Transient Neurological Dysfunction Research Articles

Quantitative Electroencephalography for Predication of Neurological Dysfunction in Type A Aortic Dissection: A Prospective Observational Study.

Type A aortic dissection presents challenges with postoperative cerebral complications, and this study evaluates the predictive value of quantitative electroencephalography for perioperative brain function prognosis. Amplitude-integrated electroencephalography (aEEG) processes raw signals through filtering, amplitude integration, and time compression, displaying the data in a semilogarithmic format. Using this method, postoperative relative band power (post-RBP) α% and dynamic aEEG (ΔaEEG) grade were significantly associated with neurological dysfunction in univariate and multivariable analyses, with area under the receiver operating characteristic curve of 0.876 (95% CI, 0.825-0.926) for the combined model. Postoperative relative band power α% and ΔaEEG were significantly associated with adverse outcomes, with area under the receiver operating characteristic curve of 0.903 (95% CI, 0.835-0.971) for the combined model. Postoperative relative band power α% and ΔaEEG were significantly associated with transient neurological dysfunction and stroke, with areas under the receiver operating characteristic curve of 0.818 (95% CI, 0.760-0.876) and 0.868 (95% CI, 0.810-0.926) for transient neurological dysfunction, and 0.815 (95% CI, 0.743-0.886) and 0.831 (95% CI, 0.746-0.916) for stroke. Among 56 patients, the Alberta Stroke Program Early Computed Tomography score was superior to ΔaEEG in predicting neurological outcomes (area under the receiver operating characteristic curve of 0.872 versus 0.708 [95% CI, 0.633-0.783]; P<0.05). Perioperative quantitative electroencephalography monitoring offers valuable insights into brain function changes in patients with type A aortic dissection. ∆aEEG grades can aid in early detection of adverse outcomes, while postoperative relative band power and ∆aEEG grades predict transient neurological dysfunction. Quantitative electroencephalography can assist cardiac surgeons in assessing brain function and improving outcomes in patients with type A aortic dissection. URL: https://www.chictr.org.cn; Unique identifier: ChiCTR2200055980.

Effects of temperature on transient neurologic dysfunction after total arch replacement.

The relationship between cooling status during aortic surgery with hypothermic circulatory arrest and postoperative neurologic dysfunction remains unknown. In the present study, we evaluated the effect of cooling status on transient neurologic dysfunction after total arch replacement. We studied patients who underwent elective total arch replacement with hypothermic circulatory arrest and antegrade selective cerebral perfusion from December 2011 to January 2021. Changes in tympanic temperature trends recorded during surgery were plotted. Several parameters, including the nadir temperature, cooling speed, and degree of cooling (cooling area, or the area under the curve of inverted temperature trends from cooling to rewarming as calculated by the integral method), were analyzed. The relationships between these variables and transient neurologic dysfunction were evaluated. Transient neurologic dysfunction was observed in 33 (14.5%) of the 228 included patients. In the transient neurologic dysfunction group, the cooling area was larger (2417.3 vs. 1920.8°Cmin; P < 0.001) and the cooling speed was higher (0.68 vs. 0.51°C/min; P < 0.001) than in the non-transient neurologic dysfunction group. A multivariate logistic model revealed that both the cooling area (odds ratio = 1.13 per 100°Cmin; P < 0.001) and cooling speed (odds ratio = 3.69 per °C/min; P = 0.041) were independent risk factors for transient neurologic dysfunction. Both the cooling area, which indicates the degree of cooling, and cooling speed had significant relationships with transient neurologic dysfunction after total arch replacement. Together, these findings indicate that overcooling and rapid cooling may contribute to brain injury.

Post-traumatic Transient Neurological Dysfunction: A Proposal for Pathophysiology.

