Author: Bc. Alice Pernicová Title: Motor and cognitive consequences of hypoxic-ischemic damage Objectives: The aim of this diploma work was asses the impact of Enriched Environment on development of rats after hypoxic-ischemic damage. Methods: Experiment was performed in 30 Long Evans rats from breeding in Institute of Physiology, Academy of Sciences of the Czech Republic. All rats were operated for dissection of carotid. Than randomly were half of rats chosen for hypoxic-ischemic damage. Group with hypoxic-ischemic damage were divided into control and experimental group, same procedure was with rats without HIE. For one week were rats from experimental group in special Enriched Environment cage, than they were split into smaller cages with Enriched Environment. Rats from control groups were in normal cages without special equipment. After defined time were all rats tested by chosen test: Reaching test, Ladder rung walking test, Bar holding test, Rotarod test, Morris water maze test, Open filed test. For data analysis were used Microsoft Excel 365, Sigma plot. Results: Results of test showed, that Enriched Environment can positively enhance motoric and cognitive deficit in rat development with hypoxic-ischemic damage. But it is obvious, that Enriched Environment can positively enhance development...

O presente trabalho objetivou explorar a eventual variação da expressão do mRNA e da proteína S100b no hipocampo, cerebelo e córtex cerebral de ratos neonatos em condições de anóxia, comparativamente à condições controle. Este estudo foi desenvolvido em ratos albinos, divididos em dois grupos: o grupo Experimental Anóxia (EA) e o grupo Experimental Controle (EC), que por sua vez foram subdivididos em tempos de 2, 4, 6, 12 e 24 horas no que se refere à coleta de amostras após a aplicação dos estímulos pré-estabelecidos para cada grupo. Dos períodos avaliados, nossos resultados indicaram que a anóxia proporcionou um pico na expressão gênica de S100b após duas horas e proteica após 4 horas nas áreas do hipocampo e cerebelo. O córtex cerebral do grupo EA quando comparado ao grupo EC, não apresentou nenhum aumento significante de S100b nos períodos avaliados. Os resultados obtidos contribuem de forma crucial para elucidação do papel da proteína S100b como biomarcadora na EHI, bem como no esclarecimento parcial da função deste gene com relação à fisiopatologia da doença. / The aim of the present study was to investigate the temporal variation in the expression of S100b mRNA and protein in the hippocampus, cerebellum, and cerebral cortex of newborn rats under conditions of anoxia compared with control rats. The study was performed using two groups albino rats: Experimental Anoxia (EA) and Experimental Control (EC). The animals in both EA and EC were distributed in the following subgroups relative to the time elapsed since the application of the stimuli predefined for each group: two, four, six, 12, and 24 hours. Anoxia induced a peak in the S100b gene expression after two hours and protein expression after 4 hours in the hippocampus and cerebellum. With respect to the cerebral cortex, S100b never exhibited a significant increase in the EA group compared with the EC group. The results of the present study represent a crucial contribution to the elucidation of the role protein S100b plays as a biomarker in HIE, as well as a contribution to the elucidation of the role the corresponding gene plays in the physiopathology of the disease.

