Damage Factor Research Articles

Identifying risk factors for wheelchair damage, part failure, and adverse consequences to the user

No tools or technologies exist to inform data-driven inspection schedules for wheelchairs. To develop such a schedule, this study identifies risk factors linked with manual wheelchair damage, part failures, and consequences and evaluates preferences for a new wheelchair servicing technology. A mixed methods study was performed with manual wheelchair users at The Ohio State University Martha Morehouse Clinic. Demographic data, wheelchair information, failure counts, and consequences suffered by the user were collected using surveys. Wheelchair usage was collected for a month using a sensor. A servicing smartphone app that connects with the sensor was demonstrated as a new servicing technology, and participant preferences were recorded. Thirty participants completed the survey testing procedures. Twenty-three collected usage data and eighteen collected it for over a week. At least 215 wheelchair part failures with an average of 13.4 ± 14.8 self-reported part failures and 4.7 ± 4.8 high-risk failures occurred in 12 months before the first study visit. Two weeks of collected data from 18 participants showed that normalised road shocks, age, and weight were associated with the condition of wheels and frames, as well as self-reported caster failures. Participants responded with a favourable preference for the new wheelchair servicing technology, with more than half of them interested in buying and using it. Risk factors like road shocks and user’s age and weight are associated with part damage towards failures and self-reported failures that risk injury. These factors can be modelled to develop and test the efficacy of wheelchair inspection schedules.

Arterial Stiffness as a New Predictor of Clinical Outcome in Patients with Polycythemia Vera

Background: Thrombotic adverse events and disease progression are crucial in Polycythemia Vera (PV), as it stands as the leading cause of mortality. The pulse wave velocity (PWV) is a valuable indicator of arterial aging and often plays a significant independent role in contributing to cardiovascular adverse events (CV-AEs). The aim of this study was to examine the relationship between PWV and critical vascular function parameters, with the goal of identifying new predictive factors of vascular damage and exploring a potential connection with disease progression. Methods: Non-invasive aortic stiffness was assessed through carotid–femoral PWV measurement. PWV was measured using the SphygmoCor device. History of arterial or venous thrombosis (TAEs) or other CV-AEs was collected at baseline. PWV measurements were repeated at baseline, at 6 and at 12 months. Results: The study involved 28 PV patients aged 27 to 77 years, with 57.1% being male. Fourteen patients (50%) reported a high-risk thrombotic score at diagnosis, and 60.7% had at least one comorbidity. Multivariable regression models showed that hemoglobin levels were independently associated with PWV (β: 0.68, SE 0.24, p < 0.01). During the follow-up period (median duration 21.3 months, range 6–33), a total of 13 events were documented. Specifically, two patients exhibited a loss of response to treatment, four patients presented an increase in spleen diameters, three patients displayed an escalation of systemic symptoms, and three patients had a clear progression to secondary myelofibrosis. PWV (per 1 m/s: OR 1.70, 95% CI 1.00–2.91, p = 0.047) and leukocyte count (per 1 × 103/μL: OR 1.47, 95% CI: 1.04–2.09, p = 0.043) were significant predictors of events, independently of waist circumference, blood pressure, treatment, and hematocrit. Conclusions: PWV has demonstrated its potential as an effective tool for monitoring PV patients. It stands as a clinical parameter that can predict the risk of progression in PV patients. Further investigation is essential to fully explore this potential. If successful, it could offer clinicians a valuable resource for effectively managing PV patients.

Modern concepts on the mechanisms of endovasal laser coagulation in varicose vein disease

Mechanisms of endovasal laser coagulation (EVLC) applied in varicose vein disease are not fully understood.Purpose. To analyze currently applied EVLC mechanisms so as to prevent hemorrhagic complications and paresthesia caused by these mechanisms.Methods. This review analyses modern theories on EVLC mechanisms when applied in varicose vein disease in the lower extremities.Results. Published experimental and clinical trials, including histological ones, have shown that the degree of vein damage during EVLC session depends on many factors, such as wavelength, intensity, and optical fiber speed. Damage to veins during EVLC procedure depends on various factors, such as direct contact of the vein wall with an optical fiber tip, carbonization of blood elements leading to the increased intravenous blood temperature and to the formation of gas bubbles as well as heat convection on the vein wall through the blood.Conclusion. Destruction of the vein wall during EVLC procedure is the result of a synergistic effect of various damaging factors. Currently, 2-μm laser irradiation is being implemented into clinical practice. This technique provides better vein coagulation under less power values which promotes less postoperative complications.

