Currently, there is no known optimal therapy for carbon monoxide （CO） poisoning and CO-associated delayed neu- rological sequelae. Hyperbaric oxygen therapy （HBOT） is a well-known treatment method, but its use for...Currently, there is no known optimal therapy for carbon monoxide （CO） poisoning and CO-associated delayed neu- rological sequelae. Hyperbaric oxygen therapy （HBOT） is a well-known treatment method, but its use for CO poison- ing patients is controversial to use due to lack of evidences regarding its efficacy. Thus, it is unlikely that HBOT alone will be accepted as the standard treatment method. In this article, current and potential treatment methods of CO poi- soning are presented as well as the tentative multi-factorial pathophysiology. A series of treatments are suggested for use as a bundle therapy, with targeted temperature management as the base treatment method. Such a therapy holds a great potential, especially for the cases where HBOT is not readily available. We suggest further investigations for elucidating the effects of these suggested treatments and their roles in terms of the complex pathophysiology of CO poisoning. Future ac- ceptance of this therapy based on the improved scientific and clinical knowledge may result in injury prevention and mini- mization of the signs and the symptoms in CO poisoning.展开更多
Objective In vivo Proton Magnetic Resonance Spectroscopy （1H-MRS） can be used to evaluate the levels of specific neurochemical biomarkers of pathological mechanisms in the brain. Methods We conducted T2-Weighted Mag...Objective In vivo Proton Magnetic Resonance Spectroscopy （1H-MRS） can be used to evaluate the levels of specific neurochemical biomarkers of pathological mechanisms in the brain. Methods We conducted T2-Weighted Magnetic Resonance Imaging （MRI） and 1H-MRS with a 3.0-Tesla animal MRI system to investigate the early microstructural and metabolic profiles in vivo in the striatum of rats following carbon monoxide （CO） poisoning. Results Compared to baseline, we found significant cortical surface deformation, cerebral edema changes, which were indicated by the unclear gray/white matter border, and lateral ventricular volume changes in the brain. A significant reduction in the metabolite to total creatine （Cr） ratios of N-acetylaspartate （NAA） was observed as early as 1 h after the last CO administration, while the lactate （Lac） levels increased marginally. Both the Lac/Cr and NAA/Cr ratios leveled off at 6 h and showed no subsequent significant changes. In addition, compared to the control, the choline （Cho）/Cr ratio was slightly reduced in the early stages and significantly increased after 6 h. In addition, a pathological examination revealed mild cerebral edema on cessation of the insult and more severe cerebral injury after additional CO poisoning. Conclusion The present study demonstrated that 1H-MRS of the brain identified early metabolic changes after CO poisoning. Notably, the relationship between the increased Cho/Cr ratio in the striatum and delayed neuropsychologic sequelae requires further research.展开更多
