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Zhong JM, Luo DJ, Fan J, He J, Wang X, Nie X, Zhou DW. [Clinicopathological analysis of cytological diagnosis of mesothelioma in serosal effusion]. Zhonghua Bing Li Xue Za Zhi 2023; 52:612-614. [PMID: 37263927 DOI: 10.3760/cma.j.cn112151-20221018-00872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- J M Zhong
- Pathology Department, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - D J Luo
- Pathology Department, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - J Fan
- Pathology Department, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - J He
- Pathology Department, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - X Wang
- Pathology Department, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - X Nie
- Pathology Department, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - D W Zhou
- Pathology Department, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
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Tian F, Lewis LD, Zhou DW, Balanza GA, Paulk AC, Zelmann R, Peled N, Soper D, Santa Cruz Mercado LA, Peterfreund RA, Aglio LS, Eskandar EN, Cosgrove GR, Williams ZM, Richardson RM, Brown EN, Akeju O, Cash SS, Purdon PL. Characterizing brain dynamics during ketamine-induced dissociation and subsequent interactions with propofol using human intracranial neurophysiology. Nat Commun 2023; 14:1748. [PMID: 36991011 PMCID: PMC10060225 DOI: 10.1038/s41467-023-37463-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 03/17/2023] [Indexed: 03/31/2023] Open
Abstract
Ketamine produces antidepressant effects in patients with treatment-resistant depression, but its usefulness is limited by its psychotropic side effects. Ketamine is thought to act via NMDA receptors and HCN1 channels to produce brain oscillations that are related to these effects. Using human intracranial recordings, we found that ketamine produces gamma oscillations in prefrontal cortex and hippocampus, structures previously implicated in ketamine's antidepressant effects, and a 3 Hz oscillation in posteromedial cortex, previously proposed as a mechanism for its dissociative effects. We analyzed oscillatory changes after subsequent propofol administration, whose GABAergic activity antagonizes ketamine's NMDA-mediated disinhibition, alongside a shared HCN1 inhibitory effect, to identify dynamics attributable to NMDA-mediated disinhibition versus HCN1 inhibition. Our results suggest that ketamine engages different neural circuits in distinct frequency-dependent patterns of activity to produce its antidepressant and dissociative sensory effects. These insights may help guide the development of brain dynamic biomarkers and novel therapeutics for depression.
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Affiliation(s)
- Fangyun Tian
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Laura D Lewis
- Department of Biomedical Engineering, Boston University, Boston, MA, USA
- Department of Radiology, MGH/HST Martinos Center for Biomedical Imaging and Harvard Medical School, Boston, MA, USA
- Institute for Medical Engineering and Sciences, Department of Electrical Engineering and Computer Science, Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - David W Zhou
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA
- Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Gustavo A Balanza
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Angelique C Paulk
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Boston, MA, USA
| | - Rina Zelmann
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Boston, MA, USA
| | - Noam Peled
- Department of Radiology, MGH/HST Martinos Center for Biomedical Imaging and Harvard Medical School, Boston, MA, USA
| | - Daniel Soper
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Laura A Santa Cruz Mercado
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Robert A Peterfreund
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Linda S Aglio
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Emad N Eskandar
- Department of Neurological Surgery, Albert Einstein College of Medicine, Bronx, NY, USA
| | - G Rees Cosgrove
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Ziv M Williams
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - R Mark Richardson
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Emery N Brown
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Oluwaseun Akeju
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sydney S Cash
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Boston, MA, USA
| | - Patrick L Purdon
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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3
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Curley WH, Bodien YG, Zhou DW, Conte MM, Foulkes AS, Giacino JT, Victor JD, Schiff ND, Edlow BL. Electrophysiological correlates of thalamocortical function in acute severe traumatic brain injury. Cortex 2022; 152:136-152. [PMID: 35569326 PMCID: PMC9759728 DOI: 10.1016/j.cortex.2022.04.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 01/26/2022] [Accepted: 04/04/2022] [Indexed: 12/26/2022]
Abstract
Tools assaying the neural networks that modulate consciousness may facilitate tracking of recovery after acute severe brain injury. The ABCD framework classifies resting-state EEG into categories reflecting levels of thalamocortical network function that correlate with outcome in post-cardiac arrest coma. In this longitudinal cohort study, we applied the ABCD framework to 20 patients with acute severe traumatic brain injury requiring intensive care (12 of whom were also studied at ≥6-months post-injury) and 16 healthy controls. We tested four hypotheses: 1) EEG ABCD classifications are spatially heterogeneous and temporally variable; 2) ABCD classifications improve longitudinally, commensurate with the degree of behavioral recovery; 3) ABCD classifications correlate with behavioral level of consciousness; and 4) the Coma Recovery Scale-Revised arousal facilitation protocol yields improved ABCD classifications. Channel-level EEG power spectra were classified based on spectral peaks within pre-defined frequency bands: 'A' = no peaks above delta (<4 Hz) range (complete thalamocortical disruption); 'B' = theta (4-8 Hz) peak (severe thalamocortical disruption); 'C' = theta and beta (13-24 Hz) peaks (moderate thalamocortical disruption); or 'D' = alpha (8-13 Hz) and beta peaks (normal thalamocortical function). Acutely, 95% of patients demonstrated 'D' signals in at least one channel but exhibited within-session temporal variability and spatial heterogeneity in the proportion of different channel-level ABCD classifications. By contrast, healthy participants and patients at follow-up consistently demonstrated signals corresponding to intact thalamocortical network function. Patients demonstrated longitudinal improvement in ABCD classifications (p < .05) and ABCD classification distinguished patients with and without command-following in the subacute-to-chronic phase of recovery (p < .01). In patients studied acutely, ABCD classifications improved after the Coma Recovery Scale-Revised arousal facilitation protocol (p < .05) but did not correspond with behavioral level of consciousness. These findings support the use of the ABCD framework to characterize channel-level EEG dynamics and track fluctuations in functional thalamocortical network integrity in spatial detail.