Raloxifene Protects Oxygen-Glucose-Deprived Astrocyte Cells Used to Mimic Hypoxic-Ischemic Brain Injury

Perinatal asphyxia (PA) is a clinical condition characterized by oxygen supply suspension before, during, or immediately after birth, and it is an important risk factor for neurodevelopmental damage. Its estimated 1/1000 live births incidence in developed countries rises to 5–10-fold in developing countries. Schizophrenia, cerebral palsy, mental retardation, epilepsy, blindness, and others are among the highly disabling chronic pathologies associated with PA. However, so far, there is no effective therapy to neutralize or reduce PA-induced harm. Selective regulators of estrogen activity in tissues and selective estrogen receptor modulators like raloxifene have shown neuroprotective activity in different pathological scenarios. Their effect on PA is yet unknown. The purpose of this paper is to examine whether raloxifene showed neuroprotection in an oxygen–glucose deprivation/reoxygenation astrocyte cell model. To study this issue, T98G cells in culture were treated with a glucose-free DMEM medium and incubated at 37 °C in a hypoxia chamber with 1% O2 for 3, 6, 12, and 24 h. Cultures were supplemented with raloxifene 10, and 100 nM during both glucose and oxygen deprivation and reoxygenation periods. Raloxifene 100 nM and 10 nM improved cell survival—65.34% and 70.56%, respectively, compared with the control cell groups. Mitochondrial membrane potential was preserved by 58.9% 10 nM raloxifene and 81.57% 100 nM raloxifene cotreatment. Raloxifene co-treatment reduced superoxide production by 72.72% and peroxide production by 57%. Mitochondrial mass was preserved by 47.4%, 75.5%, and 89% in T98G cells exposed to 6-h oxygen–glucose deprivation followed by 3, 6, and 9 h of reoxygenation, respectively. Therefore, raloxifene improved cell survival and mitochondrial membrane potential and reduced lipid peroxidation and reactive oxygen species (ROS) production, suggesting a direct effect on mitochondria. In this study, raloxifene protected oxygen–glucose-deprived astrocyte cells, used to mimic hypoxic–ischemic brain injury. Two examiners performed the qualitative assessment in a double-blind fashion.

Isofraxidin alleviated radiation-induced testicular damage via the Nrf2/HO-1-NLRP3/ASC Axis

OBJECTIVE: Radiotherapy is used to treat patients with tumors; however, radiation (IR)-induced testicular injury, which has no effective treatment approved in clinical practice, significantly influences their prognosis and quality of life. The protective effects and underlying mechanisms of action of isofraxidin (IF) against IR-induced testicular injury were investigated. Methods: A mouse testis injury model was established using 5 Gy irradiation. H&E staining, immunofluorescence staining, and enzyme-linked immunosorbent assay were used to measure DNA damage, apoptosis, inflammatory reactions, and oxidative stress in the testes of mice after irradiation. The effectiveness of IF irradiation on testicular injury was evaluated, and the mechanisms of the related oxidative stress and inflammatory response pathways are discussed. Results: IF can improve IR-induced testicular injury by inhibiting the increased levels of DNA damage, apoptosis rate, oxidative stress, and inflammatory factors. The radioprotective effects of IF on testicular injury are mediated by the stimulation of Nrf2/HO-1 or suppression of NLRP3 inflammasome signaling pathways. In addition, crosstalk between the Nrf2/HO-1 and NLRP3 inflammasome signaling pathways was elucidated, in which the inhibition of the NLRP3 inflammasome was mediated by the activation of Nrf2 signaling with IF upon IR exposure. Conclusion: IF can be a potent radioprotective agent to mitigate testicular damage, and may provide a new therapeutic option to alleviate the side effects of radiotherapy in male patients with tumors.