Unexplained neurological deterioration is occasionally observed in patients with traumatic brain injuries (TBIs). We aimed to describe the clinical features of post-traumatic transient neurological dysfunction and provide new insight into its pathophysiology. We retrospectively collected data from patients with focal neurological deterioration of unknown origin during hospitalization for acute TBI for 48 consecutive months. Brain imaging, including computed tomography, diffusion-weighted imaging and perfusion-weighted imaging, and electroencephalography were conducted during the episodes. Fourteen (2.0%) patients experienced unexplained focal neurological deterioration among 713 patients who were admitted for traumatic intracranial hemorrhage during the study period. Aphasia was the predominant symptom in all patients, and hemiparesis or hemianopia was accompanied in three patients. These symptoms developed within 14 days after trauma. Structural imaging did not show any significant interval change, and electroencephalography showed persistent arrhythmic slowing in the corresponding hemisphere in most patients. Perfusion imaging revealed increased cerebral blood flow in the symptomatic hemisphere. Surgical intervention and anti-seizure medications were ineffective in abolishing the symptoms. The symptoms disappeared spontaneously after 4 h to 1 month. Transient neurological dysfunction (TND) can occur during the acute phase of TBI. Although TND may last longer than a typical transient ischemic attack or seizure, it eventually resolves regardless of treatment. Based on our observation, we postulate that this is a manifestation of spreading depolarization occurring in the injured brain, which is analogous to migraine aura.

Is axillary artery cannulation necessary in type II hybrid aortic arch repair for acute type A aortic dissection?

Axillary artery cannulation (AAC) has been widely employed in total arch replacement surgeries using the frozen elephant trunk (FET) technique for acute type A aortic dissection (ATAAD), showing better clinical results than femoral artery cannulation (FAC). Nevertheless, in type II hybrid arch repair (HAR), FAC is crucial for lower body perfusion. Hence, it is unclear whether AAC remains necessary or if AAC represents a more advantageous method for initiating cardiopulmonary bypass. We conducted a study involving patients diagnosed with ATAAD who underwent type II HAR from August 2021 to December 2022. Demographic baseline and intraoperative data were collected, and the postoperative outcomes of patients receiving FAC only were compared with those receiving AAC. There were no significant differences in baseline demographics between patients who underwent FAC alone (n = 46) and those who underwent AAC (n = 39). Patients who underwent AAC showed a lower incidence of transient neurological dysfunction (TND) post-surgery compared to those who underwent FAC (12.8% vs 32.6%, p = .032). There were no significant differences between the groups in terms of postoperative mortality within 30days, permanent neurological dysfunction (PND), length of stay in the intensive care unit (ICU) and postoperative ward, duration of mechanical ventilation, and other complications. Axillary artery cannulation may decrease the incidence of postoperative transient neurological dysfunction (TND) in type II HAR for ATAAD. Nonetheless, studies with larger sample sizes are necessary.

Clinical Management in Traumatic Brain Injury.

Traumatic brain injury is one of the leading causes of morbidity and mortality worldwide and is one of the major public healthcare burdens in the US, with millions of patients suffering from the traumatic brain injury itself (approximately 1.6 million/year) or its repercussions (2-6 million patients with disabilities). The severity of traumatic brain injury can range from mild transient neurological dysfunction or impairment to severe profound disability that leaves patients completely non-functional. Indications for treatment differ based on the injury's severity, but one of the goals of early treatment is to prevent secondary brain injury. Hemodynamic stability, monitoring and treatment of intracranial pressure, maintenance of cerebral perfusion pressure, support of adequate oxygenation and ventilation, administration of hyperosmolar agents and/or sedatives, nutritional support, and seizure prophylaxis are the mainstays of medical treatment for severe traumatic brain injury. Surgical management options include decompressive craniectomy or cerebrospinal fluid drainage via the insertion of an external ventricular drain. Several emerging treatment modalities are being investigated, such as anti-excitotoxic agents, anti-ischemic and cerebral dysregulation agents, S100B protein, erythropoietin, endogenous neuroprotectors, anti-inflammatory agents, and stem cell and neuronal restoration agents, among others.

Twenty Years of Subcutaneous Interferon-Beta-1a for Multiple Sclerosis: Contemporary Perspectives.