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Affiliation(s)
- William H Curley
- Harvard Medical School, Boston, MA, USA; Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Yelena G Bodien
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Harvard Medical School, Charlestown, MA, USA
| | - David W Zhou
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Mary M Conte
- Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY, USA
| | - Andrea S Foulkes
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Joseph T Giacino
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Harvard Medical School, Charlestown, MA, USA; Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Jonathan D Victor
- Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY, USA; Department of Neurology, New York Presbyterian Hospital, New York, NY, USA
| | - Nicholas D Schiff
- Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY, USA; Department of Neurology, New York Presbyterian Hospital, New York, NY, USA
| | - Brian L Edlow
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA.
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4
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Xiao GX, Liu C, Yu J, Gao BB, Zhou DW, Huang BX, Nie X. [Clear cell carcinoma of the abdominal wall: a clinicopathological study]. Zhonghua Bing Li Xue Za Zhi 2022; 51:347-349. [PMID: 35359048 DOI: 10.3760/cma.j.cn112151-20210821-00588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- G X Xiao
- Department of Pathology, the Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - C Liu
- Department of Pathology, the Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - J Yu
- Department of Pathology, the Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - B B Gao
- Department of Pathology, the Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - D W Zhou
- Department of Pathology, the Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - B X Huang
- Department of Pathology, the Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - X Nie
- Department of Pathology, the Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
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Paixao L, Sun H, Hogan J, Hartnack K, Westmeijer M, Neelagiri A, Zhou DW, McClain LM, Kimchi EY, Purdon PL, Akeju O, Westover MB. ICU delirium burden predicts functional neurologic outcomes. PLoS One 2021; 16:e0259840. [PMID: 34855749 PMCID: PMC8638853 DOI: 10.1371/journal.pone.0259840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 10/28/2021] [Indexed: 12/13/2022] Open
Abstract
Background We investigated the effect of delirium burden in mechanically ventilated patients, beginning in the ICU and continuing throughout hospitalization, on functional neurologic outcomes up to 2.5 years following critical illness. Methods Prospective cohort study of enrolling 178 consecutive mechanically ventilated adult medical and surgical ICU patients between October 2013 and May 2016. Altogether, patients were assessed daily for delirium 2941days using the Confusion Assessment Method for the ICU (CAM-ICU). Hospitalization delirium burden (DB) was quantified as number of hospital days with delirium divided by total days at risk. Survival status up to 2.5 years and neurologic outcomes using the Glasgow Outcome Scale were recorded at discharge 3, 6, and 12 months post-discharge. Results Of 178 patients, 19 (10.7%) were excluded from outcome analyses due to persistent coma. Among the remaining 159, 123 (77.4%) experienced delirium. DB was independently associated with >4-fold increased mortality at 2.5 years following ICU admission (adjusted hazard ratio [aHR], 4.77; 95% CI, 2.10–10.83; P < .001), and worse neurologic outcome at discharge (adjusted odds ratio [aOR], 0.02; 0.01–0.09; P < .001), 3 (aOR, 0.11; 0.04–0.31; P < .001), 6 (aOR, 0.10; 0.04–0.29; P < .001), and 12 months (aOR, 0.19; 0.07–0.52; P = .001). DB in the ICU alone was not associated with mortality (HR, 1.79; 0.93–3.44; P = .082) and predicted neurologic outcome less strongly than entire hospital stay DB. Similarly, the number of delirium days in the ICU and for whole hospitalization were not associated with mortality (HR, 1.00; 0.93–1.08; P = .917 and HR, 0.98; 0.94–1.03, P = .535) nor with neurological outcomes, except for the association between ICU delirium days and neurological outcome at discharge (OR, 0.90; 0.81–0.99, P = .038). Conclusions Delirium burden throughout hospitalization independently predicts long term neurologic outcomes and death up to 2.5 years after critical illness, and is more predictive than delirium burden in the ICU alone and number of delirium days.
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Affiliation(s)
- Luis Paixao
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
| | - Haoqi Sun
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
| | - Jacob Hogan
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States of America
| | - Katie Hartnack
- Antioch University New England, Keene, NH, United States of America
| | - Mike Westmeijer
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States of America
| | - Anudeepthi Neelagiri
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States of America
| | - David W. Zhou
- Harvard Medical School, Boston, MA, United States of America
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, United States of America
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, United States of America
| | - Lauren M. McClain
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
| | - Eyal Y. Kimchi
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
| | - Patrick L. Purdon
- Harvard Medical School, Boston, MA, United States of America
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Oluwaseun Akeju
- Harvard Medical School, Boston, MA, United States of America
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - M. Brandon Westover
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
- * E-mail:
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6
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Liu CB, Cheng JB, He JB, Chen R, Yue XY, Luo YS, Yang G, Zhou DW, Huang JS, Yu RM, Leng YM. Unusual magnetization process and magnetocaloric effect in α-CoV 2O 6driven by pulsed magnetic fields. J Phys Condens Matter 2021; 33:435703. [PMID: 34343981 DOI: 10.1088/1361-648x/ac1a31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 08/03/2021] [Indexed: 06/13/2023]
Abstract
In low-dimensional Ising spin systems, an interesting observation is the presence of step magnetization at low temperatures. Here we combine both DC and pulsed magnetic fields to study the 1/3 magnetization plateau and multiple steps in the Ising spin-chain material α-CoV2O6. Magnetization in pulsed fields is quite different from that in DC fields, showing multiple steps in an intermediate range of 4.2-6 K, inverted hysteresis below 4.2 K and asymmetric magnetization in negative fields below 11 K. We demonstrate that these unusual behaviors in magnetization are caused by the spin dynamics and the anomalous magnetocaloric effect (MCE) in α-CoV2O6, i.e., abrupt changes of sample temperature in adiabatic conditions. We successfully separate the influence between the intrinsic slow spin dynamics and the quasi-extrinsic temperature change. From the MCE, we find that some irreversible behavior is originated from the slow spin dynamics. Two different slow dynamics associated with the metastable steps are observed: one is sensitive to the slow field sweep rate at the order of ∼mT s-1and weakly depends on temperature, while the other responds to the rapid field sweep rate of ∼kT s-1and dominates at lowest temperature. We also distinguish that the metastable transition atH4is the first order and crucial for the ferrimagnetic to ferromagnetic transition. This study is useful to the understanding of multistep magnetization in α-CoV2O6and sheds light on recent experimental findings of related compounds.
