Clinical Applications of Targeted TemperatureManagement
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本草纲目英语翻译赏析Compendium of Materia Medica English Translation Appreciation。
Compendium of Materia Medica, also known as Bencao Gangmu, is a renowned Chinese medical text written by Li Shizhen during the Ming dynasty. It is considered one of the most comprehensive and systematic works on traditional Chinese medicine, encompassing a wide range of knowledge on herbs, minerals, animals, and other medicinal substances. The book is not only a valuable resource for understanding traditional Chinese medicine but also serves as a bridge for cultural exchange and mutual learning between China and the rest of the world. In this article, we will explore the English translation of Compendium of Materia Medica and appreciate its significance in the field of medicine and beyond.The English translation of Compendium of Materia Medica provides a window into the world of traditional Chinese medicine for non-Chinese speakers. It allows them to access the wealth of knowledge and wisdom contained in this ancient text, which has been passed down through generations in China. The translation also facilitates cross-cultural communication and collaboration in the field of medicine, as it enables scholars, practitioners, and students from different cultural backgrounds to engage with the concepts and practices of traditional Chinese medicine.One of the most remarkable aspects of the English translation of Compendium of Materia Medica is its contribution to the global understanding of traditional Chinese medicine. By making the content of the book accessible to a wider audience, the translation helps to dispel misconceptions and stereotypes about traditional Chinese medicine and promotes a more nuanced and accurate portrayal of its principles and practices. This, in turn, fosters greater appreciation and respect for traditional Chinese medicine as a valuable and legitimate form of healthcare.Furthermore, the English translation of Compendium of Materia Medica serves as a valuable resource for research and education in the field of traditional Chinese medicine. It provides scholars and students with a comprehensive and authoritative source ofinformation on the properties, functions, and uses of various medicinal substances, as well as the theoretical framework and clinical applications of traditional Chinese medicine. The translation also opens up new opportunities for comparative studies between traditional Chinese medicine and other medical systems, leading to a deeper understanding of the similarities and differences between different approaches to healthcare.In addition to its significance in the field of medicine, the English translation of Compendium of Materia Medica has broader implications for cultural exchange and mutual learning. It enriches the global knowledge base by introducing non-Chinese speakers to the rich heritage of traditional Chinese medicine, which is deeply rooted in Chinese history, philosophy, and culture. Through the translation, readers are able to gain insights into the holistic and integrative nature of traditional Chinese medicine, as well as its emphasis on the harmony between humans and nature.Overall, the English translation of Compendium of Materia Medica plays a vital role in promoting the global dissemination and understanding of traditional Chinese medicine. It not only facilitates cross-cultural communication and collaboration in the field of medicine but also contributes to the appreciation and preservation of traditional Chinese medicine as an important part of the world's cultural heritage. As the translation continues to reach a wider audience, it is expected to further enhance the exchange and integration of diverse medical traditions, ultimately benefiting the health and well-being of people around the world.。
临床药学专项点评干预措施英文回答:Clinical Pharmacy Intervention for Targeted Patient Groups: A Focused Review.Introduction.Clinical pharmacy services are essential for optimizing medication therapy and improving patient outcomes. Targeted interventions, which focus on specific patient groups or conditions, can enhance the effectiveness and efficiency of these services. This review provides a comprehensive overview of clinical pharmacy intervention measures for targeted patient groups, including the rationale, implementation strategies, and evaluation methods.Rationale for Targeted Interventions.Targeted interventions are based on the recognitionthat different patient groups have unique medication needs and treatment goals. By tailoring interventions to specific populations, pharmacists can:Enhance patient adherence and medication compliance.Reduce medication-related adverse events.Improve disease control and clinical outcomes.Optimize resource utilization and cost-effectiveness.Targeted Patient Groups.Targeted interventions can be designed for a wide range of patient groups, including:Elderly patients.Polypharmacy patients.Patients with specific chronic diseases (e.g.,diabetes, hypertension, heart failure)。
