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Razaqyar MS, Osta E, Towne JM, Woolsey MD, Ishaque M, Chiang FL, Fox PT. Long-Term Neurocognitive Outcomes in Pediatric Nonfatal Drowning: Results of a Family Caregiver Survey. Pediatr Neurol 2024; 151:21-28. [PMID: 38091919 DOI: 10.1016/j.pediatrneurol.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/01/2023] [Accepted: 11/03/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND Drowning is a leading cause of brain injury in children. Long-term outcome data for drowning survivors are sparse. This study reports neurocognitive outcomes for 154 children hospitalized following drowning. METHODS A survey for parent caregivers was distributed online. Likert scale items assessed 10 outcome variables in four domains: motor (three), perception (three), language (three), and social/emotional (one). Cluster analysis, outcome relative risk, and descriptive statistics were applied. RESULTS Of 208 surveys received, 154 met inclusion criteria. Coma was the most common admission status (n = 137). Cluster analysis identified three outcome groups: Mild (n = 39), Moderate (n = 75), and Severe (n = 40). Motor impairment with cognitive and perceptual sparing (deefferentation) was present in Moderate (P < 1 × 10-26) and Severe (P < 1 × 10-12) but absent in Mild. Locked-in state was endorsed in both Moderate (83%) and Severe (70%). The strongest predictor of good outcome (Mild) was hospitalization with no medical intervention (relative risk [RR] = 6.7). Responsivity on admission (RR = 4.2) or discharge (RR = 12.22) also predicted good outcome. In-hospital prognostication and counseling predicted outcome weakly (RR = 1.3) or not at all. CONCLUSIONS Long-term outcomes in pediatric drowning ranged widely. Overall, motor impairments exceeded perceptual or cognitive (P < 1 × 10-18), with "locked-in state" endorsed in most (93 of 154). The strongest predictors of good outcome were the lack of necessity for interventions and responsivity on admission or discharge. The eponym "Conrad syndrome" is proposed for locked-in state following nonfatal drowning in children.
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Affiliation(s)
- Muslima S Razaqyar
- Research Imaging Institute, University of Texas Health Science Center at San Antonio, San Antonio, Texas; Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Eri Osta
- Research Imaging Institute, University of Texas Health Science Center at San Antonio, San Antonio, Texas; School of Data Science, University of Texas at San Antonio, San Antonio, Texas
| | - Jonathan M Towne
- Research Imaging Institute, University of Texas Health Science Center at San Antonio, San Antonio, Texas; Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Mary D Woolsey
- Research Imaging Institute, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Mariam Ishaque
- Department of Neurosurgery University of Virginia, Charlottesville, Virginia
| | - Florence L Chiang
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Peter T Fox
- Research Imaging Institute, University of Texas Health Science Center at San Antonio, San Antonio, Texas; Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas; Department of Neurology, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
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2
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Perogio M, Simonit F, Da Broi U, Desinan L. Manner of death determination in a case of gastric mucosal tears. Leg Med (Tokyo) 2024; 66:102367. [PMID: 38039656 DOI: 10.1016/j.legalmed.2023.102367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 11/23/2023] [Indexed: 12/03/2023]
Abstract
Gastric tears are rarely described in the forensic pathological literature, although they can lead to a fatal acute exsanguination. Such lesions can arise from several conditions leading to an increased intragastric pressure, such as Mallory Weiss syndrome, cardiopulmonary resuscitation, acute barotrauma and operative procedures, showing peculiar morphological features. We present a case of a 32-year-old drug addicted white woman found dead in a pool of blood in the house of her drug dealer, after taking a dose of intravenous heroin. At autopsy, abundant bloody gastric content and multiple and long gastric tears, extending from the cardias and fundus regions to the gastric corpus were observed; one of them involved the subserous region, resulting in a gastric wall rupture. The victim had no history of recent vomiting and of gastro-intestinal pathologies. Drugs and ethanol levels detected in the specimens of the victim were not consistent with lethal concentrations, thus the death was attributed to acute exsanguination. After reviewing the literature, it turned out that morphological aspects of the gastric tears, such as number, size and topographical distribution, observed at autopsy were atypical compared to those of typical gastric lacerations.
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Affiliation(s)
- Maurizio Perogio
- Department of Medical, Surgical and Health Sciences, School of Legal Medicine, University of Trieste, Trieste, Italy.
| | - Francesco Simonit
- Department of Medicine, Legal Medicine, University of Udine, Udine, Italy
| | - Ugo Da Broi
- Department of Medicine, Legal Medicine, University of Udine, Udine, Italy
| | - Lorenzo Desinan
- Department of Medicine, Legal Medicine, University of Udine, Udine, Italy
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3
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Ehrhardt JD, Newsome K, Das S, McKenney M, Elkbuli A. Evaluation and Management of Watercraft-Related Injuries for Acute Care Surgeons: Towards Improving Care and Implementing Effective Public Health Prevention Policies. ANNALS OF SURGERY OPEN 2022; 3:e149. [PMID: 37600112 PMCID: PMC10431368 DOI: 10.1097/as9.0000000000000149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 02/15/2022] [Indexed: 11/27/2022] Open
Abstract
Boating has exposed humans to elemental hazards for centuries. What was once a lifelong craft and time-honored skillset is now, with modern technology, a popular recreational activity. Boating safety has inherent limitations and has been historically challenging to enforce. These circumstances have given way to a rising number of watercraft-associated injuries and fatalities. This review aims to investigate the diagnosis, work-up, and management of watercraft-related injuries, including blunt mechanisms, propeller wounds, water-force trauma, associated marine infections, and submersion injuries, as well as outline gaps in current public health policy on watercraft injuries, potential interventions, and available solutions. Motorboats and personal watercraft differ in size, power modality, and differential risk for injury. Accidents aboard watercraft often share commonalities with motor vehicles and motorcycles, namely: rapid deceleration, ejection, and collision with humans. The complexity of care is added by the austere environment in which many watercraft accidents occur, as well as the added morbidity of drowning and hypothermia. Wounds can also become infected by marine organisms, which require wound care and antimicrobial therapy specific to the aquatic environment in which the injury occurred. The treatment of these patients can be further exacerbated by the prolonged transportation times due to complicated water rescue. There are many measures that can prevent or abate watercraft injuries, but inconsistent regulations and enforcement may impair the success of these interventions. Further research is needed to identify possible solutions to common causes of watercraft injuries, such as inconsistent lifejacket use and bow riding.
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Affiliation(s)
- John D. Ehrhardt
- From the Department of Surgery, Kendall Regional Medical Center, Miami, Florida, USA
| | - Kevin Newsome
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, Florida, USA
| | - Snigdha Das
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, Florida, USA
| | - Mark McKenney
- From the Department of Surgery, Kendall Regional Medical Center, Miami, Florida, USA
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, Florida, USA
- University of South Florida, Tampa, Florida, USA
| | - Adel Elkbuli
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, Florida, USA
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4
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Challenges in Documenting Non-Fatal Drowning Disability in Bangladesh: A Community-Based Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189738. [PMID: 34574663 PMCID: PMC8467877 DOI: 10.3390/ijerph18189738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 12/01/2022]
Abstract
Limited access to health care and the lack of robust data systems means non-fatal drownings are largely missed in low-and middle-income countries. We report morbidity among individuals who experienced non-fatal drowning in the Barishal Division, Bangladesh. A representative household survey was conducted in the Barishal Division in southern Bangladesh between September 2016 and February 2017, covering a population of 386,016. The burden of non-fatal drowning was assessed using the WHODAS 2.0 disability assessment tool, a generic assessment instrument for health and disability. A total of 5164 non-fatal drowning events occurred in the one year preceding the survey. Among these 18% were multiple events. From these, 4235 people were administered the WHODAS 2.0 questionnaire. Non-fatal drowning incidence rates were highest in children aged 1–4 years at 5810 per 100,000 population, and among males. Non-fatal drowning was associated with lower socio-economic status and larger family sizes. Few respondents (6.5%; 95% CI: 4.5–8.4%) reported some level of disability (WHODAS-12 score > 8). Incidence of non-fatal drowning is high in the population, however limited impact on morbidity was found. There is a need to develop tools and methodologies for reliable and comparable data for non-fatal drowning, especially to capture post-event disability in children.
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Abstract
Objective: This case series describes the effect of angiotensin II administration on hemodynamics in patients with parenchymal lung injury due to submersion injury. Case Summary: A 33-year-old female and a 72-year-old female were both brought to the emergency department after incidents of near drowning. Upon arrival to the emergency department, both patients were hemodynamically unstable and were eventually intubated for airway protection. Imaging done by conventional chest radiograph for both patients revealed bilateral pulmonary edema. Due to their hemodynamic status, vasopressors were initiated for both patients and were quickly titrated, leading to the initiation of angiotensin II. In one patient, angiotensin II was initiated early in shock and resulted in rapid improvement of hemodynamics. In the other patient, angiotensin II was initiated later and a more muted response was observed. Conclusions: In patients with near drowning, angiotensin II appeared to improve hemodynamic status rapidly. This is the first case series to report the use of this new vasoactive agent in this population and poses noteworthy mechanistic considerations.