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Affiliation(s)
- C B Liu
- Henan International Joint Laboratory of MXene Materials Microstructure, College of Physics and Electronic Engineering, Nanyang Normal University, Nanyang 473061, People's Republic of China
| | - J B Cheng
- Henan International Joint Laboratory of MXene Materials Microstructure, College of Physics and Electronic Engineering, Nanyang Normal University, Nanyang 473061, People's Republic of China
| | - J B He
- Henan International Joint Laboratory of MXene Materials Microstructure, College of Physics and Electronic Engineering, Nanyang Normal University, Nanyang 473061, People's Republic of China
| | - R Chen
- Key Laboratory of Microelectronics and Energy of Henan Province, Henan Joint International Research Laboratory of New Energy Storage Technology, Xinyang Normal University, Xinyang 464000, People's Republic of China
| | - X Y Yue
- Institute of Physical Science and Information Technology, Anhui University, Hefei 230601, People's Republic of China
| | - Y S Luo
- Henan International Joint Laboratory of MXene Materials Microstructure, College of Physics and Electronic Engineering, Nanyang Normal University, Nanyang 473061, People's Republic of China
- Key Laboratory of Microelectronics and Energy of Henan Province, Henan Joint International Research Laboratory of New Energy Storage Technology, Xinyang Normal University, Xinyang 464000, People's Republic of China
| | - G Yang
- Henan International Joint Laboratory of MXene Materials Microstructure, College of Physics and Electronic Engineering, Nanyang Normal University, Nanyang 473061, People's Republic of China
| | - D W Zhou
- Henan International Joint Laboratory of MXene Materials Microstructure, College of Physics and Electronic Engineering, Nanyang Normal University, Nanyang 473061, People's Republic of China
| | - J S Huang
- Henan International Joint Laboratory of MXene Materials Microstructure, College of Physics and Electronic Engineering, Nanyang Normal University, Nanyang 473061, People's Republic of China
| | - R M Yu
- Henan International Joint Laboratory of MXene Materials Microstructure, College of Physics and Electronic Engineering, Nanyang Normal University, Nanyang 473061, People's Republic of China
| | - Y M Leng
- Henan International Joint Laboratory of MXene Materials Microstructure, College of Physics and Electronic Engineering, Nanyang Normal University, Nanyang 473061, People's Republic of China
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Abel JH, Badgeley MA, Meschede-Krasa B, Schamberg G, Garwood IC, Lecamwasam K, Chakravarty S, Zhou DW, Keating M, Purdon PL, Brown EN. Machine learning of EEG spectra classifies unconsciousness during GABAergic anesthesia. PLoS One 2021; 16:e0246165. [PMID: 33956800 PMCID: PMC8101756 DOI: 10.1371/journal.pone.0246165] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 01/14/2021] [Indexed: 11/22/2022] Open
Abstract
In current anesthesiology practice, anesthesiologists infer the state of unconsciousness without directly monitoring the brain. Drug- and patient-specific electroencephalographic (EEG) signatures of anesthesia-induced unconsciousness have been identified previously. We applied machine learning approaches to construct classification models for real-time tracking of unconscious state during anesthesia-induced unconsciousness. We used cross-validation to select and train the best performing models using 33,159 2s segments of EEG data recorded from 7 healthy volunteers who received increasing infusions of propofol while responding to stimuli to directly assess unconsciousness. Cross-validated models of unconsciousness performed very well when tested on 13,929 2s EEG segments from 3 left-out volunteers collected under the same conditions (median volunteer AUCs 0.99-0.99). Models showed strong generalization when tested on a cohort of 27 surgical patients receiving solely propofol collected in a separate clinical dataset under different circumstances and using different hardware (median patient AUCs 0.95-0.98), with model predictions corresponding with actions taken by the anesthesiologist during the cases. Performance was also strong for 17 patients receiving sevoflurane (alone or in addition to propofol) (median AUCs 0.88-0.92). These results indicate that EEG spectral features can predict unconsciousness, even when tested on a different anesthetic that acts with a similar neural mechanism. With high performance predictions of unconsciousness, we can accurately monitor anesthetic state, and this approach may be used to engineer infusion pumps to intelligibly respond to patients' neural activity.
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Affiliation(s)
- John H. Abel
- Department of Anesthesiology, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, United States of America
- Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA, United States of America
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, United States of America
| | - Marcus A. Badgeley
- Department of Anesthesiology, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, United States of America
- Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA, United States of America
| | - Benyamin Meschede-Krasa
- Department of Anesthesiology, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, United States of America
- Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA, United States of America
| | - Gabriel Schamberg
- Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA, United States of America
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, United States of America
| | - Indie C. Garwood
- Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA, United States of America
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, United States of America
- Harvard-MIT Health Sciences and Technology, Cambridge, MA, United States of America
| | - Kimaya Lecamwasam
- Department of Neuroscience, Wellesley College, Wellesley, MA, United States of America
| | - Sourish Chakravarty
- Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA, United States of America
| | - David W. Zhou
- Department of Anesthesiology, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, United States of America
- Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA, United States of America
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, United States of America
| | - Matthew Keating
- Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA, United States of America
| | - Patrick L. Purdon
- Department of Anesthesiology, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, United States of America
- Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA, United States of America
| | - Emery N. Brown
- Department of Anesthesiology, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, United States of America
- Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA, United States of America
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, United States of America
- Harvard-MIT Health Sciences and Technology, Cambridge, MA, United States of America
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8