Response and seismic resilience of metro tunnels under normal fault dislocation evaluated based on the quantitative method of concrete damage state

The damage to tunnels crossing active fault zones caused by earthquakes can be of a severe and irreversible nature. The paper defines the quantification of the concrete damage state based on the uniaxial compression equation and the tensile-compression curve equation. Furthermore, the paper refines the concrete damage level in conjunction with the damage factor and crack width formulas, which is one of the most significant factors affecting the durability of concrete. A three-dimensional refinement model, constructed using ABAQUS software, was employed to analyse the mechanical response and seismic resilience of the tunnel structure under normal fault displacement with variable section mitigation measures. The model incorporated a number of key parameters, including fortification length, joint location and thickness. The following conclusions were obtained: the tunnel structure is susceptible to tensile damage and the damage is widely distributed under normal fault d; the use of variable section measures can help improve and reduce the overall damage of the cross-fault metro tunnel structure; the use of tensile damage state classification to assess the damage of the tunnel structure can determine the location and extent of the damage; an appropriate protection length is required, too long/short does not maximise the mitigation effect of setting variable section measures; an appropriate lining length is required; and the lining structure is not suitable for the tunnel structure. An appropriate location and thickness of the lining structure will help to reduce the overall damage to the structure. The application of localised reinforcement to the structure, in conjunction with variable section, serves to minimise the probability of collapse of the tunnel as a whole and to enhance the seismic resilience of the underground structure across the active fault zone.

Proposing a Methodology for Axon-Centric Analysis of IOP-Induced Mechanical Insult.

IOP-induced mechanical insult on retinal ganglion cell axons within the optic nerve head (ONH) is believed to be a key factor in axonal damage and glaucoma. However, most studies focus on tissue-level mechanical deformations, overlooking that axons are long and thin, and that their susceptibility to damage likely depends on the insult's type (e.g. stretch/compression) and orientation (longitudinal/transverse). We propose an axon-centric approach to quantify IOP-induced mechanical insult from an axon perspective. We used optical coherence tomography (OCT) scans from a healthy monkey eye along with histological images of cryosections to reconstruct the axon-occupied volume including detailed lamina cribrosa (LC) pores. Tissue-level strains were determined experimentally using digital volume correlation from OCT scans at baseline and elevated IOPs, then transformed into axonal strains using axon paths estimated by a fluid mechanics simulation. Axons in the LC and post-LC regions predominantly experienced longitudinal compression and transverse stretch, whereas those in the pre-LC and ONH rim mainly suffered longitudinal stretch and transverse compression. No clear patterns were observed for tissue-level strains. Our approach allowed discerning axonal longitudinal and transverse mechanical insults, which are likely associated with different mechanisms of axonal damage. The technique also enabled quantifying insult along individual axon paths, providing a novel link relating the retinal nerve fiber layer and the optic nerve through the LC via individual axons. This is a promising approach to establish a clearer connection between IOP-induced insult and glaucoma. Further studies should evaluate a larger cohort.

Characteristics of rock strength failure and identification of hazardous areas in the roof of deep mining stope