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Qiu YB, Wan BB, Liu G, Wu YX, Chen D, Lu MD, Chen JL, Yu RQ, Chen DZ, Pang QF. Nrf2 protects against seawater drowning-induced acute lung injury via inhibiting ferroptosis. Respir Res 2020; 21:232. [PMID: 32907551 PMCID: PMC7488337 DOI: 10.1186/s12931-020-01500-2] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 08/31/2020] [Indexed: 02/08/2023] Open
Abstract
Background Ferroptosis is a new type of nonapoptotic cell death model that was closely related to reactive oxygen species (ROS) accumulation. Seawater drowning-induced acute lung injury (ALI) which is caused by severe oxidative stress injury, has been a major cause of accidental death worldwide. The latest evidences indicate nuclear factor (erythroid-derived 2)-like 2 (Nrf2) suppress ferroptosis and maintain cellular redox balance. Here, we test the hypothesis that activation of Nrf2 pathway attenuates seawater drowning-induced ALI via inhibiting ferroptosis. Methods we performed studies using Nrf2-specific agonist (dimethyl fumarate), Nrf2 inhibitor (ML385), Nrf2-knockout mice and ferroptosis inhibitor (Ferrostatin-1) to investigate the potential roles of Nrf2 on seawater drowning-induced ALI and the underlying mechanisms. Results Our data shows that Nrf2 activator dimethyl fumarate could increase cell viability, reduced the levels of intracellular ROS and lipid ROS, prevented glutathione depletion and lipid peroxide accumulation, increased FTH1 and GPX4 mRNA expression, and maintained mitochondrial membrane potential in MLE-12 cells. However, ML385 promoted cell death and lipid ROS production in MLE-12 cells. Furthermore, the lung injury became more aggravated in the Nrf2-knockout mice than that in WT mice after seawater drowning. Conclusions These results suggested that Nrf2 can inhibit ferroptosis and therefore alleviate ALI induced by seawater drowning. The effectiveness of ferroptosis inhibition by Nrf2 provides a novel therapeutic target for seawater drowning-induced ALI.
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Affiliation(s)
- Yu-Bao Qiu
- Wuxi School of Medicine, Jiangnan University, 1800 Lihu Avenue, Wuxi, 214122, Jiangsu Province, People's Republic of China
| | - Bin-Bin Wan
- Wuxi School of Medicine, Jiangnan University, 1800 Lihu Avenue, Wuxi, 214122, Jiangsu Province, People's Republic of China
| | - Gang Liu
- Wuxi School of Medicine, Jiangnan University, 1800 Lihu Avenue, Wuxi, 214122, Jiangsu Province, People's Republic of China
| | - Ya-Xian Wu
- Wuxi School of Medicine, Jiangnan University, 1800 Lihu Avenue, Wuxi, 214122, Jiangsu Province, People's Republic of China
| | - Dan Chen
- Wuxi School of Medicine, Jiangnan University, 1800 Lihu Avenue, Wuxi, 214122, Jiangsu Province, People's Republic of China
| | - Mu-Dan Lu
- Central Laboratory, The Affiliated Wuxi Maternity and Child Health Care Hospital of Nanjing Medical University, 48 Huaishu Lane, Wuxi, 214122, Jiangsu Province, People's Republic of China
| | - Jun-Liang Chen
- Wuxi School of Medicine, Jiangnan University, 1800 Lihu Avenue, Wuxi, 214122, Jiangsu Province, People's Republic of China
| | - Ren-Qiang Yu
- Central Laboratory, The Affiliated Wuxi Maternity and Child Health Care Hospital of Nanjing Medical University, 48 Huaishu Lane, Wuxi, 214122, Jiangsu Province, People's Republic of China
| | - Dao-Zhen Chen
- Central Laboratory, The Affiliated Wuxi Maternity and Child Health Care Hospital of Nanjing Medical University, 48 Huaishu Lane, Wuxi, 214122, Jiangsu Province, People's Republic of China.
| | - Qing-Feng Pang
- Wuxi School of Medicine, Jiangnan University, 1800 Lihu Avenue, Wuxi, 214122, Jiangsu Province, People's Republic of China.
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7
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Manglick MP, Ross FI, Waugh MC, Holland AJA, Cass DT, Soundappan SSV. Neurocognitive outcomes in children following immersion: a long-term study. Arch Dis Child 2018; 103:784-789. [PMID: 29572222 DOI: 10.1136/archdischild-2017-314051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 02/10/2018] [Accepted: 02/17/2018] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate long-term neurocognitive outcomes after a near-drowning incident in children who were deemed neurologically intact on discharge from hospital. DESIGN A prospective cohort study of near-drowning children. SETTING 95 drowning and near-drowning admissions, 0-16 years of age, from January 2009 to December 2013, to The Children's Hospital at Westmead, Sydney, NSW, Australia. PARTICIPANTS 23 children both met the criteria and had parental consent for the study. MAIN OUTCOME MEASURES Identification of the long-term deficits in behaviour, executive function, motor skills, communicative skills and well-being over a 5-year period. Assessment was undertaken at 3-6 months, 1 year, 3 years and 5 years after near-drowning at clinic visits. Physical developmental screening and executive function screening were done using Behavior Rating Inventory of Executive Function-Preschool version (BRIEF-P) and BRIEF. RESULT 95 drowning and near-drowning episodes occurred during the study period. 10 (11%) children died, 28 were admitted to the paediatric intensive care unit and 64 directly to a ward. 3 children died in emergency department, 7 children had severe neurological deficit on discharge from the hospital. 23 were subsequently recruited into the study; 5 (22%) of these children had abnormalities in behaviour and/or executive function at some during their follow-up. CONCLUSION Children admitted to hospital following a near-drowning event warrant long-term follow-up to identify any subtle sequelae which might be amenable to intervention to ensure optimal patient outcome.
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Affiliation(s)
- Maria Patricia Manglick
- Department of Paediatric Surgery, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Frank I Ross
- Department of Paediatric Surgery, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Mary-Clare Waugh
- Kids Rehabilitation Department, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Andrew J A Holland
- Department of Paediatric Surgery, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Daniel T Cass
- Department of Paediatric Surgery, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Soundappan S V Soundappan
- Department of Paediatric Surgery, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
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8
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Zhao Y, Ma L, Wang R, Chen T, Liu X, Jin F. 3,5,4'-Tri-O-acetylresveratrol attenuates seawater inhalation-induced acute respiratory distress syndrome via thioredoxin 1 pathway. Int J Mol Med 2018; 41:3493-3500. [PMID: 29512754 DOI: 10.3892/ijmm.2018.3528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 01/12/2018] [Indexed: 11/06/2022] Open
Abstract
The protecting effects of 3,5,4'-tri-O-acetylresveratrol (AC-Res) on seawater inhalation-induced acute respiratory distress syndrome (ARDS) by interfering with the activation of thioredoxin-1 (Trx-1) pathway were evaluated. Seawater inhalation-induced ARDS was assessed by magnitude of pulmonary edema and lung inflammation. Oxidative stress was tested by T-SOD activity and MDA content in lungs and cells. Besides, Trx-1, nuclear factor erythroid 2-related factor 2 (Nrf2) and Txnip expression were measured to explore how seawater induced oxidative stress and the mechanism by which AC-Res attenuated seawater inhalation-induced ARDS. The results showed that seawater inhalation increased wet-to-dry (W/D) ratios of lung tissues, enhanced secretion of tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β), and disturbed the oxidative distress balance probably through interfering the activity of Trx-1 pathway. While treatment of AC-Res in vivo and Res in vitro reduced W/D ratios of lung tissues, decreased cytokines in lungs and maintained the oxidative stress balance through Trx-1 pathway. In conclusion, AC-Res treatment attenuated seawater inhalation induced ARDS via Trx-1 pathway.
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Affiliation(s)
- Yilin Zhao
- Department of Respiration, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710038, P.R. China
| | - Lijie Ma
- Department of Respiration, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710038, P.R. China
| | - Ruixuan Wang
- Department of Respiration, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710038, P.R. China
| | - Tingting Chen
- School of Accounting, Xijing University, Xi'an, Shaanxi 710032, P.R. China
| | - Xueying Liu
- Department of Medicinal Chemistry, School of Pharmacy, The Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Faguang Jin
- Department of Respiration, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710038, P.R. China
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9
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Li PC, Wang BR, Li CC, Lu X, Qian WS, Li YJ, Jin FG, Mu DG. Seawater inhalation induces acute lung injury via ROS generation and the endoplasmic reticulum stress pathway. Int J Mol Med 2018; 41:2505-2516. [PMID: 29436612 PMCID: PMC5846659 DOI: 10.3892/ijmm.2018.3486] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 01/12/2018] [Indexed: 01/01/2023] Open
Abstract
Seawater (SW) inhalation can induce acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). In the present study, SW induced apoptosis of rat alveolar epithelial cells and histopathological alterations to lung tissue. Furthermore, SW administration increased generation of reactive oxygen species (ROS), whereas pretreatment with the ROS scavenger, N-acetyl-L-cysteine (NAC), significantly decreased ROS generation, apoptosis and histopathological alterations. In addition, SW exposure upregulated the expression levels of glucose-regulated protein 78 (GRP78) and CCAAT/enhancer binding protein homologous protein (CHOP), which are critical proteins in the endoplasmic reticulum (ER) stress response, thus indicating that SW may activate ER stress. Conversely, blocking ER stress with 4-phenylbutyric acid (4-PBA) significantly improved SW-induced apoptosis and histopathological alterations, whereas an ER stress inducer, thapsigargin, had the opposite effect. Furthermore, blocking ROS with NAC inhibited SW-induced ER stress, as evidenced by the downregulation of GRP78, phosphorylated (p)-protein kinase R-like ER kinase (PERK), p-inositol-requiring kinase 1α (IRE1α), p-50 activating transcription factor 6α and CHOP. In addition, blocking ER stress with 4-PBA decreased ROS generation. In conclusion, the present study indicated that ROS and ER stress pathways, which are involved in alveolar epithelial cell apoptosis, are important in the pathogenesis of SW-induced ALI.