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Edlow BL, Barra ME, Zhou DW, Foulkes AS, Snider SB, Threlkeld ZD, Chakravarty S, Kirsch JE, Chan ST, Meisler SL, Bleck TP, Fins JJ, Giacino JT, Hochberg LR, Solt K, Brown EN, Bodien YG. Personalized Connectome Mapping to Guide Targeted Therapy and Promote Recovery of Consciousness in the Intensive Care Unit. Neurocrit Care 2020; 33:364-375. [PMID: 32794142 DOI: 10.1007/s12028-020-01062-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 04/18/2020] [Indexed: 01/05/2023]
Abstract
There are currently no therapies proven to promote early recovery of consciousness in patients with severe brain injuries in the intensive care unit (ICU). For patients whose families face time-sensitive, life-or-death decisions, treatments that promote recovery of consciousness are needed to reduce the likelihood of premature withdrawal of life-sustaining therapy, facilitate autonomous self-expression, and increase access to rehabilitative care. Here, we present the Connectome-based Clinical Trial Platform (CCTP), a new paradigm for developing and testing targeted therapies that promote early recovery of consciousness in the ICU. We report the protocol for STIMPACT (Stimulant Therapy Targeted to Individualized Connectivity Maps to Promote ReACTivation of Consciousness), a CCTP-based trial in which intravenous methylphenidate will be used for targeted stimulation of dopaminergic circuits within the subcortical ascending arousal network (ClinicalTrials.gov NCT03814356). The scientific premise of the CCTP and the STIMPACT trial is that personalized brain network mapping in the ICU can identify patients whose connectomes are amenable to neuromodulation. Phase 1 of the STIMPACT trial is an open-label, safety and dose-finding study in 22 patients with disorders of consciousness caused by acute severe traumatic brain injury. Patients in Phase 1 will receive escalating daily doses (0.5-2.0 mg/kg) of intravenous methylphenidate over a 4-day period and will undergo resting-state functional magnetic resonance imaging and electroencephalography to evaluate the drug's pharmacodynamic properties. The primary outcome measure for Phase 1 relates to safety: the number of drug-related adverse events at each dose. Secondary outcome measures pertain to pharmacokinetics and pharmacodynamics: (1) time to maximal serum concentration; (2) serum half-life; (3) effect of the highest tolerated dose on resting-state functional MRI biomarkers of connectivity; and (4) effect of each dose on EEG biomarkers of cerebral cortical function. Predetermined safety and pharmacodynamic criteria must be fulfilled in Phase 1 to proceed to Phase 2A. Pharmacokinetic data from Phase 1 will also inform the study design of Phase 2A, where we will test the hypothesis that personalized connectome maps predict therapeutic responses to intravenous methylphenidate. Likewise, findings from Phase 2A will inform the design of Phase 2B, where we plan to enroll patients based on their personalized connectome maps. By selecting patients for clinical trials based on a principled, mechanistic assessment of their neuroanatomic potential for a therapeutic response, the CCTP paradigm and the STIMPACT trial have the potential to transform the therapeutic landscape in the ICU and improve outcomes for patients with severe brain injuries.
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Affiliation(s)
- Brian L Edlow
- Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. .,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA.
| | - Megan E Barra
- Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Pharmacy, Massachusetts General Hospital, Boston, MA, USA
| | - David W Zhou
- Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Andrea S Foulkes
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Samuel B Snider
- Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Zachary D Threlkeld
- Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neurology and Neurological Sciences, Stanford School of Medicine, Stanford, CA, USA
| | - Sourish Chakravarty
- Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA.,The Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - John E Kirsch
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - Suk-Tak Chan
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - Steven L Meisler
- Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Thomas P Bleck
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Joseph J Fins
- Division of Medical Ethics and Consortium for the Advanced Study of Brain Injury (CASBI), Weill Cornell Medical College, New York, NY, USA.,The Rockefeller University, New York, NY, USA.,Solomon Center for Health Law and Policy, Yale Law School, New Haven, CT, USA
| | - Joseph T Giacino
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Leigh R Hochberg
- Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,School of Engineering and Carney Institute for Brain Science, Brown University, Providence, RI, USA.,Veterans Affairs RR&D Center for Neurorestoration and Neurotechnology, VA Medical Center, Providence, RI, USA
| | - Ken Solt
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Emery N Brown
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA.,Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA.,The Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Yelena G Bodien
- Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA, USA
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9
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Zhou DW, Li ZM, Zhang SL, Wu L, Li YY, Zhou JX, Shi GZ. The optimal peripheral oxygen saturation may be 95-97% for post-cardiac arrest patients: A retrospective observational study. Am J Emerg Med 2020; 40:120-126. [PMID: 32001056 DOI: 10.1016/j.ajem.2020.01.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 01/09/2020] [Accepted: 01/19/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Current post-resuscitation guidelines recommend oxygen titration in adults with the return of spontaneous circulation after cardiac arrest. However, the optimal peripheral oxygen saturation (SpO2) is still unclear for post-cardiac arrest care. METHODS We conducted a retrospective observational study of prospectively collected data of all cardiac arrest patients admitted to the intensive care units between 2014 and 2015. The main exposure was SpO2, which were interfaced from bedside vital signs monitors as 1-min averages, and archived as 5-min median values. The proportion of time spent in different SpO2 categories was included in separate multivariable regression models along with covariates. The primary outcome measure was hospital mortality and the proportion of discharged home as the secondary outcome was reported. RESULTS 2836 post-cardiac arrest patients in ICUs of 156 hospitals were included. 1235 (44%) patients died during hospitalization and 818 (29%) patients discharged home. With multivariate regression analysis, the proportion of time spent in SpO2 of ≤89%, 90%, 91%, and 92% were associated with higher hospital mortality. The proportion of time spent in SpO2 of 95%, 96%, and 97% were associated with a higher proportion of discharged home outcome, but not associated with hospital mortality. CONCLUSIONS In this retrospective observational study, the optimal SpO2 for patients admitted to the intensive care unit after cardiac arrest may be 95-97%. Further investigation is warranted to determine if targeting SpO2 of 95-97% would improve patient-centered outcomes after cardiac arrest.