The roof of deep mining stopes is notoriously unstable and challenging to manage due to high in-situ stress and deteriorating rock conditions. To address this issue, a comprehensive approach was employed, incorporating indoor physical experiments, numerical simulations, and field tests to investigate the stope roof rock composition characteristics and strength failure modes in the Laoyingshan deep coal mine. The study revealed the distribution characteristics of the high in-situ stress field in this mining area and delineated different levels of hazards in the roof. The results indicate that, under identical lithological conditions, the mineral composition of deep rock formations is complex. Changes in some mineral components and properties were observed, leading to increased expansiveness and water absorption in clay minerals such as sodium montmorillonite and kaolinite within the basic roof layer. In simulated tests of surrounding rock strength in deep mining stopes, as stress levels approached 2 MPa, the damage factor increased, showing a trend of localized concentration. Internal damage began to exhibit noticeable spatial evolutionary expansion patterns and gradual nucleation. When stress exceeded 8 MPa, rocks transitioned from macroscopic fracture surfaces to microscopic fragmentation zones, with a sudden decrease in stiffness degradation values, internal instantaneous collapse, and phenomena akin to “rock burst” under high stress disturbance. In-situ stress testing determined that the stress field in the deep mining zone of Laoyingshan is in a thrust fault stress state, with horizontal stress predominance. The maximum stress direction is predominantly southwest-northeast, with stress magnitude reaching 25.49 MPa. By arranging post-mining and pre-mining borehole observation stations and utilizing image grayscale fracture recognition technology in MATLAB, the roof was classified into four danger levels: “extremely broken,” “broken,” “significant fractures,” and “minor fractures.” Main control measures for coupling grouting in deep-shallow zonation rigidity were proposed based on these classifications.

Implications of DNA damage in chronic lung disease.

DNA plays an indispensable role in ensuring the perpetuation of life and safeguarding the genetic stability of living organisms. The emergence of diseases linked to a wide spectrum of responses to DNA damage has garnered increasing attention within the scientific community. There is growing evidence that patterns of DNA damage response in the lungs are associated with the onset, progression, and treatment of chronic lung diseases such as chronic obstructive pulmonary disease (COPD), asthma, and bronchopulmonary dysplasia (BPD). Currently, some studies have analyzed the mechanisms by which environmental factors induce lung DNA damage. In this article, we summarize inducible factors of lung DNA damage, current indicators, and methods for diagnosing DNA damage in chronic lung diseases and explore repair mechanisms after DNA damage including nonhomologous end-joining and homology-directed repair end joining pathways. Additionally, drug treatments that may reduce DNA damage or promote repair after it occurs in the lungs are briefly described. In general, more accurate assessment of the degree of lung DNA damage caused by various factors is needed to further elucidate the mechanism of lung DNA damage and repair after damage, so as to search for potential therapeutic targets.

Analysis of local community ecological knowledge on mangrove ecotourism development in Donggala Regency, Central Sulawesi, Indonesia

The mangrove area in Donggala Regency is a unique and potential area, but the area tends to be threatened by increasing mining activities in the area. Management of the mangrove area in Donggala Regency as an ecotourism area is an alternative form as an innovative effort to maintain environmental functions as a provider of environmental services in order to remain sustainable. This study was aimed at analyzing the Local Community Ecological Knowledge (LCEK) pertaining to mangrove ecosystems and ecotourism development in Donggala Regency. The study used a survey method, utilizing the analysis of the tourism suitability index (IKW) and the carrying capacity of the area (DDK). Community knowledge and perceptions were based on a Likert scale scoring system. The results of the study and the discussion showed that people in Donggala Regency had local ecological knowledge of mangrove forests, especially mangrove habitats, mangrove damage factors and the impact of mangrove damage was better than the function of mangroves. Utilization of mangrove ecosystems in Donggala Regency is very diverse, ranging from the utilization of mangrove stems, fruits, leaves and roots and fishery products such as small fish and shellfish. The community's understanding of ecotourism activities was very good and they agreed with the ecotourism activities that were carried out.

Analysis of the Seismic Vulnerability of a Masonry Pagoda Based on Increasing Dynamic Analysis

ABSTRACTFor the seismic vulnerability analysis method of masonry pagodas, the dynamic characteristic of the Bayun Pagoda in China was conducted by using environmental excitation technology. A numerical model of the masonry pagoda was established with the finite element software Abaqus. Ten seismic waves were selected as excitation signals to conduct incremental dynamic analysis (IDA) on the pagoda. The Sa(T1,5%) served as the seismic intensity indicator, whereas the damage factor (d) and relative stress () were employed as damage indicators for seismic vulnerability analysis of the pagoda. The failure probability of the structure reaching the limit state under different seismic intensities was determined. The results indicate that, comparing the IDA curves and seismic vulnerability curves under two different damage indicators, the Sa(T1,5%) range required for the IDA curves under the damage factor (d) is smaller than the relative stress (), with lower dispersion. Additionally, the failure probability of the pagoda reaching different limit states is higher under the damage factor (d). Considering the existing damage status of the masonry pagoda, the damage factor (d) is more reasonable as the damage indicator.