英文版医学学术报告发言稿Ladies and gentlemen,It is my privilege to stand before you today to discuss an important aspect of medical advancements. As we delve deeper into our understanding of diseases and patient care, the role of healthcare professionals in research and academic studies becomes increasingly significant. In this regard, I would like to share with you some valuable insights into the essential components of a medical research paper that can contribute to the progress of our field.Firstly, the introduction section of a research paper sets the tone for the entire study. It should provide a clear background and rationale for the research, including a concise literature review of similar studies. This part serves to establish the significance of the research topic and the potential impact of the study.Next, the methodology section outlines the detailed procedures and methods used to investigate the research question. It should be transparent, enabling others to replicate the study and validate the findings independently. Accurate reporting of research methods and ethical considerations ensures the credibility and reproducibility of the study.Moving forward, the results section presents the findings obtained from the data analysis. It should be organized and concise, using appropriate statistical methods to summarize the results effectively. Clear graphs, tables, or figures can aid in the visual representation of the data and facilitate better comprehension by the readers.The discussion section allows the authors to interpret the results and link them to the existing body of knowledge. It is essential to emphasize the implications of the findings and discuss any limitations or potential biases of the study. Additionally, it provides an opportunity to propose future research directions and expand on the clinical applications of the research.Furthermore, the conclusion section should be a succinct summary of the main findings and their implications. It should avoid the repetition of the results or any new information not previously discussed. A well-crafted conclusion strengthens the overall impact of the research and can influence future studies.Lastly, proper citation and referencing are critical components of any academic paper. Accurately citing the sources used in the study acknowledges the intellectual contributions of other researchers and adds credibility to the research. Adhering to a specific citation style, such as APA or MLA, ensures consistency and conformity to academic standards.In conclusion, the various sections of a medical research paper play integral roles in advancing medical knowledge and patient care. The introduction sets the stage, the methodology ensures transparency, the results provide empirical evidence, the discussion promotes critical thinking, and the conclusion summarizes the main findings. Adhering to proper citation practices enhances the credibility of the research.Thank you for your attention, and I hope that these insights willprove valuable in your future endeavors in medical research and scholarly writing.。
肺微波消融新技术申请书英文回答:Pulmonary Microwave Ablation: A Novel Technology.Abstract.Pulmonary microwave ablation (MWA) is a minimally invasive technique that uses microwaves to ablate (destroy) lung tumors. MWA is a relatively new technology, but it has shown promising results in early clinical trials. This article provides an overview of MWA, including its principles, techniques, and clinical applications.Introduction.Lung cancer is the leading cause of cancer death worldwide. Surgery is the primary treatment for early-stage lung cancer, but it is not always possible or desirable. For patients who are not candidates for surgery, there area number of other treatment options available, including radiation therapy, chemotherapy, and targeted therapy.MWA is a new treatment option for lung cancer that has shown promising results in early clinical trials. MWA is a minimally invasive technique that uses microwaves to ablate lung tumors. Microwaves are a type of electromagnetic radiation that can penetrate tissue and cause it to heat up. This heat can then be used to destroy cancer cells.Principles of MWA.MWA is based on the principle of dielectric heating. Dielectric heating occurs when a material is exposed to an alternating electric field. The electric field causes the molecules in the material to vibrate, which generates heat. The amount of heat generated depends on the frequency ofthe electric field, the strength of the electric field, and the dielectric properties of the material.In MWA, the electric field is generated by a microwave antenna that is inserted into the tumor. The microwaveantenna emits microwaves that penetrate the tumor and cause the tumor cells to heat up. The heat generated by the microwaves can then be used to destroy the cancer cells.Techniques of MWA.There are two main techniques of MWA: percutaneous MWA and endobronchial MWA. Percutaneous MWA is performedthrough a small incision in the chest. The microwaveantenna is then inserted into the tumor through the incision. Endobronchial MWA is performed through the airway. The microwave antenna is inserted into the tumor through a bronchoscope.Clinical Applications of MWA.MWA has been used to treat a variety of lung tumors, including primary lung cancer, metastatic lung cancer, and recurrent lung cancer. MWA is also being investigated as a treatment for other types of cancer, such as liver cancer and kidney cancer.Advantages of MWA.MWA has a number of advantages over other treatment options for lung cancer. These advantages include:Minimally invasive: MWA is a minimally invasive procedure that does not require surgery. This can lead to a shorter recovery time and less pain for the