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Affiliation(s)
- D W Zhou
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Z M Li
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - S L Zhang
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - L Wu
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Y Y Li
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - J X Zhou
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - G Z Shi
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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10
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Walsh EC, Lee JM, Terzakis K, Zhou DW, Burns S, Buie TM, Firth PG, Shank ES, Houle TT, Brown EN, Purdon PL. Age-Dependent Changes in the Propofol-Induced Electroencephalogram in Children With Autism Spectrum Disorder. Front Syst Neurosci 2018; 12:23. [PMID: 29988455 PMCID: PMC6024139 DOI: 10.3389/fnsys.2018.00023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 05/04/2018] [Indexed: 12/14/2022] Open
Abstract
Patients with autism spectrum disorder (ASD) often require sedation or general anesthesia. ASD is thought to arise from deficits in GABAergic signaling leading to abnormal neurodevelopment. We sought to investigate differences in how ASD patients respond to the GABAergic drug propofol by comparing the propofol-induced electroencephalogram (EEG) of ASD and neurotypical (NT) patients. This investigation was a prospective observational study. Continuous 4-channel frontal EEG was recorded during routine anesthetic care of patients undergoing endoscopic procedures between July 1, 2014 and May 1, 2016. Study patients were defined as those with previously diagnosed ASD by DSM-V criteria, aged 2-30 years old. NT patients were defined as those lacking neurological or psychiatric abnormalities, aged 2-30 years old. The primary outcome was changes in propofol-induced alpha (8-13 Hz) and slow (0.1-1 Hz) oscillation power by age. A post hoc analysis was performed to characterize incidence of burst suppression during propofol anesthesia. The primary risk factor of interest was a prior diagnosis of ASD. Outcomes were compared between ASD and NT patients using Bayesian methods. Compared to NT patients, slow oscillation power was initially higher in ASD patients (17.05 vs. 14.20 dB at 2.33 years), but progressively declined with age (11.56 vs. 13.95 dB at 22.5 years). Frontal alpha power was initially lower in ASD patients (17.65 vs. 18.86 dB at 5.42 years) and continued to decline with age (6.37 vs. 11.89 dB at 22.5 years). The incidence of burst suppression was significantly higher in ASD vs. NT patients (23.0% vs. 12.2%, p < 0.01) despite reduced total propofol dosing in ASD patients. Ultimately, we found that ASD patients respond differently to propofol compared to NT patients. A similar pattern of decreased alpha power and increased sensitivity to burst suppression develops in older NT adults; one interpretation of our data could be that ASD patients undergo a form of accelerated neuronal aging in adolescence. Our results suggest that investigations of the propofol-induced EEG in ASD patients may enable insights into the underlying differences in neural circuitry of ASD and yield safer practices for managing patients with ASD.
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Affiliation(s)
- Elisa C Walsh
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States.,Harvard Medical School/Massachusetts Institute of Technology, Division of Health Sciences and Technology, Cambridge, MA, United States
| | - Johanna M Lee
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States.,Harvard Medical School/Massachusetts Institute of Technology, Division of Health Sciences and Technology, Cambridge, MA, United States
| | - Kristina Terzakis
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, United States.,College of Nursing, Villanova University, Villanova, PA, United States
| | - David W Zhou
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, United States.,Lurie Center for Autism, Mass General Hospital for Children, Boston, MA, United States
| | - Sara Burns
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Timothy M Buie
- Lurie Center for Autism, Mass General Hospital for Children, Boston, MA, United States.,Department of Gastroenterology, Mass General Hospital for Children, Boston, MA, United States
| | - Paul G Firth
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Erik S Shank
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Timothy T Houle
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Emery N Brown
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States.,Harvard Medical School/Massachusetts Institute of Technology, Division of Health Sciences and Technology, Cambridge, MA, United States.,Department of Brain and Cognitive Science, Massachusetts Institute of Technology, Cambridge, MA, United States.,Institute for Medical Engineering and Sciences, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Patrick L Purdon
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
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11
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Nagaraj SB, McClain LM, Boyle EJ, Zhou DW, Ramaswamy SM, Biswal S, Akeju O, Purdon PL, Westover MB. Electroencephalogram Based Detection of Deep Sedation in ICU Patients Using Atomic Decomposition. IEEE Trans Biomed Eng 2018; 65:2684-2691. [PMID: 29993386 DOI: 10.1109/tbme.2018.2813265] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE This study was performed to evaluate how well states of deep sedation in ICU patients can be detected from the frontal electroencephalogram (EEG) using features based on the method of atomic decomposition (AD). METHODS We analyzed a clinical dataset of 20 min of EEG recordings per patient from 44 mechanically ventilated adult patients receiving sedatives in an intensive care unit (ICU) setting. Several features derived from AD of the EEG signal were used to discriminate between awake and sedated states. We trained support vector machine (SVM) classifiers using AD features and compared the classification performance with SVM classifiers trained using standard spectral and entropy features using leave-one-subject-out validation. The potential of each feature to discriminate between awake and sedated states was quantified using area under the receiver operating characteristic curve (AUC). RESULTS The sedation level classification system using AD was able to reliably discriminate between sedated and awake states achieving an average AUC of 0.90, which was significantly better () than performance achieved using spectral (AUC = 0.86) and entropy (AUC = 0.81) domain features. A combined feature set consisting of AD, entropy, and spectral features provided better discrimination (AUC = 0.91, ) than any individual feature set. CONCLUSIONS Features derived from the atomic decomposition of EEG signals provide useful discriminative information about the depth of sedation in ICU patients. SIGNIFICANCE With further refinement and external validation, the proposed system may be able to assist clinical staff with continuous surveillance of sedation levels in mechanically ventilated critically ill ICU patients.
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12
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Nagaraj SB, Ramaswamy SM, Biswal S, Boyle EJ, Zhou DW, Mcclain LM, Rosenthal ES, Purdon PL, Westover MB. Heart rate variability as a biomarker for sedation depth estimation in ICU patients. Annu Int Conf IEEE Eng Med Biol Soc 2017; 2016:6397-6400. [PMID: 28269712 DOI: 10.1109/embc.2016.7592192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
An automated patient-specific system to classify the level of sedation in ICU patients using heart rate variability signal is presented in this paper. ECG from 70 mechanically ventilated adult patients with administered sedatives in an ICU setting were used to develop a support vector machine based system for sedation depth monitoring using several heart rate variability measures. A leave-one-subject-out cross validation was used for classifier training and performance evaluations. The proposed patient-specific system provided a sensitivity, specificity and an AUC of 64%, 84.8% and 0.72, respectively. It is hoped that with the help of additional physiological signals the proposed patient-specific sedation level prediction system could lead to a fully automated multimodal system to assist clinical staff in ICUs to interpret the sedation level of the patient.
