Selective Brain Hypothermia in the Comprehensive Rehabilitation of Patients with Chronic Consciousness Disorders

Aim: to evaluate clinical effectiveness of selective hypothermia of cerebral cortex for the recovery of awareness in patients with chronic disorders of consciousness (CDC).   Material and methods. 111 patients with CDC 30 and more days after a cerebral event (ischemic or hemorrhagic stroke, brain injury) were included in the study. Exclusion criteria were anoxic brain injury (sequelae of a prolonged asystole or asphyxia), active sepsis, arrhythmia, baseline hypothermia (body temperature lower than 35.5 °С). Experimental group included 60 patients, of them 39 patients were in a vegetative state (VS), 21 patients exhibited patterns of minimally conscious state (MCS). Control group incluted 51 patients, of them 32 patients were in VS and 19 patients were in MCS. Patients in the experimental group received 10 sessions (120 minutes each) of selective brain hypothermia (SBH) during the 14-days follow-up period. Patients of both groups received standard identical neurological treatment and rehabilitation procedures. Patients in the control group did not undergo brain hypothermia. The induction of SBH involved cooling of the whole surface of the craniocerebral area of scalp using special helmets. The temperature of the internal surface of the helmet was 3–7 °С. Temperature of the frontal lobes of the cortex was monitored with non-invasive microwave radiothermometry, axillary temperature was also registered. The level of consciousness was evaluated using «Coma Recovery Scale-Revised» (CRS-R) scale.   Results. 120-minutes long SBH session reduced the temperature of the frontal lobes of the cerebral cortex by 2.4–3.1 °С with no impact on the axillary temperature. Evaluation using CRS-R revealed improvement in all studied functions (auditory, visual, motor, oromotor, communication, arousal) in patients in the experimental group after 10 SBH sessions. Level of consciousness in patients from the experimental group in VS increased from 4.5 ± 0.33 to 8.7 ± 0.91 points (P < 0.001), for patients in MCS from 11.3 ± 1.0 to 18.2 ± 0.70 (P < 0.001) points. In the control group, scores of patients in VS rose from 4.3 ± 0.37 to 6.8 ± 0.49 (P < 0.001) points with the most significant changes in auditory and visual functions (P<0.001). In the control group of patients in MCS the oromotor function improved (P < 0.05), overall CRS-R scores changed insignificantly from 9.1 ± 0.57 to 10.1 ± 0.86 (P < 0.1). The best outcome (CRS-R > 19 points) was seen in patients from the experimental group [6 in VS (15.4 %) and 8 in MCS (31.8 %)]. In the control group, the best results did not exceed 10 points for the patents in VS, while 4 patients in MCS (21 %) reached 12–16 scores. During 30-day follow-up period of hospitalization after the SBH sessions mortality rate was 10 % (6 patients) in the experimental group and 21.6% (11 patients) in the control group.   Conclusion. Patients with CDC could benefit from serial SBH sessions performed as a part of comprehensive treatment and rehabilitation strategy. We suggest that selective reduction of frontal lobe temperature improves neurogenesis, neuronal regeneration, and neuroplasticity

Селективная гипотермия коры больших полушарий в комплексной реабилитации пациентов с хроническими нарушениями сознания

