Volumetric changes in brain MRI of infants with hypoxic-ischemic encephalopathy and abnormal neurodevelopment who underwent therapeutic hypothermia.

BACKGROUND: Hypoxic-ischemic encephalopathy (HIE) is a severe neonatal complication that can result in 40-60 % of long-term morbidity. Magnetic Resonance Imaging (MRI) is a noninvasive method which is usually performed before discharge to visually assess acquired cerebral lesions associated with HIE and severity of lesions possibly providing a guide for detecting adverse outcomes. This study aims to evaluate the impact of HIE on brain volume changes observed in MRI scans performed at a mean 10 days of life, which can serve as a prognostic indicator for abnormal neurodevelopmental (ND) outcomes at 18-24 months among HIE infants. METHODS: We retrospectively identified a cohort of HIE patients between June 2013 and March 2017. The inclusion criteria for therapeutic hypothermia (TH) were a gestational age ≥35 weeks, a birth weight ≥1800 g, and the presence of ≥ moderate HIE. Brain MRI was performed at a mean 10 days of life and brain volumes (total brain volume, cerebral volume, cerebellar volume, brain stem volume, and ventricle volume) were measured for quantitative assessment. At 18-24 months, the infants returned for follow-up evaluations, during which their cognitive, language, and motor skills were assessed using the Bayley Scales of Infant and Toddler Development III. RESULTS: The study recruited a total of 240 infants between 2013 and 2017 for volumetric brain MRI evaluation. Among these, 83 were normal control infants, 107 were TH-treated HIE infants and 37 were HIE infants who did not receive TH due to contraindications. Clinical evaluation was further proceeded. We compared the brain volumes between the normal control infants (n = 83) with normal ND but TH-treated HIE infants (n = 76), abnormal ND TH-treated HIE infants (n = 31), and the severe HIE MRI group with no TH (n = 37). The abnormal ND TH-treated HIE infants demonstrated a significant decrease in brainstem volume and an increase in ventricle size (p < 0.001) (Table 4). Lastly, the severe brain MRI group who did not receive TH showed significantly smaller brain stem (p = 0.006), cerebellar (p = 0.006) and cerebrum volumes (p = 0.027), accompanied by larger ventricular size (p = 0.013) compared to the normal control group (Table 5). CONCLUSION: In addition to assessing the location of brain injuries in MRI scans, the reduction in brain stem volume coupled with an increase in ventricular volume in HIE infants may serve as a biomarker indicating severe HIE and adverse long-term ND outcomes among HIE infants who either received therapeutic hypothermia (TH) treatment or not.

A disposable OSL dosimeter for in vivo measurement of rectum dose during brachytherapy.

PURPOSE: We aimed to develop a disposable rectum dosimeter and to demonstrate its ability to measure exposure dose to the rectum during brachytherapy for cervical cancer treatment using high-dose rate 192 Ir. Our rectum dosimeter measures the dose with an optically stimulated luminescence (OSL) sheet which was furled to a catheter. The catheter we used is 6 mm in diameter; therefore, it is much less invasive than other rectum dosimeters. The rectum dosimeter developed in this study has the characteristics of being inexpensive and disposable. It is also an easy-to-use detector that can be individually sterilized, making it suitable for clinical use. METHODS: To obtain a dose calibration curve, phantom experiments were performed. Irradiation was performed using a cubical acrylic phantom, and the response of the OSL dosimeter was calibrated with the calculation value predicted by the treatment planning system (TPS). Additionally, the dependence of catheter angle on the dosimeter position and repeatability were evaluated. We also measured the absorbed dose to the rectum of patients who were undergoing brachytherapy for cervical cancer (n = 64). The doses measured with our dosimeters were compared with the doses calculated by the TPS. In order to examine the causes of large differences between measured and planned doses, we classified the data into common and specific cases when performing this clinical study. For specific cases, the following three categories were considered: (a) patient movement, (b) gas in the vagina and/or rectum, and (c) artifacts in the X-ray image caused by applicators. RESULTS: A dose calibration curve was obtained in the range of 0.1 Gy-10.0 Gy. From the evaluation of the dependence of catheter angle on the dosimeter position and repeatability, we determined that our dosimeter can measure rectum dose with an accuracy of 3.1% (k = 1). In this clinical study, we succeeded in measuring actual doses using our rectum dosimeter. We found that the deviation of the measured dose from the planned dose was derived to be 12.7% (k = 1); this result shows that the clinical study included large elements of uncertainty. The discrepancies were found to be due to patient motion during treatment, applicator movement after planning images were taken, and artifacts in the planning images. CONCLUSIONS: We present the idea that a minimally invasive rectum dosimeter can be fabricated using an OSL sheet. Our clinical study demonstrates that a rectum dosimeter made from an OSL sheet has sufficient ability to evaluate rectum dose. Using this dosimeter, valuable information concerning organs at risk can be obtained during brachytherapy.