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13
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Zhou DW, Westover MB, McClain LM, Nagaraj SB, Bajwa EK, Quraishi SA, Akeju O, Cobb JP, Purdon PL. Clustering analysis to identify distinct spectral components of encephalogram burst suppression in critically ill patients. Annu Int Conf IEEE Eng Med Biol Soc 2016; 2015:7258-61. [PMID: 26737967 DOI: 10.1109/embc.2015.7320067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Millions of patients are admitted each year to intensive care units (ICUs) in the United States. A significant fraction of ICU survivors develop life-long cognitive impairment, incurring tremendous financial and societal costs. Delirium, a state of impaired awareness, attention and cognition that frequently develops during ICU care, is a major risk factor for post-ICU cognitive impairment. Recent studies suggest that patients experiencing electroencephalogram (EEG) burst suppression have higher rates of mortality and are more likely to develop delirium than patients who do not experience burst suppression. Burst suppression is typically associated with coma and deep levels of anesthesia or hypothermia, and is defined clinically as an alternating pattern of high-amplitude "burst" periods interrupted by sustained low-amplitude "suppression" periods. Here we describe a clustering method to analyze EEG spectra during burst and suppression periods. We used this method to identify a set of distinct spectral patterns in the EEG during burst and suppression periods in critically ill patients. These patterns correlate with level of patient sedation, quantified in terms of sedative infusion rates and clinical sedation scores. This analysis suggests that EEG burst suppression in critically ill patients may not be a single state, but instead may reflect a plurality of states whose specific dynamics relate to a patient's underlying brain function.
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14
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Purdon PL, Pavone KJ, Akeju O, Smith AC, Sampson AL, Lee J, Zhou DW, Solt K, Brown EN. The Ageing Brain: Age-dependent changes in the electroencephalogram during propofol and sevoflurane general anaesthesia. Br J Anaesth 2015; 115 Suppl 1:i46-i57. [PMID: 26174300 DOI: 10.1093/bja/aev213] [Citation(s) in RCA: 224] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Anaesthetic drugs act at sites within the brain that undergo profound changes during typical ageing. We postulated that anaesthesia-induced brain dynamics observed in the EEG change with age. METHODS We analysed the EEG in 155 patients aged 18-90 yr who received propofol (n=60) or sevoflurane (n=95) as the primary anaesthetic. The EEG spectrum and coherence were estimated throughout a 2 min period of stable anaesthetic maintenance. Age-related effects were characterized by analysing power and coherence as a function of age using linear regression and by comparing the power spectrum and coherence in young (18- to 38-yr-old) and elderly (70- to 90-yr-old) patients. RESULTS Power across all frequency bands decreased significantly with age for both propofol and sevoflurane; elderly patients showed EEG oscillations ∼2- to 3-fold smaller in amplitude than younger adults. The qualitative form of the EEG appeared similar regardless of age, showing prominent alpha (8-12 Hz) and slow (0.1-1 Hz) oscillations. However, alpha band dynamics showed specific age-related changes. In elderly compared with young patients, alpha power decreased more than slow power, and alpha coherence and peak frequency were significantly lower. Older patients were more likely to experience burst suppression. CONCLUSIONS These profound age-related changes in the EEG are consistent with known neurobiological and neuroanatomical changes that occur during typical ageing. Commercial EEG-based depth-of-anaesthesia indices do not account for age and are therefore likely to be inaccurate in elderly patients. In contrast, monitoring the unprocessed EEG and its spectrogram can account for age and individual patient characteristics.
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Affiliation(s)
- P L Purdon
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA Department of Brain and Cognitive Science
| | - K J Pavone
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - O Akeju
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA
| | - A C Smith
- Department of Brain and Cognitive Science
| | - A L Sampson
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - J Lee
- Harvard-Massachusetts Institute of Technology Division of Health Sciences and Technology
| | - D W Zhou
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - K Solt
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA
| | - E N Brown
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA Department of Brain and Cognitive Science Harvard-Massachusetts Institute of Technology Division of Health Sciences and Technology Institute for Medical Engineering and Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA
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15
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Zhou DW, Mowrey DD, Tang P, Xu Y. Percolation Model of Sensory Transmission and Loss of Consciousness Under General Anesthesia. Phys Rev Lett 2015; 115:108103. [PMID: 26382705 PMCID: PMC4656020 DOI: 10.1103/physrevlett.115.108103] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Indexed: 06/05/2023]
Abstract
Neurons communicate with each other dynamically; how such communications lead to consciousness remains unclear. Here, we present a theoretical model to understand the dynamic nature of sensory activity and information integration in a hierarchical network, in which edges are stochastically defined by a single parameter p representing the percolation probability of information transmission. We validate the model by comparing the transmitted and original signal distributions, and we show that a basic version of this model can reproduce key spectral features clinically observed in electroencephalographic recordings of transitions from conscious to unconscious brain activities during general anesthesia. As p decreases, a steep divergence of the transmitted signal from the original was observed, along with a loss of signal synchrony and a sharp increase in information entropy in a critical manner; this resembles the precipitous loss of consciousness during anesthesia. The model offers mechanistic insights into the emergence of information integration from a stochastic process, laying the foundation for understanding the origin of cognition.