BACKGROUND Delayed neurological sequelae(DNS)caused by carbon monoxide(CO)intoxication poses considerable treatment challenges for clinical practitioners.In this report,we used nuclear medicine imaging and the Mini-Me...BACKGROUND Delayed neurological sequelae(DNS)caused by carbon monoxide(CO)intoxication poses considerable treatment challenges for clinical practitioners.In this report,we used nuclear medicine imaging and the Mini-Mental State Examination(MMSE)to evaluate the effectiveness of intravascular laser irradiation of blood(ILIB)therapy for the management of DNS.CASE SUMMARY A 51-year-old woman presented to our medical center experiencing progressive bradykinesia,rigidity of limbs,gait disturbance,and cognitive impairment.Based on her neurological deficits,laboratory tests and imaging findings,the patient was diagnosed with delayed neurological sequelae of CO intoxication.She received intensive rehabilitation and ILIB therapy during 30 sessions over 2 mo after diagnosis.Brain single-photon emission computed tomography was performed both prior to and after ILIB therapy.The original hypoperfusion area in bilateral striata,bilateral frontal lobe,right parietal lobe,and bilateral cerebellum showed considerable improvement after completion of therapy.The patient’s MMSE score also increased markedly from 6/30 to 25/30.Symptoms of DNS became barely detectable,and the woman was able to carry out her daily living activities independently.CONCLUSION ILIB therapy could facilitate recovery from delayed neurological sequelae in patients with CO intoxication,as demonstrated by improved cerebral blood flow and functional outcomes in our patient.展开更多
Objective To research the expression of hypoxia-inducible factor-1 alpha(HIF-1α)and heme oxygenase-1(HO-1)in hippocampus of rats with delayed encephalopathy after acute carbon monoxide poisoning(DEACMP)and its functi...Objective To research the expression of hypoxia-inducible factor-1 alpha(HIF-1α)and heme oxygenase-1(HO-1)in hippocampus of rats with delayed encephalopathy after acute carbon monoxide poisoning(DEACMP)and its functions.Methods One hundred and fiftysix rats were selected and randomly divided into展开更多
Background: Carbon monoxide (CO) poisoning remains a major cause of accidental injuries and multiple studies have indicated that CO is also associated with significantly severe or long-term toxicity to the central ner...Background: Carbon monoxide (CO) poisoning remains a major cause of accidental injuries and multiple studies have indicated that CO is also associated with significantly severe or long-term toxicity to the central nervous system. Given that CO poisoning causes serious morbidity and mortality, a better understanding of epidemiological features and clinical characteristics of acute CO poisoning in China is crucial.Methods: We collected the clinical data of acute CO poisoning in patients between November 2019 and April 2020 across Shandong province, China and analyzed its characteristics focusing on the weekly amount and the severity of the confirmed cases.Results: A total number of 21,088 acute CO poisoning cases were diagnosed. The overall incidence of acute CO poisoning was approximately 0.021%. On severity rankings, 63% of confirmed cases (n=13,378) were mild, 27%(n=5635) were moderate, and 10% (n=2075) were severe. Interestingly, the coastal cities had more confirmed cases than the inland/suburban areas in Shandong. Meanwhile, the number of confirmed cases was negatively correlated with the local mean daily temperature (P=0.0167).Conclusions: Mild acute CO poisoning cases accounted for the majority of all confirmed cases during the winter of 2019. In Shandong province, which is located in east China, residents of the coastal cities are more susceptible to CO poisoning than residents of inland cities.展开更多