patient.Precise: MWA can be used to target specific tumors with great precision. This can help to preserve healthy tissue and reduce the risk of side effects.Effective: MWA has been shown to be effective in treating a variety of lung tumors.Safe: MWA is a safe procedure with a low risk of complications.Disadvantages of MWA.MWA also has some disadvantages, including:Not suitable for all patients: MWA is not suitable for all patients, such as patients with large tumors or tumors that are located near critical structures.Can cause side effects: MWA can cause side effects, such as pain, swelling, and bleeding.Not always curative: MWA is not always curative for lung cancer.Conclusion.MWA is a promising new treatment option for lung cancer. MWA is a minimally invasive, precise, and effective procedure that can be used to treat a variety of lung tumors. MWA is still under investigation, but it has the potential to become a valuable tool in the fight against lung cancer.中文回答:肺微波消融,一项新技术。
核磁共振成像MRI的一些小知识(A little knowledge of MRI in MRI)1. What is MRI?MRI is an abbreviation of the English Magnetic Resonance Imaging, or MRI. It is a new method of high-tech imaging examination in recent years, which was applied to the clinical medical imaging diagnosis of new technology in the early 1980s. It has no ionizing radiation (radiation) damage; Non-skeletal pseudo shadow; Multi-parameter imaging with multiple directions (transverse, coronal, sagittal plane, etc.); Height of soft tissue resolution; There is no need to use contrast agents to show the unique advantages of vascular structure. Therefore, it is regarded as another important development in the field of medical imaging.What is T1 and T2?T1 and 12 is organized in a certain time interval after a series of pulses to accept physical change in the characteristics of different groups have different T1 and T2, it depends on the rf pulse of the hydrogen protons on magnetic field in the organization of the reaction. By setting the MRI imaging parameters (TR and TE), TR is repeated time namely rf pulse interval, TE is applying rf pulse echo time namely from to accept to ask the time signal, TR and TE units are milliseconds (ms), can make organization Tl or T2 characteristics respectively from the images (T1 - or T2 - weighted images; t2-weighted through imaging parameters setting can also make both Tl and T2 characteristic image, called proton density weighted.3. What is the signal strength change characteristic of hematoma?The signal strength of hematoma varies with time as a result of the change in the nature of hemoglobin (e.g., oxyhemoglobin transformation into deoxyhemoglobin and orthopaemia). These characteristics help to determine the period of hemorrhage, acute hemorrhage (oxygen or deoxyhemoglobin) T1 weighted image is low signal or other signal, and subacute hematoma is high signal; Chronic hematoma is a low signal in all sequences due to the deposition of hemosiderin.4. What are the clinical applications of MRI?Mri images are very similar to CT images, both of which are "digital images" and show the anatomical and pathological cross-sectional images of different structures with different grayscale. Like CT, magnetic resonance imaging can also be applied to various systemic diseases, such as tumors, inflammation, trauma, degenerative diseases, and various congenital diseases. Magnetic resonance imaging (fmri) without bony artifact, can make more direct direction (transection, coronal, sagittal, or any Angle) layer, the brain, spinal cord and spinal anatomical and pathological changes of display, especially superior to CT, magnetic resonance imaging by its "empty effect", but without vascular contrast, showed that the vascular structures, therefore, in the "no damage" to show blood vessel (except for tiny blood vessels), as well as to the tumor, lymph node and differentiate between vascular structures, are unique. Magnetic resonance imaging (mri) has a soft tissue resolution capability that is higher than thatof CT, and it can sensitively detect changes in water content in the composition of tissues, so it can be more effective and early detection of lesions than CT. In recent years, the research of magnetic resonance blood imaging technology has made it possible to measure blood flow and blood flow rate in living organisms. Heart switch control the use of magnetic resonance imaging can clearly, fully display the heart, myocardial, pericardium, and other fine structure of the heart, for nondestructive inspection and diagnosis of acquired and congenital heart diseases, including coronary heart disease, etc.), and heart function examination, provides a reliable way. With a variety of rapid scanning sampling sequence and 3 d scanning technology research and successfully applied to clinical, magnetic resonance angiography and new technology has entered clinical film photography, and perfected. Recently, to realize the combination of the magnetic resonance imaging (fmri) and local spectroscopy (i.e., the combination of MRI and MRS), as well as other nuclei, such as fluorine except hydrogen proton magnetic resonance imaging (fmri), sodium, phosphorous, etc, these achievements will be able to more effectively improve the magnetic resonance imaging in the diagnosis of specificity, also broadened its clinical use. Main disadvantages of magnetic resonance imaging technique is needed for it to scan for a long time, so for