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Affiliation(s)
- David W. Zhou
- Department of Anesthesiology, University of Pittsburgh School of Medicine
- Department of Biological Sciences, Carnegie Mellon University, Pittsburgh, PA
| | - David D. Mowrey
- Department of Anesthesiology, University of Pittsburgh School of Medicine
- Department of Computational and Systems Biology, University of Pittsburgh School of Medicine
| | - Pei Tang
- Department of Anesthesiology, University of Pittsburgh School of Medicine
- Department of Computational and Systems Biology, University of Pittsburgh School of Medicine
- Department of Pharmacology & Chemical Biology, University of Pittsburgh School of Medicine
| | - Yan Xu
- Department of Anesthesiology, University of Pittsburgh School of Medicine
- Department of Pharmacology & Chemical Biology, University of Pittsburgh School of Medicine
- Department of Structural Biology, University of Pittsburgh School of Medicine
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16
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Zhong RZ, Li HY, Fang Y, Sun HX, Zhou DW. Effects of dietary supplementation with green tea polyphenols on digestion and meat quality in lambs infected with Haemonchus contortus. Meat Sci 2015; 105:1-7. [PMID: 25746574 DOI: 10.1016/j.meatsci.2015.02.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 01/20/2015] [Accepted: 02/09/2015] [Indexed: 10/24/2022]
Abstract
Ujumqin sheep are susceptible to infection by the gastrointestinal nematode Haemonchus contortus, which reduces productivity and total meat yield in sheep. Thus, the effects of green tea polyphenol (GTP) supplements (0, 2, 4, or 6g of GTP/kg feed) on dietary nutrient digestibility and meat quality in lambs infected with H. contortus were examined; control lambs were not infected. H. contortus infections did not affect digestion but the apparent digestibilities of nutrients were decreased by dietary 2g of GTP/kg feed supplementation. There was an interaction between treatment and sampling time on plasma total protein, urea nitrogen, and amino acid concentrations. The antioxidant activity and meat color of INFGTP0 lambs decreased. In conclusion, H. contortus infections in lambs decreased meat quality, but appropriate levels of dietary GTP supplementation diminished these negative effects though lower dose of GTP supplement showed negative effects on digestion.
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Affiliation(s)
- R Z Zhong
- Northeast Institute of Geography and Agroecology, Chinese Academy of Sciences, Changchun, Jilin 130102, PR China; College of Animal Science and Technology, Jilin Agricultural University, Changchun, Jilin 130118, PR China
| | - H Y Li
- College of Animal Science and Technology, Jilin Agricultural University, Changchun, Jilin 130118, PR China
| | - Y Fang
- Northeast Institute of Geography and Agroecology, Chinese Academy of Sciences, Changchun, Jilin 130102, PR China
| | - H X Sun
- Northeast Institute of Geography and Agroecology, Chinese Academy of Sciences, Changchun, Jilin 130102, PR China
| | - D W Zhou
- Northeast Institute of Geography and Agroecology, Chinese Academy of Sciences, Changchun, Jilin 130102, PR China.
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17
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Zhong RZ, Sun HX, Liu HW, Zhou DW. Effects of tannic acid on Haemonchus contortus larvae viability and immune responses of sheep white blood cells in vitro. Parasite Immunol 2014; 36:100-6. [PMID: 24558656 DOI: 10.1111/pim.12092] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Direct inhibitory effects of tannic acid on Haemonchus contortus viability were studied in vitro using the larval migration inhibition (LMI) assay. Sheep white blood cells (WBC) were preincubated with 5 and 50 lg/mL tannic acid or not followed by whole H. contortus antigen (WHA). Cells were harvested at 24 h post-incubation to test host immune responses. Concentrations of 50, 100, 500, 1000, 3000 and 5000 lg/mL tannic acid inhibited larvae migration by 19.8, 42.4, 46.3, 92.0, 93.7 and 100%, respectively, within 96 h post-incubation (P < 0.001). The relative mRNA levels of interferon (IFN)-c, interleukin (IL)-2, IL-4 and IL-10 were increased by WHA stimulation without tannic acid. However, the increased effects on IFN-c and IL-2 were inhibited by tannic acid preincubation (P < 0.001), while the increases in IL-4 and IL-10 were greatly enhanced by tannic acid preincubation (P < 0.001). Changes in protein levels of all cytokines essentially paralleled the changes in their corresponding mRNA levels. In conclusion, tannic acid is directly harmful to larvae in a dose- and time-dependent manner and modulates immune responses of sheep WBC stimulated by H. contortus antigen by inhibiting Th1 cytokines and increasing Th2 cytokine expression in vitro.
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18
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Liu HW, Zhou DW, Li K. Effects of chestnut tannins on performance and antioxidative status of transition dairy cows. J Dairy Sci 2013; 96:5901-7. [PMID: 23871369 DOI: 10.3168/jds.2013-6904] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Accepted: 06/04/2013] [Indexed: 11/19/2022]
Abstract
This study was conducted to evaluate the effects of chestnut tannins (CT) on performance and antioxidative status of transition dairy cows. Twenty multiparous Chinese Holstein cows in late gestation were paired according to expected calving date and randomly assigned either to a diet supplemented with CT (CNT, 10 g of CT/kg of diet, dry matter basis) or to an unsupplemented control (CON) diet from 3 wk prepartum to 3 wk postpartum. Blood samples were taken on d -21, 1, 7, and 21 relative to calving for analysis of superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), total antioxidant capacity (T-AOC), and malondialdehyde (MDA). Liver samples were taken by puncture biopsy on d 1 and 21 relative to calving for analysis of SOD, GSH-Px, and MDA. Data were analyzed for a completely randomized block design with repeated measures. The addition of CT had no significant effects on dry matter intake, body weight, body condition score, milk yield, 3.5% fat-corrected milk yield, and milk composition but did decrease milk MDA and somatic cell score in transition dairy cows. Dry matter intake decreased from d -21 to 0 and increased from d 1 to 21 relative to calving across treatments. During the experimental period, body weight and body condition score decreased, whereas milk MDA and somatic cell score increased across treatments. A time effect was also observed for plasma MDA, which peaked on d 1 relative to calving and remained higher than that on d -21 relative to calving across treatments. Addition of CT decreased MDA concentrations in plasma and liver. Neither time nor CT × time effects were observed for SOD and T-AOC in plasma and SOD and GSH-Px in liver; a time effect was observed for plasma GSH-Px, which peaked on d 1 relative to calving and remained higher than those on d -21 relative to calving across treatments. Addition of CT increased SOD, GSH-Px, and T-AOC activities in plasma and SOD and GSH-Px activities in liver. In conclusion, addition of CT might inhibit lipid peroxidation and increase antioxidant enzymes activities in plasma and liver of transition dairy cows. Supplementation of CT may be a feasible means to improve the antioxidative status of transition dairy cows.