目的探讨弥散加权成像(DWI)/表观弥散系数(ADC)值对急性CO中毒迟发性脑病的预测价值。方法回顾性分析76例急性CO中毒患者,根据临床分为无迟发性脑病组(52例)和迟发性脑病组(24例),比较两组患者的临床特征,并分别测量苍白球、侧脑室周围...目的探讨弥散加权成像(DWI)/表观弥散系数(ADC)值对急性CO中毒迟发性脑病的预测价值。方法回顾性分析76例急性CO中毒患者,根据临床分为无迟发性脑病组(52例)和迟发性脑病组(24例),比较两组患者的临床特征,并分别测量苍白球、侧脑室周围白质区、半卵圆中心、额顶叶皮质区四个区域的平均ADC值,并与同期正常人群(20例)进行比较,通过绘制受试者工作特征曲线(receiver operating characteristic,ROC),计算曲线下面积(area under the curve,AUC)预测迟发性脑病的发生。结果76例CO患者中,DNS发生率为24例(31.6%),苍白球是最常见受累部位,占68例(89.5%),DNS组和非DNS组中,苍白球区平均ADC值分别为(0.639±0.064)×10^(-3)mm^(2)/s和(0.665±0.056)×10^(-3)mm^(2)/s,明显低于正常对照组平均ADC值分别为(0.701±0.029)×10^(-3)mm^(2)/s,三组比较差异有统计学差异(F=7.061,P=0.001),DNS组侧脑室周围白质区、半卵圆中心区、额顶叶皮质区的ADC值均低于非DNS组和正常对照组,但是无统计学差异(P=0.749,0.144,0.568)。非DNS组和DNS组的苍白球ADC值ROC曲线显示其AUC为0.636(95%CI 0.500~0.772),最佳界值为0.645×10^(-3)mm^(2)/s,敏感度为71.2%,特异度为58.3%。苍白球/丘脑的ADC比值ROC曲线显示其AUC为0.624(95%CI 0.482~0.766),其最佳界值为0.811,敏感度为63.5%,特异度为62.5%。结论苍白球的弥散受限是急性CO中毒患者的特征性表现,DWI/ADC值得测定可以作为预测迟发性脑病得敏感指标。展开更多
目的对急性一氧化碳中毒迟发性神经精神后遗症(DNS)危险因素进行分析和研究。方法回顾性分析2015年1月至2017年1月河北省承德市中国人民解放军第二六六医院急诊科收治的急性一氧化碳中毒的60例患者的病例资料。按照是否出现迟发性神经...目的对急性一氧化碳中毒迟发性神经精神后遗症(DNS)危险因素进行分析和研究。方法回顾性分析2015年1月至2017年1月河北省承德市中国人民解放军第二六六医院急诊科收治的急性一氧化碳中毒的60例患者的病例资料。按照是否出现迟发性神经精神后遗症进行分组,出现迟发性神经精神后遗症的患者33例归为迟发性神经精神后遗症组,即DNS组;未出现迟发性神经精神后遗症的患者27例归为非迟发性神经精神后遗症组,即非DNS组。比较两组患者年龄、GCS评分、中毒时时间等因素对DNS的影响及白细胞计数较高、肌酸激酶较高、肌酸激酶同工酶变化情况,以及简易精神状态检查表(mini-mental state examination,MMES)评分、日常生活活动(activities of daily living,ADL)评分。结果相对于非DNS组,DNS组年龄大于60岁、GCS评分低于13分、中毒时间大于6 h的患者出现神经精神后遗症的概率较高,差异有统计学意义(P<0.05),患者白细胞计数较高、肌酸激酶较高、肌酸激酶同工酶较高可以间接提醒可能患神经精神后遗症的几率较大,差异有统计学意义(P<0.05)。比较两组患者MMES评分和ADL评分,可观察到非DNS组的评分低于DNS组,差异具有统计学意义(P<0.05)。结论具有年龄大、中毒时间长、格拉斯哥评分(GCS)较低、在中毒后24 h内没有进行高压氧治疗等因素的患者出现迟发性神经精神后遗症的概率较大,因此对具有上述因素的患者应加强观察治疗,给予高度重视,以减少患者神经精神后遗症的出现。展开更多
文摘Currently, there is no known optimal therapy for carbon monoxide （CO） poisoning and CO-associated delayed neu- rological sequelae. Hyperbaric oxygen therapy （HBOT） is a well-known treatment method, but its use for CO poison- ing patients is controversial to use due to lack of evidences regarding its efficacy. Thus, it is unlikely that HBOT alone will be accepted as the standard treatment method. In this article, current and potential treatment methods of CO poi- soning are presented as well as the tentative multi-factorial pathophysiology. A series of treatments are suggested for use as a bundle therapy, with targeted temperature management as the base treatment method. Such a therapy holds a great potential, especially for the cases where HBOT is not readily available. We suggest further investigations for elucidating the effects of these suggested treatments and their roles in terms of the complex pathophysiology of CO poisoning. Future ac- ceptance of this therapy based on the improved scientific and clinical knowledge may result in injury prevention and mini- mization of the signs and the symptoms in CO poisoning.
