingulate gyrus， left parahippocampal gyrus， left lingual gyrus， left putamen， left thalamus（P＜0.05）； Relative to OG， the T1 values of SG were significantly higher in the right posterior cingulate gyrus， right calcarine fissure and surrounding cortex， and left putamen （P＜0.05）. ConclusionsEven after recovering from COVID-19， patients may still have persistent or delayed damage to their brain gray matter structure， which is correlated with the severity of the condition. SyMRI can serve as a sensitive tool to assess the extent of microstructural damage to the central nervous system， aiding in early diagnosis of the disease.

Animal models and SARS-CoV-2-induced pulmonary and neurological injuries

Laboratory animals are essential mainly for experiments aiming to study pathogenesis and evaluate antivirals and vaccines against emerging human infectious diseases. Preclinical studies of coronavirus disease 19 (COVID-19) pathogenesis have used several animal species as models: transgenic human ACE2 mice (K18 mice), inbred BALB/c or C57BL/6N mice, ferrets, minks, domestic cats and dogs, hamsters, and macaques. However, the choice of an animal model relies on several limitations. Besides the host susceptibility, the researcher's experience with animal model management and the correct interpretation of clinical and laboratory records are crucial to succeed in preclinical translational research. Here, we summarise pathological and clinical findings correlated with virological data and immunological changes observed from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) experimental infections using different well-established SARS-CoV-2 animal model species. This essay aims to critically evaluate the current state of animal model translation to clinical data, as described in the human SARS-CoV-2 infection.

Current status of monitoring of cerebral oxygen supply and demand during perioperative cardiac surgery in children with extracorporeal circulation / 解放军医学杂志

Cardiopulmonary bypass (CPB) is often accompanied by postoperative nerve injury in children. Studies have shown that monitoring of cerebral blood flow and cerebral oxygenation during enhanced operation can help to detect the adverse events of cerebral ischemia and hypoxia in time, guide physicians to adjust perfusion parameters in time, and can significantly reduce the incidence of postoperative nerve injury and improve the prognosis of children. Transcranial doppler (TCD) can directly reflect cerebral perfusion and indirectly reflect cerebral oxygen supply and demand by monitoring cerebral blood flow velocity, and jugular blood oxygen saturation (SjbO2) and cerebral local oxygen saturation (CrSO2) directly reflect cerebral oxygen supply and demand by monitoring cerebral oxygenation in the cerebral hemisphere. Therefore, the combined monitoring of these indexes during the perioperative period of cardiac surgery in children can reflect the cerebral oxygen supply and demand in an all-round way, and prevent the ischemic and hypoxic nerve injury. The research status has been reviewed in present paper of TCD, SjbO2 and CrSO2 in monitoring cerebral oxygen supply and demand during perioperative cardiac surgery in children with CPB in order to provide evidence for the prevention of postoperative nerve injury.

Lateral rectus abdominis approach versus posteromedian sacrum approach for unstable sacral fracture complicated with lumbosacral plexus injury / 中华创伤骨科杂志

Objective To compare the lateral rectus abdominis approach versus posteromedian sacrum approach in the surgical treatment of unstable sacral fracture complicated with lumbosacral plexus injury.Methods From June 2010 to December 2014,33 unstable sacral fractures complicated with lumbosacral plexus injury were treated at Department of Orthopaedics,Spinal and Pelvic Surgery Center,Zhongnan Hospital.Of them,24 were fresh and 9 obsolete.The lateral rectus abdominis approach was adopted in 17 patients and the posteromedian sacrum approach in 16.All the patients received surgical treatment within 2 to 12 weeks (average,4.5 weeks) after injury.The 2 groups were compared in terms of operation time,bleeding volume,complications,weight-bearing time,visual analogue scale (VAS),European QOL Five Dimensional health scale (EQ-5D) and lumbosacral injury classification and severity scale (LSICS).Results The 2 groups were compatible due to their insignificant differences in baseline data (P ＞ 0.05).Their follow-up time ranged from 17 to 37 months (average,26.8 months).Perioperatively,infection and necrosis of the lumbosacral incision appeared in 2 patients and iatrogenic injury to the lumbosacral plexus in 3 patients.All the other incisions healed well without major complications like infection,pressure ulcer or implant failure.There were no significant differences between the 2 groups in operation time (235.8± 72.0 minutes versus 318.0 ± 64.7 minutes),intraoperative bleeding volume (558.8 ± 125.7 mL versus 734.0 ±98.0 mL),weight-bearing time (9.4 ±2.4 weeks versus 11.3 ±2.3 weeks),postoperative complications,VAS(1.1 ±0.6 points versus 1.0 ±0.6 points),EQ-5D (0.82 ±0.09 points versus 0.78 ±0.06 points) or LSICS (P ＞ 0.05).The final follow-ups revealed significant improvements in VAS,EQ-5D and LSICS in all the patients (P ＜ 0.05).Conclusion The lumbosacral plexus can be well decompressed via both the lateral rectus abdominis approach and the posteromedian sacrum approach,leading to satisfactory clinical outcomes.