Seismic response of a mid-story isolated stilted structure in mountainous areas

Research on the SSI effect on flat sites has yielded many valuable conclusions. However, current research on the impacts of various special local terrains on structural dynamics remains limited. For mountainous areas, it is common to construct houses in a multi-step, climbing, and laterally staggered architectural form that follows the mountain terrain. Only through the analysis of the combined action of the upper and lower parts can the seismic performance of this type of structural form be better revealed; considering the influence of SSI effects will be closer to the actual seismic effects. Therefore, to identify the damage factors of the mid-story isolated stilted structures under earthquakes and provide optimized design plans for the structures, six models are established considering three slopes and two types of foundations based on the engineering case in Chongqing, China. Through the elastic-plastic time-history analysis under earthquakes in the down and transverse-slope directions, concludes, compared with not considering SSI, the seismic response of the mid-story isolated stilted structures considering SSI in mountainous areas is amplified. With the increase of the mountain slope, the seismic response of the structures considering SSI increases, and the amplification coefficients are between 1–1.8. The amplification coefficients of the structures without SSI are concentrated around 1, which is less influenced by the slope. The damage to the stilted isolated layer is mainly concentrated in the column and the beam end, and the maximum seismic response appears in the short columns. The foundation soil stress increases with the increase of the mountain slope.

Research Progress of Hawthorn in the Treatment of Non-alcoholic Fatty Liver Disease

Non-alcoholic fatty liver disease refers to a metabolic disease of the liver caused by long-term heavy drinking and other clear liver damage factors, with triglyceride-dominated lipids accumulating in liver cells for pathological changes. In traditional Chinese medicine, it is often classified as "accumulation", "liver puffiness", "liver", "fat qi" and other categories. Hawthorn is the most commonly used Chinese medicine for the treatment of non-alcoholic fatty liver disease. This review is to summarize the latest research progress of hawthorn effective components in the treatment of this disease, and summarize and explain the understanding and application of traditional Chinese medicine, pharmacological effects and mechanism progress, in order to provide more basis for the clinical treatment of NAFLD with traditional Chinese medicine.

Health burden and costs attributed to the carbon footprint of health systems in the European Union

Abstract Background Health systems have an environmental impact of around 4.6% of global emissions, contributing to aggravating the climate crisis. However, the health impact of the carbon emissions originated by health systems is not regularly assessed. We aim to estimate the health burden and associated costs of the carbon footprint of health systems across the European Union (EU). Methods We calculated DALYs and associated costs based on human health damage factors (DALYs/kg-CO2e) by considering four scenarios. Three scenarios for shared socioeconomic pathways (S1 - high growth, S2 - baseline, and S3 - low growth) represented variations of global society, demographics, and economics until 2100. A fourth scenario (S4) considered the current EU’s 55% reduction goal of greenhouse gas emissions. The healthcare sector’s emissions per capita (in CO2-equivalent) in 2019 were extracted from the Lancet Countdown, and population data were retrieved from Eurostat for the same year. Results In the EU, 365,047 DALYs (95%CI: 194,692-535,403) are expected to be caused by health systems’ emissions at baseline (S2). In an S1 scenario, the burden would slightly decrease to 315,374 DALYs (95%CI: 170,355-462,393), whereas a S3 scenario would increase 486,730 DALYs (95%CI: 243,365-681,422). If EU’s carbon goals are met, the burden could be substantially reduced to 164,271 DALYs (95%CI: 87,611-240,931). The monetisation of DALYs can result in costs amounting to 25.6 billion euros. Conclusions CO2 emissions from health systems are expected to significantly impact human health. It is therefore of the utmost importance to ensure that EU climate policies for healthcare buildings are in line with the Paris Agreement. This will require the implementation of climate mitigation programmes within the health sector and a review of clinical practices at the local level. Key messages • The carbon footprint of health systems is estimated to significantly impact health, with high economic burden. • EU climate policies for healthcare buildings and procurement must be aligned with the Paris Agreement.

