Search Results (79)

Background/Objectives: Out-of-hospital cardiac arrest (OHCA) has persistently low survival rates. While advanced airway management (AAM) is crucial during cardiopulmonary resuscitation, optimal timing remains unclear. This study examined the association between early AAM and clinical outcomes in adult OHCA patients. Methods: This retrospective study analyzed Korean nationwide OHCA registry data (August 2019–December 2022). Adult patients with emergency medical service-treated OHCA of presumed medical origin receiving AAM were included. Early AAM was defined as airway placement within 5 min of CPR initiation. Time-dependent propensity score matching controlled for selection bias and time-related confounding. Structural equation modeling examined associations between AAM timing and other prehospital interventions. Primary outcome was survival to hospital discharge with good neurological recovery (cerebral performance category 1–2). Results: Among 51,869 patients receiving AAM, 27,591 received early AAM and 24,278 received delayed AAM. After propensity score matching, 12,014 patients were included per group with balanced characteristics. Early AAM was associated with higher prehospital return of spontaneous circulation (11.8% vs. 10.5%; adjusted RR 1.21, 95% CI 1.12–1.29) and favorable neurological recovery (5.8% vs. 5.1%; adjusted RR 1.12, 95% CI 1.01–1.23). AAM timing correlated with timing of other critical interventions, including rhythm analysis and epinephrine administration. Conclusions: Early AAM within 5 min of CPR initiation was associated with improved neurological outcomes and increased prehospital ROSC in OHCA. Airway timing may indicate overall resuscitation quality, emphasizing the importance of coordinated, timely prehospital interventions. Full article

In vitro fertilization (IVF) exposes embryos to environmental stressors that can disrupt early development and confer long-term health risks, though the mechanisms remain poorly understood. Here, we tested the hypothesis that reducing incubation temperature during the first zygotic cleavage would promote long-term developmental stability in IVF-conceived offspring. Using a mouse model, we compared the long-term effects of standard (37 °C) versus reduced (35 °C) IVF culture temperature on energy balance, circadian rhythms, sleep architecture, and brain histone modifications. Although offspring from both IVF groups exhibited increased body mass without notable effects on glucose metabolism, significant disruptions in circadian rhythms and sleep–wake patterns were detected. The 37 °C group exhibited altered amplitudes in oxygen consumption rhythms and respiratory exchange ratios, as well as pronounced alterations in sleep–wake patterns, including reduced sleep duration and increased nighttime activity. The 35 °C group displayed intermediate phenotypes, substantiating the importance of optimizing embryo incubation parameters. These metabolic and behavioral changes were paralleled by altered histone modifications in the cerebral cortex of IVF offspring, suggesting an epigenetic basis for circadian misalignment. Our results identify disrupted circadian rhythm and sleep architecture as a novel mechanism contributing to metabolic dysfunction in IVF-conceived offspring. The partial mitigation of these effects through reduced culture temperature underscores the importance of optimizing IVF protocols to minimize long-term epigenetic and metabolic risks. Full article

Thiamine is a vitamin essential for the function of central metabolic enzymes, of which pyruvate dehydrogenase (PDH) possesses one of the broadest regulations. Diurnal effects of thiamine supplementation on energy metabolism have previously been shown for the rat brain. Here, we report data on the diurnal changes and the effects of thiamine administration to rats on the function of thiamine-dependent enzymes in the cerebral cortex, heart, and liver. The most pronounced diurnal differences were found at the level of cerebral PDH activity. Analysis of PDH phosphorylation in five rat tissues revealed diurnal and thiamine-dependent differences in the cerebral cortex and heart. The expression of tissue-specific PDH kinases PDK3 and PDK4 showed a daytime-dependent response to thiamine administration in the cerebral cortex and heart, respectively. In addition, cardiac PDK4 expression was doubled in the evening, compared to morning. Furthermore, cerebral cortex demonstrated tissue-specific diurnal changes in thiamine diphosphate (ThDP) and monophosphate levels. Elevation of blood, cardiac, and cerebral ThDP was more effective upon the evening thiamine administration. Importantly, only ThDP was elevated in the rat cerebral cortex exclusively after evening thiamine supplementation. Coenzyme role of ThDP and/or other thiamine functions in nerve tissue reduced the existing daytime changes in animal behavior and ECG parameters. The reported data on diurnal regulation of central energy metabolism as well as the diurnal difference in thiamine accumulation in the cerebral cortex, heart, and other tissues are of clinical importance, as high doses of thiamine are used for the treatment of acute thiamine deficiencies and many other mostly neurological diseases in patients. Full article