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Affiliation(s)
- Peng-Cheng Li
- Department of Respiratory Medicine, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710038, P.R. China
| | - Bo-Rong Wang
- Department of Respiratory Medicine, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710038, P.R. China
| | - Cong-Cong Li
- Department of Respiratory Medicine, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710038, P.R. China
| | - Xi Lu
- Department of Respiratory Medicine, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710038, P.R. China
| | - Wei-Sheng Qian
- Department of Respiratory Medicine, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710038, P.R. China
| | - Yu-Juan Li
- Department of Microbiology and Immunology, Shanxi Medical University, Taiyuan, Shanxi 030001, P.R. China
| | - Fa-Guang Jin
- Department of Respiratory Medicine, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710038, P.R. China
| | - De-Guang Mu
- Department of Respiratory Medicine, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710038, P.R. China
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10
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Çağlar A, Er A, Özden Ö, Karaarslan U, Akgul F, Koroğlu TF, Duman M. Efficacy of Early Noninvasive Ventilation in Three Cases of Nonfatal Drowning with Pulmonary Oedema in the Paediatric Emergency Department. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791602300206] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Drowning is still one of the most important causes of the preventable mortality worldwide. Some patients should be treated with noninvasive ventilation immediately in the emergency department (ED). The practice of noninvasive ventilation has been increased recently in the paediatric ED. We present here three nonfatal drowning patients with pulmonary oedema and hypoxia who were successfully treated with noninvasive ventilation in the paediatric emergency department. All of the patients had aspirated sea water during swimming. In addition, two of the patients had aspirated water during snorkeling. Noninvasive ventilation was applied to the patients immediately in paediatric emergency service. All of the patient's clinical and radiological findings recovered rapidly. There are limited reports about use of noninvasive ventilation in nonfatal drowning cases in the paediatric emergency department. We emphasize that the early application of noninvasive ventilation should be a preventive method for reducing the morbidity of nonfatal drowning cases. (Hong Kong j.emerg.med. 2016;23:42-46)
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Affiliation(s)
| | | | - Ö Özden
- Dokuz Eylul University, Faculty of Medicine, Department of Paediatric Intensive Care Unit, Turkey
| | - U Karaarslan
- Dokuz Eylul University, Faculty of Medicine, Department of Paediatric Intensive Care Unit, Turkey
| | | | - TF Koroğlu
- Dokuz Eylul University, Faculty of Medicine, Department of Paediatric Intensive Care Unit, Turkey
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11
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Ishaque M, Manning JH, Woolsey MD, Franklin CG, Tullis EW, Beckmann CF, Fox PT. Functional integrity in children with anoxic brain injury from drowning. Hum Brain Mapp 2017; 38:4813-4831. [PMID: 28759710 DOI: 10.1002/hbm.23745] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 07/10/2017] [Accepted: 07/15/2017] [Indexed: 01/10/2023] Open
Abstract
Drowning is a leading cause of accidental injury and death in young children. Anoxic brain injury (ABI) is a common consequence of drowning and can cause severe neurological morbidity in survivors. Assessment of functional status and prognostication in drowning victims can be extremely challenging, both acutely and chronically. Structural neuroimaging modalities (CT and MRI) have been of limited clinical value. Here, we tested the utility of resting-state functional MRI (rs-fMRI) for assessing brain functional integrity in this population. Eleven children with chronic, spastic quadriplegia due to drowning-induced ABI were investigated. All were comatose immediately after the injury and gradually regained consciousness, but with varying ability to communicate their cognitive state. Eleven neurotypical children matched for age and gender formed the control group. Resting-state fMRI and co-registered T1-weighted anatomical MRI were acquired at night during drug-aided sleep. Network integrity was quantified by independent components analysis (ICA), at both group- and per-subject levels. Functional-status assessments based on in-home observations were provided by families and caregivers. Motor ICNs were grossly compromised in ABI patients both group-wise and individually, concordant with their prominent motor deficits. Striking preservations of perceptual and cognitive ICNs were observed, and the degree of network preservation correlated (ρ = 0.74) with the per-subject functional status assessments. Collectively, our findings indicate that rs-fMRI has promise for assessing brain functional integrity in ABI and, potentially, in other disorders. Furthermore, our observations suggest that the severe motor deficits observed in this population can mask relatively intact perceptual and cognitive capabilities. Hum Brain Mapp 38:4813-4831, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Mariam Ishaque
- Research Imaging Institute, University of Texas Health Science Center at San Antonio, San Antonio, Texas.,Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Janessa H Manning
- Merrill Palmer Skillman Institute, Wayne State University, Detroit, Michigan
| | - Mary D Woolsey
- Research Imaging Institute, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Crystal G Franklin
- Research Imaging Institute, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | | | - Christian F Beckmann
- Department of Cognitive Neuroscience, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Donders Center for Cognitive Neuroimaging, Radboud University, Nijmegen, The Netherlands.,Centre for Functional MRI of the Brain, University of Oxford, Oxford, United Kingdom
| | - Peter T Fox
- Research Imaging Institute, University of Texas Health Science Center at San Antonio, San Antonio, Texas.,Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas.,South Texas Veterans Healthcare System, San Antonio, Texas.,Shenzhen University School of Medicine, Shenzhen, People's Republic of China
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12
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da Silva IRF, Frontera JA. Neurologic complications of acute environmental injuries. HANDBOOK OF CLINICAL NEUROLOGY 2017; 141:685-704. [PMID: 28190442 DOI: 10.1016/b978-0-444-63599-0.00037-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Environmental injuries can result in serious neurologic morbidity. This chapter reviews neurologic complications of thermal burns, smoke inhalation, lightning strikes, electric injury, near drowning, decompression illness, as well as heat stroke and accidental hypothermia. Knowing the pathophysiology and clinical presentation of such injuries is essential to proper management of primary and secondary medical complications. This chapter highlights the most frequently encountered neurologic injuries secondary to common environmental hazards, divided into the topics: injuries related to fire, electricity, water, and the extremes of temperature.
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Affiliation(s)
- I R F da Silva
- Neurocritical Care Unit, Americas Medical City, Rio de Janeiro, Brazil
| | - J A Frontera
- Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
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13
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Winkler EA, Yue JK, Burke JF, Chan AK, Dhall SS, Berger MS, Manley GT, Tarapore PE. Adult sports-related traumatic brain injury in United States trauma centers. Neurosurg Focus 2017; 40:E4. [PMID: 27032921 DOI: 10.3171/2016.1.focus15613] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Sports-related traumatic brain injury (TBI) is an important public health concern estimated to affect 300,000 to 3.8 million people annually in the United States. Although injuries to professional athletes dominate the media, this group represents only a small proportion of the overall population. Here, the authors characterize the demographics of sports-related TBI in adults from a community-based trauma population and identify predictors of prolonged hospitalization and increased morbidity and mortality rates. METHODS Utilizing the National Sample Program of the National Trauma Data Bank (NTDB), the authors retrospectively analyzed sports-related TBI data from adults (age ≥ 18 years) across 5 sporting categories-fall or interpersonal contact (FIC), roller sports, skiing/snowboarding, equestrian sports, and aquatic sports. Multivariable regression analysis was used to identify predictors of prolonged hospital length of stay (LOS), medical complications, inpatient mortality rates, and hospital discharge disposition. Statistical significance was assessed at α < 0.05, and the Bonferroni correction for multiple comparisons was applied for each outcome analysis. RESULTS From 2003 to 2012, in total, 4788 adult sports-related TBIs were documented in the NTDB, which represented 18,310 incidents nationally. Equestrian sports were the greatest contributors to sports-related TBI (45.2%). Mild TBI represented nearly 86% of injuries overall. Mean (± SEM) LOSs in the hospital or intensive care unit (ICU) were 4.25 ± 0.09 days and 1.60 ± 0.06 days, respectively. The mortality rate was 3.0% across all patients, but was statistically higher in TBI from roller sports (4.1%) and aquatic sports (7.7%). Age, hypotension on admission to the emergency department (ED), and the severity of head and extracranial injuries were statistically significant predictors of prolonged hospital and ICU LOSs, medical complications, failure to discharge to home, and death. Traumatic brain injury during aquatic sports was similarly associated with prolonged ICU and hospital LOSs, medical complications, and failure to be discharged to home. CONCLUSIONS Age, hypotension on ED admission, severity of head and extracranial injuries, and sports mechanism of injury are important prognostic variables in adult sports-related TBI. Increasing TBI awareness and helmet use-particularly in equestrian and roller sports-are critical elements for decreasing sports-related TBI events in adults.
