Current Controversies in Newer Therapies to Treat Birth Asphyxia

Despite major advances in monitoring technology and knowledge of fetal and neonatal pathophysiology, neonatal hypoxic-ischemic encephalopathy (HIE) remains one of the main causes of severe adverse neurological outcome in children. Until recently, there were no therapies other than supportive measures. Over the past several years, mild hypothermia has been proven to be safe to treat HIE. Unfortunately, this neuroprotective strategy seems efficient in preventing brain injury in some asphyxiated newborns, but not in all of them. Thus, there is increasing interest to rapidly understand how to refine hypothermia therapy and add neuroprotective or neurorestorative strategies. Several promising newer treatments to treat birth asphyxia and prevent its devastating neurological consequences are currently being tested. In this paper, the physiopathology behind HIE, the currently available treatment, the potential alternatives, and the next steps before implementation of these other treatments are reviewed

Imaging of acute traumatic injuries of the thoracic aorta

Abstract.: Blunt traumatic aortic injuries are a major concern in the settings of high-speed deceleration accidents, since they are associated with a very high mortality rate; however, with prompt diagnosis and surgery, 70% of the patients with a blunt aortic lesion who reach the hospital alive will survive. This statement challenges the emergency radiologist in charge to evaluate the admission radiological survey in a severe chest trauma patient. With a 95% negative predictive value for the identification of blunt traumatic aortic lesions, plain chest film represents an adequate screening test. If aortography remains the gold standard, it tends, at least in hemodynamically stable trauma patients, to be replaced by spiral-CT angiography (SCTA), which demonstrates a 96.2% sensitivity, a 99.8% specificity, and a 99.7% accuracy. In unstable patients, trans-esophageal echography (TEE) plays a major diagnostic role. Knowledge of advantages and pitfalls of these imaging techniques, as reviewed in this article, will help the emergency radiologist to choose the appropriate algorithm in the diagnosis of traumatic aortic injury, for each trauma patien

Extracorporeal Membrane Oxygenation Use in Asphyxiated Newborns Treated with Hypothermia: Review of the Current Evidence

Asphyxiated newborns may be hemodynamically unstable during their first days of life. They often present with severe persistent pulmonary hypertension and/or cardiac dysfunction, which may require aggressive supportive management to maintain homeostasis and prevent further brain injury. In the most severe cases, extracorporeal membrane oxygenation (ECMO) may be required to ensure adequate oxygenation, ventilation and cardiac output. However, due to the risk of irreversible brain injury, clinicians often are concerned about offering ECMO to these newborns. Therapeutic hypothermia during the first days of life has become the standard of care for these newborns to improve their prognosis; however, this treatment in itself has been associated with increased hemodynamic instability and coagulopathy. An additional concern with using ECMO in these newborns is the potential increased bleeding risk when continuing the hypothermia treatment during the ECMO course. This chapter reviews the reported feasibility of performing hypothermia during ECMO. We also review the reported outcomes of asphyxiated newborns treated with hypothermia and ECMO and highlight their potential survival without neurodevelopmental impairments. Thus, ECMO should be considered as a therapeutic option for asphyxiated newborns treated with hypothermia

Automated versus manual post-processing of perfusion-CT data in patients with acute cerebral ischemia: influence on interobserver variability

The purpose of this study is to compare the variability of PCT results obtained by automatic selection of the arterial input function (AIF), venous output function (VOF) and symmetry axis versus manual selection. Imaging data from 30 PCT studies obtained as part of standard clinical stroke care at our institution in patients with suspected acute hemispheric ischemic stroke were retrospectively reviewed. Two observers performed the post-processing of 30 CTP datasets. Each observer processed the data twice, the first time employing manual selection of AIF, VOF and symmetry axis, and a second time using automated selection of these same parameters, with the user being allowed to adjust them whenever deemed appropriate. The volumes of infarct core and of total perfusion defect were recorded. The cerebral blood volume (CBV), cerebral blood flow (CBF), mean transit time (MTT) and blood-brain barrier permeability (BBBP) values in standardized regions of interest were recorded. Interobserver variability was quantified using the Bland and Altman's approach. Automated post-processing yielded lower coefficients of variation for the volume of the infarct core and the volume of the total perfusion defect (15.7% and 5.8%, respectively) compared to manual post-processing (31.0% and 12.2%, respectively). Automated post-processing yielded lower coefficients of variation for PCT values (11.3% for CBV, 9.7% for CBF, and 9.5% for MTT) compared to manual post-processing (23.7% for CBV, 32.8% for CBF, and 16.7% for MTT). Automated post-processing of PCT data improves interobserver agreement in measurements of CBV, CBF and MTT, as well as volume of infarct core and penumbra

The Impact of Ventilation on the Development of Brain Injury in Asphyxiated Newborns Treated with Hypothermia