Multiple sclerosis (MS) is a chronic, progressive, inflammatory disorder of the central nervous system. Relapsing-remitting MS (RRMS), the most common form of the disease, is characterized by transient neurological dysfunction with concurrent accumulation of disability. Over the past three decades, disease-modifying therapies (DMTs) capable of reducing the frequency of relapses and slowing disability worsening have been studied and approved for use in patients with RRMS. The first DMTs were interferon-betas (IFN-βs), which were approved in the 1990s. Among them was IFN-β-1a for subcutaneous (sc) injection (Rebif®), which was approved for the treatment of MS in Europe and Canada in 1998 and in the USA in 2002. Twenty years of clinical data and experience have supported the efficacy and safety of IFN-β-1a sc in the treatment of RRMS, including pivotal trials, real-world data, and extension studies lasting up to 15years past initial treatment. Today, IFN-β-1a sc remains an important therapeutic option in clinical use, especially around pregnancy planning and lactation, and may also be considered for aging patients, in which MS activity declines and long-term immunosuppression associated with some alternative therapies is a concern. In addition, IFN-β-1a sc is used as a comparator in many clinical studies and provides a framework for research into the mechanisms by which MS begins and progresses.

Enhancing Performance of Convolutional Neural Network-Based Epileptic Electroencephalogram Diagnosis by Asymmetric Stochastic Resonance.

Epilepsy is a chronic disorder that leads to transient neurological dysfunction and is clinically diagnosed primarily by electroencephalography. Several intelligent systems have been proposed to automatically detect seizures, among which deep convolutional neural networks (CNNs) have shown better performance than traditional machine-learning algorithms. Owing to artifacts and noise, the raw electroencephalogram (EEG) must be preprocessed to improve the signal-to-noise ratio prior to being fed into the CNN classifier. However, because of the spectrum overlapping of uncontrollable noise with EEG, traditional filters cause information loss in EEG; thus, the potential of classifiers cannot be fully exploited. In this study, we propose a stochastic resonance-effect-based EEG preprocessing module composed of three asymmetrical overdamped bistable systems in parallel. By setting different asymmetries for the three parallel units, the inherent noise can be transferred to the different spectral components of the EEG through the asymmetric stochastic resonance effect. In this process, the proposed preprocessing module not only avoids the loss of information of EEG but also provides a CNN with high-quality EEG of diversified frequency information to enhance its performance. By combining the proposed preprocessing module with a residual neural network, we developed an intelligent diagnostic system for predicting seizure onset. The developed system achieved an average sensitivity of 98.96% on the CHB-MIT dataset and 95.45% on the Siena dataset, with a false prediction rate of 0.048/h and 0.033/h, respectively. In addition, a comparative analysis demonstrated the superiority of the developed diagnostic system with the proposed preprocessing module over other existing methods.

Extra-anatomic revascularization and a new cannulation strategy for preoperative cerebral malperfusion due to severe stenosis or occlusion of supra-aortic branch vessels in acute type A aortic dissection

ObjectivesAcute type A aortic dissection (ATAAD) with severe stenosis or occlusion of the true lumen of aortic arch branch vessels often leads to an increased incidence of severe postsurgical neurological complications and mortality rate. In this study, we aimed to introduce our institutional extra-anatomic revascularization and cannulation strategy with improved postoperative outcomes for better management of patients with cerebral malperfusion in the setting of ATAAD. MethodsTwenty-eight patients with ATAAD complicated by severe stenosis or occlusion of the aortic arch branch vessels, as noted on combined computed tomography angiography of the aorta and craniocervical artery, between January 2021 and June 2022 were included in this study. Basic patient characteristics, surgical procedures, hospitalization stays, and early follow-up results were analyzed. ResultsThe median follow-up duration was 16.5 months (interquartile range: 11.5–20.5), with a 100% completion rate. The 30-day mortality rates was 7.1% (2/28 patients); two patients had multiple cerebral infarctions on preoperative computed tomography and persistent coma. Postoperative transient neurological dysfunction occurred in 10.7% (3/28) of the patients, and no new permanent neurological dysfunction occurred. Of all the patients, 3.6% (1/28) had novel acute renal failure. No other deaths, secondary surgeries, or serious complications occurred during the early follow-up period. ConclusionsUse of extra-anatomic revascularization and a new cannulation strategy before cardiopulmonary bypass is safe and feasible and may reduce the high incidence of postoperative neurological complications in patients with ATAAD and cerebral malperfusion.

Simplified total arch reconstruction with a stented graft for extended aortic arch dilation.