Stroke is a significant global health concern characterized by the abrupt disruption of cerebral blood flow, leading to neurological impairment. Accurate and timely diagnosis—enabled by imaging modalities such as computed tomography (CT) and magnetic resonance imaging (MRI)—is essential for differentiating stroke types and initiating interventions like thrombolysis, thrombectomy, or surgical management. In parallel, recent advancements in wearable technology, particularly smart clothing, offer new opportunities for stroke prevention, real-time monitoring, and rehabilitation. These garments integrate various sensors, including electrocardiogram (ECG) electrodes, electroencephalography (EEG) caps, electromyography (EMG) sensors, and motion or pressure sensors, to continuously track physiological and functional parameters. For example, ECG shirts monitor cardiac rhythm to detect atrial fibrillation, smart socks assess gait asymmetry for early mobility decline, and EEG caps provide data on neurocognitive recovery during rehabilitation. These technologies support personalized care across the stroke continuum, from early risk detection and acute event monitoring to long-term recovery. Integration with AI-driven analytics further enhances diagnostic accuracy and therapy optimization. This narrative review explores the application of smart clothing in conjunction with traditional imaging to improve stroke management and patient outcomes through a more proactive, connected, and patient-centered approach. Full article

Background/Objectives: Niemann-Pick disease Type C (NPC) represents an autosomal recessive disorder with an incidence rate of 1 in 100,000 live births that belongs to the lysosomal storage diseases (LSDs). NPC is characterized by the abnormal accumulation of unesterified cholesterol, in addition to being an autosomal recessive inherited pathology, which belongs to LSDs. It occurs in 95% of cases due to mutations in the NPC1 gene, while 5% of cases are due to mutations in the NPC2 gene. In the cerebral cortex (CC), the disease shows lipid inclusions, increased cholesterol and multiple sphingolipids in neuronal membranes, and protein aggregates such as hyperphosphorylated tau, α-Synuclein, TDP-43, and β-amyloid peptide. Mitochondrial damage and oxidative stress are some alterations at the cellular level in NPC. Therefore, the aim of this work was to determine the gene expression profile in the CC of NPC1 mice in order to identify altered molecular pathways that may be related to the pathophysiology of the disease. Methods: In this study, we performed a microarray analysis of a 22,000-gene chip from the cerebral cortex of an NPC mutant mouse compared to a WT mouse. Subsequently, we performed a bioinformatic analysis in which we found groups of dysregulated genes, and their expression was corroborated by qPCR. Finally, we performed Western blotting to determine the expression of proteins probably dysregulated. Results: We found groups of dysregulated genes in the cerebral cortex of the NPC mouse involved in the ubiquitination, fatty acid metabolism, differentiation and development, and underexpression in genes with mitochondrial functions, which could be involved in intrinsic apoptosis reported in NPC, in addition, we found a generalized deregulation in the cortical circadian rhythm pathway, which could be related to the depressive behavior that has even been reported in NPC patients. Conclusions: Recognizing that there are changes in the expression of genes related to ubiquitination, mitochondrial functions, and cortical circadian rhythm in the NPC mutant mouse lays the basis for targeting treatments to new potential therapeutic targets. Full article