基金supported by the National Natural Science Foundation of China,‘Study on the pathogenic effect of HO-1/CO in the delayed encephalopathy after acute CO poisoning’,(Grant No.81101024)
文摘Objective In vivo Proton Magnetic Resonance Spectroscopy （1H-MRS） can be used to evaluate the levels of specific neurochemical biomarkers of pathological mechanisms in the brain. Methods We conducted T2-Weighted Magnetic Resonance Imaging （MRI） and 1H-MRS with a 3.0-Tesla animal MRI system to investigate the early microstructural and metabolic profiles in vivo in the striatum of rats following carbon monoxide （CO） poisoning. Results Compared to baseline, we found significant cortical surface deformation, cerebral edema changes, which were indicated by the unclear gray/white matter border, and lateral ventricular volume changes in the brain. A significant reduction in the metabolite to total creatine （Cr） ratios of N-acetylaspartate （NAA） was observed as early as 1 h after the last CO administration, while the lactate （Lac） levels increased marginally. Both the Lac/Cr and NAA/Cr ratios leveled off at 6 h and showed no subsequent significant changes. In addition, compared to the control, the choline （Cho）/Cr ratio was slightly reduced in the early stages and significantly increased after 6 h. In addition, a pathological examination revealed mild cerebral edema on cessation of the insult and more severe cerebral injury after additional CO poisoning. Conclusion The present study demonstrated that 1H-MRS of the brain identified early metabolic changes after CO poisoning. Notably, the relationship between the increased Cho/Cr ratio in the striatum and delayed neuropsychologic sequelae requires further research.
文摘BACKGROUND Delayed neurological sequelae(DNS)caused by carbon monoxide(CO)intoxication poses considerable treatment challenges for clinical practitioners.In this report,we used nuclear medicine imaging and the Mini-Mental State Examination(MMSE)to evaluate the effectiveness of intravascular laser irradiation of blood(ILIB)therapy for the management of DNS.CASE SUMMARY A 51-year-old woman presented to our medical center experiencing progressive bradykinesia,rigidity of limbs,gait disturbance,and cognitive impairment.Based on her neurological deficits,laboratory tests and imaging findings,the patient was diagnosed with delayed neurological sequelae of CO intoxication.She received intensive rehabilitation and ILIB therapy during 30 sessions over 2 mo after diagnosis.Brain single-photon emission computed tomography was performed both prior to and after ILIB therapy.The original hypoperfusion area in bilateral striata,bilateral frontal lobe,right parietal lobe,and bilateral cerebellum showed considerable improvement after completion of therapy.The patient’s MMSE score also increased markedly from 6/30 to 25/30.Symptoms of DNS became barely detectable,and the woman was able to carry out her daily living activities independently.CONCLUSION ILIB therapy could facilitate recovery from delayed neurological sequelae in patients with CO intoxication,as demonstrated by improved cerebral blood flow and functional outcomes in our patient.
文摘Objective To research the expression of hypoxia-inducible factor-1 alpha(HIF-1α)and heme oxygenase-1(HO-1)in hippocampus of rats with delayed encephalopathy after acute carbon monoxide poisoning(DEACMP)and its functions.Methods One hundred and fiftysix rats were selected and randomly divided into
基金supported by a grant from the Shandong Medical and Health Science and Technology Development Project(No.2017WSG01004).
文摘Background: Carbon monoxide (CO) poisoning remains a major cause of accidental injuries and multiple studies have indicated that CO is also associated with significantly severe or long-term toxicity to the central nervous system. Given that CO poisoning causes serious morbidity and mortality, a better understanding of epidemiological features and clinical characteristics of acute CO poisoning in China is crucial.Methods: We collected the clinical data of acute CO poisoning in patients between November 2019 and April 2020 across Shandong province, China and analyzed its characteristics focusing on the weekly amount and the severity of the confirmed cases.Results: A total number of 21,088 acute CO poisoning cases were diagnosed. The overall incidence of acute CO poisoning was approximately 0.021%. On severity rankings, 63% of confirmed cases (n=13,378) were mild, 27%(n=5635) were moderate, and 10% (n=2075) were severe. Interestingly, the coastal cities had more confirmed cases than the inland/suburban areas in Shandong. Meanwhile, the number of confirmed cases was negatively correlated with the local mean daily temperature (P=0.0167).Conclusions: Mild acute CO poisoning cases accounted for the majority of all confirmed cases during the winter of 2019. In Shandong province, which is located in east China, residents of the coastal cities are more susceptible to CO poisoning than residents of inland cities.