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Affiliation(s)
- Ethan A Winkler
- Department of Neurological Surgery, University of California, San Francisco; and.,Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California
| | - John K Yue
- Department of Neurological Surgery, University of California, San Francisco; and.,Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California
| | - John F Burke
- Department of Neurological Surgery, University of California, San Francisco; and.,Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California
| | - Andrew K Chan
- Department of Neurological Surgery, University of California, San Francisco; and.,Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California
| | - Sanjay S Dhall
- Department of Neurological Surgery, University of California, San Francisco; and.,Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California
| | - Mitchel S Berger
- Department of Neurological Surgery, University of California, San Francisco; and
| | - Geoffrey T Manley
- Department of Neurological Surgery, University of California, San Francisco; and.,Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California
| | - Phiroz E Tarapore
- Department of Neurological Surgery, University of California, San Francisco; and.,Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California
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Prognostic Utility of Computed Tomography Histogram Analysis in Patients With Post-Cardiac Arrest Syndrome: Evaluation Using an Automated Whole-Brain Extraction Algorithm. J Comput Assist Tomogr 2017; 40:612-6. [PMID: 26953771 DOI: 10.1097/rct.0000000000000396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate the prognostic utility of computed tomography (CT) histogram analysis with an automated whole-brain extraction algorithm in patients with post-cardiac arrest syndrome (PCAS). METHODS Computed tomography data from consecutive patients between January 2009 and February 2012 were obtained and retrospectively analyzed. All CT images were obtained using a 64-detector-row CT scanner with a slice thickness of 4.0 mm. A brain region was extracted from the whole-brain CT images using our original automated algorithm and used for the subsequent histogram analysis. The obtained histogram statistics (mean brain tissue CT value, kurtosis, and skewness), as well as clinical parameters, were compared between the good and poor outcome groups using the Student t test. In addition, receiver operating characteristic curve analysis was performed for the discrimination between the 2 groups for each parameter. RESULTS One hundred thirty-eight consecutive PCAS patients were enrolled. The patients were classified into good (n = 47) and poor (n = 91) outcome groups. The mean brain tissue CT value was significantly higher in the good outcome group than in the poor outcome group (P < 0.05). Kurtosis, skewness, and age were significantly lower in the good outcome group than in the poor outcome group (P < 0.0001, P < 0.05, and P < 0.05, respectively). The area-under-the-curve values for kurtosis, mean brain tissue CT value, skewness, and age were 0.751, 0.639, 0.623, and 0.626, respectively. A combination of the 4 parameters increased the diagnostic performance (area under the curve = 0.814). CONCLUSIONS Histogram analysis of whole-brain CT images with our automated extraction algorithm is useful for assessing the outcome of PCAS patients.
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Diao M, Zhang S, Wu L, Huan L, Huang F, Cui Y, Lin Z. Hydrogen Gas Inhalation Attenuates Seawater Instillation-Induced Acute Lung Injury via the Nrf2 Pathway in Rabbits. Inflammation 2016; 39:2029-2039. [DOI: 10.1007/s10753-016-0440-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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16
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Radiologic, Neurologic and Cardiopulmonary Aspects of Submersion Injury. Pediatr Emerg Care 2016. [PMID: 26221788 DOI: 10.1097/pec.0000000000000477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Many indices and scores are used in critical care medicine to aid management and predict risk of mortality. We report 2 cases of submersion injury and discuss the usefulness and application of common respiratory and critical care indices. The respiratory indices help better understand the pulmonary pathophysiology and characterize the severity of lung injury and ventilation/perfusion mismatch. Severe lung injury resolved after ventilation support with appropriate positive end-expiratory pressure in both cases. The 6-year-old girl survived the near-fatal submersion injury intact despite grossly abnormal initial Glasgow Coma Scale (GCS) and high Pediatric Index of Mortality 2 scores, whereas the 5-year-old boy with grossly abnormal GCS and Pediatric Index of Mortality 2 scores died despite resolution of lung injury. These cases illustrate that resuscitation should be promptly instituted at the scene to ensure optimal outcome because initial pulmonology and neurology indices may not reliably predict mortality or intact survival. The GCS score was not initially designed for prognostication. Nevertheless, 2 serial GCS scores of 3, one performed at emergency department and one at the pediatric intensive care unit, were associated with nonsurvival in our second patient.
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Burke CR, Chan T, Brogan TV, Lequier L, Thiagarajan RR, Rycus PT, McMullan DM. Extracorporeal life support for victims of drowning. Resuscitation 2016; 104:19-23. [PMID: 27107689 DOI: 10.1016/j.resuscitation.2016.04.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 03/21/2016] [Accepted: 04/11/2016] [Indexed: 11/19/2022]
Abstract
AIM Unintentional drowning is a significant public health concern in the United States and represents a leading cause of death in the pediatric population. Extracorporeal life support (ECLS) may be used to support drowning victims, but outcomes have not been well defined. This study examined survival rates and risk factors for death in this population. METHODS Retrospective data from the Extracorporeal Life Support Organization registry was examined to determine outcomes of ECLS and risk factors for death in drowning victims. RESULTS Two hundred forty-seven patients who received ECLS following a drowning event between 1986 and 2015 were identified. Eighty-four (34%) did not experience cardiac arrest prior to ECLS, whereas 86 (35%) experienced a pre-ECLS cardiac arrest but had return of spontaneous circulation prior to ECLS, and 77 (31%) were placed on ECLS during cardiopulmonary resuscitation (ECPR). Overall survival was 51.4%; 71.4% in patients who did not experience a cardiac arrest, 57.0% in patients who required cardiopulmonary resuscitation prior to ECLS, and 23.4% in patients who received ECPR (p<0.001). Logistic regression analysis identified ECPR, venoarterial mode of ECLS, renal failure, and cardiopulmonary resuscitation during ECLS as risk factors associated with mortality. CONCLUSIONS Outcomes in drowning victims supported with ECLS are encouraging; particularly in patients who do not experience cardiac arrest. These data suggest that early initiation of ECLS in drowning patients with respiratory insufficiency may be beneficial to reduce the likelihood of complete cardiopulmonary failure and ECPR. Additionally, ECLS appears to improve survival in patients who experience post-drowning cardiac arrest.
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Affiliation(s)
- Christopher R Burke
- Division of Cardiac Surgery, Seattle Children's Hospital, Seattle, WA, United States
| | - Titus Chan
- Division of Critical Care Medicine, Seattle Children's Hospital, Seattle, WA, United States
| | - Thomas V Brogan
- Division of Critical Care Medicine, Seattle Children's Hospital, Seattle, WA, United States
| | - Laurance Lequier
- Division of Critical Care Medicine, Stollery Children's Hospital, Edmonton, AB, United States
| | - Ravi R Thiagarajan
- Department of Cardiology, Children's Hospital, Boston, MA, United States
| | - Peter T Rycus
- Extracorporeal Life Support Organization, Ann Arbor, MI, United States
| | - D Michael McMullan
- Division of Cardiac Surgery, Seattle Children's Hospital, Seattle, WA, United States.
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Ishaque M, Manning JH, Woolsey MD, Franklin CG, Tullis EW, Fox PT. Lenticulostriate arterial distribution pathology may underlie pediatric anoxic brain injury in drowning. NEUROIMAGE-CLINICAL 2016; 11:167-172. [PMID: 26937385 PMCID: PMC4753806 DOI: 10.1016/j.nicl.2016.01.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 01/20/2016] [Accepted: 01/21/2016] [Indexed: 11/17/2022]
Abstract
Drowning is a leading cause of neurological morbidity and mortality in young children. Anoxic brain injury (ABI) can result from nonfatal drowning and typically entails substantial neurological impairment. The neuropathology of drowning-induced pediatric ABI is not well established. Specifically, quantitative characterization of the spatial extent and tissue distribution of anoxic damage in pediatric nonfatal drowning has not previously been reported but could clarify the underlying pathophysiological processes and inform clinical management. To this end, we used voxel-based morphometric (VBM) analyses to quantify the extent and spatial distribution of consistent, between-subject alterations in gray and white matter volume. Whole-brain, high-resolution T1-weighted MRI datasets were acquired in 11 children with chronic ABI and 11 age- and gender-matched neurotypical controls (4–12 years). Group-wise VBM analyses demonstrated predominantly central subcortical pathology in the ABI group in both gray matter (bilateral basal ganglia nuclei) and white matter (bilateral external and posterior internal capsules) (P < 0.001); minimal damage was found outside of these deep subcortical regions. These highly spatially convergent gray and white matter findings reflect the vascular distribution of perforating lenticulostriate arteries, an end-arterial watershed zone, and suggest that vascular distribution may be a more important determinant of tissue loss than oxygen metabolic rate in pediatric ABI. Further, these results inform future directions for diagnostic and therapeutic modalities. First quantitative characterization of anoxic brain injury in pediatric drowning Voxel-based morphometry revealed predominant central subcortical pathology. Lenticulostriate arterial distribution may underlie gray and white matter damage. Predominant damage of motor-system components observed.
