Scoping Review on the Diagnosis, Prognosis, and Treatment of Pediatric Disorders of Consciousness.

peer reviewed[en] BACKGROUND AND OBJECTIVES: Comprehensive guidelines for diagnosis, prognosis, and treatments of disorders of consciousness (DoCs) in pediatric patients have not yet been released. We aim to summarize available evidence for DoCs with >14 days duration, to support the future development of guidelines for children aged 6 months to 18 years. METHODS: This scoping review was reported based on PRISMA-ScR guidelines. A systematic search identified records from 4 databases: PubMed, Embase, Cochrane Library, and Web of Science. Abstracts received 3-blind reviews. Corresponding full-text articles rated as "in-scope" and reporting data not published in any other retained article (i.e., no double reporting) were identified and assigned to 5 thematic evaluating teams. Full-text articles were reviewed using a double-blind standardized form. Level of evidence was graded, and summative statements were generated. RESULTS: On November 9, 2022, 2167 documents had been identified; 132 articles were retained, of which 33 (25%) were published over the last 5 years. Overall, 2161 individuals met the inclusion criteria; female patients were 527 of 1554 (33.9%) cases included, whose sex was identifiable. Of 132 articles, 57 (43.2%) were single case reports, and only 5 (3.8%) clinical trials; the level of evidence was prevalently low (80/132; 60.6%). Most studies included neurobehavioral measures (84/127; 66.1%), and neuroimaging (81/127; 63.8%); 59 (46.5%) were mainly related to diagnosis, 56 (44.1%) to prognosis, and 44 (34.6%) to treatment. Most frequently used neurobehavioral tools included the Coma Recovery Scale-Revised, Coma/Near Coma Scale, Level of Cognitive Functioning Assessment Scale and Post-Acute Level of Consciousness scale. Electroencephalography, event related potentials, structural computerized tomography and Magnetic Resonance Imaging were the most frequently used instrumental techniques. In 29/53 (54.7%) cases DoC improvement was observed, which was associated to treatment with amantadine. DISCUSSION: The literature on pediatric DoCs is mainly observational, and clinical details are either inconsistently presented or absent. Conclusions drawn from many studies convey insubstantial evidence, and have limited validity, and low potential for translation in clinical practice. Despite these limitations, our work summarizes the extant literature and constitutes a base for future guidelines related to diagnosis, prognosis and treatment of pediatric DoCs

Three-dimensional analysis of Eu dopant atoms in Ca-alpha-SiAlON via through-focus HAADF-STEM imaging

Three-dimensional (3D) distributional analysis of individual dopant atoms in materials is important to development of optical, electronic, and magnetic materials. In this study, we adopted through-focus high-angle annular dark-field (HAADF) imaging for 3D distributional analysis of Eu dopant atoms in Ca-alpha-SiAION phosphors. In this context, the effects of convergence semi-angle and Eu z-position on the HAADF image contrast were investigated. Multi-slice image simulation revealed that the contrast of the dopant site was sensitive to change of the defocus level. When the defocus level matched the depth position of a Eu atom, the contrast intensity was significantly increased. The large convergence semi angle greatly increased the depth resolution because the electron beam tends spread instead of channeling along the atomic columns. Through-focus HAADF-STEM imaging was used to analyze the Eu atom distribution surrounding 10nm cubes with defocus steps of 0.68nm each. The contrast depth profile recorded with a narrow step width clearly analyzed the possible depth positions of Eu atoms. The radial distribution function obtained for the Eu dopants was analyzed using an atomic distribution model that was based on the assumption of random distribution. The result suggested that the Ca concentration did not affect the Eu distribution. The decreased fraction of neighboring Eu atoms along z-direction might be caused by the enhanced short-range Coulomb-like repulsive forces along the z-direction. (C) 2017 Elsevier B.V. All rights reserved

The safety and feasibility of transcranial direct current stimulation for patients with chronic severe traumatic brain injury in Japan, a phase I study

Background: Despite evidence regarding the benefits of transcranial direct current stimulation (tDCS) in patients with severe traumatic brain injury, few trials have examined the treatment safety. Therefore, we created a phase I trial in Japan to investigate the safety of tDCS after severe brain injury. Methods: We verified the safety of tDCS through constant left frontal anodal stimulation at 2 mA for 20 min for 5 consecutive days. Additionally, we added a variable stimuli period to explore the effects of stimulus intensity, location, and duration. We adapted a traditional 3 + 3 study design. We assessed the rate of adverse effects, including skin burns and clinical seizure. Changes in neurological symptoms were evaluated using the Glasgow Coma Scale, Coma Recovery Scale-Revised, and 4 states of consciousness (coma, unresponsive wakefulness syndrome, minimally conscious state, and severe disability). Results: Six patients completed the study. No obvious adverse events were observed during the constant stimulation period or the variable stimulation period (right frontal anodal stimulation, stimulation frequency 2–4 mA, 1 or 5 times per week for a period of 4 weeks). Regarding the Coma Recovery Scale-Revised, patients in 4 out of 6 instances (66.7 %) improved by more than 1 point. Conclusion: Our phase I safety study indicated that a single course of tDCS was safe in patients with severe traumatic brain injury. The next step is a phase II trial to investigate the preliminary efficacy and safety of tDCS at 2 mA (in comparison with sham stimulation)