Birth asphyxia and the resulting neonatal encephalopathy are a significant cause of mortality and long-term morbidity in children. Hypothermia is currently the only neuroprotective treatment to have been clinically tested in large trials to prevent the development of brain injury in some term asphyxiated newborns. Most of the asphyxiated newborns treated with hypothermia are intubated at birth as per resuscitation measures and remain on mechanical ventilation during some part of the hypothermia treatment or during the whole length of the treatment. They also may present with oxygenation problems. Very often, they present with hypocapnia that can be worsened with the use of mechanical ventilation during the first days of life. When taking care of these newborns, a few important points should be remembered about the impact of asphyxia and therapeutic hypothermia on oxygenation and ventilation. In this article, we review some of the physiopathology behind neonatal encephalopathy and the implications of brain cooling from a respiratory point of view. Strategies to optimize oxygenation and ventilation for these newborns, as well as to prevent further brain injury, are also discussed based on a current literature review

Fjernledelse under digitalisering

Fjernledelse som følge av digitaliseringen etter koronavirusutbruddet i 2020 har aldri vært så relevant. Med digitalisering i denne oppgaven menes en virtuell organisering bestående av hjemmekontor og digitale interaksjoner mellom leder og medarbeidere, og mellom kollegaer. Tidligere forskning hevdet at fysisk avstand nøytraliserer effektene av lederskapet grunnet reduserte sosiale interaksjoner. Formålet med studien var å få kunnskap om hvordan digitalisering påvirker ledernes mulighet til å utøve innflytelse på medarbeiderne. Utviklingen innen informasjons- og kommunikasjonsteknologi har bidratt til at man kan gjennomføre visuelle interaksjoner i sanntid. Problemstillingen i studien er: Hvordan har digitalisering påvirket fjernledelse i kunnskapsorganisasjoner? Det finnes lite forskning om fjernledelse, og spesielt i forhold til digitalisering. Det er bakgrunnen for valg av en kvalitativ metode ved intervju av tre fjernledere fra en kunnskapsorganisasjon. For å svare på problemstillingen er det utviklet tre åpne forskningsspørsmål som tar for seg sentrale elementer i lederskapet: tillit, makt og tilhørighet. Hensikten er å studere hvordan ledere opplever at disse elementene varierer under digitalisering, i forhold til fjernledelse. Konklusjonen på oppgaven tyder på at digitalisering kan bidra til et mer inkluderende lederskap i forhold til en distribuert organisering, fordi alle medlemmene i teamet stiller med like forutsetninger. I tillegg peker resultatene på at digitalisering kan medføre en større faglig og sosial avhengighet mellom leder og kunnskapsarbeidere, som igjen øker behovet og mulighetene for relasjonell tillit og normativ makt. Ledermakt ser ut til å være svekket under digitalisering fordi det er vanskeligere å måle innsats, men også fordi ledere opplever redusert kontroll over verdifulle ressurser som medarbeiderne ønsker seg. Digital avstand som følge av digitalisering tydeliggjør viktigheten av tillit, tilgjengelighet og relasjonsutvikling i lederskapet. Digitalisering gjør det mulig å bygge, samt bevare relasjoner ved fysisk avstand, men det krever mer innsats av lederen som må ha fokus på relasjonelle og emosjonelle ferdigheter. Selv om det er mulig å utvikle en kultur for samarbeid og trygghet digitalt, så viser funnene at en mulig kombinasjon av fysisk og digital samhandling for fremtiden er å foretrekke

Perfusion computed tomography relative threshold values in definition of acute stroke lesions

BACKGROUND: Perfusion computed tomography (CT) is a relatively new technique that allows fast evaluation of cerebral hemodynamics by providing perfusion maps and gives confirmation of perfusion deficits in ischemic areas. Some controversies exist regarding accuracy of quantitative detection of tissue viability: penumbra (tissue at risk) or core (necrosis). PURPOSE: To define brain tissue viability grade on the basis of the perfusion CT parameters in acute stroke patients. MATERIAL AND METHODS: A multimodal CT imaging protocol; unenhanced CT of the brain, CT angiography of head and neck blood vessels, followed by brain perfusion CT and 24 h follow-up brain CT was performed. Perfusion deficits were detected first visually, with subsequent manual quantitative and relative measurements in affected and contra-lateral hemisphere in 87 acute stroke patients. RESULTS: Visual perfusion deficit on perfusion CT images was found in 78 cases (38 women, 40 men; mean age, 30-84 years). Penumbra lesions (n = 49) and core lesions (n = 42) were detected by increased mean transit time (MTT) on perfusion CT maps in comparison to contra-lateral hemispheres. Cerebral blood volume (CBV) mean values in the penumbra group were increased in the penumbra group and decreased in the core group. Cerebral blood flow (CBF) values were decreased in penumbra and markedly decreased in core lesion. CONCLUSION: Perfusion CT measurements are reliable in estimation of penumbra and core lesions in acute stroke patients, if relative threshold values are used. The most accurate parameter of hypoperfusion is increased MTT above 190%. Relative threshold values for irreversible lesion are CBFpublishersversionPeer reviewe

Pneumothorax and subcutaneous emphysema secondary to blunt chest injury

This is the case of a patient with a history of blunt chest trauma associated with subcutaneous emphysema and pneumothorax. The patient complained of inspiratory stridor on presentation. Anatomical relationships can explain the pathophysiological process