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Affiliation(s)
- H W Liu
- Northeast Institute of Geography and Agroecology, Chinese Academy of Sciences, Jilin 130102, P R China
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19
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Abstract
This study was conducted to investigate the influence of pasture intake on meat quality, lipid oxidation, and fatty acid composition of geese. One hundred twenty Dongbei White male geese (a local breed; BW = 878 ± 13 g; 28 d old) were randomly and equally divided into 2 treatments with 6 pens of 10 geese per treatment. The 2 treatments consisted of birds fed ad libitum a corn-based feed. One-half of the birds had no access to pasture (control) while the other half had access to an alfalfa (Medicago sativa)-based pasture (pasture). The study lasted 42 d. Body weight and feed intake were recorded weekly. At the end of the study, geese were slaughtered to collect meat samples. Results showed that pasture intake reduced subcutaneous fat thickness (P < 0.05) and abdominal fat yield (P < 0.05) of geese compared with control. Geese with access to pasture had greater cooking loss (P < 0.05) and lightness (L*) value (P < 0.05) and lower pH at 24 h postmortem (pH24; P < 0.05) and thiobarbituric acid reacting substance values (P < 0.05) at 0 and 30 min of forced oxidation. Moreover, pasture intake increased linolenic acid (C18:3n-3; P < 0.05) and eicosapentaenoic acid (C20:5n-3; P < 0.05) and reduced the n-6:n-3 ratio (P < 0.05) in the breast muscle of geese compare with the control. In conclusion, pasture intake did not enhance growth performance but improved carcass characteristics and meat quality and changed fatty acid composition of geese.
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Affiliation(s)
- H W Liu
- Northeast Institute of Geography and Agroecology, Chinese Academy of Sciences, Jilin 130102, PR China
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Zhong RZ, Xiao WJ, Zhou DW, Tan CY, Tan ZL, Han XF, Zhou CS, Tang SX. Effect of tea catechins on regulation of cell proliferation and antioxidant enzyme expression in H2 O2 -induced primary hepatocytes of goat in vitro. J Anim Physiol Anim Nutr (Berl) 2012; 97:475-84. [PMID: 22416977 DOI: 10.1111/j.1439-0396.2012.01288.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Tea catechins (TC) are polyphenols that have potent antioxidant activity. The objectives of this study were to determine the effects of TC on antioxidant status of hepatocytes challenged with H2 O2 . Primary hepatocytes of goat were exposed to 1 mm H2 O2 without or with 5, 50 and 500 μg/ml TC. The cells were harvested at 48 h post-treatment to determine effects of TC on proliferation, apoptotic features and membrane integrity of cells, and expression of genes and activities of antioxidant enzymes. H2 O2 exposure caused damage to cells (p < 0.001). A lower concentration of TC (5 μg/ml) displayed a protective effect by inhibiting exorbitant cell proliferation and DNA degradation. Both H2 O2 exposure and TC pre-incubation affected expression of antioxidant enzymes at mRNA and protein levels (p < 0.001). The activities of catalase (CAT) (p = 0.027), CuZn-superoxide dismutase (CuZn-SOD) (p < 0.001) and glutathione peroxidase (GPx) (p < 0.001) increased with TC pre-incubation followed by H2 O2 challenge. Changes of CuZn-SOD activity induced by H2 O2 and TC basically paralleled the changes in the corresponding mRNA and protein levels, but the correlation in CAT and GPx expression displayed slightly different patterns at different concentrations of TC. These findings infer that oxidative stress can induce deleterious cellular responses and this unfavourable condition may be alleviated by treatment with TC.
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Affiliation(s)
- R Z Zhong
- Key Laboratory of Agro-ecological Processes in Subtropical Region, Institute of Subtropical Agriculture, The Chinese Academy of Sciences, Changsha, Hunan, China
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Zhou DW, Bao G, Ma YM, Cui T, Liu BB, Zou GT. Peierls transition in sodium under high pressure: a first-principles study. J Phys Condens Matter 2009; 21:025508. [PMID: 21813985 DOI: 10.1088/0953-8984/21/2/025508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We have used first-principles calculations to investigate the electronic structure of the new oP8 phase of sodium which was experimentally reported recently (Gregoryanz et al 2008 Science 320 1054). Our results show the transition from I-43d to oP8 structure, which happens at room temperature, can also happen at 0 K. The I-43d structure will change to the oP8 structure at about 155 GPa and 0 K, rather than the CsIV structure at 190 GPa and 0 K, as the previous studies (Neaton et al 2001 Phys. Rev. Lett. 86 2830) predicted. It is also found that the oP8 structure forms a new nonequilateral triangle Na(3) structure and mainly distributes charge accumulation in the voids of the structure, rather than within the Na(3) triangles. Electronic density of states analysis shows that the oP8 structure opens a deeper pseudogap close to the Fermi level through symmetry breaking of the structure compared with that of the I-43d structure. Together with its unusual charge density distribution, it is found that the Peierls mechanism works for the transition to the oP8 structure. Differing from previous results about the Peierls mechanism of light alkali metals, the unit which produces a one-dimensional charge density wave is the Na(3) cluster instead of the pairing mechanism.
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Affiliation(s)
- D W Zhou
- State Key Laboratory of Superhard Materials, Jilin University, Changchun 130012, People's Republic of China
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Hao ZH, Zhou JB, Jin DW, Zhou DW, Li XD. Different plantar interface effects on dynamics of the lower limb. Conf Proc IEEE Eng Med Biol Soc 2007; 2005:6021-4. [PMID: 17281634 DOI: 10.1109/iembs.2005.1615864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
The moments acting on the lower limb joints influence the life of the arthrosis. These loads may depend on the footwear and action style. The footwear factor was studied with three-dimensional gait measure system. Five young women in their 20s, wear 7 cm high-heeled shoes and sneakers, and walked in 10 m gait laboratory walkway. Inversed dynamics was used to analysis the torques at the ankle, knee and hip. Results showed that peak adduction moments at the knee and ankle increased and flexion/extension moments at hip increased with high-heel shoes compared with the sneakers. The high-heeled shoes result in greater load in lower limb joints especial to the knee and hip.
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Affiliation(s)
- Z H Hao
- Division of Intelligent & Biomechdanical System, State Key Laboratory of Tribology, Tsinghua University, Beijing. China
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Zhou DW, Chen GY, Wu ZK. [A new concept of biomechanics in spinal surgery and its influences on the development of artificial implantation]. Zhonghua Wai Ke Za Zhi 1990; 28:595-8. [PMID: 2086049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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