Background/Objectives: Patterned Sensory Enhancement (PSE), a Neurologic Music Therapy technique, utilizes rhythm and other musical elements to facilitate functional movement in diverse clinical populations. This scoping review is the first to systematically synthesize the current evidence surrounding PSE’s use and its effects on motor function across various populations in order to evaluate its therapeutic potential, identify gaps in the existing literature, and guide future research efforts. Methods: A literature search was conducted across five major databases (MEDLINE, Embase, PsycINFO, CINAHL, and Scopus) in accordance with the PRISMA-ScR guidelines. Results: From 1018 screened articles, 15 met the inclusion criteria. PSE has been demonstrated as effective across clinical populations, including Cerebral Palsy, stroke, Parkinson’s Disease, and psychiatric conditions. However, the results for studies on geriatric populations remain inconsistent. Despite the variability in the outcome measures and movement types assessed, PSE is consistently supported as an effective approach for enhancing motor function. However, to date, only a small number of studies across populations have been conducted. Conclusions: This scoping review suggests that PSE holds significant potential for improving motor function across a range of clinical populations. Further research is needed to explore the long-term effects, use standardized terminology, and identify the optimal implementation strategies tailored to the unique needs of different populations to maximize its therapeutic benefit. Full article

Sleep is a fundamental part of life for all living beings. The propensity to fall asleep is regulated by a circadian rhythm, which controls the secretion of the hormone melatonin. Melatonin secretion is linked to the light and dark phases of the day/night cycle. Getting proper sleep is an essential part of a healthy lifestyle. Scientific evidence shows that sleeping less than 7 h per night, or as little as 2 h per night, is a cardiovascular, metabolic, and cerebral risk factor. In addition, the role of sleep is fundamental for the recovery phase for athletes. Nutrition, supplementation, and exercise can greatly support the quality and quantity of sleep. They can have positive effects on sleep through specific physiological and biochemical responses. The objective of this short review is to critically investigate the possible sleep benefits of nutrition, exercise, and supplementation and to discuss further directions for research in this area. Full article

Background: Extracorporeal cardiopulmonary resuscitation (eCPR) is a method for initiation of cardiopulmonary bypass during resuscitation of a patient with refractory cardiac arrest to support end-organ perfusion. This retrospective study evaluates which prognostic markers are seen in patients with poor outcomes who underwent eCPR in our rural tertiary care center. Study Design/Methods: All patients who underwent eCPR at our center from May 2013 to January 2023 were analyzed in a retrospective manner. We then compared outcomes in patients who survived to discharge (survivors) versus those who did not survive to discharge (non-survivors). Demographic factors, body mass index, peak serum lactate in 24 h, initial rhythm, lowest mean arterial pressure within the first six hours, a requirement of renal replacement therapy, and the number of blood transfusions required during the hospitalization were analyzed. Results: 37 patients (24 males and 13 females) with a median age of 58 years (IQR: 48–65) were included. The overall mortality rate was 75.7%, and all survivors had good neurological outcomes, which were defined as Cerebral Performance Category (CPC) scores of 1 or 2. The most significant factors seen in non-survivors were obesity as measured by BMI more than 30 (odds ratio = 7.33; 95% CI 1.40–38.33; p = 0.02), and lowest MAP <65 within the first 6 h despite being on extracorporeal membrane oxygenation (0% vs. 74.1%; p = <0.01). Conclusions: This retrospective study demonstrates that initial presentations of patients who underwent eCPR with obesity and MAPS < 65 within the first 6 h despite ECMO support were seen in patients with higher mortality. Full article