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Key Words
- ABI, anoxic brain injury
- ACA, anterior cerebral artery
- Anoxic brain injury
- CT, computerized tomography
- DTI, diffusion tensor imaging
- Drowning
- HI-BI, hypoxic-ischemic brain injury
- Hypoxic-ischemic brain injury
- MCA, middle cerebral artery
- MNI, Montreal Neurological Institute
- MPRAGE, magnetization prepared rapid gradient echo
- MRI
- PLIC, posterior limb of the internal capsule
- VBM
- VBM, voxel-based morphometry
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Affiliation(s)
- Mariam Ishaque
- Research Imaging Institute, University of Texas Health Science Center at San Antonio, 8403 Floyd Curl Drive, San Antonio, TX 78229, USA; Department of Radiological Sciences, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA.
| | - Janessa H Manning
- Merrill Palmer Skillman Institute, Wayne State University, 71 E Ferry Street, Detroit, MI 48202, USA.
| | - Mary D Woolsey
- Research Imaging Institute, University of Texas Health Science Center at San Antonio, 8403 Floyd Curl Drive, San Antonio, TX 78229, USA.
| | - Crystal G Franklin
- Research Imaging Institute, University of Texas Health Science Center at San Antonio, 8403 Floyd Curl Drive, San Antonio, TX 78229, USA.
| | - Elizabeth W Tullis
- Research Imaging Institute, University of Texas Health Science Center at San Antonio, 8403 Floyd Curl Drive, San Antonio, TX 78229, USA; Conrad Smiles Fund, USA.
| | - Peter T Fox
- Research Imaging Institute, University of Texas Health Science Center at San Antonio, 8403 Floyd Curl Drive, San Antonio, TX 78229, USA; Department of Radiological Sciences, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA; South Texas Veterans Healthcare System, 7400 Merton Minter Boulevard, San Antonio, TX 78229, USA; Shenzhen University School of Medicine, Neuroimaging Laboratory, Nanhai Avenue 3688, Shenzhen, Guangong, 518060, People's Republic of China.
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Kim KI, Lee WY, Kim HS, Jeong JH, Ko HH. Extracorporeal membrane oxygenation in near-drowning patients with cardiac or pulmonary failure. Scand J Trauma Resusc Emerg Med 2014; 22:77. [PMID: 25496812 PMCID: PMC4269952 DOI: 10.1186/s13049-014-0077-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 12/03/2014] [Indexed: 02/05/2023] Open
Abstract
Background The aim of this study was to determine the early outcomes of using extracorporeal membrane oxygenation (ECMO) in near-drowning patients with cardiac or pulmonary failure. Methods This study was based on data from 9 patients including 2 children (mean age 33; 8 males, 1 female) who received ECMO after near-drowning between 2008 and 2013. Veno-arterial or veno-arteriovenous ECMO was used in 2 patients with sustained cardiac arrest and veno-venous ECMO was used in 7 patients with severe acute respiratory distress syndrome (ARDS). The means of the partial arterial oxygen pressure (PaO2), Murray score, sequential organ failure assessment (SOFA) score, and simplified acute physiology score II (SAPS-II) prior to ECMO were 59.7 ± 9.9 mmHg on 100% oxygen, 3.5 ± 0.6, 11.4 ± 1.9, and 73.0 ± 9.2, respectively. Results The PaO2 mean improved to 182 ± 152 mmHg within 2 h post-ECMO. The mean of SOFA score and SAPS-II decreased significantly to 8.6 ± 3.2 (p = 0.013) and 46.4 ± 5.1 (p = 0.008), respectively, at 24 h post-ECMO with mean flow rate of 3.9 ± 0.8 l/min. ECMO was weaned at a mean duration of 188 (range, 43–672) h in all patients. Seven patients were discharged home without neurological sequelae, while 2 patients who had hypoxic brain damage died after further referral. The overall survival with favourable neurological outcomes at 3 months was 77.8%. There were no complications related to ECMO. Conclusions ECMO was safe and effective for patients with ongoing cardiac arrest or ARDS after a near-drowning incident and can be used as a resuscitative strategy in near-drowning patients with cardiac or pulmonary failure resistant to conventional ventilator therapy.
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Affiliation(s)
| | - Won Yong Lee
- Department of Cardiothoracic Surgery, Hallym University Sacred Heart Hospital, 896, Pyeongchon-dong, Dongan-gu, Anyang-si 431-796, Gyeonggi-do, Korea.
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Mu J, Zhang J, Dong H, Liu L. A rare type of drowning with a latent period following surviving an episode of immersion. Forensic Sci Med Pathol 2014; 11:74-7. [PMID: 25388903 DOI: 10.1007/s12024-014-9625-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2014] [Indexed: 11/24/2022]
Abstract
Drowning is a leading cause of accidental death worldwide and its diagnosis is an important part of forensic investigation. It is generally acknowledged that hypoxia due to airway obstruction by fluid is the primary mechanism of death in drowning. Drowned individuals are usually found dead in the water or show severe clinical signs once out of the water. However, sudden death due to drowning after a short period of recovery following immersion/submersion has rarely been reported. A case of a 40-year-old man who died suddenly due to severe pulmonary edema about 40 min after he was recovered from an episode of immersion is reported. We suspected delayed lung injury due to water aspiration as the prime cause of death. This rare type of drowning should be well recognized by a clinician or forensic pathologist.
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Affiliation(s)
- Jiao Mu
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, Hubei, 430030, People's Republic of China
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Endothelial Semaphorin 7A promotes inflammation in seawater aspiration-induced acute lung injury. Int J Mol Sci 2014; 15:19650-61. [PMID: 25353180 PMCID: PMC4264131 DOI: 10.3390/ijms151119650] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 09/30/2014] [Accepted: 10/15/2014] [Indexed: 11/17/2022] Open
Abstract
Inflammation is involved in the pathogenesis of seawater aspiration-induced acute lung injury (ALI). Although several studies have shown that Semaphorin 7A (SEMA7A) promotes inflammation, there are limited reports regarding immunological function of SEMA7A in seawater aspiration-induced ALI. Therefore, we investigated the role of SEMA7A during seawater aspiration-induced ALI. Male Sprague–Dawley rats were underwent seawater instillation. Then, lung samples were collected at an indicated time for analysis. In addition, rat pulmonary microvascular endothelial cells (RPMVECs) were cultured and then stimulated with 25% seawater for indicated time point. After these treatments, cells samples were collected for analysis. In vivo, seawater instillation induced lung histopathologic changes, pro-inflammation cytokines release and increased expression of SEMA7A. In vitro, seawater stimulation led to pro-inflammation cytokine release, cytoskeleton remodeling and increased monolayer permeability in pulmonary microvascular endothelial cells. In addition, knockdown of hypoxia-inducible factor (HIF)-1α inhibited the seawater induced increase expression of SEMA7A. Meanwhile, knockdown of SEMA7A by specific siRNA inhibited the seawater induced aberrant inflammation, endothelial cytoskeleton remodeling and endothelial permeability. These results suggest that SEMA7A is critical in the development of lung inflammation and pulmonary edema in seawater aspiration-induced ALI, and may be a therapeutic target for this disease.
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Bone marrow mesenchymal stem cells ameliorates seawater-exposure-induced acute lung injury by inhibiting autophagy in lung tissue. PATHOLOGY RESEARCH INTERNATIONAL 2014; 2014:104962. [PMID: 25215261 PMCID: PMC4152987 DOI: 10.1155/2014/104962] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 07/25/2014] [Accepted: 07/25/2014] [Indexed: 12/24/2022]
Abstract
Seawater drowning can lead to acute lung injury (ALI). Several studies have shown that bone marrow mesenchymal stem cells (BMSC) treatment could attenuate ALI. However, the mechanisms underlying this phenomenon still remain elusive. Therefore, this study aimed to investigate whether BMSC treatment can ameliorate seawater-induced ALI and its underlying mechanisms in a rat model. In this study, arterial blood gas, lung weight coefficient, and TNF-α, and IL-8 in bronchoalveolar lavage fluid (BALF), as well as histopathology examination, were used to detect the lung injury of seawater exposure. Moreover, western blot and RT-PCR were used to explore autophagy in lung tissues. The results demonstrated that seawater exposure induced ALI including impaired arterial blood gas, pulmonary edema, histopathologic changes, and inflammatory response in lung tissues. What is more, these changes were partly ameliorated by BMSC treatment through inhibition of autophagy in lung tissues. The application of BMSC may be a potential effective treatment for seawater-induced ALI.
