Objective Bone marrow mesenchymal stem cells (BMSCs) play an important role in repairing nerve injury, meanwhile external temperature has significant effect on BMSCs transplantation, prol iferation, and differentiation. To investigate the effect of BMSCs transplantation and mild hypothermia on repair of rat spinal cord injury (SCI). Methods Forty-five female adult SD rats (weighing 200-250 g) were made the models of hemitransection SCI and divided randomly into 3 groups according to different treatments: group A (SCI group), group B (BMSCs transplantation group), and group C [BMSCs transplantation combined with mild hypothermia (33-35 ) group]. At 1, 2, 4, 6, and 8 weeks after injury, the fuction of hind l imb was evaluated with Basso Beattie and Bresnahan (BBB) score and incl ined plane test. At 4 weeks after injury, histopathology and BrdU immunohistochemistry staining were performed. At 8 weeks after injury, horseradishperoxidase (HRP) retrograde nerve trace and transmission electron microscope (TEM) testing were performed to observe the regeneration of axon. Results After 4 weeks, the function of hind l imb obviously recovered in groups B and C, there were significant differences in BBB score between groups B, C and group A (P lt; 0.05), between group B and group C (P lt; 0.05). There was no significant difference (P gt; 0.05) in tilt angle among 3 groups after 1 and 2 weeks, and there were significant differences (P lt; 0.05) among 3 groups after 4 weeks. HE staining showed that significant cavity could be seen in group A, l ittle in group B, and no cavity in group C. BrdU immunohistochemistry staining showed that the number of positive cells was 0, 90.54 ± 6.23, and 121.22 ± 7.54 in groups A, B, and C, respectively; showing significant differences (P lt; 0.01) among 3 groups. HRP retrograde neural tracing observation showed that the number of HRP positive nerve fibers was 10.35 ± 1.72, 43.25 ± 2.65, and 84.37 ± 4.59 in groups A, B, and C, respectively, showing significant differences (P lt; 0.01) among 3 groups. TEM observation showed that a great amount of unmyel inated nerve fibers and myel inated nerve fibers were found in central transverse plane in group C. Conclusion The BMSCs transplantation play an impontant role in promotion of recovering the function of hind l imb after SCI, and mild hypothermia has synergism effects.
Objective To investigate the effect of mild hypothermia on neurological function in rats with spinal cord injury (SCI) based on the adenosine monophosphate activated protein kinase (AMPK)/Nod-like receptor protein 3 (NLRP3) pathway. MethodsFifty 7-8 weeks old SPF male Sprague Dawley rats were used to establish rat model of SCI by Allen’s method. Among them, 48 successfully modeled rats were randomly divided into SCI group, mild hypothermia group (SCI+mild hypothermia treatment), and Compound C group (SCI+mild hypothermia+20 mg/kg AMPK/NLRP3 pathway inhibitor Compound C), with 16 rats in each group; another 16 normal rats with laminectomy were selected as sham-operation group. Basso-Beattie-Bresnahan (BBB) score was used to evaluate the motor ability of rats at 1, 3, 7, 14 days after treatment. After 14 days, the rats were sacrificed, and the spinal cord histopathological morphology was observed by HE staining, the neuronal apoptosis in spinal cord tissue was detected by TUNEL assay, and the serum levels of interleukin 2 (IL-2), IL-6, transforming growth factor β1 (TGF-β1), malondialdehyde (MDA), and superoxide dismutase (SOD) were detected by ELISA. The expression of AMPK/NLRP3 pathway protein, including B-cell lymphoma 2 (Bcl-2), Bcl-2-associated X protein (Bax), and cleaved-Caspase-9 were detected by Western blot. Results At 1 day after treatment, the rats in SCI group, mild hypothermia group, and Compound C group did not recover their motor ability; at 3, 7, and 14 days, the BBB score of SCI group was significantly lower than that of SCI group (P<0.05), the BBB score of mild hypothermia group was significantly higher than that of SCI group (P<0.05), and the BBB score of Compound C group was significantly lower than that of mild hypothermia group (P<0.05). Compared with the sham-operation group, the SCI group displayed obvious pathological changes in the spinal cord tissue, with disordered tissue architecture, inflammatory infiltration, and blurred interstitial boundaries. The neuronal apoptosis rate, Bax/Bcl-2 ratio, cleaved Caspase-9 expression, NLRP3 protein expression, serum IL-2, IL-6, and MDA levels were elevated, whereas serum TGF-β1, SOD levels, and spinal cord phosphorylation AMPK/AMPK protein expression significantly decreased (P<0.05). Compared with the SCI group, the above phenomena significantly improved in the mild hypothermia group (P<0.05), while the Compound C group showed the opposite trend of change compared to the mild hypothermia group (P<0.05). Conclusion Mild hypothermia can attenuate neurological dysfunction after SCI in rats, potentially by activating the AMPK/NLRP3 pathway.
