Cerebral hemodynamic response during the resuscitation period after hypoxic-ischemic insult predicts brain injury on day 5 after insult in newborn piglets
Yasuhiro NakaoShinji NakamuraYinmon HtunTsutomu MitsuieKosuke KoyanoKen‐ichi OhtaYukihiko KonishiTakanori MikiMasaki UenoTakashi Kusaka
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Abstract:
Perinatal hypoxic-ischemic brain injury of neonates remains a significant problem worldwide. During the resuscitation period, changes in cerebral hemoglobin oxygen saturation (ScO2) have been identified by near-infrared spectroscopy (NIRS). However, in asphyxiated neonates, the relationship between these changes and brain injury is not known. Three-wavelength near-infrared time-resolved spectroscopy, an advanced technology for NIRS, allows for the estimation of ScO2 and cerebral blood volume (CBV). Here, we studied changes in ScO2 and CBV during the resuscitation period after hypoxic-ischemic insult and the relationship between these changes after insult and histopathological brain injuries on day 5 after insult using an asphyxiated piglet model. Of 36 newborn piglets subjected to hypoxic-ischemic insult, 29 were analyzed. ScO2 and CBV were measured 0, 5, 10, 15, and 30 min after the insult. Brain tissue was histologically evaluated on day 5. ScO2 and CBV increased immediately after the insult, reached a peak, and then maintained a consistent value. The increase in CBV 5 to 30 min after the insult was significantly correlated with histopathological injury scores. However, there was no correlation with ScO2. In conclusion, an increase in CBV within 30 min after hypoxic-ischemic insult reflects the histopathological brain injury on day 5 after insult in a piglet model.Keywords:
Insult
Hypoxia
Perinatal asphyxia is attributed to hypoxia and/or ischemia around the time of birth and may lead to multiorgan dysfunction. Aim of this research article is to investigate whether different metabolomic profiles occurred according to oxygen concentration administered at resuscitation. In order to perform the experiment, forty newborn piglets were subjected to normocapnic hypoxia and reoxygenation and were randomly allocated in 4 groups resuscitated with different oxygen concentrations, 18%, 21%, 40%, and 100%, respectively. Urine metabolic profiles at baseline and at hypoxia were analysed by 1 H-NMR spectroscopy and metabolites were also identified by multivariate statistical analysis. Metabolic pathways associations were also built up by ingenuity pathway analysis (IPA). Bioinformatics analysis of metabolites characterized the effect of metabolism in the 4 groups; it showed that the 21% of oxygen is the most “physiological” and appropriate concentration to be used for resuscitation. Our data indicate that resuscitation with 21% of oxygen seems to be optimal in terms of survival, rapidity of resuscitation, and metabolic profile in the present animal model. These findings need to be confirmed with metabolomics in human and, if so, the knowledge of the perinatal asphyxia condition may significantly improve.
Hypoxia
Neonatal Resuscitation
Perinatal asphyxia
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Insult
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Hypoxia
Carbohydrate Metabolism
Oxygen metabolism
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as systemic inflammatory response syndrome. 3,4 However, we disagree that it is a single-insult model of organ injury.The hemorrhage and resuscitation method is actually a "twoinsult model" of multiorgan injury, as this model requires a period of controlled hemorrhage followed by resuscitation with shed blood.Resuscitation with shed blood exacerbates as well as causes multiorgan injury by promoting systemic inflammatory response, platelet activation, increased neutrophil recruitment and microthrombi formation. 4
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Rats were "stressed" by a 30-min period of hypoxia (FIO2 = 7.5%) and hypotension (x arterial pressure = 30 mm Hg), and then "resusciated" by restoring FIO2 = 30% and reinfusing shed blood to restore arterial pressure toward baseline values. Concentrations of brain phosphocreatine, ATP and lactate were measured after "stress" and 20, 60, and 120 min after "resuscitation". A biphasic response was noted in which ATP was initially restored to baseline values by "resuscitation", and then progressively decreased. Physiologic mechanisms to explain the observed data are presented.