Reconstruction of the aortic arch and its three supra-aortic vessels remains a great surgical challenge with postoperative complications. We present a simplified total arch reconstruction with a modified stent graft (s-TAR) and compared its operative outcomes with conventional total arch replacement (c-TAR). This retrospective analysis of prospectively collected data from all consecutive patients who had ascending aortic aneurysm with extended aortic arch dilation and underwent simultaneous ascending aorta replacement and aortic arch reconstruction with the s-TAR or c-TAR between 2018 and 2021. The indication for intervention was maximum diameter of ascending aorta >55 mm and aortic arch in zone II >35 mm. A total of 84 patients were analyzed: 43 in the s-TAR group and 41 in the c-TAR group. No inter-group differences were found for sex, age, comorbidities, or EuroSCORE II results. All patients were successfully treated with s-TAR or c-TAR, and none died intraoperatively. Cardiopulmonary bypass, selective cerebral perfusion, and lower-body circulatory arrest time were significantly shorter in the s-TAR group, which also had a lower incidence of prolonged ventilation and transient neurologic dysfunction. No patient in either group experienced permanent neurologic dysfunction. The incidence of recurrent laryngeal nerve injury and paraplegia was markedly increased in the c-TAR group; however, no such events were observed in the s-TAR group. Both perioperative blood loss and the incidence of reoperation for bleeding were significantly lower in the s-TAR group. The in-hospital mortality rate was 0% in the s-TAR group and 4.9% in the c-TAR group. The s-TAR group had significantly shorter intensive care unit (ICU) stay and lower total hospitalization costs. The s-TAR technique is a safe and effective alternative for total arch reconstruction with shorter operation time, lower rate of postoperative complications and lower total hospitalization costs compared with c-TAR.

Redo Total Aortic Arch Replacement in Patients with Aortic Dissection After Open-Heart Surgery and Long-Term Follow-Up Results.

The objectives of this study were to investigate the main treatment strategies and long-term follow-up results of aortic dissection surgery after open-heart surgery (ADSOHS) and to analyze the risk factors that cause ADSOHS. One hundred thirty-seven patients with ADSOHS hospitalized in our hospital from January 2009 to December 2018 were selected as the research object. Long-term follow-up results, complications, mortality, and changes of cardiac function before and after operation were used to explore the value of Sun's operation. The length of stay in intensive care unit of these 137 patients ranged from 9.5 to 623.75 hours (average of 76.41±97.29 hours), auxiliary ventilation time ranged from 6.0 to 259.83 hours (average of 46.16±55.59 hours), and hospital stay ranged from six to 85 days (average of 25.06±13.04 days). There were seven cases of postoperative low cardiac output, 18 cases of coma and stroke, and six cases of transient neurological dysfunction. A total of 33 patients died; 19 patients died during the perioperative period, 18 died during Sun's operation and one died during other operation; and 14 patients died during follow-up (January 2021), 12 cases of Sun's operation and two cases of other operations. ADSOHS treatment strategy is of high application value, and the risk of neurological complications and mortality is low. The main risk factors are postoperative low cardiac output, coma, stroke, and transient neurological dysfunction. The extracorporeal circulation time is relatively long. Short- and long-term follow-up effects are good, and it is worthy of clinical promotion.

Influence of Autologous Bone Marrow Stem Cell Therapy on the Levels of Inflammatory Factors and Conexin43 of Patients with Moyamoya Disease.