   Aim: to evaluate clinical effectiveness of selective hypothermia of cerebral cortex for the recovery of awareness in patients with chronic disorders of consciousness (CDC).   Material and methods. 111 patients with CDC 30 and more days after a cerebral event (ischemic or hemorrhagic stroke, brain injury) were included in the study. Exclusion criteria were anoxic brain injury (sequelae of a prolonged asystole or asphyxia), active sepsis, arrhythmia, baseline hypothermia (body temperature lower than 35.5 °С). Experimental group included 60 patients, of them 39 patients were in a vegetative state (VS), 21 patients exhibited patterns of minimally conscious state (MCS). Control group incluted 51 patients, of them 32 patients were in VS and 19 patients were in MCS. Patients in the experimental group received 10 sessions (120 minutes each) of selective brain hypothermia (SBH) during the 14-days follow-up period. Patients of both groups received standard identical neurological treatment and rehabilitation procedures. Patients in the control group did not undergo brain hypothermia. The induction of SBH involved cooling of the whole surface of the craniocerebral area of scalp using special helmets. The temperature of the internal surface of the helmet was 3–7 °С. Temperature of the frontal lobes of the cortex was monitored with non-invasive microwave radiothermometry, axillary temperature was also registered. The level of consciousness was evaluated using «Coma Recovery Scale-Revised» (CRS-R) scale.   Results. 120-minutes long SBH session reduced the temperature of the frontal lobes of the cerebral cortex by 2.4–3.1 °С with no impact on the axillary temperature. Evaluation using CRS-R revealed improvement in all studied functions (auditory, visual, motor, oromotor, communication, arousal) in patients in the experimental group after 10 SBH sessions. Level of consciousness in patients from the experimental group in VS increased from 4.5 ± 0.33 to 8.7 ± 0.91 points (P < 0.001), for patients in MCS from 11.3 ± 1.0 to 18.2 ± 0.70 (P < 0.001) points. In the control group, scores of patients in VS rose from 4.3 ± 0.37 to 6.8 ± 0.49 (P < 0.001) points with the most significant changes in auditory and visual functions (P<0.001). In the control group of patients in MCS the oromotor function improved (P < 0.05), overall CRS-R scores changed insignificantly from 9.1 ± 0.57 to 10.1 ± 0.86 (P < 0.1). The best outcome (CRS-R > 19 points) was seen in patients from the experimental group [6 in VS (15.4 %) and 8 in MCS (31.8 %)]. In the control group, the best results did not exceed 10 points for the patents in VS, while 4 patients in MCS (21 %) reached 12–16 scores. During 30-day follow-up period of hospitalization after the SBH sessions mortality rate was 10 % (6 patients) in the experimental group and 21.6% (11 patients) in the control group.   Conclusion. Patients with CDC could benefit from serial SBH sessions performed as a part of comprehensive treatment and rehabilitation strategy. We suggest that selective reduction of frontal lobe temperature improves neurogenesis, neuronal regeneration, and neuroplasticity.   Цель исследования. Оценить перспективы клинического применения селективной гипотермии коры больших полушарий головного мозга (СГКМ) у пациентов с хроническими нарушениями сознания (ХНС).   Материал и методы. В пилотное открытое когортное исследование включили 111 пациентов с ХНС через 30 и более дней после церебральных катастроф (ишемический и геморрагических инсульты, травмы головного мозга). Критерии исключения: аноксические повреждения головного мозга (последствия длительной асистолии, асфиксии), активный септический процесс, нарушения сердечного ритма, исходная гипотермия (ниже 35,5 °С). Основную группу составили 60 пациентов: в вегетативном состоянии (ВС), n = 39 и в состоянии минимального сознания (СМС), n = 21. Группу сравнения — 51 пациент: в ВС, n = 32 и в СМС, n = 19. Пациентам основной группы выполнили 10 сеансов СГКМ длительностью 120 минут в период 14-и дней наблюдения. В обеих группах пациентам проводили стандартную медикаментозную нейротропную терапию и реабилитационные мероприятия. Пациентам группы сравнения СГКМ не проводили. Для индукции СГКМ охлаждали всю поверхность краниоцеребральной области головы с помощью шлемов-криоаппликаторов при температуре внутренней поверхности шлемов 3–7 °С. Контролировали температуру лобных отделов коры мозга при помощи неинвазивной СВЧ-радиотермометрии, регистрировали аксиальную температуру. Уровень сознания оценивали по шкале восстановления после комы «Coma Recovery Scale-Revised» (CRS-R, 2004 г.).   Результаты. Применение СГКМ позволило снизить температуру лобных отделов коры мозга на 2,4–3,1 °С без изменений аксиальной температуры. У пациентов основной группы выявили статистически значимый рост всех исследованных функций (слуховой, зрительной, двигательной, речевой, коммуникативной, бодрствования). Суммарный показатель вырос от 6,9 ± 0,6 до 12,1 ± 0,9 баллов (р < 0,001). У пациентов в ВС — от 4,5 ± 0,3 до 8,7 ± 0,9 баллов (р < 0,001), у пациентов в СМС — от 11,3 ± 1,0 до 18,2 ± 0,7 баллов (р < 0,001). В группе сравнения суммарный показатель вырос от 6,1 ± 0,5 до 8,1 ± 0,5 (р < 0,05). У пациентов в ВС суммарные данные возросли от 4,3 ± 0,4 до 6,8 ± 0,5 баллов (р < 0,001), причем наиболее значимо нарастали слуховая и зрительная функции (р < 0,001). У пациентов группы сравнения в СМС возросла речевая функция (р < 0,05), а суммарные показатели повысились незначительно от 9,1 ± 0,6 до 10,1 ± 0,9 баллов (р > 0,1). Лучшие результаты (CRS-R > 16 баллов) получили у пациентов основной группы: в ВС — у 6-и пациентов (15,4 %) и СМС — у 8-и (38,1 %). В группе сравнения у пациентов в ВС лучшие результаты по CRS-R не превышали 10 баллов, а у 4-х пациентов в СМС (21 %) на 14-ый день был достигнут уровень 12–16 баллов. При наблюдении в течение 30 дней после курса СГКМ летальность пациентов основной группы составила 6 пациентов (10 %), в группе сравнения — 11 пациентов (21,6 %).   Заключение. Применение курсов СГКМ у пациентов с ХНС в составе комплексных лечебно-реабилитационных мероприятий целесообразно. Высказали предположение, что селективное понижение температуры коры больших полушарий улучшает процессы нейрогенеза, нейрорегенерации и нейропластичности