<p>Hypoxic ischemic encephalopathy (HIE) is a serious birth complication of full term infants; 40-60% of affected infants die by 2 years or have severe disabilities. Infants with HIE often have a normal gestation and parents anticipate a healthy birth. HIE can be managed with aggressively with moderate hypothermia < 6 hours of life, cardiopulmonary support, and seizure management. Experimental interventions such as moderate hypothermia > 6 hours of life and umbilical cord stem cell transplant are also available. Additional decision-making for these infants may include long-term developmental therapy, nutritional support, and respiratory support. However, who makes these decisions, what factors influence decision-making and the long-term impact of decision-making on parents and health care providers remains unknown. Therefore, the purpose of this study was to explore parental and health care provider decision-making for infants with HIE.</p><p>A longitudinal case study design was used to study 11 cases of infants with HIE. Each case included the infant, the parent, and the infant's providers. Infant medical record data, interviews and questionnaires were used to collect data from infant birth through 6 months of age. Content analysis was used to analyze the interviews. Descriptive statistics were used with the questionnaires. Visualization techniques were used to search for patterns and trends in the assembled data. </p><p>All infants required resuscitation and their treatment plans included aggressive care or aggressive and experimental care. The level of parental participation varied with in the first week of life depending on whether the infant was enrolled in experimental interventions plus aggressive care or only aggressive care. Parental hopefulness was lower in parents of infants who received experimental interventions, but the infants receiving experimental interventions were less critically ill than infants who received aggressive care only. Parental stress was also lower among parents of infants who received experimental interventions over the first 2 months of life. </p><p>Parents were concerned about the short and long-term impact of HIE, few parents understood that even though their infant had appropriate developmental outcomes at 6-months that did mean that neurological damage occurred. However in one case of an infant, the neurological development became central to the parental decision-making for the infant. Parents became less hopeful as diagnostic examinations continued find more complex conditions that were individually not problematic for the parents, but when the complexity of the infant's illnesses continued to unfold, parents feared that too many complications existed for their daughter to have an acceptable quality of life. Yet, when parents broached the topic of transitioning from aggressive care to palliative care with providers, they were told that withholding/withdrawing treatment was not appropriate for the infant. Not discussing withholding or withdrawing treatment ultimately created conflict between parents and providers due to differences in opinions about the predicted neurological outcomes for the infant. The conflict led to distrust and parents regretted most decisions they made for their infant. </p><p>Parental and provider decision-making is complex and many of the decisions within the 6-month trajectory were made within the first 6 hours of birth. Parents felt that the decision-making was appropriate in most cases, but the extent of the infant's injury remains unknown. How parents will evaluate the decision-making when the infant begins to miss developmental milestones is unknown. Results from this dissertation suggest that decision-making is a trajectory and decisions are not made in isolation. Implications for practice include discussing and educating parents during the first 6 months and later about developmental milestones and the importance of continuing therapy, even when the infant appears normal. Providers can also acknowledge to parents, up front, that the extent of the neurological injury is unknown and different providers may have different opinions about the long-term effects. By acknowledging these differences, providers can begin discussing the treatment options with parents and educating them about the specific needs of their infant.</p> / Dissertation

A participação de marcadores bioquímicos na avaliação de quadros de asfixia neonatal é cada vez mais relevante. A proteína S100B tem um papel destacado nestas pesquisas. O objetivo deste estudo foi procurar destacar a importância da proteína S100B na avaliação de recém-nascidos a termo com quadros de encefalopatia hipóxico-isquêmica, assim como correlacionar com outras substâncias que também participam do processo isquêmico. Foram analisados 21 casos de recém-nascidos a termo que desenvolveram quadro de encefalopatia hipóxico-isquêmica, no período de setembro de 2003 a outubro de 2004. Realizadas coletas no 1º e 4º dia de vida e dosadas, por método imunocitoquímico, a proteína S100B e o lactato. Foi possível detectar uma correlação positiva entre as 2 substâncias, assim como, quando comparadas entre si, observou-se também significância estatística. / Biochemical markers have played an increasingly relevant role in the assessment of neonatal asphyxia. The S100B protein is particularly important in research conducted in this field. The purpose of this study was to underline the importance of S100B protein in the assessment of term newborn infants with hypoxic ischemic encephalopathy, as well as to relate it to other substances also involved in the ischemic process. An assessment was made from September 2003 to October 2004 of twenty-one term newborn infants who developed hypoxic ischemic encephalopathy. Samples were collected on the 1st and 4th day of life and S100B protein and lactate levels were calculated using the immune cytochemical method. A positive relationship was found between the 2 substances. Additionally, a comparison between the two substances showed a statistically significant correlation.