Moyamoya disease is a medical condition that shows the typical characteristics like continuous and chronic thickening of the walls and the contraction of the internal carotid artery; as a result, the internal diameter of the artery gets narrowed. There are six phases of the disease ranging from I to VI (moyamoya vessels completely disappear, followed by the complete blockage of the arteries). Surgery is a commonly recommended treatment for the moyamoya disease. Our research study identifies the effect of autologous bone marrow stem cell therapy (ABMSCT) on the levels of inflammatory factors and Conexin43 (Cx43) protein in patients suffering from moyamoya. In our study, we have selected 52 moyamoya patients admitted to our hospital from 30 July 2019 to 10 February 2020. The control group (CG) was treated with superficial temporal artery to a middle cerebral artery (STA-MCA) bypass + encephalo-duro-myosinangiosis (EDMS). The experimental group (Exp. Grp) was treated with ABMSC. The cerebral vascular tissue of the patients was treated with hematoxylin-eosin (HE) staining. Immunohistochemical staining was used to identify the levels of Cx43 protein. The concentrations of vascular endothelial growth factor (VEGF), inflammatory factor interleukin-6 (IL6), interleukin-1β (IL1β), tumor necrosis factor (TNFα), and anti-inflammatory factor interleukin-1β (IL1β) were determined by enzyme-linked immunosorbent assay (ELISA). We have found that after treatment of the expression of Cx43 protein, the proportions of grade IV (7.7%), grade III (311.5%), and grade II (3.8%) patients in the Exp. Grp were lower than those in the CG. The proportion of grade I patients in the Exp. Grp (77%) was higher than that in the CG (38.5%). After treatment, the inflammatory factors IL6 (0.97 ± 0.82 pg/mL), IL1β (8.33 ± 1.21 pg/mL), and TNFα (1.73 ± 0.71 pg/mL) in the Exp. Grp were lower than those in the CG. The anti-inflammatory factor IL1β (15.09 ± 4.72 pg/mL) increased in the Exp. Grp compared with the CG (11.25 ± 3.48 pg/mL) post treatment. Intracranial infection, hydrocephalus, hemiplegia, and transient neurological dysfunction in the Exp. Grp were lower than those in the CG, with statistical differences (P < 0.05). Our study suggests that the treatment of autologous bone marrow stem cells (ABMSC) was beneficial to balance the inflammatory response of disorders, reduce the damage of vascular tissue in the brain, and regulate tissue repair by co-acting with various inflammatory factors as compared to traditional surgery. We conclude that the involvement of Cx43 in the occurrence and development of moyamoya. We also have found that the risk factors of intracranial infection after ABMSCT were less as compared to those after conventional surgery.

Resveratrol reduces p38 mitogen-activated protein kinase phosphorylation by activating Sirtuin 1 to alleviate cognitive dysfunction after traumatic brain injury in mice.

Traumatic brain injury (TBI) is characterized by neuronal loss and subsequent brain damage and can be accompanied by transient or permanent neurological dysfunction. The recovery of cognitive function after TBI is a challenge. This study aimed at investigating whether treatment with resveratrol (RSV) could prevent cognitive dysfunction after TBI in mice. TBI mouse model using weight drop-impact method. Male mice aged from 7 to 9 weeks were randomly divided into four groups: TBI group, TBI + vehicle group, TBI + RSV group, and sham-operated control group. The animals from the TBI + vehicle group and TBI + RSV group were intraperitoneally injected at 3 and 24 h post-TBI with placebo and RSV (3%, 5 ml/kg), respectively. Two days after TBI, the hippocampus of mice was extracted, and western blot analysis was performed for Sirtuin 1 (SIRT1), synaptophysin (SYP), p38 mitogen-activated protein kinase (MAPK), and P-p38 MAPK. Moreover, behavioral functions of TBI mice were evaluated by Y maze to determine RSV efficacy in preventing cognitive impairment in TBI. RSV increased the expression of SIRT1 protein, which in turn activated the phosphorylation of p38 MAPK. Taken together, our findings suggest that RSV exerts a strong beneficial effect on improving neurological function induced by TBI.

Comparison of two surgical approaches for acute type A aortic dissection: hybrid debranching versus total arch replacement

BackgroundThe goal of this study was to determine the clinical outcomes of total arch replacement with frozen elephant trunk surgery and hybrid debranching surgery for acute type A aortic dissection patients.MethodsFrom January 2017 to December 2019, the clinical data of acute type A aortic dissection patients were retrospectively collected and analyzed. There were 142 patients underwent total arch replacement with frozen elephant trunk surgery and 35 patients underwent hybrid debranching surgery.ResultThe age, the body mass index and the renal insufficiency of patients in the hybrid group were higher than those in the total arch replacement (TAR) group (all P < 0.01). The operation time, the cardiopulmonary bypass time and the aortic occlusion time of patients in the TAR group were significantly longer than those in the hybrid group (all P < 0.01). Patients in the debranching group had shorter ventilator-assisted breathing time, shorter postoperative hospital stay time and shorter intensive care unit (ICU) stay time. The incidence of pulmonary infection and transient neurological dysfunction were lower, and the transfusions of red blood cells and plasma during the perioperative period were smaller. The survival rates at 2 years were 91.9% and 85.9% in the TAR and hybrid groups, respectively.ConclusionHybrid debranching operation is a safe and effective method for acute type A aortic dissection. Compared with TAR surgery, hybrid debranching surgery has the characteristics of less trauma, rapid recovery and lower incidence of complication.