Change of coagulation after NovoSeven® use for bleeding during cardiac surgery.

Objectives Recombinant activated factor VII has been used for the treatment of hemophilia, factor VII deficiency, and Glanzmann's thrombasthenia. Off-label uses have recently been increasing, and there are reports that recombinant activated factor VII is effective for the treatment of excessive bleeding during or after cardiovascular surgery. We retrospectively reviewed the effectiveness of recombinant activated factor VII and its influence on the coagulation system as a treatment for uncontrollable bleeding during cardiovascular surgery. Methods Between April 2009 and May 2015, recombinant activated factor VII was used to treat uncontrollable bleeding during cardiovascular surgery in 17 patients at our hospital. The indications for recombinant activated factor VII administration were critical uncontrollable bleeding during surgery and normal platelet and fibrinogen levels. Results Blood loss significantly decreased in every case after recombinant activated factor VII administration ( p < 0.05). No adverse thromboembolic events were encountered. The prothrombin time-international normalized ratio, activated partial thromboplastin time, fibrin degradation product and D-dimer levels decreased significantly after recombinant activated factor VII administration. One day later, all blood coagulation test values were almost within the normal ranges. Conclusions Recombinant activated factor VII has a strong hemostatic action, but it is necessary to exclude surgical bleeding to exhibit the hemostatic effect. Administration that does not comply with the indications for recombinant activated factor VII may lead to serious complications such as thromboembolism. In properly selected patients, recombinant activated factor VII is an effective agent for the treatment of uncontrollable bleeding during cardiovascular surgery.

[Efficacy of Recombinant Activated Factor VII for Intractable Bleeding after Cardiovascular Surgery].

UNLABELLED: Recombinant activated factor VII (rFVIIa) has been used for the treatment of hemophilia, factor VII deficiency, and Glanzmann's thrombasthenia. We retrospectively reviewed the effectiveness of rFVIIa for the treatment of uncontrollable bleeding after cardiovascular surgery. MATERIAL AND METHODS: Eight patients received rFVIIa for the treatment of uncontrollable bleeding after admission to the intensive care unit following cardiovascular surgery between April 2009 and July 2014. RESULTS: Blood loss was significantly decreased in 7 of the 8 cases after the administration of rFVIIa (p<0.05). No adverse thromboembolic events were encountered. The quantity of blood loss and prothrombin time-international normalized ratio(PT-INR), activated partial thromboplastin time(APTT), fibrin degradation products(FDP) and D-dimer levels decreased significantly after the administration of rFVIIa (p<0.05). The blood coagulation test values were almost within the normal range at 24 hours after administration. CONCLUSION: In appropriately selected patients, rFVIIa is an effective agent for the treatment of excessive bleeding after cardiovascular surgery.

[Invalid sensors judged by the BIS A-2000 monitors may display clinically acceptable BIS values on the external equipments].

The bispectral index (BIS) is widely used to measure anesthetic levels in the perioperative period. In our hospital, the BIS monitors (A-2000) are connected to bedside monitors and display BIS values on them through outside input. All datas on the bedside monitors are transmitted to anesthesia information management system automatically. We report cases that were impossible to measure BIS values with the displays of "Invalid Sensor" on the BIS A-2000 sensor, but BIS values were measurable on the bedside monitors. One possible reason is thought that the BIS Quatro Sensor transmits both EEG signals and sensor information to the BIS A-2000 monitor separately. BIS A-2000 monitors may process EEG signals and sensor information individually, and transfer BIS parameters to the external equipments, regardless of sensor information.

Self-assembly of active IrO2 colloid catalyst on an ITO electrode for efficient electrochemical water oxidation.

Active catalysts for water oxidation to evolve O(2) are required for the construction of artificial photosynthetic devices that are expected to be promising energy-providing systems in the future. The citrate-stabilized IrO(2) colloid was self-assembled onto an indium tin oxide (ITO) electrode to form a monolayer of the colloidal IrO(2) particles when it was dipped in the colloid solution. The self-assembly could be achieved by a chemical interaction between carboxylate groups on the citrate stabilizer and hydroxyl groups on the ITO surface to form ester bonds. Efficient electrocatalysis for water oxidation was demonstrated using the electrode modified by the self-assembled IrO(2) colloid to yield the highest turnover frequency ((2.3-2.5) x 10(4) h(-1)) of IrO(2) in the hitherto-reported catalysts for electrochemical water oxidation.