ObjectivesTo systematically review the efficacy of hypothermia intervention on adult severe craniocerebral injury.MethodsCNKI, WanFang Data, VIP, CBM, PubMed, EMbase, Web of Science and The Cochrane Library databases were electronically searched to collect randomized controlled trials (RCTs) of hypothermia intervention on severe craniocerebral injury from the establishment of the database to July 2nd, 2020.Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 25 RCTs involving 2 949 patients were included. The results of meta-analysis showed that the mortality of hypothermia intervention group was lower than that of normal body temperature group (RR=0.72, 95%CI 0.58 to 0.89, P=0.003), and the prognosis of hypothermia intervention group was better than that of normal body temperature group (RR=1.29, 95%CI 1.15 to 1.46, P<0.000 1).ConclusionsCurrent evidence shows that the hypothermia intervention has a lower mortality rate and a higher prognosis rate in the treatment of adult severe brain injury. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
ObjectiveTo systematically review the efficacy and safety of intravascular cooling versus surface cooling for induced mild hypothermia on the prognosis of patients with cardiac arrest (CA) after resuscitation.MethodsPubMed, EMbase, The Cochrane Library, CNKI and WanFang Data databases were electronically searched to collect cohort studies and randomized controlled trials (RCTs) about the efficacy and safety of intravascular cooling versus surface cooling for CA patients after resuscitation from inception to July 2019. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using Stata 13.0 software.ResultsA total of 9 cohort studies and 3 RCTs involving 2 104 patients were included. The results of meta-analysis showed that: the rate of good neurological function was significantly higher (OR=1.45, 95%CI 1.18 to 1.78, P<0.001) and the induction time was significantly shorter (SMD=−1.35, 95%CI −2.34 to −0.36, P=0.008) in the intravascular cooling group, but there was no statistical difference in mortality between two groups (OR=0.84, 95%CI 0.70 to 1.00, P=0.053). In terms of complications related to mild hypothermia, the rate of excessive hypothermia (OR=0.27, 95%CI 0.18 to 0.41, P<0.001) and arrhythmia (OR=0.60, 95%CI 0.40 to 0.89, P=0.012) was significantly lower in the patients treated with intravascular cooling, but the incidence of coagulopathy was higher (OR=1.61, 95%CI 1.05 to 2.49, P=0.03). There was no statistical difference in the incidence of pneumonia between two groups (OR=1.20, 95%CI 0.94 to 1.53, P=0.147).ConclusionCurrent evidence shows that intravascular cooling has significant neurological protection for patients with CA compared with surface cooling since it can decrease the induction time and the rate of excessive hypothermia and arrhythmia, but it may have a negative effect on the coagulation function. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusion.
目的探讨亚低温联合持续肾脏替代治疗（CRRT）对心脏外科术后重症心力衰竭的临床效果 方法回顾性分析我中心2009年2月至2013年12月行心脏外科术后重症心力衰竭38例患者的临床资料，其中男18例、女20例，年龄55～74岁，虽应用大剂量血管活性药物及主动脉内球囊反搏（IABP）辅助循环，心力衰竭无改善，采用CRRT及亚低温联合治疗。监测患者在联合治疗前后心脏指数（CI）值、混合静脉血氧饱和度（SvO2）、尿量、肌酐（Cr）及乳酸（Lac）的变化。 结果亚低温联合CRRT治疗后，患者CI较治疗前明显改善[（2.3± 0.7）L/（min· m2）vs.（1.8± 0.2）L/（min· m2）]，SvO2升高（62%± 5%vs.50%± 4%），乳酸明显降低[（8.6± 2.3）mmol/L vs.（3.0± 1.1）mmol/L]，尿量明显增加[（2.5± 0.9）ml/h vs.（1.0± 0.7）ml/h]，Cr明显下降[（140± 19）mmol/L vs.（292± 24）mmol/L]。 结论亚低温联合CRRT治疗心脏外科术后重症心力衰竭能有效改善循环功能，且操作简单易行。
Objective To explore the therapeutic effect of mild hypothermia on the inflammatory response, organ function and outcome in perioperative patients with acute Stanford type A aortic dissection (AAAD). Methods From February 2017 to February 2018, 56 patients with AAAD admitted in our department were enrolled and randomly allocated into two groups including a control group and an experimental group. After deep hypothermia circulatory arrest during operation, in the control group (n=28), the patients were rewarmed to normal body temperatures (36 to 37 centigrade degree), and which would be maintained for 24 hours after operation. While in the experimental group (n=28), the patients were rewarmed to mild hypothermia (34 to 35 centigrade degree), and the rest steps were the same to the control group. The thoracic drainage volume and the incidence of shivering at the first 24 hours after operation, inflammatory indicators and organ function during perioperation, and outcomes were compared between the two groups. There were 20 males and 8 females at age of 51.5±8.7 years in the control group, 24 males and 4 females at age of 53.3±11.2 years in the experimental group.Results There was no obvious difference in the basic information and operation information in patients between the two groups. Compared to the control group, at the 24th hour after operation, the level of peripheral blood matrix metalloproteinases (MMPs) was lower than that in the experimental group (P=0.008). In the experimental group, after operation, the awakening time was much shorter (P=0.008), the incidence of bloodstream infection was much lower (P=0.019). While the incidence of delirium, acute kidney injury (AKI), hepatic insufficiency, mechanical ventilation duration, intensive care unit (ICU) stays, or hospital mortality rate showed no statistical difference. And at the first 24 hours after operation, there was no difference in the thoracic drainage volume between the two groups, and no patient suffered from shivering. Conclusion The mild hypothermia therapy is able to shorten the awakening time and reduce the incidence of bloodstream infection after operation in the patients with AAAD, and does not cause the increase of thoracic drainage volume or shivering.