Background/Objectives: Transcutaneous electrical acupoint stimulation (TEAS), also known as transcutaneous electroacupuncture stimulation, delivers electrical pulses to the skin over acupuncture points (“acupoints”) via surface electrodes. Electroencephalography (EEG) is an important tool for assessing the changes in the central nervous system (CNS) that may result from applying different TEAS frequencies peripherally—i.e., acting via the peripheral nervous system (PNS)—and determining how these influence cerebral activity and neural plasticity. Methods: A total of 48 healthy volunteers were allocated in a semi-randomized crossover study to receive four different TEAS frequencies: 2.5 pulses per second (pps); 10 pps; 80 pps; and sham (160 pps at a low, clinically ineffective amplitude). TEAS was applied for 20 min to each hand at the acupuncture point Hegu (LI4). The EEG was recorded during an initial 5 min baseline recording, then during TEAS application, and after stimulation for a further 15 min, separated into three periods of 5 min (initial, intermediate, and final) in order to assess post-stimulation changes. Source localization analysis was conducted for the traditional five EEG frequency bands: delta (0.1–3.9 Hz), theta (4–7.9 Hz), alpha (8–13 Hz), beta (14–30 Hz), and gamma (30.1–45 Hz). Results: Within-group source localization analyses of EEG data showed that during the initial 5 min post-stimulation, theta oscillations in the 2.5 pps TEAS group increased over the parahippocampal gyrus (t = 4.42, p < 0.01). The 10 pps TEAS group exhibited decreased alpha rhythms over the inferior parietal gyrus (t = −4.20, p < 0.05), whereas the sham (160 pps) TEAS group showed decreased delta rhythms over the postcentral gyrus (t = −3.97, p < 0.05). During the intermediate 5 min post-stimulation, the increased theta activity over the left parahippocampal gyrus (BA27) remained in the 2.5 pps TEAS group (t = 3.97, p < 0.05). However, diminished alpha rhythms were observed in the 10 pps TEAS group over the postcentral gyrus (t = −4.20, p < 0.01), as well as in the delta rhythms in the sham (160 pps) TEAS group in the same area (t = −4.35, p < 0.01). In the final 5 min post-stimulation, reduced alpha rhythms were exhibited over the insula in the 10 pps TEAS group (t = −4.07, p < 0.05). Interaction effects of condition by group demonstrate decreased alpha rhythms in the 10 pps TEAS group over the supramarginal gyrus during the initial 5 min post-stimulation (t = −4.31, p < 0.05), and decreased delta rhythms over the insula in the sham TEAS group during the final 5 min post-stimulation (t = −4.42, p < 0.01). Conclusions: This study revealed that low TEAS frequencies of 2.5 pps and 10 pps modulate theta and alpha oscillations over the brain areas related to emotional and attentional processes driven by external stimuli, as well as neural synchronization of delta rhythms in the sham group in brain areas related to stimulus expectation at baseline. It is hoped that these findings will stimulate further research in order to evaluate such TEAS modulation effects in clinical patients. Full article

Background/Objectives: Out-of-hospital cardiac arrests (OHCAs) are common, with return of spontaneous circulation (ROSC) achieved in approximately 25% of patients. However, it remains unknown whether post-ROSC care delivered by a pre-hospital critical care team (CCT) improves patient outcomes. We therefore aimed to investigate this in OHCA patients admitted to our intensive care unit (ICU). Methods: In this retrospective observational study, consecutive adults with ROSC after non-traumatic OHCA admitted to our ICU between 1 September 2019 and 31 August 2022 were included. We compared patients who received post-ROSC care from a CCT to those who received standard care. The primary outcome was a good neurological outcome on hospital discharge (defined as Cerebral Performance Category 1–2). Descriptive statistics, Area Under the Receiver Operating Characteristic Curve (AUC) values, and adjusted Odds Ratios (ORs) are reported. We constructed multivariable logistic regression models that adjusted for the component variables of the MIRACLE2 score. Results: We included 126 OHCAs (median age 63 years, 69% male), which were largely witnessed (82%), involved bystander cardiopulmonary resuscitation (87%), and had an initial shockable rhythm (61%). The prevalence of good neurological outcomes was higher in patients who received post-ROSC care from a pre-hospital CCT (37% vs. 17%, p = 0.012). The MIRACLE2 score was a strong predictor of good neurological outcomes (AUC 0.932), and in our multivariable analysis, good neurological outcome was associated with both CCT presence post-ROSC (aOR 3.77, 95% CI 1.02–13.89) and the delivery of PHEA (aOR 4.10, 95% CI 1.10–15.27, p = 0.035). Furthermore, in patients meeting the Utstein criteria (n = 69), good neurological outcomes were also more prevalent with CCT presence post-ROSC (62% vs. 29%, p < 0.001). Conclusions: We found that post-ROSC care delivered by a pre-hospital CCT was associated with good neurological outcomes on hospital discharge. Full article