Application of retrograde cerebral perfusion in aortic root replacement combined with right half aortic arch replacement.

After cardiac surgery involving the aortic arch, the incidence of neurological complications remains high, therefore it is very important to take measures to protect brain. This study is to investigate the safety and effectiveness of deep hypothermic circulatory arrest and retrograde cerebral perfusion for aortic root combined with right half aortic arch replacement. Clinical data of 31 patients, who underwent aortic root and right half aortic arch replacement with deep hypothermic circulatory arrest and retrograde cerebral perfusion in Xiangya Hospital, Central South University, were retrospectively analyzed. This cohort included 23 aortic aneurysms and 8 aortic dissections. Aortic root replacement was conducted in 26 patients by Bentall procedures, and 5 patients by David procedures. Time of deep hypothermic circulatory arrest and retrograde cerebral perfusion in surgery was (21.9±5.2) min. The in-hospital mortality, postoperative neurological dysfunction and other major adverse complications were observed and recorded. No in-hospital death and permanent neurological dysfunction occurred. Two patients had transient neurological dysfunction and 2 patients with aortic dissection requiring long-time ventilation due to hypoxemia, 1 patient underwent resternotomy. During 6-36 months of follow-up, all patients recovered satisfactorily. Deep hypothermic circulatory arrest and retrograde cerebral perfusion can be safely and effectively applied in aortic root and right half aortic arch replacement, and which can simplify the surgical procedures and be worth of clinical promotion.

Unilateral versus bilateral antegrade cerebral perfusion during surgical repair for patients with acute type A aortic dissection

ObjectivesTo compare unilateral versus bilateral antegrade cerebral perfusion (ACP) techniques on cerebral protection during acute type A aortic dissection repair. MethodsUsing an institutional database, we retrospectively reviewed patients who underwent acute type A aortic dissection repair with selective ACP techniques from October 2008 to December 2019. Primary end point was the detection of neurologic dysfunctions. The secondary end point was mortality. For baseline adjustment, the propensity score matching method was used. Multivariable logistic regression analysis was performed to determine the predictor of neurologic events. ResultsAmong 522 patients (aged 62.0 ± 14.9 years; 45.7% women), unilateral and bilateral ACP techniques were used in 357 (64.7%) and 165 (35.3%) patients, respectively. Transient (19.6% vs 21.2%; P = .65) and permanent (7.0% vs 10.3%; P = .70) neurologic dysfunction rates were not significantly different in patients with unilateral versus bilateral ACP, respectively. Observed mortality rate was higher in the patients with bilateral ACP (hazard ratio, 2.05; 95% CI, 1.33-3.14; P = .001). Propensity-score matching yielded 94 pairs of patients. In matched analysis, bilateral ACP did not significantly lower the risks for transient (odds ratio, 0.87; 95% CI, 0.42-1.81; P = .71) and permanent (odds ratio, 1.42; 95% CI, 0.55-3.85; P = .47) neurologic dysfunction or death (hazard ratio, 1.65; 95% CI, 0.87-3.15; P = .13). In the multivariable analysis, the ACP technique was not significantly associated with perioperative neurologic deficit. ConclusionsDespite additional supply, the patients undergoing bilateral ACP during acute type A aortic dissection repair did not have superior outcomes in neurologic and death events compared with the patients undergoing unilateral ACP.

Novel Caspase-1 inhibitor CZL80 improves neurological function in mice after progressive ischemic stroke within a long therapeutic time-window.

