Prolonged Vegetative State Research Articles

Mapping of a Major QTL, <i>qHD6-SD</i> Responsible for Days to heading Under Natural Short Day Conditions to Develop Rice Varieties adaptable to Tropical Regions

In the tropics (Southeast Asian countries), indica rice is more common than japonica. Japonica rice is mainly cultivated in temperate regions, including Korea, Japan, and China (northeast regions) due to its poor adaptation to tropical areas. To develop tropically-adapted high-yielding japonica rice, breeders should overcome the challenges, including extremely early flowering, low biomass accumulation, and inferior panicle traits. This study investigated 180 F9 recombinant inbred lines (RILs) developed from a cross between Ilpum (temperate japonica) and Zenith (indica) as a case population to identify quantitative trait loci (QTLs) that influence the said traits. Here we identified two major QTLs, qHD6-SD and qHD6- LD, conferring days to heading under short day (SD) and long day (LD) conditions, respectively. Finer mapping revealed that both qHD6-SD and qHD6-LD located in the similar 98 kb region harbored the Hd1 gene. Days to heading in the RILs harboring the Zenith allele type of qHD6-SD under SD conditions were significantly longer than those in the RILs harboring the Ilpum allele type. On the contrary, days to heading in the RILs harboring the Zenith allele type of qHD6-SD under LD conditions were significantly shorter than those in the RILs harboring the Ilpum allele type. This bi-functionality of qHD6-SD upon heading strongly support the claim that both qHD6-SD and qHD6-LD might be the Hd1 gene. Our findings further support the claim that the functional allele type of Hd1 gene delays long-day heading and promotes extremely early short-day heading. Therefore, a non-functional Hd1 type is critical to tropical adaptation of japonica rice since it delays the heading date, which is essential to attain prolonged vegetative state in order to achieve optimum biomass, increased spikelet number, and grain filling capacity.

Additive effect of cerebrolysin and amantadine on disorders of consciousness secondary to acquired brain injury: A retrospective case-control study.

Acquired brain injury can cause disorders of consciousness. An additive effect of cerebrolysin and amantadine has been postulated, but not systematically studied. The present study aimed to investigate this additive effect in patients with disorders of consciousness secondary to acquired brain injury. The medical records of patients diagnosed with disorders of consciousness after acquired brain injury were reviewed. The patients were categorized into 2 groups: single regimen (amantadine only) and dual regimen (amantadine plus cerebrolysin). The patients' conscious states were assessed using the Coma Recovery Scale-Revised (CRS-R) before, and after 4 weeks of drug administration. Data for a total of 84 patients were analysed. The degree of change in CRS-R and the proportion of patients in the disorders of consciousness category showing a change was higher in the dual regimen group than in the single regimen group. Analysis of patients who had initially been in a prolonged vegetative state or minimally conscious state minus before administration showed that the patients in the dual regimen group had greater increases in CRS-R scores than those in the single regimen group. This study identified that an amantadine-plus-cerebrolysin regimen additively affects patients with prolonged disorders of consciousness. A future controlled trial is needed to investigate the efficacy of each regimen in patients with prolonged disorders of consciousness secondary to acquired brain injury, particularly for patients who have remained in a prolonged vegetative state after acquired brain injury.

Reversible conductive hearing impediments among patients with severe brain injury

Purpose: Rehabilitation of patients with severe traumatic brain injury may include auditory stimuli. Hampering the function of the external, middle ear or Eustachian tube generates a conductive auditory deficit up to 35 dB that may potentially hinder auditory rehabilitation. The objective was to evaluate the incidence of conductive hearing impediments among patients with severe brain injury.Methods: The cross-section study included adults with severe brain injury hospitalized in a rehabilitation center. The patients presented with a prolonged vegetative state, were dependent on mechanical ventilation and gastrostomy tube feeding. Assessment of external, middle ear and Eustachian tube included otoscopy, tympanometry, nasopharyngoscopy, gag reflex and soft palate evaluations.Results: Nineteen patients (38 ears) were evaluated: 14 males and 5 females, aged 18–93 years (average 59). All patients had a normal nasopharynx, lacked a gag reflex, palatal movements or supraglottic sensation. Eighteen ears (47%) had middle ear effusion, 26 (68%) ears had cerumen impaction, and 14 (37%) had both.Conclusions: Many patients with severe brain injury have reversible and treatable impairments that cause potential conductive hearing loss. Routine otoscopic examination and treatment if required, that is, removal of impacted cerumen or middle ear drainage, have rehabilitating and general health benefits.Implications for rehabilitationAuditory stimulation was suggested for rehabilitation in patients with severe traumatic brain injury.Many patients have cerumen and/or otitis media with effusion causing conductive hearing impairment as well as general health issues.Both aural impediments are diagnosed by routine otoscopy, are easily treated, and may affect rehabilitation.