The hydromechanical coupled numerical method in pseudo-3D axisymmetric domain with cracks extension and coalescence applies to the decompression failure problem

The stress-strain state of the saturated porous media determines the behavior of fracturing, which defines the efficiency of developing tight oil, shale, coalbed, and thermal energy fields. Therefore, reliable hydromechanical coupled simulations with destruction reconstruction are critical.The proposed innovative simulator has a strong interrelation between fluid flow and rock deformation of porous media and realizes a fully coupled pseudo-transient numerical method by high-performance computing (HPC) tools. To increase the detail of the results in the problem, a finite difference numerical algorithm was implemented in the axisymmetric cylindrical domain, which reduces from three to two dimensions without loss of precision. Highly efficient parallelization using CUDA on the GPU computes meshes of up to one billion cells, allowing the simulation of a total core sample to sub-micrometer resolution in an appropriate time. The algorithm has been validated to find the exact solution to the cylinder problem. The proposed model accounts for cracks propagation with their coalescence within a single computational static grid, which keeps timing close to the continuous model.This comprehensive implementation enables solving industrial problems, such as modeling core sample damage during rapid decompression. High-resolution simulations help reconstruct fracture propagation, analyze the initial stress state, and identify critical damage factors. The comparison with the exact solution to the cylinder problem confirmed the reliability of the algorithm. The calculation results show a strong dependence of decompression failure on the coalescence and elongation of cracks, influenced significantly by the rock's cohesion. Microcracks length and distribution play a decisive role in the decompressive destruction behavior of the rock sample. For the first time, the simulations demonstrated the decompressive destruction of a core sample during an uncontrolled, rapid core retrieval operation.

Peculiarities of brain cell functioning during hyperglicemia and diabetes mellitus

Hyperglycemia is a symptom and damaging factor of diabetes mellitus (DM) that leads to systemic complications in the body, including macro- and microangiopathies of the brain, impaired blood supply, the appearance of foci of neurodegeneration and might be a trigger of neuroinflammation. Nervous tissue is characterized by a high level of energy consumption and is highly sensitive to fluctuations in the level of metabolic substrates. Therefore, it is extremely important to study the effect of high glucose levels on the functional state of the central nervous system. This review attempts to comprehensively assess the effects of hyperglycemia on brain cells. Analysis of experimental data obtained in in vivo and in vitro models of diabetes on the morphofunctional state of neurons, microglia and astrocytes showed that the direct and indirect effects of glucose in high concentrations depends on the cell type. Receptors and intracellular signaling cascades of astrocytes and microglia, that mediate the effects of hyperglycemia and the development of neuroinflammation, can act as therapeutic targets for the correction for the consequences of diabetes. Thus, finding ways to modulate the functional activity of glial cells may be an effective strategy to reduce the severity of the consequences of CNS damage.

The environmental impact on aging: Insights from buccal mucosa and molecular biomarkers

Buccal epithelial cells serve as a primary barrier against the inhalation and ingestion of harmful substances, working alongside immune system cells such as natural killer cells to protect the body from health-damaging factors. These epithelial cells can also be used as an alternative tissue source for monitoring the genotoxic effects of external factors such as chemical exposure. This assessment can be performed using molecular biomarkers of aging, which reflect biological age and indicate cellular aging acceleration due to internal and external damage factors, such as environmental hazards. In contrast to chronological age, which merely reflects the passage of time, biological age accounts for individual variation in aging processes. Molecular biomarkers are crucial for distinguishing between normal and pathological processes in the body and for identifying the effects of external factors such as chemical exposures. The identification of specific biomarkers enhances the ability to detect and monitor adverse biological responses and accelerated aging. This review aims to highlight the routes through which environmental hazards enter the body, the application of buccal epithelial cells in assessing genetic modifications, and the introduction of potential molecular biomarkers. However, further research is necessary to elucidate the roles of these biomarkers in determining aging rates and individual variability. Understanding their implications may also help identify new therapeutic targets for preventing premature aging, treating age-related diseases, and developing potential treatments.