Progressive ischemic stroke (PIS) is featured by progressive neurological dysfunction after ischemia. Ischemia-evoked neuroinflammation is implicated in the progressive brain injury after cerebral ischemia, while Caspase-1, an active component of inflammasome, exaggerates ischemic brain injury. Current Caspase-1 inhibitors are inadequate in safety and druggability. Here, we investigated the efficacy of CZL80, a novel Caspase-1 inhibitor, in mice with PIS. Mice and Caspase-1-/- mice were subjected to photothrombotic (PT)-induced cerebral ischemia. CZL80 (10, 30 mg·kg-1·d-1, i.p.) was administered for one week after PT onset. The transient and the progressive neurological dysfunction (as foot faults in the grid-walking task and forelimb symmetry in the cylinder task) was assessed on Day1 and Day4-7, respectively, after PT onset. Treatment with CZL80 (30 mg/kg) during Day1-7 significantly reduced the progressive, but not the transient neurological dysfunction. Furthermore, we showed that CZL80 administered on Day4-7, when the progressive neurological dysfunction occurred, produced significant beneficial effects against PIS, suggesting an extended therapeutic time-window. CZL80 administration could improve the neurological function even as late as Day43 after PT. In Caspase-1-/- mice with PIS, the beneficial effects of CZL80 were abolished. We found that Caspase-1 was upregulated during Day4-7 after PT and predominantly located in activated microglia, which was coincided with the progressive neurological deficits, and attenuated by CZL80. We showed that CZL80 administration did not reduce the infarct volume, but significantly suppressed microglia activation in the peri-infarct cortex, suggesting the involvement of microglial inflammasome in the pathology of PIS. Taken together, this study demonstrates that Caspase-1 is required for the progressive neurological dysfunction in PIS. CZL80 is a promising drug to promote the neurological recovery in PIS by inhibiting Caspase-1 within a long therapeutic time-window.

Comparison of short-term outcomes of mild and moderate hypothermic circulatory arrest in aortic arch surgery: a single center retrospective cohort study.

BackgroundAortic arch surgery is one of the major challenges in modern aortic surgery, special cerebral and visceral organ protective strategies are still under progress. Whether mild hypothermic circulatory arrest (Mi-HCA) can be safely used in aortic arch surgery (AAS) is the focus of attention.MethodsFrom January 2017 to June 2021, a retrospective cohort study of 138 consecutive patients was conducted at Beijing Anzhen Hospital. The study comprised patients who underwent AAS performed by a single surgeon during moderate-to-mild HCA. According to the core temperature at the beginning of circulatory arrest, the patients were divided into three groups: T1 group (n=45; 25.76±0.75 ℃), T2 group (n=43; 28.79±0.81 ℃), T3 group (n=50; 31.46±0.79 ℃). Perioperative clinical data were analyzed to assess the differences between groups.ResultsIn this cohort, the average durations of the operation, cardiopulmonary bypass (CPB), cross-clamp, circulatory arrest, and selective antegrade cerebral perfusion (SACP) were 6.53±1.48 h, 184.07±56.69 min, 101.04±37.92 min, 23.01±9.86 min, and 27.18±11.52 min, respectively. We observed new postoperative permanent neurological dysfunction (PND) in 12 patients (8.7%) and transient neurological dysfunction in 18 patients (13.04%). The in-hospital mortality rate was 6.52% (n=9). The durations of the operation, CPB, cross-clamp, circulatory arrest, and SACP were significantly reduced in the Mi-HCA group (i.e., T3 group, P<0.001; P<0.001; P<0.001; P=0.002; P<0.001, respectively). The incidence of PND and major adverse events (MAEs) were significantly reduced among the three groups (P=0.025; P=0.035). Multivariate logistic regression analysis models showed that Mi-HCA was an independent protective factor in reducing postoperative MAEs [relative risk (RR) =0.12; 95% confidence interval (CI): 0.02–0.90; P=0.0385].ConclusionsThe short-term outcomes of Mi-HCA combined with SACP in AAS were acceptable. Similarly, the protection of distal organs and the spinal cord was observed compared to the MHCA strategy, and a lower incidence of MAEs was obtained. Current data suggest that the mild hypothermia strategy can be safely applied for AAS.

Prognosis and Risk Factors of Stroke After Thoracic Endovascular Aortic Repair for Stanford Type B Aortic Dissection.