Papel do gestor hospitalar na implantação da rede de cuidados a pessoa com deficiência no âmbito da Zona da Mata Mineira / Role of the hospital manager in the implementation of the care network for people with disabilities within the Zona da Mata Mineira

Relatório final de pesquisa de mestrado, com objetivo de identificar como profissionais gestores médicos e enfermeiros responsáveis por unidades de internação hospitalar procedem no preparo de alta das pessoas com sequelas neurológicas, traumatológicas ou ortopédicas, dependentes de ingresso em programas de reabilitação, considerando-as potenciais usuárias de programas de reabilitação física. Trata-se de um estudo descritivo e exploratório, com abordagem quanti-qualitativa, realizado no segundo semestre de 2014, com 13 enfermeiros e 12 médicos. O cenário do estudo foi Santa Casa de Misericórdia de Juiz de Fora-MG, por promover atendimento a esta clientela no âmbito do Sistema Único de Saúde (SUS), cujos encaminhamentos pós-alta hospitalar são feitos para a rede credenciada de serviços de atenção básica às unidades de reabilitação da região. Os critérios de inclusão foram ser maior de 18 anos, gestor hospitalar, enfermeiro ou médico que exerça cargo de chefia em unidades de internação clínica/ cirúrgica/urgência/emergência e unidade de terapia intensiva, além de concordar em participar voluntariamente do estudo e assinar o Termo de Consentimento Livre e Esclarecido. Dados coletados através de entrevistas, baseados em roteiro semiestruturado, transcritas na íntegra e analisados a luz da estatística descritiva para os dados quantitativos, devidamente complementados pela técnica de análise temática de conteúdo. Da análise dos dados emergiram as seguintes categorias temáticas: Conhecimento sobre a rede de cuidados da pessoa com deficiência; Critérios usados para alta dos clientes com sequelas neurológicas incapacitantes; Preparo da alta hospitalar: envolvimento da família, rede básica e demais serviços; e Visita domiciliar: avaliação da ambiência e acessibilidade. Para a elaboração do primeiro artigo a ser publicado em periódico indexado nas bases de dados da área de conhecimento, valeu-se de duas categorias temáticas, a saber: 1) Critérios usados para alta dos clientes com sequelas neurológicas; 2) Preparo da alta e seus desdobramentos. Ambas decodificadas, analisadas, discutidas e formatadas na forma de manuscrito submetido a periódico da área. O perfil sóciodemográfico dos participantes deste estudo apontou prevalência de participantes do sexo feminino (56%). A faixa etária dos participantes da pesquisa revelou que 64,54% (8) enfermeiros estão entre a faixa etária de 31 a 40 anos, ao passo que 66,66 (8) gestores médicos têm entre 41 a 60 anos, além de haver mais médicos na faixa etária de 61 a 70 anos. Quanto ao tempo de formação, observou-se que 84,62% dos enfermeiros estão formados em período de 1 a 10 anos, em contrapartida, médicos informaram maior tempo de formados, inclusive 16,67% (2) atuando por período de 41 a 50 anos. Do tempo de atuação no setor, ficou constatado que 76,92% (10) enfermeiros atuam entre 1 a 10 anos e que 8,33% (1) médico já atua no setor há período correspondente a 41 a 50 anos. O tempo de atuação na instituição mostrou prevalência de enfermeiros 76,92% (10) entre 1 a 10 anos, enquanto maior percentual de médicos 41,67% (5) entre 11 e 20 anos. No transcurso do estudo surgiu a necessidade de se propor a implantação de um Protocolo de encaminhamento hospitalar de clientes com lesão neurológica incapacitante para atendimento na Rede de Cuidados à Pessoa com Deficiência referenciado pelo Sistema Único de Saúde. Concomitantemente, outras possíveis categorias temáticas deverão ser trabalhadas a posteriori, visando a elaboração de outros manuscritos para futuras submissões em periódicos indexados. Conclui-se que, tanto médicos quanto enfermeiros comungam da opinião que os critérios de alta desta clientela devem ser exclusivamente de competência médica, enquanto outros participantes compartilham da opinião de que a alta deve ser compartilhada com a equipe de saúde. De acordo com os relatos dos participantes do estudo, predomina a perspectiva de que a família deve ser envolvida no preparo da alta desses clientes, em função do reconhecimento do importante papel de cuidadores domiciliares prestando cuidados no dia a dia dessas pessoas. O mesmo pôde ser observado nos relatos dos gestores que participaram deste estudo, no concernente ao encaminhamento desses clientes para os serviços de saúde e reabilitação disponíveis na comunidade, embora com menor expressão. O estudo também aponta para a necessidade de ampliar a divulgação das implicações da Rede a partir da implantação dos Centros Especializados de Reabilitação, considerando relevante a oportunidade oferecida aos participantes de tomar conhecimento sobre as implicações da Rede de Cuidados da Pessoa com Deficiência