some checkill-matched patients often difficult, organ in the sport, such as gastrointestinal tract due to lack of proper contrast agent, often show is not clear;For the lungs, the imaging effects are not satisfactory due to the low concentration of hydrogen protons in the breathing exercise and the alveolar. Mri imaging of calcification andbone lesions is not as accurate and sensitive as CT. The spatial resolution room of magnetic resonance imaging is still to be improved.1, the brain and spinal cord MRI of brain lesions, encephalitis, brain white matter lesions, cerebral infarction, cerebral CT is more sensitive than the diagnosis of congenital anomaly, etc, can be found early pathological changes, and more accurate positioning. The lesions on the base of the skull and the brain stem were more clearly visible without the artifact. MRI does not show cerebral blood vessels by contrast agent, and it is found that there are aneurysms and arteriovenous malformations. MRI can also directly display cranial nerves, which can be found in the early lesions that occur in these nerves. MRI can directly show the full appearance of the spinal cord, and therefore has important diagnostic value for spinal tumor or internal tumor of the spinal cord, leukodystrophy, spinal cord injury, spinal cord injury, etc. For disc lesions, MRI can show its denaturation, prominence, expansion or removal. It shows that the spinal canal stenosis is also better. For cervical and thoracic vertebra, CT often showed dissatisfaction, while MRI showed clearly. In addition, MRI is also very sensitive to the presentation of vertebral metastatic tumors.2. The neoplastic lesions of the head and neck MRI in the eye and ear nose and throat were shown to be good, such as the invasion of the skull base and cranial nerve by nasopharyngeal carcinoma, and the MRI showed more clearly and more accurately than the CT. MRI can also do angiography on the neck, showing abnormal blood vessels. In the neck mass, MRI can also show its range and features to help characterize it.3. Chest MRI can directly show myocardial and left ventricular cavity (heart gate control) to understand the condition of myocardial damage and determine cardiac function. The condition of the large blood vessels in the mediastinum can be clearly shown. The positioning of mediastinal tumor is also very helpful. The condition of pulmonary edema, pulmonary embolism and lung tumor can also be shown. Can distinguish the property of pleural effusion, distinguish the blood vessel section or the lymph node.4. The diagnosis of abdominal MRI on the liver, kidney, pancreas, spleen, adrenal and other substantive organ diseases can provide valuable information and help to confirm the diagnosis. Small lesions are also more likely to be shown, so early lesions can be found. MR pancreatic cholangiography (MRCP) can show biliary and pancreatic duct, which can be replaced by ERCP. MR urography (MRU) can show dilated ureteral and renal pelvis, especially for patients with renal dysfunction and IVU.5. Pelvic MRI can show the pathological changes of uterus, ovary, bladder, prostate and seminal vesicle. The endometrium and muscle layer can be seen directly, which can be helpful for early diagnosis of uterine tumor. The diagnosis of ovarian, bladder, prostate and other lesions is also very valuable.6. Posterior peritoneal MRI has great value for the tumor of the retroperitoneal membrane and the relationship with the surrounding organs. The abdominal aorta or other large vascular lesions can also be shown, such as abdominal aortic aneurysm, bu-cha syndrome, renal artery stenosis, etc.7. MRI of musculoskeletal system injury to cartilage disk, tendon and ligament in the joint, showing a higher rate than CT. Due to the sensitivity of bone marrow changes, bone metastasis, osteomyelitis, aseptic necrosis and leukemic bone marrow infiltration were detected early. The soft tissue block of bone tumor was shown clearly. There is also some diagnostic value for soft tissue injury.5. What are the advantages of MRI over CT?1. No ionizing radiation;2. Multi-azimuth imaging(cross-section, coronal plane, sagittal plane and inclined plane); The details of the anatomical structure are better; 4. More sensitive to subtle pathological changes of organizational structure (such as infiltration of bone marrow and cerebral edema); The type of the tissue (such as fat, blood and water) is determined by signal strength. 6. Organization comparison is better than CT.6. What are the types and indications of MRI contrast agent?1. Paramagnetic positive contrast agent. Commonly used Gd - DTPA (ma genevin), Mn - DPDP, etc. Its function mainly causes T1 to be shortened, and the T1 weighted image is high signal.2. Super paramagnetic substance. The most commonly used are super - paramagnetic iron oxide particles (SPIO), AMI - 25 and Resovist. Its function mainly causes T2 to be shortened,The T2 weighted image is the low signal. (2) indications: 1. Differential diagnosis of certain tumors. 2. Determine whetherthe blood-brain barrier is damaged. 