A participação de marcadores bioquímicos na avaliação de quadros de asfixia neonatal é cada vez mais relevante. A proteína S100B tem um papel destacado nestas pesquisas. O objetivo deste estudo foi procurar destacar a importância da proteína S100B na avaliação de recém-nascidos a termo com quadros de encefalopatia hipóxico-isquêmica, assim como correlacionar com outras substâncias que também participam do processo isquêmico. Foram analisados 21 casos de recém-nascidos a termo que desenvolveram quadro de encefalopatia hipóxico-isquêmica, no período de setembro de 2003 a outubro de 2004. Realizadas coletas no 1º e 4º dia de vida e dosadas, por método imunocitoquímico, a proteína S100B e o lactato. Foi possível detectar uma correlação positiva entre as 2 substâncias, assim como, quando comparadas entre si, observou-se também significância estatística. / Biochemical markers have played an increasingly relevant role in the assessment of neonatal asphyxia. The S100B protein is particularly important in research conducted in this field. The purpose of this study was to underline the importance of S100B protein in the assessment of term newborn infants with hypoxic ischemic encephalopathy, as well as to relate it to other substances also involved in the ischemic process. An assessment was made from September 2003 to October 2004 of twenty-one term newborn infants who developed hypoxic ischemic encephalopathy. Samples were collected on the 1st and 4th day of life and S100B protein and lactate levels were calculated using the immune cytochemical method. A positive relationship was found between the 2 substances. Additionally, a comparison between the two substances showed a statistically significant correlation.

A participação de marcadores bioquímicos na avaliação de quadros de asfixia neonatal é cada vez mais relevante. A proteína S100B tem um papel destacado nestas pesquisas. O objetivo deste estudo foi procurar destacar a importância da proteína S100B na avaliação de recém-nascidos a termo com quadros de encefalopatia hipóxico-isquêmica, assim como correlacionar com outras substâncias que também participam do processo isquêmico. Foram analisados 21 casos de recém-nascidos a termo que desenvolveram quadro de encefalopatia hipóxico-isquêmica, no período de setembro de 2003 a outubro de 2004. Realizadas coletas no 1º e 4º dia de vida e dosadas, por método imunocitoquímico, a proteína S100B e o lactato. Foi possível detectar uma correlação positiva entre as 2 substâncias, assim como, quando comparadas entre si, observou-se também significância estatística. / Biochemical markers have played an increasingly relevant role in the assessment of neonatal asphyxia. The S100B protein is particularly important in research conducted in this field. The purpose of this study was to underline the importance of S100B protein in the assessment of term newborn infants with hypoxic ischemic encephalopathy, as well as to relate it to other substances also involved in the ischemic process. An assessment was made from September 2003 to October 2004 of twenty-one term newborn infants who developed hypoxic ischemic encephalopathy. Samples were collected on the 1st and 4th day of life and S100B protein and lactate levels were calculated using the immune cytochemical method. A positive relationship was found between the 2 substances. Additionally, a comparison between the two substances showed a statistically significant correlation.

O presente trabalho objetivou explorar a eventual variação da expressão do mRNA e da proteína S100b no hipocampo, cerebelo e córtex cerebral de ratos neonatos em condições de anóxia, comparativamente à condições controle. Este estudo foi desenvolvido em ratos albinos, divididos em dois grupos: o grupo Experimental Anóxia (EA) e o grupo Experimental Controle (EC), que por sua vez foram subdivididos em tempos de 2, 4, 6, 12 e 24 horas no que se refere à coleta de amostras após a aplicação dos estímulos pré-estabelecidos para cada grupo. Dos períodos avaliados, nossos resultados indicaram que a anóxia proporcionou um pico na expressão gênica de S100b após duas horas e proteica após 4 horas nas áreas do hipocampo e cerebelo. O córtex cerebral do grupo EA quando comparado ao grupo EC, não apresentou nenhum aumento significante de S100b nos períodos avaliados. Os resultados obtidos contribuem de forma crucial para elucidação do papel da proteína S100b como biomarcadora na EHI, bem como no esclarecimento parcial da função deste gene com relação à fisiopatologia da doença. / The aim of the present study was to investigate the temporal variation in the expression of S100b mRNA and protein in the hippocampus, cerebellum, and cerebral cortex of newborn rats under conditions of anoxia compared with control rats. The study was performed using two groups albino rats: Experimental Anoxia (EA) and Experimental Control (EC). The animals in both EA and EC were distributed in the following subgroups relative to the time elapsed since the application of the stimuli predefined for each group: two, four, six, 12, and 24 hours. Anoxia induced a peak in the S100b gene expression after two hours and protein expression after 4 hours in the hippocampus and cerebellum. With respect to the cerebral cortex, S100b never exhibited a significant increase in the EA group compared with the EC group. The results of the present study represent a crucial contribution to the elucidation of the role protein S100b plays as a biomarker in HIE, as well as a contribution to the elucidation of the role the corresponding gene plays in the physiopathology of the disease.