Background: Stroke is a severe complication of patients with type B aortic dissection (TBAD) after thoracic endovascular aortic repair (TEVAR). Our aim is to identify predictors of stroke after TEVAR.Methods: From February 2016 to February 2019, 445 patients with TBAD who underwent TEVAR were retrospectively analyzed. Univariate and multivariate analyses were performed to identify predictors of stroke after TEVAR.Results: The total incidence of stroke was 11.5%, with transient neurological dysfunction (TND) of 10.6% and permanent neurological dysfunction (PND) of 0.9%. The average age of the patients was 53.0 ± 3.2 years, and the male/female ratio was 1.17. Univariate analysis suggested that age, body mass index (BMI), diabetes mellitus, chronic obstructive pulmonary disease (COPD), the urgency of repair, type of anesthesia, and left subclavian artery (LSCA) processing were potential risks factors of stroke after TEVAR. Multiple logistic regression identified that LSCA coverage (OR = 5.920, 95% CI: 2.077–16.878), diabetes mellitus (OR = 3.036, 95% CI: 1.025–8.995), and general anesthesia (OR = 2.498, 95% CI: 1.002–6.229) were independent predictors of stroke after TEVAR.Conclusions: Left subclavian artery (LSCA) coverage, diabetes mellitus, and general anesthesia were independent risk factors of stroke after TEVAR for TBAD.

Modified Technique for Retrograde Cerebral Perfusion during Hemiarch Aortic Replacement.

Background Uncertainty remains regarding the optimal method of brain protection for procedures that require repair or replacement of the aortic arch. We examined the early outcomes of a technique for brain protection in patients undergoing partial aortic arch (hemiarch) replacement that involves deep hypothermic circulatory arrest (DHCA) and retrograde cerebral perfusion (RCP) of cold blood from the superior vena cava toward the end of the arrest interval. Methods During a recent 15-year interval, 520 patients underwent elective or urgent/emergent ascending aortic and hemiarch replacement as an isolated (47 patients) or combined (473 patients) procedure employing DHCA (mean nasopharyngeal temperature at circulatory arrest, 17.1°C and mean duration, 19.3 minutes) supplemented with RCP of cold blood from the superior vena cava toward the end of the arrest interval (mean, 6.7 minutes). The mean age of the patients was 59.5 years, and 65% were male. Results The in-hospital and 30-day mortality rates were 1.2% (six patients). Seven patients (1.4%) sustained a stroke and 19 patients (3.7%) had transient neurologic dysfunction that completely resolved by the time of hospital discharge. Four patients (0.77%) developed postoperative renal failure requiring dialysis. Twenty-one patients (4%) required ventilator support for >48 hours and five patients (0.96%) required a tracheostomy. The median hospital length of stay was 6 days. Conclusion DHCA with a brief interval of RCP is a safe and effective technique for brain protection during hemiarch aortic replacement. RCP reduces the duration of brain ischemia and permits removal of particulate matter and air from the arterial circulation.

Balance cerebral perfusion with superficial temporal artery pressure plus jugular bulb oxyhemoglobin saturation improve neurologic outcome during thoracic aorta surgery

Objective The aim of this study is to analyze superficial temporal artery plus jugular bulb oxyhemoglobin saturation (SjO2) monitoring during thoracic aortic procedure with regard to neurologic outcomes. Methods We performed a prospective study of patients undergoing thoracic aortic surgery. Between Sep. 2014 and Oct. 2017, 96 patients undergoing thoracic aortic procedure were recruited and divided into two group by random number table method: study group and control group. Circulatory maintenance included deep hypothermia circulatory arrest (DHCA) and selective cerebral perfusion (SCP) method during operation. Superficial temporal artery and SjO2 of patients in study group were monitored. Whereas, only SjO2 was monitored based on clinical experience of patients in control group. In order to evaluate the incidences of postoperative neurological dysfunction, the cerebral perfusion rate and blood flow rate during the surgery of patients in study group and control group were compared. Results The flow rate of SCP in the study group was significantly lower than that in the control group (P<0.05). The recovery time, extubation time and intensive care unit(ICU) residence time of the patients in the study group were significantly shorter than the time values in the control group. In addition, the incidences of permanent neurological dysfunction (PND) and transient neurological dysfunction (TND) in the study group were significantly lower than the incidences in the control group. The difference was statistically significant (P<0.05). Conclusions The application of monitoring superficial temporal artery plus SjO2 can benefit to cerebral perfusion and decrease the neurological injury. Key words: Superficial temporal artery; Jugular vein; Oxyen saturation; Deep hypothermia circulatory arrest; Cerebral protection; Thoracic aorta surgery