3. Improve the detection rate of pathological changes.7. How to distinguish T1 weighted image from T2 weighted image?The TE and TR values of the image can be distinguished, the short can be 20ms, the length can be 80ms, the TR can be 600ms, and the length can be 3000 + ms. Short TE short TR for T1 weighted image, and TE. TR - length T2 - weighted image, short TE long TR - weighted image of proton density. Understanding the signal characteristics of water and fat helps to distinguish between a T1 weighted image and a T2 weighted image, especially if the image does not show characteristic TE and TR values. Look at liquid structures such as ventricles, arms or cerebrospinal fluid. If the liquid is bright, it is likely to be a t2-weighted image. If the liquid is dark, it may be a T1 weighted image. If the liquid is bright, and other structures are not like the t2-weighted image, and both TR and TE are short, it may be a gradient echo image.8. What are the common imaging sequences and methods used for magnetic resonance imaging?Magnetic resonance imaging is obtained by using specific imaging sequence scanning. At present, the most commonly used in clinic is the spin - echo sequence (SE sequence). Repeatedly time by changing the sequence of the TR (radio frequency) and TE (echo time) two parameters, respectively for proton density beta, T1 and T2 weighted images, three different imaging parameters of weighted images, each representing the three different kinds of magnetic resonance characteristic of theorganization, so as to distinguish the normal tissues and identify lesions. In addition, there is a reverse response sequence (IR sequence), which is obtained in this sequence, which can be heavily embodied in the T1 feature of the organization (heavy T1 weighting). The saturation response sequence (SR sequence) is the proton density plus only sequence; Partial saturation sequence (PS sequence) is a T1 - weighted sequence. None of these sequences are more popular than the SE sequence, and the applications are not widely available. The rapid imaging sequence effectively promotes the clinical application of magnetic resonance imaging. The RARE sequence introduced from west Germany, for example, is a severelyt2-weighted imaging sequence that has high sensitivity to the display of lesions. FLASH, FISH is also fast imaging sequences and their scanning imaging time in milliseconds (conventional scanning imaging time sequence, usually in seconds), therefore, to a great extent, overcome the magnetic resonance imaging (mri) scan time long Achilles' heel, for dynamic magnetic resonance imaging (mri) and magnetic resonance imaging (fmri) film photography, create the necessary conditions. For patients with magnetic resonance imaging, to avoid a paramagnetic material such as iron, such as watches, metal necklace, false teeth, metal buttons, metal ring into the examination room, because these items with a paramagnetic material, can affect the uniformity of the magnetic field, produce large no signal in the image artifacts, unfavorable to lesions of the display. Patients with pacemakers are not allowed to perform magnetic resonance imaging. The body has reserved metal shrapnel, postoperative with silver clip residues (silver clip composition may contain a small amount of paramagnetic substance), gold property in patients with fixed plate, suchas pseudarthrosis, magnetic resonance imaging to be treated cautiously, check to closely observe when necessary, the patient if there are any local discomfort, should immediately stop check, prevent the shrapnel, silver clip mobile in the high magnetic field, so that damage to nearby large blood vessels and important organization. During the mri scan, the patient must maintain a balanced breathing, reduce swallowing, and avoid autonomous or involuntary body and limb movements. For children or delirious patients who are unable to cooperate with the examination, some sedatives may be used as appropriate. During magnetic resonance imaging, still need to correctly choose layer cutting direction and different weighted imaging parameters of pulse sequence, so that as far as possible in a short time, the disease location and qualitative diagnosis of conventional for in addition to the examination of spinal column and spinal cord, most first as fast T2 weightedcross-sectional imaging, so that preliminary judge lesions and the length of the T2 values. Then, a t1-weighted coronary or sagittal plane image was further developed to determine the anatomical relationship between the lesion and its adjacent structure, and the length of T1 value of the lesion.If the above examination has not solved the problem, it can also be used as a long TR SE multiecho sequence as appropriate. The first echo of this sequence is a weighted image of proton density, and the anatomical resolution of soft tissue is higher. The fourth echo image is a T2 weighted image, which is beneficial to the comparison of tissues. The longer scan time of the multi-echo imaging sequence is its deficiency. Spine and spinal cord has walked up and down the anatomical features, appropriate to check for T2 weighted fast and SE sequencet1-weighted sagittal section imaging scans, finally can depend on is shown in suspicious lesion site, further for T2 and/or SE sequence T1 weighted imaging scans cross sectional tangent plane, to determine the characteristics of lesions and their relationship with the spinal cord, etc. An mri examination of the upper abdomen (liver, pancreas, kidney, adrenal, etc.) is suitable for an empty stomach, and the water that is drunk before the examination can make the boundary of the stomach and the left lobe of the liver and the spleen be more clearly displayed.9. What should patients prepare before an MRI