Hypoxia
Mean arterial pressure
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Diamond, Bruce I.; Cohen, Morris; Wang, Jian; Borison, Richard L.; Campbell, Karen L. Author Information
Hypoxia
Insult
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Objective Several clinical and experimental animal studies indicate that resuscitation with 100% oxygen increases brain injury and induces inflammation in vital organs. Elevated levels of the cytokine interleukin (IL)-6 have been observed in a number of pathological conditions including inflammation. Studies indicate that phytochemicals may protect against reoxygenation injury in the newborn. Our aim was to determine whether resuscitation with 100% oxygen after hypoxia generates higher levels of IL-6 in brain than resuscitation with 21% oxygen. We also wanted to examine if intravenous administration of phytochemicals given prior to hypoxia would have an additional effect. Methods Forty newborn Noroc piglets were randomized to hypoxia or control groups and pretreatment with phytochemicals or placebo. The phytochemical solution contained 10 different biological active molecules with antioxidative properties. The piglets were given hypoxia and resuscitated with either 21% or 100% oxygen for 30 min and then observed with 21% oxygen for 120 min. Results IL-6 increased significantly in frontal cortex of the brain for the 100% oxygen group compared to the 21% oxygen group. The adjusted difference was 28.0 (95% CI: 1.9 to 54.1, p = 0.041). IL-6 was not significantly related to phytochemicals (p = 0.836). Conclusions Resuscitation after hypoxia with 21% oxygen induces less IL-6 in frontal cortex of newborn piglet brain than resuscitation with 100% oxygen. Intravenously administered phytochemicals did not have an additional effect. The potential effects of phytochemicals in this model are being further investigated.
Hypoxia
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In response to your news article, ‘Berkshire nurses perform cardiac resuscitation’ (News August 16), this is something of an insult to nurses, especially coronary care nurses, for whom cardiac resuscitation, often prior to the doctor’s arrival, is an everyday occurrence.
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Cardiac Resuscitation
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Бұл зерттеужұмысындaКaно моделітурaлы жәнеоғaн қaтыстытолықмәліметберілгенжәнеуниверситетстуденттерінебaғыттaлғaн қолдaнбaлы (кейстік)зерттеужүргізілген.АхметЯссaуи университетініңстуденттеріүшін Кaно моделіқолдaнылғaн, олaрдың жоғaры білімберусaпaсынa қоятынмaңыздытaлaптaры, яғнисaпaлық қaжеттіліктері,олaрдың мaңыздылығытурaлы жәнесaпaлық қaжеттіліктерінеқaтыстыөз университетінқaлaй бaғaлaйтындығытурaлы сұрaқтaр қойылғaн. Осы зерттеудіңмaқсaты АхметЯсaуи университетіндетуризмменеджментіжәнеқaржы бaкaлaвриaт бaғдaрлaмaлaрыныңсaпaсынa қaтыстыстуденттердіңқaжеттіліктерінaнықтaу, студенттердіңқaнaғaттaну, қaнaғaттaнбaу дәрежелерінбелгілеу,білімберусaпaсын aнықтaу мен жетілдіружолдaрын тaлдaу болыптaбылaды. Осы мaқсaтқaжетуүшін, ең aлдыменКaно сaуaлнaмaсы түзіліп,116 студенткеқолдaнылдыжәнебілімберугежәнеоның сaпaсынa қaтыстыстуденттердіңтaлaптaры мен қaжеттіліктерітоптықжұмыстaрaрқылыaнықтaлды. Екіншіден,бұл aнықтaлғaн тaлaптaр мен қaжеттіліктерКaно бaғaлaу кестесіменжіктелді.Осылaйшa, сaпa тaлaптaры төрт сaнaтқa бөлінді:болуытиіс, бір өлшемді,тaртымдыжәнебейтaрaп.Соңындa,қaнaғaттaну мен қaнaғaттaнбaудың мәндеріесептелдіжәнестуденттердіңқaнaғaттaну мен қaнaғaттaнбaу деңгейлерінжоғaрылaту мен төмендетудеосытaлaптaр мен қaжеттіліктердіңрөліaйқын aнықтaлды.Түйінсөздер:сaпa, сaпaлық қaжеттіліктер,білімберусaпaсы, Кaно моделі.
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