文摘目的探讨弥散加权成像(DWI)/表观弥散系数(ADC)值对急性CO中毒迟发性脑病的预测价值。方法回顾性分析76例急性CO中毒患者,根据临床分为无迟发性脑病组(52例)和迟发性脑病组(24例),比较两组患者的临床特征,并分别测量苍白球、侧脑室周围白质区、半卵圆中心、额顶叶皮质区四个区域的平均ADC值,并与同期正常人群(20例)进行比较,通过绘制受试者工作特征曲线(receiver operating characteristic,ROC),计算曲线下面积(area under the curve,AUC)预测迟发性脑病的发生。结果76例CO患者中,DNS发生率为24例(31.6%),苍白球是最常见受累部位,占68例(89.5%),DNS组和非DNS组中,苍白球区平均ADC值分别为(0.639±0.064)×10^(-3)mm^(2)/s和(0.665±0.056)×10^(-3)mm^(2)/s,明显低于正常对照组平均ADC值分别为(0.701±0.029)×10^(-3)mm^(2)/s,三组比较差异有统计学差异(F=7.061,P=0.001),DNS组侧脑室周围白质区、半卵圆中心区、额顶叶皮质区的ADC值均低于非DNS组和正常对照组,但是无统计学差异(P=0.749,0.144,0.568)。非DNS组和DNS组的苍白球ADC值ROC曲线显示其AUC为0.636(95%CI 0.500~0.772),最佳界值为0.645×10^(-3)mm^(2)/s,敏感度为71.2%,特异度为58.3%。苍白球/丘脑的ADC比值ROC曲线显示其AUC为0.624(95%CI 0.482~0.766),其最佳界值为0.811,敏感度为63.5%,特异度为62.5%。结论苍白球的弥散受限是急性CO中毒患者的特征性表现,DWI/ADC值得测定可以作为预测迟发性脑病得敏感指标。
文摘目的对急性一氧化碳中毒迟发性神经精神后遗症(DNS)危险因素进行分析和研究。方法回顾性分析2015年1月至2017年1月河北省承德市中国人民解放军第二六六医院急诊科收治的急性一氧化碳中毒的60例患者的病例资料。按照是否出现迟发性神经精神后遗症进行分组,出现迟发性神经精神后遗症的患者33例归为迟发性神经精神后遗症组,即DNS组;未出现迟发性神经精神后遗症的患者27例归为非迟发性神经精神后遗症组,即非DNS组。比较两组患者年龄、GCS评分、中毒时时间等因素对DNS的影响及白细胞计数较高、肌酸激酶较高、肌酸激酶同工酶变化情况,以及简易精神状态检查表(mini-mental state examination,MMES)评分、日常生活活动(activities of daily living,ADL)评分。结果相对于非DNS组,DNS组年龄大于60岁、GCS评分低于13分、中毒时间大于6 h的患者出现神经精神后遗症的概率较高,差异有统计学意义(P<0.05),患者白细胞计数较高、肌酸激酶较高、肌酸激酶同工酶较高可以间接提醒可能患神经精神后遗症的几率较大,差异有统计学意义(P<0.05)。比较两组患者MMES评分和ADL评分,可观察到非DNS组的评分低于DNS组,差异具有统计学意义(P<0.05)。结论具有年龄大、中毒时间长、格拉斯哥评分(GCS)较低、在中毒后24 h内没有进行高压氧治疗等因素的患者出现迟发性神经精神后遗症的概率较大,因此对具有上述因素的患者应加强观察治疗,给予高度重视,以减少患者神经精神后遗症的出现。