exam?1. Before entering the examination room, the patient must take out all the metal objects, such as watches, keys, pens, COINS, glasses and various magnetic CARDS.2. Give moderate sedatives to infants, fidgety and melancholic patients. The abdomen examination is best empty abdomen, can serve the gastrointestinal contrast agent, also can not use. Abdominal straps may be used to reduce the pseudo shadow caused by respiratory movement.10. Which patients are not suitable for MRI scan?1. With cardiac pacemaker.2. Aneurysm after aneurysm surgery.3. Eyeball metal foreign body.4. Critically ill patients with various rescue equipment.5. Patients with various metal implants should be careful when checking.Are there any contraindications for MRI examination?The contraindication is that the patient is equipped with a magnetic susceptibility substance or device, and the loss of movement or function of these structures can cause adverse consequences. 1. Cardiac pacemaker; 2. Cochlear implant; Some artificial heart valves; 4. Skeletal growth stimulator and nerve stimulator (TENs); 5. Arterial clamp or ring; 6. Metal structure (box week); 7. Some prostheses. Prior to any MRI examination, the examination of the above contraindications is necessary for all patients. Some manufacturers have now produced non-ferromagnetic surgical clips and other devices and must consult radiologists if there is any safety problem.What is the signal strength?Signal strength according to the brightness of the signal generated by a certain organization, organization for high signal light (white), and dark organization for low signal, such as between signals, often used to judge the relationship between diseased tissue signals and its surrounding structures (such as a lump is high signal than the surrounding tissue). Note that MRI USES strength rather than density, and the concept of density is used on CT and X-ray plates。
全身相位角 inbody 英语Phase Angle Measurement in InBody: A Comprehensive AnalysisIntroduction:Phase angle measurement is an important indicator of overall health and body composition analysis. InBody, a leading brand in body composition analysis devices, provides a reliable and accurate measurement of phase angle. This article aims to explore the concept of phase angle, its significance, and the role of InBody in measuring and interpreting this crucial health parameter.Understanding Phase Angle:Phase angle is a measurement that indicates the distribution of the body's electrical current, providing valuable information about cellular health and the body's ability to function properly. It is calculated by measuring the phase shift between the current and voltage as they pass through the body's tissues. A higher phase angle suggests better cellular integrity and overall health.Significance of Phase Angle Measurement:Phase angle measurement is increasingly recognized as an important prognostic indicator of various health conditions and overall well-being. It provides valuable insights into the body's cellular health, nutritional status, and the efficacy of medical treatments. Higher phase angle values are associated with better health outcomes, including increased muscle mass, better immune function, and reduced mortality risk.Role of InBody in Phase Angle Measurement:InBody devices utilize a unique bioelectrical impedance analysis (BIA) technology to accurately measure phase angle. BIA is a non-invasive method that involves passing a safe, low-level electrical current through the body and measuring its resistance and reactance. InBody's advanced algorithms then calculate the phase angle based on these measurements.InBody's phase angle measurement is highly reliable and reproducible. The devices are known for their accuracy and precision, providing consistent and comparable results. Moreover, InBody devices are designed to measure the phase angle in a quick and hassle-free manner, making them suitable for routine health assessments and monitoring.Interpreting Phase Angle Results:Interpretation of phase angle results requires consideration of various factors, including age, sex, and overall health status. Generally, a higher phase angle indicates better health and cellular integrity. Individuals with higher phase angles tend to have higher muscle mass, better cellular hydration, and improved immune function.On the other hand, a lower phase angle may suggest cellular dysfunction, compromised nutritional status, or the presence of chronic illnesses. Individuals with lower phase angles may benefit from targeted interventions, such as nutritional support, physical activity, and medical management.Clinical Applications of Phase Angle Measurement:Phase angle measurement has a wide range of clinical applications. It can be used to monitor nutritional status, especially in individuals with malnutrition or undergoing medical treatments such as cancer therapies. Phase angle can also be utilized as a prognostic indicator in various chronic conditions, including chronic kidney disease, cardiovascular diseases, and HIV/AIDS.Moreover, phase angle measurement can help in assessing the effectiveness of interventions, such as nutritional interventions, exercise programs, and disease management protocols. By monitoring changes in phase angle over time, healthcare professionals can evaluate the impact of these interventions on cellular health and overall well-being.Conclusion:Phase angle measurement in InBody devices provides a reliable and accurate assessment of cellular health and overall well-being. With its advanced BIA technologyand precise algorithms, InBody enables healthcare professionals and individuals to monitor and interpret phase angle values effectively. The measurement of phase angle has emerged as a valuable tool in assessing nutritional status, disease prognosis, and treatment efficacy. By understanding and utilizing phase angle measurements, we can gain valuable insights into our cellular health and make informed decisions to optimize our well-being.。