Influence of alkaline and environmental processing of oil and grain outs on Beta-glucane output

Beta-glucan is a branched polysaccharide whose monomers are bound by (1,3, 1,4) and (1,6) beta-glucosidic bonds and has a wide spectrum of biological activity and, above all, immunomodulating and anti-inflammatory. Beta-glucan is found in fungi, yeast, bacteria, algae. However, the isolation of beta-glucan from this raw material, both natural and obtained in industrial conditions by biotechnological methods, is economically costly. A promising source of beta-glucan are grains: oats, barley, wheat, rye, rice, corn and millet. The industrial interest in cereals is associated with a high content of soluble branched non-starchy polysaccharides, from which beta-glucan production is possible. The purpose of this work is to determine the effect of alkaline and two-step alkaline and enzymatic methods for treating oat and oat bran grains on the efficiency of beta-glucan release. As a result of the studies, it has been established that the combination of alkaline and enzymatic methods for the isolation of beta glucan from the grain of oats of holed grinded and oat bran is more effective than the alkaline method. The yield of beta-glucan in the treatment with the alkaline and enzymatic method of oat bran is higher than that from the grain of oats of the hollow grinded. It has been shown that beta-glucan isolated from oat bran by two-step alkaline and enzymatic one-step alkaline methods contains fewer concomitant substances compared to beta-glucan isolated from the grain of oats of the hollow grinded. The higher yield of beta-glucan from oat bran can be explained by the high content in them, and also by the use of a grain-sized grain. The preliminary dissolution of the proteins of the aleuron layer and endosperm in sodium hydroxide, as well as starch and subsequent enzymatic hydrolysis thereof, leads to a more complete recovery of beta-glucan

One-year demographical and clinical indices of patients with chronic disorders of consciousness