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1α,25-dihydroxyvitamin D3 ameliorates seawater aspiration-induced acute lung injury via NF-κB and RhoA/Rho kinase pathways. PLoS One 2014; 9:e104507. [PMID: 25118599 PMCID: PMC4132109 DOI: 10.1371/journal.pone.0104507] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 07/10/2014] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Inflammation and pulmonary edema are involved in the pathogenesis of seawater aspiration-induced acute lung injury (ALI). Although several studies have reported that 1α,25-Dihydroxyvitamin D3 (calcitriol) suppresses inflammation, it has not been confirmed to be effective in seawater aspiration-induced ALI. Thus, we investigated the effect of calcitriol on seawater aspiration-induced ALI and explored the probable mechanism. METHODS Male SD rats receiving different doses of calcitriol or not, underwent seawater instillation. Then lung samples were collected at 4 h for analysis. In addition, A549 cells and rat pulmonary microvascular endothelial cells (RPMVECs) were cultured with calcitriol or not and then stimulated with 25% seawater for 40 min. After these treatments, cells samples were collected for analysis. RESULTS Results from real-time PCR showed that seawater stimulation up-regulated the expression of vitamin D receptor in lung tissues, A549 cells and RPMVECs. Seawater stimulation also activates NF-κB and RhoA/Rho kinase pathways. However, we found that pretreatment with calcitriol significantly inhibited the activation of NF-κB and RhoA/Rho kinase pathways. Meanwhile, treatment of calcitriol also improved lung histopathologic changes, reduced inflammation, lung edema and vascular leakage. CONCLUSIONS These results demonstrated that NF-κB and RhoA/Rho kinase pathways are critical in the development of lung inflammation and pulmonary edema and that treatment with calcitriol could ameliorate seawater aspiration-induced ALI, which was probably through the inhibition of NF-κB and RhoA/Rho kinase pathways.
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Buggia M, Canham L, Tibbles C, Landry A. Near Drowning and Adult Respiratory Distress Syndrome. J Emerg Med 2014; 46:821-5. [DOI: 10.1016/j.jemermed.2014.01.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 01/27/2014] [Indexed: 11/24/2022]
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Suominen PK, Sutinen N, Valle S, Olkkola KT, Lönnqvist T. Neurocognitive long term follow-up study on drowned children. Resuscitation 2014; 85:1059-64. [PMID: 24709615 DOI: 10.1016/j.resuscitation.2014.03.307] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 03/10/2014] [Accepted: 03/23/2014] [Indexed: 11/24/2022]
Abstract
AIM OF THE STUDY Report cognitive and neurological outcome later in life of surviving drowned children who had received CPR either from bystanders or from emergency medical services (EMS) units. METHODS Forty children who had drowned and admitted to pediatric intensive care unit after successful CPR between 1985 and 2007, were eligible for the study. Of those 21 gave a consent for neurological and neuropsychological examinations. All data are expressed as median (interquartile range). Mann-Whitley U, Wilcoxon signed ranks and Chi square tests were used. RESULTS The median age of the 21 patients at drowning was 2.4 (1.8, 5.5) years and 12.5 (8.6, 19.4) years at the time of neurological and neuropsychological examination. The median interval between the drowning accident and examinations was 8.1 (5.4, 14.4) years. Twelve patients (57.1%) had either signs of minor (6/21) or major neurological dysfunction (6/21). Eight subjects (40.0%) had full-scale intelligence quotient (FIQ) of less than 80 (range 20-78). The median estimated submersion time of the subjects with normal FIQ was 3.5 (2.0, 7.5)min, which was significantly shorter than for those with FIQ<80, 12.5 (5.0, 22.5)min (p=0.0013). Cognitive or neurologic deficits were detected in 17 of the 21 subjects, although 11 of them were reported to have a full recovery at the hospital discharge. CONCLUSIONS This study showed that 57% of the drowned and resuscitated children had neurological dysfunction and 40% a low FIQ. Neurological and neuropsychological long term follow-up in drowned children is highly recommended.
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Affiliation(s)
| | | | - Saija Valle
- Children's Hospital, Helsinki University Central Hospital, Finland
| | - Klaus T Olkkola
- University of Turku and Turku University Hospital, Finland; Helsinki University Central Hospital and Institute of Clinical Medicine, University of Helsinki, Helsinki, Finland
| | - Tuula Lönnqvist
- Children's Hospital, Helsinki University Central Hospital, Finland
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Yilmaz S, Cakar MA, Vatan MB, Kilic H, Keser N. ECG Changes Due to Hypothermia Developed After Drowning: Case Report. Turk J Emerg Med 2014; 14:37-40. [PMID: 27331164 PMCID: PMC4909879 DOI: 10.5505/1304.7361.2014.60590] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 05/15/2013] [Indexed: 11/04/2022] Open
Abstract
Drowning is one of the fatal accidents frequently encountered during the summer and is the most common cause of accidental death in the world. Anoxia, hypothermia, and metabolic acidosis are mainly responsible for morbidty. Cardiovascular effects may occur secondary to hypoxia and hypothermia. Atrial fibrillation, sinus dysrhythmias (rarely requiring treatment), and, in serious cases, ventricular fibrillation or asystole may develop, showing as rhythm problems on electrocardiogram and Osborn wave can be seen, especially during hypothermia. A 16-year-old male patient who was admitted to our hospital's emergency service with drowning is presented in this article. In our case, ventricular fibrillation and giant J wave (Osborn wave) associated with hypothermia developed after drowning was seen. We present this case as a reminder of ECG changes due to hypothermia that develop after drowning. Response to cardiopulmonary resuscitation after drowning and hypothermia is not very good. Mortality is very high, so early resuscitation and aggressive treatment of cardiovascular and respiratory problems are important for life.
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Affiliation(s)
- Sabiye Yilmaz
- Department of Cardiology, Yenikent State Hospital, Sakarya
| | - Mehmet Akif Cakar
- Department of Cardiology, Sakarya University Faculty of Medicine, Sakarya
| | | | - Harun Kilic
- Department of Cardiology, Sakarya University Faculty of Medicine, Sakarya
| | - Nurgul Keser
- Department of Cardiology, Sakarya University Faculty of Medicine, Sakarya
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Ma L, Zhao Y, Li B, Wang Q, Liu X, Chen X, Nan Y, Liang L, Chang R, Liang L, Li P, Jin F. 3,5,4'-Tri-O-acetylresveratrol attenuates seawater aspiration-induced lung injury by inhibiting activation of nuclear factor-kappa B and hypoxia-inducible factor-1α. Respir Physiol Neurobiol 2012; 185:608-14. [PMID: 23219988 DOI: 10.1016/j.resp.2012.11.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 11/27/2012] [Accepted: 11/27/2012] [Indexed: 12/20/2022]
Abstract
Resveratrol is a phytoalexin synthesized by a wide variety of plants, which has been proven to be effective in suppressing oxidative stress and inflammation. The aim of the present study was to investigate the effect of Resveratrol's prodrug: 3,5,4'-tri-O-acetylresveratrol, on seawater drowning-induced acute lung injury (SWD-ALI). Histological changes were assessed to study lung injuries; cytokines in lung samples were monitored by ELISA to reflect inflammation; T-SOD and MDA activity were detected to examine oxidative stress in lung tissues. Besides, we also tested the expression of NF-κB and HIF-1α to probe the possible protecting mechanism of 3,5,4'-tri-O-acetylresveratrol on AWD-ALI. The results showed that pretreatment with different doses of 3,5,4'-tri-O-acetylresveratrol improved seawater-induced lung histopathologic changes, alleviated lung edema, reduced the production of inflammatory mediators including TNF-α and IL-1β, inhibited MDA activity, and enhanced T-SOD activity, which was possibly associated with inhibition of NF-κB and HIF-1α. In conclusion, the current study demonstrated that 3,5,4'-tri-O-acetylresveratrol exhibited a protective effect on SWD-ALI by inhibiting of the inflammatory response, which may also involve the suppression of oxidative stress in lung tissues.
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Affiliation(s)
- Lijie Ma
- Department of Respiration, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, China
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Paal P, Milani M, Brown D, Boyd J, Ellerton J. Termination of Cardiopulmonary Resuscitation in Mountain Rescue. High Alt Med Biol 2012; 13:200-8. [DOI: 10.1089/ham.2011.1096] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Peter Paal
- Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Austria
- International Commission for Mountain Emergency Medicine (ICAR MEDCOM)
| | - Mario Milani
- International Commission for Mountain Emergency Medicine (ICAR MEDCOM)
- Department of Laboratory Medicine, Anatomical Pathology and Department of Emergency Services, SSUEm/118, A.O. Ospedale di Lecco, Lecco, Italy. Mountain and Cave Rescue National Association (CNSAS) MedCom, Italy
| | - Douglas Brown
- International Commission for Mountain Emergency Medicine (ICAR MEDCOM)
- Department of Emergency Medicine, University of British Columbia, Vancouver, Canada
| | - Jeff Boyd
- International Commission for Mountain Emergency Medicine (ICAR MEDCOM)
- Department of Emergency Medicine, Mineral Springs Hospital, Banff, Canada
- International Federation of Mountain Guides
| | - John Ellerton
- International Commission for Mountain Emergency Medicine (ICAR MEDCOM)
- Mountain Rescue Council (England & Wales) Pinfold, Penrith, Cumbria, England
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Suominen PK, Vähätalo R. Neurologic long term outcome after drowning in children. Scand J Trauma Resusc Emerg Med 2012; 20:55. [PMID: 22894549 PMCID: PMC3493332 DOI: 10.1186/1757-7241-20-55] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 08/01/2012] [Indexed: 11/03/2022] Open
Abstract
Drowning is a major source of mortality and morbidity in children worldwide. Neurocognitive outcome of children after drowning incidents cannot be accurately predicted in the early course of treatment. Therefore, aggressive out-of-hospital and in-hospital treatment is emphasized. There are "miracle" cases after long submersion times that have been reported in the medical literature, which mostly concern small children. However, many of the survivors will remain severely neurologically compromised after remarkably shorter submersion times and will consequently be a great burden to their family and society for the rest of their lives. The duration of submersion, the need of advanced life support at the site of the accident, the duration of cardiopulmonary resuscitation, whether spontaneous breathing and circulation are present on arrival at the emergency room are important factors related to survival with mild neurological deficits or intact function in drowned children. Data on long-term outcome are scarce. The used outcome measurement methods and the duration of follow-up have not been optimal in most of the existing studies. Proper neurological and neurophysiological examinations for drowned children are superior to outcome scales based chart reviews. There is evidence that gross neurological examination at the time of discharge from the hospital in young children does not reveal all the possible sequelae related to hypoxic brain injury and thus long-term follow-up of drowned resuscitated children is strongly recommended.