美国、欧盟和中国生物技术药物的比较一、本文概述Overview of this article随着全球科技的快速发展,生物技术已成为推动医疗进步的重要力量。
本文旨在探讨美国、欧盟和中国在生物技术药物领域的发展现状、优势和挑战。
通过对比分析这三个地区的生物技术药物产业,我们将揭示不同国家和地区的产业特点、发展趋势以及面临的挑战。
With the rapid development of global technology, biotechnology has become an important force driving medical progress. This article aims to explore the current development status, advantages, and challenges of the United States, the European Union, and China in the field of biotechnology drugs. By comparing and analyzing the biotechnology and pharmaceutical industries in these three regions, we will reveal the industry characteristics, development trends, and challenges faced by different countries and regions.我们将概述生物技术药物的定义、分类及其在医药领域的应用。
接着,我们将分别介绍美国、欧盟和中国在生物技术药物研发、生产和市场准入方面的政策和法规。
通过对比分析,我们将揭示这三个地区在生物技术药物领域的优势和不足。
We will provide an overview of the definition, classification, and application of biotechnology drugs in the pharmaceutical field. Next, we will introduce the policies and regulations of the United States, the European Union, and China in the research and development, production, and market access of biotechnology drugs. Through comparative analysis, we will reveal the advantages and disadvantages of these three regions in the field of biotechnology drugs.在此基础上,我们将进一步探讨各国在生物技术药物研发和生产方面的主要企业、创新药物和技术突破。
重组人脑利钠肽治疗心力衰竭疗效观察李永才【摘要】目的观察重组人脑利钠肽治疗心力衰竭的临床疗效.方法将入选的心力衰竭患者随机分为治疗组和对照组,对照组给予常规药物治疗,治疗组在常规药物治疗基础上加用重组人脑利钠肽治疗.结果两组治疗后较治疗前临床症状、射血分数、血浆N末端B型利钠肽原(NT-proBNP)以及6 min步行试验均有改善(P<0.05).治疗后两组间相比,治疗组患者临床症状、射血分数、血浆NT-proBNP以及6min步行试验改善明显(P<0.05).结论重组人脑利钠肽可有效治疗心力衰竭,且安全性高,无明显不良反应.【期刊名称】《中西医结合心脑血管病杂志》【年(卷),期】2012(010)012【总页数】2页(P1512-1513)【关键词】重组人脑利钠肽;心力衰竭;血浆N末端B型利钠肽原【作者】李永才【作者单位】山西省晋城煤业集团总医院,048006【正文语种】中文【中图分类】R541.6;R256.2心力衰竭是一种以心室功能不全、神经内分泌激活、肾素-血管紧张素-固酮系统(RAAS)的活性增强和外周血流分布异常为特征的复杂的临床综合征,是许多疾病的终末环节,已成为心血管疾病的重要死亡原因之一。
重组人脑利钠肽(rh BNP)作为一种治疗心力衰竭的新型药物,显示出比传统治疗心衰的药物不可比拟的优势。
现就重组人脑利钠肽治疗心力衰竭疗效进行探讨。
1 资料与方法1.1 临床资料将2009年10月—2011年6月就诊于我院门诊及住院的心力衰竭患者60例,按1∶1分为治疗组和对照组。
治疗组30例,年龄(58.3±8.6)岁,男18例,女12例;对照组30例,年龄(56.7±9.4)岁,男16例,女14例。
两组患者年龄、性别相比差异无统计学意义(P>0.05),具有可比性。
1.2 入选标准心力衰竭Ⅲ级~Ⅳ级;年龄40岁~70岁;收缩压≥90 mm Hg(1 mm Hg=0.133 k Pa),舒张压≥60 mm Hg;可合并有冠心病、高血压、扩张型心肌病、肺心病等疾病。
干细胞与免疫细胞的临床应用1. IntroductionThe clinical application of stem cells and immune cells has been a topic of great interest and debate in the medical field. In recent years, there has been a growing body of research and development in the use of these cells for various medical conditions. In this article, we will explore the potential and challenges of using stem cells and immune cells in clinical settings.2. Understanding Stem CellsFirst, let's delve into the concept of stem cells. Stem cells are undifferentiated cells that have the ability to differentiate into specialized cell types. They are the foundation of development in multicellular organisms, and have the potential to repair, replace, or restore damaged tissues in the body. The use of stem cells in regenerative medicine has shown promise in treating a wide range of diseases and injuries.3. Clinical Applications of Stem CellsStem cell therapy has been studied and applied in various medical fields, including cardiology, neurology, orthopedics,and oncology. For example, in cardiology, stem cells have been used to regenerate cardiac tissue in patients with heart disease. In neurology, stem cell therapy offers potential treatments for conditions such as Parkinson's disease and spinal cord injuries. While there have been significant advancements in the clinical use of stem cells, challenges such as ethical considerations, safety, and regulation still need to be addressed.4. Exploring Immune CellsOn the other hand, immune cells play a critical role in the body's defense against infections and diseases. Different types of immune cells, such as T cells, B cells, and natural killer cells, have unique functions in the immune system. Harnessing the power of immune cells in clinical applications has the potential to revolutionize the treatment of cancer, infectious diseases, and autoimmune disorders.5. Immunotherapy and Cancer TreatmentOne of the most exciting developments in the field of immune cell therapy is the use of immunotherapy in cancer treatment. Immunotherapies, such as chimeric antigen receptor (CAR) T-cell therapy, have demonstrated remarkable success in treating certain types of cancer. By reprogramming a patient's ownimmune cells to recognize and attack cancer cells, immunotherapy offers a targeted and personalized approach to cancer treatment.6. Clinical Challenges and OpportunitiesDespite the significant progress in the clinical applications of stem cells and immune cells, there are still challenges that need to be ovee. These include the need for standardized protocols, long-term safety and efficacy data, and ethical considerations. Additionally, the high cost and accessibility of these treatments pose barriers