Final report of master's research, in order to identify how professional medical officers and nurses responsible for hospital units come in preparing discharge for people with neurological, traumatology and orthopedic sequelae, entry of dependents in rehabilitation programs, considering the potential users of physical rehabilitation programs. This is a descriptive study, with quantitative and qualitative approach, conducted in the second half of 2014, with 13 nurses and 12 doctors. The setting was Santa Casa de Fora-MG Judge's mercy for foster care to this clientele within the Unified Health System (SUS), whose hospital after referrals are made to the accredited primary care services to rehabilitation units in the region. Inclusion criteria were being older than 18, hospital manager, nurse or doctor who performs management positions in clinical inpatient units / surgical / emergency / rescue and care unit, and agree to participate voluntarily in the study and sign the Term of Consent. Data collected through interviews based on semi-structured, fully transcribed and analyzed in light of the descriptive statistics for quantitative data, duly complemented by the technique of thematic content analysis. The data analysis emerged the following thematic categories: Knowledge about the person's care network with disabilities; Criteria used for discharge customer with disabling neurological sequelae; Hospital discharge preparation: family involvement, core network and other services; and Home visit: evaluation of ambience and affordability. For the preparation of the first article to be published in peer-reviewed journal in the data bases of the area of know ledge, drew on two themes, namely: 1) Criteria used for discharge customer with neurological sequelae; 2) the discharge preparation and its consequences. Both decoded, analyzed, discussed and formatted in the form of manuscript submitted to periodic the area. The sociodemographic profile of the study participants pointed prevalence of female participants (56%). The age range of study participants revealed that 64.54% (8) nurses are between the age group of 31 to 40 years old, whereas 66.66 (8) medical managers have between 41 to 60 years old , plus there is more physicians aged 61-70 years old. As for the time of formation, it was found that 84.62% of nurses is formed in a period of 1 to 10 years, in contrast, reported medical longer formed, including 16.67% (2) operating for a period of 41 to 50 years old. Actuation time in the industry, it was found that 76.92% (10) nurses work between 1-10 years and 8.33% (1) Medical already operates in the industry for the period corresponding to 41 to 50 years old. The performance in the institution showed prevalence of nurses 76.92% (10) between 1-10 years old, while higher percentage of physicians 41.67% (5) between 11 and 20 years old. In the course of the study it became necessary to propose the implementation of a hospital Routing Protocol customers with disabling neurological injury to meet in person to Care Network with Disabilities referenced by the Unified Health System. At the same time, other possible themes will be worked a posteriori, in order to develop other manuscripts for future submissions in indexed journals. It is concluded that both doctors and nurses share the opinion that the discharge criteria of this clientele must be medical competence exclusively, while other participants share the view that the increase should be shared with the health team. According to the reports of the study participants, the predominant view is that the family should be involved in the preparation of these clients discharge, due to the recognition of the important role of home caregivers providing daily care to these people. The same could be observed in the accounts of the managers who participated in this study, regarding the referral of these clients to health and rehabilitation services available in the community, although to a lesser extent. The study also points to the need to broaden the dissemination of Network implications from the implementation of the Specialized Rehabilitation Centers, relevant considering the opportunity for participants to become aware of the implications of the Person with Disability Care Network