Pre- and Apnoeic high flow oxygenation for RApid sequence intubation in The Emergency department (Pre-AeRATE): study protocol for a multicentre, randomised controlled trial

BackgroundMaintaining adequate oxygenation during rapid sequence intubation (RSI) is imperative to prevent peri-intubation adverse events that can lead to increased duration of hospital and intensive care unit stay, or a prolonged vegetative state requiring long-term institutionalisation. Despite employing current best practices during RSI, desaturation during intubation still occurs. High-flow nasal cannula (HFNC) oxygenation may potentially improve oxygenation during pre- and apnoeic oxygenation to allow a longer safe apnoeic time for RSI.ObjectiveWe aim to test the hypothesis that the use of humidified high-flow oxygenation via nasal cannula at 60 L/min maintains higher oxygen saturation compared with current usual care of non-rebreather mask and standard nasal cannula at an oxygen flow rate of 15 L/min for pre- and apnoeic oxygenation.MethodsThis is a multi-centre randomised controlled trial enrolling adult patients aged 21 years and older who require rapid sequence intubation due to medical, surgical, or traumatic conditions in the Emergency Departments (EDs) of the National University Hospital and the Ng Teng Fong General Hospital. Eligible patients will undergo randomisation at an equal ratio into intervention or control arms. The primary endpoint will be the lowest oxygen saturation achieved during the first intubation attempt from time of administration of paralytic agent until quantitative end-tidal carbon dioxide is detected if the first intubation attempt is successful, or until the start of the second attempt if it is not.DiscussionProlongation of safe apnoea time through maintenance of oxygen saturation above 90% using HFNC oxygenation during RSI could potentially change current clinical practice, improve standard of care, and translate to better outcomes for patients.Trial registrationClinicalTrials.gov, NCT03396094. Registered on 10 January 2018.

‘Is she alive? Is she dead?’ Representations of chronic disorders of consciousness in Douglas Coupland's Girlfriend in a Coma

Depictions of coma have come to dominate literary and filmic texts over the last half century, a phenomenon coinciding with advancements in medical technology that have led to remarkable increases...

Treatment choice for patients with hemorrhagic cerebral stroke expected to be in a disabled condition--An analysis of questionnaire responses of patients' families

Many patients with cerebral stroke are successively treated with the latest advances in medical therapies. Surgical hematoma evacuation is a treatment option for patients with hemorrhagic cerebral stroke, however; it may result in a prolonged vegetative state. The difficult choice of whether or not such surgery should be performed is mostly made by the family, frequently in an urgent manner, and nurses need to understand the factors affecting this decision-making. We performed statistical analyses on the responses of 30 patients' families who answered our questionnaire, presuming disabilities after the surgery were expected. Multiple answers were obtained according to the severity of the expected disabilities after the surgery. The refusal of surgery increased as the expected disabilities worsened, and the statistically significant factor affecting the decision-making process was "what they would wish if they suffered a stroke themselves." The 18 nurses working in the neurological ward who responded to the same questionnaire wished surgery more in the case of the patient's cognition being preserved. Since it is rare for patients with stroke to have an advance directive, patients' families have to decide the treatment choice in most cases. In the clinical setting, such decisions frequently need to be made rapidly, however; the decision should be made by speculating on the patients' own will, and it is desirable for medical staff to explain the expected outcomes of the surgery in detail as far as possible.

The vegetative state: A report of two cases with a long-term follow-up

Objectives: To demonstrate that patients with Prolonged Vegetative State (PVS) can show signs of improvements and important changes and, consequently, to strengthen the necessity to evaluate them with long-term serial follow-ups. Setting: Rehabilitation of patients with severe traumatic brain injury (TBI). Participants: Two people with severe TBI discharged after a long period of inpatient rehabilitation in a condition of PVS. Results: After 5 years some important changes happened and the initial prognosis was proved to be wrong. Conclusion: Sometimes patients declared to be in PVS have the possibility to recover, especially when initial clinical conditions are particularly severe and do not allow the emergence of the state of consciousness. It is important to conduct regular follow-ups to better evaluate changes and, if it is necessary, to re-adjust the rehabilitation accordingly.