Background: Extracorporeal cardiopulmonary resuscitation (ECPR) has the potential to improve neurological outcomes in patients with refractory out-of-hospital cardiac arrest (OHCA), offering an alternative to conventional cardiopulmonary resuscitation (CCPR). However, its effectiveness in OHCA remains controversial despite advancements in resuscitation techniques. Methods: This retrospective single-center study compared neurological outcomes and 30-day survival between ECPR and CCPR patients from January 2014 to January 2022. Patients aged 18–75 with witnessed OHCA, minimal no flow and low flow times, and cardiac arrests occurring at home or in public places were included. All patients were transported directly to our institution, a tertiary medical center serving the southeastern region of Seoul, where extracorporeal membrane oxygenation implantation was consistently performed in the emergency department. Neurological outcomes were assessed using Cerebral Performance Category scores, with good outcomes defined as scores of 1–2. Statistical analyses included logistic regression models and Kaplan–Meier survival curves, adjusted for confounders using inverse probability of treatment weighting. Results: ECPR was associated with significantly better neurological outcomes than CCPR (p < 0.001). Factors predicting poor outcomes included older age and longer low flow times, while male sex and shockable rhythms were protective. No significant difference was found in 30-day survival between the ECPR and CCPR groups, although a trend toward better survival was noted with ECPR. Conclusions: ECPR may improve neurological outcomes in patients with refractory OHCA compared to CCPR, although it does not significantly affect 30-day survival. Further studies are necessary to validate these findings and explore the long-term impacts of ECPR. Full article

Background/Objectives: This study uses machine learning and multicenter registry data for analyzing the determinants of a favorable neurological outcome in patients with out-of-hospital cardiac arrest (OHCA) and developing decision support systems for various subgroups. Methods: The data came from the Korean Cardiac Arrest Research Consortium registry, with 2679 patients who underwent OHCA aged 18 or above with the return of spontaneous circulation (ROSC). The dependent variable was a favorable neurological outcome (Cerebral Performance Category score 1–2), and 68 independent variables were included, e.g., first monitored rhythm, in-hospital cardiopulmonary resuscitation (CPR) duration and post-ROSC pH. A random forest was used for identifying the major determinants of the favorable neurological outcome and developing decision support systems for the various subgroups stratified by the major variables. Results: Based on the random forest variable importance, the major determinants of the OHCA patient outcomes were the in-hospital CPR duration (0.0824), in-hospital electrocardiogram on emergency room arrival (0.0692), post-ROSC pH (0.0579), prehospital ROSC before emergency room arrival (0.0565), coronary angiography (0.0527), age (0.0415), first monitored rhythm (EMS) (0.0402), first monitored rhythm (community) (0.0401), early coronary angiography within 24 h (0.0304) and time from scene arrival to CPR stop (0.0301). It was also found that the patients could be divided into six subgroups in terms of their prehospital ROSC and first monitored rhythm (EMS), and that a decision tree could be developed as a decision support system for each subgroup to find the effective cut-off points regarding the in-hospital CPR duration, post-ROSC pH, age and hemoglobin. Conclusions: We identified the major determinants of favorable neurological outcomes in successfully resuscitated patients who underwent OHCA using machine learning. This study demonstrates the strengths of a random forest as an effective decision support system for each stratified subgroup (prehospital ROSC and first monitored rhythm by EMS) to find its own optimal cut-off points for the major in-hospital variables (in-hospital CPR duration, post-ROSC pH, age and hemoglobin). Full article

