Neurologic Outcomes After Prenatal Treatment of Twin-Twin Transfusion Syndrome

Introduction: There is a paucity of data evaluating the impact of heart rate (HR) during Targeted Temperature Management (TTM) and neurologic outcomes. Current resuscitation guidelines do not specify a HR goal during TTM. We sought to determine the relationship between HR and neurologic outcomes in a single-center registry dataset. Methods: We retrospectively studied 432 consecutive patients who completed TTM (33°C) after cardiac arrest from 2008 to 2017. We evaluated the relationship between neurologic outcomes and HR during TTM. Pittsburgh Cerebral Performance Categories (CPC) at discharge were used to determine neurological recovery. Statistical analysis included chi square, Student’s t-test and Mann-Whitney U. A logistic regression model was created to evaluate the strength of contribution of selected variables on the outcome of interest. Results: Approximately 94,000 HR data points from 432 patients were retrospectively analyzed; the mean HR was 82.17 bpm over the duration of TTM. Favorable neurological outcomes were seen in 160 (37%) patients. The mean HR in the patients with a favorable outcome was lower than the mean HR of those with an unfavorable outcome (79.98 bpm vs 85.67 bpm p < 0.001). Patients with an average HR of 60-91 bpm were 2.4 times more likely to have a favorable neurological outcome compared to than HR’s < 60 or > 91 (odds ratio [OR] = 2.36, 95% confidence interval [CI] 1.61-3.46, p < 0.001). Specifically, mean HR’s in the 73-82 bpm range had the greatest rate of favorable outcomes (OR 3.56, 95% CI 1.95-6.50), p < 0.001. Administration of epinephrine, a history of diabetes mellitus and hypertension all were associated with worse neurological outcomes independent of HR. Conclusion: During TTM, mean HRs between 60-91 showed a positive association with favorable outcomes. It is unclear whether a specific HR should be targeted during TTM or if heart rates between 60-91 bpm might be a sign of less neurological damage.

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Prenatal treatment with rapamycin restores enhanced hippocampal mGluR-LTD and mushroom spine size in a Down’s syndrome mouse model

Molecular Brain ◽

10.1186/s13041-021-00795-6 ◽

2021 ◽

Vol 14 (1) ◽

Author(s):

Jesús David Urbano-Gámez ◽

Juan José Casañas ◽

Itziar Benito ◽

María Luz Montesinos

Keyword(s):

Intellectual Disability ◽

Pyramidal Neurons ◽

Metabotropic Glutamate Receptor ◽

Therapeutic Potential ◽

Mammalian Target Of Rapamycin ◽

Memory Deficits ◽

Prenatal Treatment ◽

Hippocampal Pyramidal Neurons ◽

Metabotropic Glutamate ◽

Mushroom Spines

AbstractDown syndrome (DS) is the most frequent genetic cause of intellectual disability including hippocampal-dependent memory deficits. We have previously reported hippocampal mTOR (mammalian target of rapamycin) hyperactivation, and related plasticity as well as memory deficits in Ts1Cje mice, a DS experimental model. Here we characterize the proteome of hippocampal synaptoneurosomes (SNs) from these mice, and found a predicted alteration of synaptic plasticity pathways, including long term depression (LTD). Accordingly, mGluR-LTD (metabotropic Glutamate Receptor-LTD) is enhanced in the hippocampus of Ts1Cje mice and this is correlated with an increased proportion of a particular category of mushroom spines in hippocampal pyramidal neurons. Remarkably, prenatal treatment of these mice with rapamycin has a positive pharmacological effect on both phenotypes, supporting the therapeutic potential of rapamycin/rapalogs for DS intellectual disability.

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Effect of Out-of-Hospital Tranexamic Acid vs Placebo on 6-Month Functional Neurologic Outcomes in Patients With Moderate or Severe Traumatic Brain Injury

JAMA ◽

10.1001/jama.2020.8958 ◽

2020 ◽

Vol 324 (10) ◽

pp. 961 ◽

Cited By ~ 11

Author(s):

Susan E. Rowell ◽

Eric N. Meier ◽

Barbara McKnight ◽

Delores Kannas ◽

Susanne May ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Tranexamic Acid ◽

Severe Traumatic Brain Injury ◽

Neurologic Outcomes

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Effects of fetal corticosteroid treatments on postnatal surfactant function in preterm lambs

Journal of Applied Physiology ◽

10.1152/jappl.1995.79.3.846 ◽

1995 ◽

Vol 79 (3) ◽

pp. 846-851 ◽

Cited By ~ 14

Author(s):

T. Ueda ◽

M. Ikegami ◽

D. Polk ◽

K. Mizuno ◽

A. Jobe

Keyword(s):

Surface Area ◽

Dynamic Compliance ◽

Alveolar Space ◽

Prenatal Treatment ◽

Ultrasound Guided ◽

Functional Characteristics ◽

Arterial Pco2 ◽

Alveolar Surfactant ◽

Pool Sizes

Effects of prenatal corticosteroid on the properties of surfactant have not previously been evaluated. A single ultrasound-guided fetal injection with 0.5 mg/kg betamethasone 48 h before delivery of preterm lambs at 134- to 135-days gestation improved oxygenation, lowered the ventilatory pressures required to maintain arterial PCO2 between 30 and 40 Torr and decreased the protein leak of albumin from the intravascular to the alveolar space. This dose of glucocorticoid did not alter surfactant-saturated phosphatidylcholine pool sizes in the airspaces of preterm lambs. However, the treatment changed the characteristics of the surfactant recovered from the ventilated preterm lambs. The in vitro conversion from heavy to light subtype surfactant decreased from 59% for the saline-treated lambs to 37% for the corticosteroid-treated lambs after 180 min of surface area cycling (P < 0.02). Surfactant from the corticosteroid-treated lambs also increased the dynamic compliance of preterm surfactant-deficient rabbits more than did surfactant from the saline-treated lambs (P < 0.05). Prenatal treatment of preterm lambs with betamethasone improved the functional characteristics of surfactant without significant effects on the alveolar surfactant pool sizes.

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