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Affiliation(s)
- Pertti K Suominen
- Department of Anaesthesia and Intensive Care, Children's Hospital, Helsinki University Central Hospital, Stenbäckinkatu 9, FIN-00029 HUS, Helsinki, Finland.
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Han F, Luo Y, Li Y, Liu Z, Xu D, Jin F, Li Z. Seawater induces apoptosis in alveolar epithelial cells via the Fas/FasL-mediated pathway. Respir Physiol Neurobiol 2012; 182:71-80. [PMID: 22609371 DOI: 10.1016/j.resp.2012.05.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2011] [Revised: 05/09/2012] [Accepted: 05/10/2012] [Indexed: 01/11/2023]
Abstract
Our previous study showed that seawater can cause lung tissue cell apoptosis; in the present study, the immunohistochemistry and Western blot analysis results demonstrated that Fas, FasL, and cleaved caspase-8 and caspase-3 were up-regulated in the rat lungs exposed to seawater. We found that seawater-induced human lung alveolar epithelial A549 cell apoptosis was concentration and time dependent. Moreover, seawater increased the expression of Fas, FasL, and cleaved caspase-8 and caspase-3 in A549 cells. The incubation of A549 cells in the presence of FasL-neutralising antibody (NOK-2) or caspase-8 inhibitor (Z-IETD-FMK) resulted in a decrease of seawater-induced cell apoptosis. NOK-2 inhibited Fas/FasL interaction and reduced the cleavage of caspase-8 and caspase-3, and Z-IETD-FMK blocked caspase-8 and caspase-3 activation. Seawater similarly produced a significant increase in rat alveolar type II cell apoptosis and expression of Fas and cleaved caspase-8. In summary, the Fas/FasL pathway involved in alveolar epithelial cell (AEC) apoptosis could be important in the pathogenesis of seawater-induced acute lung injury (SW-ALI).
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Affiliation(s)
- Feng Han
- Department of Respiratory Medicine, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, PR China
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Pérez-Cárceles MD, del Pozo S, Sibón A, Noguera JA, Osuna E, Vizcaya MA, Luna A. Serum biochemical markers in drowning: diagnostic efficacy of Strontium and other trace elements. Forensic Sci Int 2011; 214:159-66. [PMID: 21873008 DOI: 10.1016/j.forsciint.2011.07.047] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Revised: 07/04/2011] [Accepted: 07/25/2011] [Indexed: 11/29/2022]
Abstract
The aim of our study was to analyse several serum biochemical markers in order to evaluate the discriminant capacity of trace elements individually and jointly in drowning (seawater drowning and freshwater drowning) and their correlation with age, sex, postmortem interval, time in water and concentrations of the trace elements in the drowning medium. Sixty-seven cases of drowning (53 seawater drownings (SWD); 14 freshwater drownings (FWD) and 73 control cases (other asphyxias, n=44, and other causes of death, n=29) were selected according to the scene, cause and circumstances of death, together with autopsy findings. Serum strontium (Sr), magnesium (Mg), sodium (Na), chloride (Cl), calcium (Ca), iron (Fe), urea, creatinine (Cr) and cardiac Troponine T (cTn-T) were measured in the left ventricle (Lv), right ventricle (Rv) and peripheral blood. Lv-Rv differences for each marker and Sr, Mg, Na, Cl, Ca and Fe concentrations in the drowning medium were determinated. Mean concentrations of Sr, Cl and Mg in both ventricles and peripheral serum and Lv-Rv differences and Ca Lv and Na Rv were significantly higher in cases of drowning than for other causes of death. In SWD, Sr, Mg, Ca, Na and Cl were significantly higher in Lv than in Rv as a result of aspirating water. In contrast, haemodilution is evident from the significantly higher levels of Fe and urea in Rv than in Lv in cases of SWD, and from the higher Mg and Cr levels in Rv in FWD. In the case of SWD, serum levels of Sr are confirmed as the best parameter for diagnosis, although other trace elements may also be useful, such as the serum concentrations of Mg and Cl. In the case of FWD, the joint determination of Sr and other biochemical markers, especially Fe, may increase correct diagnosis.
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Affiliation(s)
- M D Pérez-Cárceles
- Department of Legal and Forensic Medicine, University of Murcia, Murcia, Spain.
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Li JH, Xu M, Xie XY, Fan QX, Mu DG, Zhang Y, Cao FL, Wang YX, Zhao PT, Zhang B, Jin FG, Li ZC. Tanshinone IIA suppresses lung injury and apoptosis, and modulates protein kinase B and extracellular signal-regulated protein kinase pathways in rats challenged with seawater exposure. Clin Exp Pharmacol Physiol 2011; 38:269-77. [PMID: 21314841 DOI: 10.1111/j.1440-1681.2011.05498.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
1. Tanshinone IIA (TIIA) is one of the main active components of the Chinese herb, Danshen. In the present study, we investigated the role of apoptosis in seawater exposure-induced acute lung injury (ALI), and explored the effects of TIIA on lung injury, apoptosis, and protein kinase B (Akt) and extracellular signal-regulated protein kinase (ERK) pathways in seawater-challenged rats. The rats were randomly divided into four groups: (i) naive group, no drug was given; (ii) TIIA control group, TIIA (50 mg/kg) was given intraperitoneally; (iii) seawater (SW) group, seawater (4 mL/kg) was given; and (iv) TIIA/SW group, TIIA (50 mg/kg) was injected intraperitoneally 10 min after seawater instillation. 2. The results showed that TIIA treatment significantly improved seawater exposure-induced lung histopathological changes, alleviated the decrease in PaO(2) , and reduced lung oedema, vascular leakage and cell infiltration. As shown by terminal deoxynucleotidyl transferase-mediated nick end labelling (TUNEL) assay, seawater exposure induced apoptosis in lung tissue cells. Furthermore, seawater exposure also changed apoptosis-related factors Bcl-2 and caspase-3, and caused a reduction in the activation of Akt and ERK1/2 pathways. Furthermore, TIIA treatment decreased the number of apoptotic cells, reversed changes in Bcl-2 and caspase-3, and upregulated the activation of Akt and ERK1/2 in seawater-challenged rats. 3. In conclusion, the data suggest that apoptosis might play an important role in seawater exposure-induced lung injury and that TIIA could significantly attenuate the severity of ALI and apoptosis in seawater-challenged rats, which is possibly through modulation of Akt and ERK1/2 pathways.
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Affiliation(s)
- Jia-Huan Li
- Department of Respiration, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
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Reversal of intractable hypoxemia with exogenous surfactant (calfactant) facilitating complete neurological recovery in a pediatric drowning victim. Pediatr Emerg Care 2010; 26:571-3. [PMID: 20693854 DOI: 10.1097/pec.0b013e3181ea7246] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To report the successful reversal of intractable hypoxemia after exogenous surfactant (calfactant) administration, facilitating neurological recovery in a toddler cold-water drowning victim with significant circulatory arrest time. METHODS Case report and review of literature. RESULTS A 2(1/2)-year-old girl cold-water drowning victim with severe, intractable hypoxemia after submersion time of approximately 15 minutes and arrest time of approximately 45 minutes was given 80 mL/m of calfactant endotracheally with reversal of her hypoxemia and eventual neurologically intact survival. CONCLUSIONS Surfactant replacement with calfactant is a rational, useful, and potentially lifesaving treatment for acute hypoxemic respiratory failure due to drowning.
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Severe childhood injuries and poisoning in a densely populated city: Where do they occur and what type? J Crit Care 2010; 25:175.e7-12. [DOI: 10.1016/j.jcrc.2009.06.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2009] [Revised: 05/13/2009] [Accepted: 06/04/2009] [Indexed: 11/22/2022]
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Affiliation(s)
- Kam-Lun Ellis Hon
- Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, 6/F, Clinical Sciences Building, Shatin, Hong Kong.