Uso de hipotermia en el paro cardiorrespiratorio extrahospitalario: reporte de un caso / Use of hypothermia in out of hospital pediatric arrest: a case report

Moderate hypothermia decreases mortality and improves neurological outcome in adults as well as newborns affected with Neonatal Asphyxia. The effect of hypothermia among children with cardiac arrest (CRA) is not known. Objective: Case description of the use of therapeutic hypothermia in a pediatric patient with cardiac arrest. Clinical Case: Four-year-old girl who presented extra-hospitalary CRA, where moderate hypothermia (34 degrees Celsius) was used for neurological protection in a PICU. The patient was discharged in satisfactory neurological condition, as rated through a Pediatric Cerebral Performance Category (PCPC) Test assessment, with a score of 2, similar to her baseline evaluation. Use of Hypothermia in PICU is discussed, as well as methods to induce this state and potential side effects of the treatment.

La hipotermia moderada mejora la mortalidad y el pronóstico neurológico en el paro cardíaco en adultos y en recién nacidos con asfixia neonatal. El efecto de la hipotermia en niños con paro cardiorrespiratorio (PCR) no se conoce. Objetivo: Describir el uso de la Hipotermia terapéutica en el PCR en una paciente pediátrica, y actualizar el conocimiento en dicha materia. Caso clínico: Preescolar sexo femenino, 4 años de edad que presentó un PCR extra hospitalario en la que se uso como neuroprotección hipotermia moderada (34 °C) durante 48 horas en la unidad de cuidados intensivos pediátricos, lo que permitió su alta en una condición neurológica satisfactoria, estimada por la escala Pediatric Cerebral Performance Category (PCPC) de 2, similar a su condición basal. También se revisa el uso de hipotermia en cuidado intensivo pediátrico, los métodos para inducir hipotermia y potenciales efectos secundarios de esta terapia.

Analysis of Neurological Complications on Antegrade Versus Retrograde Cerebral Perfusion in the Surgical Treatment of Aortic Dissection / 대한흉부외과학회지

BACKGROUND: In the surgical treatment of aortic dissection, aortic arch replacement under total circulatory arrest is often performed after careful inspection to determine the severity of disease progression. Under circulatory arrest, antegrade or retrograde cerebral perfusion is required for brain protection. Recently, antegrade cerebral perfusion has been used more, because of the limitation of retrograde cerebral perfusion. This study is to compare these two methods especially in the respect to neurological complications. MATERIAL AND METHOD: Forty patients with aortic dissection involving aortic arch from May 2000 to May 2004 were enrolled in this study, and the methods of operation, clinical recovery, and neurological complications were retrospectively reviewed. RESULT: In the ACP (antegrade cerebral perfusion) group, axillary artery cannulation was performed in 10 out of 15 cases. In the RCP (retrograde cerebral perfusion) group, femoral artery Cannulation was performed in 24 out of 25 cases. The average esophageal and rectal temperature under total circulatory arrest was 17.2oC and 22.8oC in the group A, and 16.0oC and 19.7oC in the group B, respectively. Higher temperature in the ACP group may have brought the shorter operation and cardiopulmonary bypass time. However, the length of period for postoperative clinical recovery and admission duration did not show any statistically significant differences. Eleven out of the total 15 cases in the ACP group and thirteen out of the total 25 cases in the RCP group showed neurological complication but did not show statistically significant difference. In each group, there were 5 cases with permanent neurological complications. All 5 cases in the ACP group showed some improvements that enabled routine exercise. However all 5 cases in RCP group did not show significant improvements. CONCLUSION: The Antegrade cerebral perfusion, which maintains orthordromic circulation, brings moderate degree of hypothermia and, therefore, shortens the operation time and cardiopulmonary bypass time. We concluded that Antegrade cerebral perfusion is safe and can be used widely under total circulatory arrest.