Association between uncooperativeness and the glucose metabolism of patients with chronic behavioral disorders after severe traumatic brain injury: a cross-sectional retrospective study

Abstract Bakground Patients with behavioral disorders following severe traumatic brain injury (sTBI) often have disorders of consciousness that make expressing their emotional distress difficult. However, no standard method for assessing the unsettled and unforeseen responses that are associated with behavioral disorders has yet to be established. Because the thalamus is known to play a role in maintaining consciousness and cognition, we used 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) to examine the association between brain glucose metabolism in the thalamus and behavioral disorders. Methods We retrospectively analyzed 70 consecutive patients with sTBI who had been involved in motor vehicle accidents. To assess behavioral disorders, we evaluated 18 symptoms using the Brief Psychiatric Rating Scale (BPRS): Emotional Withdrawal, Conceptual Disorganization, Tension, Mannerisms and Posturing, Motor Retardation, Uncooperativeness, Blunted Affect, Excitement, Somatic Concern, Anxiety, Feeling of Guilt, Grandiosity, Depressive Mood, Hostility, Suspiciousness, Hallucinatory Behavior, Unusual Thought Content, and Disorientation. First, we identified clinical characteristics of sTBI patients with behavioral disorders. Next, we retrospectively analyzed 18F-FDG-PET/CT data to assess how thalamic activity was related with abnormal behaviors. Results Twenty-six patients possessed the minimum communicatory ability required for psychiatric interview. Among them, 15 patients (57.7%) were diagnosed with behavioral disorder, 14 of whom had reached a stable psychiatric state after about 426.6 days of treatment. Excitement (13 patients) and uncooperativeness (10 patients) were the most frequently observed symptoms. Available 18F-FDG-PET/CT data indicated that thalamic glucose metabolism was imbalanced and lateralized (p = 0.04) in 6 patients who exhibited uncooperativeness. Conclusions Behavioral symptoms of excitement and uncooperativeness were common in patients with sTBI, although most symptoms improved as the chronic stage continued. Our data support the idea that imbalanced laterality of glucose metabolism in the thalamus might be related to behavioral disorders characterized by uncooperativeness. Trial registration UMIN 000029531. Registered 27 March 2017, retrospectively registered

Activity enhancement of platinum oxygen-reduction electrocatalysts using ion-beam induced defects

High activity is one of the primary requirements for the catalysts in proton exchange membrane fuel cell applications. Platinum (Pt) is the best-known catalyst especially for oxygen reduction at the cathode; however, further activity improvements are still required. Previous computational studies suggested that the catalytic activity of Pt nanoparticles could be enhanced by a Pt−carbon support interaction. We have recently found that an enhanced electronic interaction occurs at the interface between an argon-ion (Ar+)-irradiated glassy carbon (GC) surface and Pt nanoparticles. Here, we report a more than two-fold increase in specific activity (SA) for the Pt nanoparticles on the Ar+-irradiated GC substrate compared to that on the non-irradiated GC substrate. The mechanism of this activity enhancement was investigated by local structure analysis of the interface. Ar+ irradiation of the carbon support led to the formation of the Pt−C bonding, thus protecting the deposited Pt nanoparticles from oxidation

Activity enhancement of platinum oxygen-reduction electrocatalysts using ion-beam induced defects

High activity is one of the primary requirements for the catalysts in proton exchange membrane fuel cell applications. Platinum (Pt) is the best known catalyst, especially for oxygen reduction at the cathode; however, further activity improvements are still required. Previous computational studies suggested that the catalytic activity of Pt nanoparticles could be enhanced by a Pt-carbon (C) support interaction. We have recently found that an enhanced electronic interaction occurs at the interface between an argon-ion (Ar+)-irradiated glassy carbon (GC) surface and Pt nanoparticles. Here, we report a more than twofold increase in specific activity for the Pt nanoparticles on the Ar+-irradiated GC substrate compared to that on the nonirradiated GC substrate. The mechanism of this activity enhancement was investigated by local structure analysis of the interface. Ar+ irradiation of the carbon support led to the formation of Pt-C bonding, thus protecting the deposited Pt nanoparticles from oxidation

Additional file 1: of Association between uncooperativeness and the glucose metabolism of patients with chronic behavioral disorders after severe traumatic brain injury: a cross-sectional retrospective study

Figure S1. Representative images of a three-dimensional volume of interest measurement (a) and color mapped image (b) of glucose metabolism measured via 18F-fluorodeoxyglucose positron emission tomography/computed tomography. (PPTX 380 kb

Additional file 2: of Association between uncooperativeness and the glucose metabolism of patients with chronic behavioral disorders after severe traumatic brain injury: a cross-sectional retrospective study

Table S1. Comparison between the patients who were evaluated for psychiatric assessment (the evaluable group) and those who could not be assessed (the unevaluable group). (DOCX 18 kb

Additional file 4: of Association between uncooperativeness and the glucose metabolism of patients with chronic behavioral disorders after severe traumatic brain injury: a cross-sectional retrospective study

Figure S2. All available 18F-fluorodeoxyglucose positron emission tomography/computed tomography images for the 14 patients who had severe traumatic brain injury with or without a behavioral disorder. (PPTX 885 kb