Study on the creep constitutive model of layered rockconsidering anisotropic and damage factors after hightemperature exposure

The failure of layered rock after high temperature exposure is a major concern in deep underground engineering projects. This paper proposes an improved Nishihara creep constitutive model that considers damage factors and the bedding angle, which overcomes the shortcomings of the deviation in the description of the conventional Nishihara model in the acceleration stage. The constitutive model is verified by the conventional triaxial creepiest. The theoretical curve has a high degree of fitting with the experimental curve. The experimental results show that a temperature of [Formula: see text] has an obvious influence on the steady creep rate and the creep strain of layered sandstone, and [Formula: see text] can be regarded as the temperature threshold for the long-term strength and change from anisotropic to isotropic of layered sandstone. The irreversible melting mixing phenomenon at the boundary of mineral particles with increasing temperature is the mechanism by which different treatment temperatures affect the anisotropy degree of layered rock.

Cerebroprotective properties of nitric oxide in children in cardiac surgery (literature review)

Background. Cardiac surgery in conditions of cardiopulmonary bypass (CPB) in children with congenital heart defects is characterized by a complex of damaging factors (initial immaturity of organs and systems, the fact of non-physiology of cardiopulmonary bypass, frequent use of perfusion and non-perfusion hypothermia, comorbid infection), which dictates the validity of using a number of strategies aimed at protecting vital organs and the brain above all.The objective was to study the effectiveness of the use of nitric oxide to protect the brain in children during surgical correction of congenital heart defects in cardiopulmonary bypass conditions.Materials and methods. A literary search was performed in domestic and international bibliographic databases for keywords: nitric oxide, cerebroprotection, cardiopulmonary bypass, organoprotection, inhalation of nitric oxide, children.Results. The review provides up-to-date information on the effect of nitric oxide on the components of the neurovascular unit: angiogenesis, proliferation and myelination of nerve cells, the role in neuroinflammation and deep hypothermic circulatory arrest.Conclusion. The results of many studies confirm the effectiveness of nitric oxide for neuroprotection. However, there is a deficit of clinical researches in general and in the pediatric patient population, which does not yet allow to definitely state its effectiveness.

Early Period Survival and Neurologic Prognosis in Newborns with Perinatal Asphyxia: A Tertiary Center Experience and a Mortality Chart

Background: Clinicians require more data regarding mortality and brain damage risk factors in perinatal asphyxia. Objectives: To assess early term outcomes and identify mortality risk factors in perinatal asphyxia. Methods: This study was conducted in a referral-center tertiary intensive care unit in Istanbul, Turkey, between 2016 and 2023. We included all patients who underwent therapeutic hypothermia treatment due to perinatal asphyxia. We recorded laboratory follow-up data, magnetic resonance imaging (MRI) findings, amplitude-integrated electroencephalograms (aEEG) results, mortality, and clinical outcomes. Both conventional frequentist statistical methods and Bayesian methods were used for analysis. Results: A total of 164 patients were included in the study, with an overall mortality rate of 9.8%. Risk factors for mortality included LDH, troponin I, INR, lactate, 2nd day creatinine, voltage anomalies, seizures, and male gender, as well as APGAR scores. A basic chart for mortality prediction was developed. The Sarnat score showed strong evidence, and APGAR 1 showed anecdotal evidence for association with brain damage, although brain damage was independent of laboratory results and other clinical findings, based on moderate and anecdotal evidence from Bayesian calculations. Cranial MRI findings revealed profound damage in 14.8% of Sarnat 1, 21.8% of Sarnat 2, and 50% of Sarnat 3 patients. Conclusions: This study presents prognostic factors for survival and brain damage in perinatal asphyxia. We recommend obtaining cranial MRI for all patients diagnosed with asphyxia, as most laboratory tests were independent of brain damage. Given that profound brain damage can occur even in Sarnat stage I patients, we emphasize the importance of therapeutic hypothermia for these patients.