Background: Extracorporeal cardiopulmonary resuscitation (eCPR) offers cardiorespiratory support to patients experiencing cardiac arrest. However, this technology is not yet considered a standard treatment, and the evidence on eCPR criteria and its association with survival and good neurological outcomes remains scarce. Therefore, we aimed to investigate the overall mortality and risk factors for mortality. Moreover, we provide a comparison of demographic, clinical, and laboratory characteristics of patients, including neurological outcomes and adverse events during support. Methods: This retrospective analysis included in-hospital and out-of-hospital cardiac arrest patients who received eCPR and were admitted between January 2008 and June 2022 at a tertiary and trauma one-level university hospital in Austria. Results: In total, 90 patients fulfilled inclusion criteria, 41 (46%) patients survived until intensive care unit discharge, and 39 (43%) survived until hospital discharge. The most common cause of cardiac arrest was myocardial infarction (42, 47%), and non-shockable initial rhythm was reported in 50 patients (56%). Of 33 survivors with documented outcomes, 30 had a good recovery as measured with Cerebral Performance Category score, 2 suffered severe disability, and 1 remained in a persistent vegetative state. Finally, multivariate analysis identified asystole as initial rhythm (HR 2.88, p = 0.049), prolonged CPR (HR 1.02, p = 0.043), and CPR on the weekend (HR 2.57, p = 0.032) as factors with a higher risk of mortality. Conclusions: eCPR-related decision-making could be additionally supported by the comprehension of the reported risk factors for mortality and severe disability. Further studies are needed to elucidate the impact of peri-arrest variables on outcomes, aiming to improve patient selection. Full article

Atrial fibrillation (AF) and dementia are major global public health issues and share common risk factors, especially after the age of 65 and regardless of the presence of stroke. Despite accounting for potential confounders, AF appears to be an independent risk factor for cognitive decline and dementia. The mechanisms are likely to be multifactorial and may include AF-related ischemic stroke, cerebral hypoperfusion, microbleeds, systemic inflammation, genetic factors, and small vessel disease, leading to brain atrophy and white matter damage. The early aggressive management of AF and comorbidities may reduce the risk of dementia. Indeed, the early detection of AF-related cognitive impairment should allow for the early implementation of measures to prevent the development of dementia, mainly through integrative approaches involving the correction of risk factors and maintenance of rhythm control. Well-designed prospective studies are needed to determine whether early detection and AF treatment can prevent dementia and identify whether optimal integrative measures are effective in preventing cognitive impairment and dementia. Full article

(1) The development and utilization of the vast saline–alkali land worldwide is an important way to solve the worsening food crisis. Eriocheir sinensis, due to its strong osmotic regulation capability and its characteristics of being suitable for culturing in alkaline water, has become a potential aquaculture species in saline–alkali water. The brain and heart are the key tissues for signal transduction and energy supply under environmental stress. (2) This study is the first to explore the synergistic regulatory molecular mechanism by integrated analysis on cerebral ganglion proteomics and heart metabolomics of Eriocheir sinensis under alkalinity stress. (3) The results indicate that the cerebral ganglion and heart of E. sinensis were closely related in response to acute alkalinity stress. The differential regulatory pathways mainly involved regulation of energy metabolism, amino acid metabolism, and homeostasis maintenance. Importantly, alkalinity stress induced the regulation of antioxidants and further adjusted longevity and rhythm in the cerebral ganglion and heart, reflecting that the cerebral ganglion and heart may be the key tissues for the survival of Eriocheir sinensis under an alkalinity environment. (4) This study provides a theoretical reference for research on the regulation mechanism of E. sinensis under alkalinity condition and contributes to the development of aquaculture in saline–alkali water. Full article