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Forler J, Carsin A, Arlaud K, Bosdure E, Viard L, Paut O, Camboulives J, Dubus JC. [Respiratory complications of accidental drownings in children]. Arch Pediatr 2009; 17:14-8. [PMID: 19896350 DOI: 10.1016/j.arcped.2009.09.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2008] [Revised: 09/06/2009] [Accepted: 09/30/2009] [Indexed: 11/30/2022]
Abstract
Accidental drownings are severe and sometimes mortal events in children. Our study aims to better clarify the epidemiology and the respiratory complications of these accidents in our hospital. We led a retrospective study over 10 years concerning the children hospitalized for accidental drowning in our hospital centre. Age at the moment of the accident, sex, history of accident, hospitable care, thoracic imaging and neurological outcome of the children were studied. In total, 83 children were hospitalized (5 years on average, 70% being boys). The drowning especially took place in fresh water (71%), particularly in swimming pools (51.8%). Stages III and IV of drowning concerned 40.9% of the population. The coverage was the following one: admittance in ICU 57.8%, mechanical ventilation 34.9%, oxygen therapy 16.9%, antibiotics 87.9%. A normal chest x-ray was present in 45.7% of the cases. Drowning in fresh water, especially in contaminated fresh water (canal, WC, etc.), induced atelectasis (10.8%), whereas drowning in sea water induced diffuse infiltrates (8.4%). Aspiration pneumonia (33.7%) was present in both cases and a pulmonary oedema (6%) was only noticed during stage IV drowning. The secondary infections were rare (1 case was suspected and another probable). A child presented a secondary acute respiratory distress syndrome (1.2 %). Finally, 7 deaths (8.4%) and 1 case with severe neurological sequelae (1.2%) were noted. Accidental drowning causes important consequences in children. The long-term respiratory outcomes have not been properly studied. Prevention of such accidents is based on parental vigilance during their child's bathe.
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Affiliation(s)
- J Forler
- Unité de pneumologie et médecine infantile, CHU Timone-Enfants, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France
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Ballesteros MA, Gutiérrez-Cuadra M, Muñoz P, Miñambres E. Prognostic factors and outcome after drowning in an adult population. Acta Anaesthesiol Scand 2009; 53:935-40. [PMID: 19496759 DOI: 10.1111/j.1399-6576.2009.02020.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Drowning remains an actual problem. Although medical assistance has improved, it still has high rates of morbidity and mortality. We set out to explore the clinical characteristics and outcome of drowning patients admitted to the intensive care unit (ICU) of tertiary-care university hospital. METHODS We designed a retrospective observational study to analyse all drowning patients admitted to our ICU after successful cardiopulmonary resuscitation. The study was conducted during 1 January 1992-31 December 2005. There was no exclusion. We used a univariate analysis to evaluate the effect on patient and management characteristics on survival. RESULTS There were 43 patients (five children and 38 adults), with male predominance. Fifteen patients, all adults (34.9%), died. Submersion time, age, Glasgow Coma Score (GCS), pupillary reactivity and acute physiology and chronic health evaluation (APACHE II) at ICU admission were related to mortality. Non-survivors presented a higher glycaemia level at ICU admission than survivors (P=0.005). CONCLUSIONS The outcome is closely related to the patient's clinical status on arrival to the hospital. We have found that submersion time, age, GCS, pupillary reactivity and APACHE II at ICU admission were related to mortality. Further research in prospective studies is needed.
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Affiliation(s)
- M A Ballesteros
- Critical Care Medicine, Servicio de Medicina Intensiva, Santander, Spain.
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Kon AA. The "window of opportunity:" helping parents make the most difficult decision they will ever face using an informed non-dissent model. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2009; 9:55-56. [PMID: 19326316 DOI: 10.1080/15265160802716811] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Alexander A Kon
- University of California Davis, Department of Pediatrics, Ticon II, 2516 Stockton Boulevard, Sacramento, CA 95817, USA.
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Gastric mucosal tears and wall micro perforations after cardiopulmonary resuscitation in a drowning case. J Forensic Leg Med 2009; 16:24-6. [DOI: 10.1016/j.jflm.2008.05.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2007] [Revised: 03/10/2008] [Accepted: 05/18/2008] [Indexed: 11/23/2022]
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Hon KLE, Leung TF, Chan SYJ, Cheung KL, Ng PC. Indoor versus outdoor childhood submersion injury in a densely populated city. Acta Paediatr 2008; 97:1261-4. [PMID: 18498426 DOI: 10.1111/j.1651-2227.2008.00861.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To review the outcome of childhood submersion injury (SI). METHODS We reviewed discharge data of all children with SI who were hospitalized in a university teaching hospital between January 2002 and January 2008. RESULTS There were 15 admissions (8 males and 7 females). Outdoor SI (n = 10) were more common than indoor SI (n = 5) and 7 cases occurred in public swimming pools with life guard service. There were significant differences between the two types of SI. Indoor SI more likely occurred in the Chinese mainland. The victims were generally younger, more likely to have low Glasgow Coma Scale (GCS), asystole and intubation at the emergency department (ED). They were more likely to require intensive care, ventilatory support, neurological imaging and had worse neurological sequlae of death or hypoxic-ischaemic encephalopathy (HIE). CONCLUSION Indoor SI was associated with worse prognosis. All patients with GCS of 3 at ED and required intensive care support were either dead or incapacitated. Low GCS, pulselessness and intubation at the ED and seizures are also associated with adverse outcomes. Describing the mode of paediatric SI in a city where SI rarely occurs serves to heighten public awareness especially of home safety in the prevention of SI.
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Affiliation(s)
- Kam-Lun Ellis Hon
- Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
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Heffner GG, Rozanski EA, Beal MW, Boysen S, Powell L, Adamantos S. Evaluation of freshwater submersion in small animals: 28 cases (1996–2006). J Am Vet Med Assoc 2008; 232:244-8. [DOI: 10.2460/javma.232.2.244] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Pädiatrische Intensivmedizin. DIE INTENSIVMEDIZIN 2008. [PMCID: PMC7120893 DOI: 10.1007/978-3-540-72296-0_84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Dieses Kapitel soll einen verständlichen Überblick geben über Besonderheiten der intensivmedizinischen Betreuung des Kindes, insbesondere des Kleinkindes, im Vergleich zur Intensivmedizin beim Erwachsenen. Es werden deshalb nicht alle Aspekte der pädiatrischen Intensivmedizin im Sinne eines eigenständigen Lehrbuchs beleuchtet. In einem ersten Teil (·Kap. 84.2-84.4) werden allgemeine Themen und Aspekte inklusive die kardiopulmonale Reanimation behandelt, in einem zweiten Teil (·Kap. 84.5) werden spezifische pädiatrische Krankheitsbilder und ihre Therapie diskutiert.
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Maisch S, Ntalakoura K, Boettcher H, Helmke K, Friederich P, Goetz AE. [Severe accidental hypothermia with cardiac arrest and extracorporeal rewarming. A case report of a 2-year-old child]. Anaesthesist 2007; 56:25-9. [PMID: 17096105 DOI: 10.1007/s00101-006-1110-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
In patients with severe hypothermia and cardiac arrest, active rewarming is recommended by extracorporeal circulation with cardiopulmonary bypass. The current guidelines for resuscitation of the European Resuscitation Council now include the recommendation regarding patients with hypothermia remaining comatose after initial resuscitation to accomplish an active rewarming only up to a temperature of 32-34 degrees C and to maintain a mild hypothermia for 12-24 h. We report the case of a 2-year-old boy who suffered from severe hypothermia after falling into ice-cold water. On discovery cardiac arrest with asystole was present and the first measured temperature was 23.8 degrees C. Resuscitation led to restoration of spontaneous circulation. The patient was rewarmed by extracorporeal circulation with cardiopulmonary bypass to 33 degrees C then mild hypothermia was maintained for a further 12 h. On the third day after the accident the patient was extubated and after a further 9 days was discharged without any sequelae.
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Affiliation(s)
- S Maisch
- Klinik für Anästhesiologie, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg.
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Affiliation(s)
- Robyn J Meyer
- The University of Arizona Steele Memorial Children's Research Center, Tucson, Arizona, USA
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Robles LA, Curiel A. Posttraumatic cervical disc herniation: an unusual cause of near drowning. Am J Emerg Med 2005; 23:905-7. [PMID: 16291453 DOI: 10.1016/j.ajem.2005.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2005] [Accepted: 07/18/2005] [Indexed: 10/25/2022] Open
Affiliation(s)
- Luis A Robles
- Hospital Ameri-med, Puerto Vallarta Jalisco, CP 48310, Mexico.
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Burford AE, Ryan LM, Stone BJ, Hirshon JM, Klein BL. Drowning and near-drowning in children and adolescents: a succinct review for emergency physicians and nurses. Pediatr Emerg Care 2005; 21:610-6; quiz 617-9. [PMID: 16160669 DOI: 10.1097/01.pec.0000177204.21774.35] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Amy E Burford
- Emergency Physician, Riverside Regional Medical Center, Newport News, VA, USA
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