This work aims to evaluate the prognostic value of the demographical and clinical data on long-term outcomes (up to 12 months) in patients with severe acquired brain injury with vegetative state/unresponsive wakefulness syndrome (VS/UWS/UWS) or a minimally conscious state (MCS). Patients (n = 211) with VS/UWS/UWS (n = 123) and MCS (n = 88) were admitted to the Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology after anoxic brain injury (n = 53), vascular lesions (n = 59), traumatic brain injury (n = 93), and other causes (n = 6). At the beginning of the 12-month study, younger age and a higher score by the Coma Recovery Scale-Revised (CRS-R) predicted a survival. However, no reliable markers of significant positive dynamics of consciousness were found. Based on the etiology, anoxic brain injury has the most unfavorable prognosis. For patients with vascular lesions, the first three months after injury have the most important prognostic value. No correlations were found between survival, increased consciousness, and gender. The demographic and clinical characteristics of patients with chronic DOC can be used to predict long-term mortality in patients with chronic disorders of consciousness. Further research should be devoted to finding reliable predictors of recovery of consciousness. © 2021 by the authors. Licensee MDPI, Basel, Switzerland

Correction of Local Brain Temperature after Severe Brain Injury Using Hypothermia and Medical Microwave Radiometry (MWR) as Companion Diagnostics

The temperature of the brain can reflect the activity of its different regions, allowing us to evaluate the connections between them. A study involving 111 patients in a vegetative state or minimally conscious state used microwave radiometry to measure their cortical temperature. The patients were divided into a main group receiving a 10-day selective craniocerebral hypothermia (SCCH) procedure, and a control group receiving basic therapy and rehabilitation. The main group showed a significant improvement in consciousness level as measured by CRS-R assessment on day 14 compared to the control group. Temperature heterogeneity increased in patients who received SCCH, while remaining stable in the control group. The use of microwave radiometry to assess rehabilitation effectiveness and the inclusion of SCCH in rehabilitation programs appears to be a promising approach.journal articl

Neurogenic bladder dysfunction in patients emerged from chronic disorders of consciousness

The observational study aimed to analyse the neurogenic bladder dysfunction in patients during the recovery from the chronic disorder of consciousness. We compared aetiology, level of consciousness, age with the neurogenic bladder dysfunction in these cases. The study results suggested that the increase in the consciousness level partially restores the bladder function, which significantly reduces the risk of infections and somatic disorders, thereby affecting the duration and quality of life. Recovery of the bladder function also depends on the aetiology of the disorder of consciousness: patients in the anoxic group had the least chance of bladder function recovery making global brain ischaemia an unfavourable factor. Correlations between urination dysfunctions with age and level of consciousness at admission have not been found. © 2021 Science, Engineering and Health Studies. All rights reserved

Effect of retinohypothalamic tract dysfunction on melatonin level in patients with chronic disorders of consciousness

Objective: The aim of this study is to compare the secretion level of nocturnal melatonin and the characteristics of the peripheral part of the visual analyzer in patients with chronic disorders of consciousness (DOC). Materials and Methods: We studied the level of melatonin in 22 patients with chronic DOC and in 11 healthy volunteers. The fundus condition was assessed using the ophthalmoscopic method. Results: The average level of nocturnal melatonin in patients with DOC differed by 80% from the level of indole in healthy volunteers. This reveals a direct relationship between etiology, the level of consciousness, gaze fixation, coma recovery scale-revised score and the level of melatonin secretion. Examination by an ophthalmologist revealed a decrease in the macular reflex in a significant number of DOC patients, which in turn correlates negatively with the time from brain injury and positively with low values of nocturnal melatonin. © 2021 by the authors

Correction of Local Brain Temperature after Severe Brain Injury Using Hypothermia and Medical Microwave Radiometry (MWR) as Companion Diagnostics

The temperature of the brain can reflect the activity of its different regions, allowing us to evaluate the connections between them. A study involving 111 patients in a vegetative state or minimally conscious state used microwave radiometry to measure their cortical temperature. The patients were divided into a main group receiving a 10-day selective craniocerebral hypothermia (SCCH) procedure, and a control group receiving basic therapy and rehabilitation. The main group showed a significant improvement in consciousness level as measured by CRS-R assessment on day 14 compared to the control group. Temperature heterogeneity increased in patients who received SCCH, while remaining stable in the control group. The use of microwave radiometry to assess rehabilitation effectiveness and the inclusion of SCCH in rehabilitation programs appears to be a promising approach