Localised proton MR spectroscopy of brain metabolism changes in vegetative patients.

We examined 14 vegetative brain-injured patients with proton magnetic resonance single-volume spectroscopy (1H MRS) at 1.5 T to establish whether there were changes in relative concentrations of N-acetyl aspartate (NAA), choline (Cho) and creatine (CR) metabolites from those found in healthy brains. Spectra were obtained from two different (2 x 2 x 2 cm) volumes of interest in the left and in the right frontal cortex, normal on MRI. All spectra revealed abnormalities compared with normal spectra obtained from age-matched control subjects. Values outside the normal range for at least one of the metabolite ratios were observed in all patients. Cho/Cr was markedly higher and NAA/Cho and NAA/Cr were markedly lower than in the control subjects. At different times six patients regained awareness and the ability to obey commands, and four were re-examined; changes in metabolite ratios were observed, which were different in individual patients. The NAA/Cho ratio reaches statistical significance in discriminating between the patients with a poor outcome (death or prolonged vegetative state) and those who regained awareness; the dividing line appears to be at a value of about 1.6.

Outcome and Acute Care Hospital Costs After Warm Water Near Drowning in Children

Predictive efforts using individual factors or scoring systems do not adequately identify all intact survivors, and therefore all drowning victims are aggressively resuscitated in most emergency departments. More reliable outcome prediction is needed to guide early treatment decisions. The charts of 274 near drowning patients admitted to Loma Linda University Children's Hospital were retrospectively reviewed. Patient outcome was categorized into good (near normal function), and poor (vegetative or dead) categories. Discriminant analysis was used to identify combinations of variables most able to predict outcome and a clinical classification system was constructed. The acute care hospital costs for each group were compared. Discriminant analysis classification achieved 95% accuracy, predicting death in 6 intact survivors. No combination of variables could accurately separate all intact survivors from the vegetative and dead groups. The clinical classification method achieved 93% overall accuracy, predicting death in 5 intact survivors. Of patients predicted to have a poor outcome, 5 (6.3%) survived intact. Children may experience an unpredictable, prolonged vegetative state followed by full recovery. Vegetative patients are the most expensive to care for (consuming 53% of total costs) while intact survivors are the least expensive. The majority of costs were spent on patients with poor outcome. Individual outcome cannot be reliably predicted in the emergency department; therefore, aggressive resuscitation of near drowning victims should be performed. Decisions to subsequently withdraw life support should be made based on integration of likelihood of survival, high (but not absolute) certainty, and parental/societal issues. The vegetative patients are the most expensive to care for, while intact survivors are least expensive. Reduction of expenditures on patients likely to have vegetative or dead outcome would result in substantial savings, but loss of normal survivors.

Termination of Nutrition and Hydration in a Child With Vegetative State

A child in a vegetative state may present difficult decisions for physicians and families regarding the course of treatment. We report a case of a child who entered a prolonged vegetative state following status epilepticus. The child's parents requested termination of artificial means of nutrition and hydration. That request culminated in a complex legal intervention by multiple state agencies and attracted local media attention. This article presents the details of the case and discusses the medical and legal complexities encountered. The diagnosis and prognosis of the persistent vegetative state in children have recently been defined. Decision making in these circumstances should be based on adequate, careful clinical evaluation of the medical facts. Hospital ethics committees can provide an independent forum in which the diverse viewpoints in a case may be examined. Decision making should optimally be accomplished between families and caretakers.

Recovery of cognition after prolonged vegetative state

AbstractA 43‐year‐old man remained in a vegetative state for one and one‐half years after resuscitation from cardiac arrest. During the vegetative period neurological examinations provided little indication of recovery. Initially, his EEG showed activity of delta and theta frequencies. After eighteen months intellectual functions partially recoverd; his verbal WAIS score is now 100, although he remains severely physically disabled. The usual prognostic criteria did not predict the cognitive outcome in this patient with prolonged medical coma.