Neonatal asphyxia is the third largest cause of neonatal mortality in Vietnam, and many of the surviving patients suffer from permanent brain damage. A cooling mattress used for treatment of infants suffering from asphyxia has been shown to have problems with providing a stable body temperature for the patients. The main purpose of this project is to assess potential problems with routines and the use of the most central technical equipment used to treat newborns suffering from asphyxia, as well as constructing a phantom to simulate a newborn infant in the process of cooling. The purpose of the simulation is to investigate new methods of using the cooling mattress to achieve a more stable body temperature when cooling the patient. The project was done at Phu San Hostpial and Vietnam National Children's Hospital in Hanoi, Vietnam. The technical evaluation was conducted with observations, interviews and a question form. The results showed that there were issues with the sensors connected to the ventilators, noise level from alarms and routines concerning sanitation. The phantom was based on a water bottle, an interest heater and a pump to mix the water. It proved not possible to construct a phantom that met the necessary criteria. / Asfyxi hos nyfödda är den tredje största orsaken till neonatal dödlighet i Vietnam, och många av de överlevande får permanenta hjärnskador. En nedkylningsmadrass som används till behandling av nyfödda med asfyxi har visat sig ha problem med att hålla patientens kroppstemperatur stabil. Arbetets huvudsakliga syfte är att undersöka potentiella problem med rutiner och användningen av den viktigaste tekniken vid behandling av nyfödda som lider av asfyxi, samt även konstruera en fantom som ska kunna simulera en nyfödd vid nedkylning. Simuleringen har som syfte att undersöka nya användningsmetoder av nedkylningsmadrassen för att uppnå en mer stabil kroppstemperatur hos patienten. Arbetet gjordes vid Phu San Hospital, och National Children’s Hospital i Hanoi, Vietnam. Utvärderingen av teknikens användning gjordes via observationer, intervjuer och ett frågeformulär. Resultaten sammanställdes för att hitta potentiella förbättringar till teknikens användning. Det framkom problem med sensorerna kopplat till ventilatorerna, ljudnivån från alarmer och rutiner kring sanitering. Fantomet baserades på en vattenflaska, en doppvärmare och en pump som blandade vattnet. Det visade sig inte vara möjligt att konstruera en fantom som uppfyllde alla kriterier med de resurser som var tillgängliga.

No description available.

We studied Heart Rate Variability (HRV) evolution during therapeutic hypothermia in newborns with hypoxic ischemic encephalopathy (HIE) using spectral analysis. We hypothesized that HRV measures are predictive of neurological outcome in babies with HIE. Non-stationarity in the data causes inaccurate quantification of the spectral power. A modification was proposed to power spectral analysis approach to mitigate the effect of non-stationarity. The modified and the standard approaches were applied to cardiac beat-to-beat intervals of newborns receiving hypothermia treatment. The performance of the approaches in distinguishing the RRi dynamics of two groups of newborns was assessed using area under the receiver operating characteristic (ROC) curve. Our results showed that the modified spectral analysis distinguished the two groups of neonates better than the standard approach. These results may be useful in identifying the deteriorating physiology of the infants receiving hypothermia treatment early in time and strategize alternate interventions for them.