to widespread implementation. However, with continued research and technological advancements, the potential for stem cell and immune cell therapy to transform medicine is undeniable.7. ConclusionIn conclusion, the clinical application of stem cells and immune cells holds immense potential for advancing the field of medicine. From regenerative medicine to cancer immunotherapy, these novel approaches have the power to revolutionize the way we treat and manage diseases. However, it is vital to approach this field with caution, ensuring that ethical, safety, and regulatory considerations are thoroughlyaddressed. As we continue to uncover the therapeutic capabilities of stem cells and immune cells, the future of medicine looks brighter than ever.8. Personal PerspectivePersonally, I find the intersection of stem cell and immune cell therapy to be a fascinating and promising area of research. The potential to harness the body's own healing mechanisms and immune defenses for clinical applications is a testament to the incredible potential of modern medicine. As we navigate theplexities of translating these scientific advancements into tangible treatments, I am hopeful that the collaboration between researchers, clinicians, and regulatory bodies will ultimately benefit patients in need of innovative therapies.。
T argeted temperature management (TTM) has been intermittently used for over 100 years but has only recently achieved a mainstream role in clinical prac-tice. In the early 1900s, Russian clinicians placed snow on patients in cardiac arrest in an attempt to achievereturn of spontaneous circulation (ROSC). 1In 1937,Fay 2 applied refrigeration to patients with cancer and observed tumor shrinkage and devascularization. In1958, Williams and Spencer 3 published a case seriesof patients resuscitated from intraoperative arrest, dem-onstrating better neurologic outcomes when patients received TTM. The guideline for heart-lung resusci-tation by Safar, 4 published in 1964, recommendedthe initiation of hypothermia if there was no sign of neurologic recovery within 30 min of arrest. Theseearly implementation attempts did not translate into widespread clinical use, and it was not until 2002 that major clinical trials were published readdressing theeffi cacy of TTM in postarrest patients. 5,6C urrent clinical indications for TTM as a neuropro-tective therapy include adult patients with postcardiac arrest syndrome (PCAS) and neonates with hypoxic-ischemic encephalopathy (HIE); success in these con-ditions, coupled with lessons learned from early failures in the implementation of TTM, has motivated inves-tigators to reconsider this therapy for other disease processes, including ischemic stroke, traumatic brain injury (TBI), hepatic encephalopathy, septic shock, and acute myocardial infarction. These entities will be further examined in this review of clinical TTM use.Targeted temperature management (TTM) has been investigated experimentally and used clinically for over 100 years. The initial rationale for the clinical application of TTM, historically referred to as therapeutic hypothermia, was to decrease the metabolic rate, allowing the injured brain time to heal. Subsequent research demonstrated the temperature dependence of diverse cellular mechanisms including endothelial dysfunction, production of reactive oxygen species, and apo-ptosis. Consequently, modern use of TTM centers on neuroprotection following focal or global neurologic injury. Despite a solid basic science rationale for applying TTM in a variety of disease processes, including cardiac arrest, traumatic brain injury, ischemic stroke, neonatal ischemic encephalopathy, sepsis-induced encephalopathy, and hepatic encephalopathy, human effi cacy data are limited and vary greatly from disease to disease. Ten years ago, two landmark investiga-tions yielded high-quality data supporting the application of TTM in comatose survivors of out-of-hospital cardiac arrest. Additionally, TTM has been demonstrated to improve outcomes for neonatal patients with anoxic brain injury secondary to hypoxic ischemic encephalopathy. Trials are currently under way, or have yielded confl icting results in, examining the utility of TTM for the treatment of ischemic stroke, traumatic brain injury, and acute myocardial infarction. In this review, we place TTM in historic context, discuss the pathophysiologic rationale for its use, review the general concept of a TTM protocol for the management of brain injury, address some of the common side effects encountered when lowering human body temperature, and examine the data for its use in diverse disease conditions with in-depth examination of TTM for postarrest care and pediatric applications. C HEST 2014; 145(2):386–393A bbreviations: C PT 5 Current Procedural Terminology; GCS 5 Glasgow Coma Score; HIE 5 hypoxic-ischemic encepha-lopathy; ICP 5 intracranial pressure; NABISH 5 North American Brain Injury Study: Hypothermia; OHCA 5 out-of-hospital cardiac arrest; PCAS 5 postcardiac arrest syndrome; PCI 5 percutaneous coronary intervention; ROSC 5 return of spontaneous circulation; STEMI 5 ST segment-elevation myocardial infarction; TBI 5 traumatic brain injury; TTM 5 targeted temperature managementTemperature ManagementS arah M. P erman ,M D ;M unish G oyal ,M D ;R obert W. N eumar ,M D ,P hD ;A lexis A. T opj ian ,M D ;and D avid F. G aieski ,M DM echanisms of Neurologic ProtectionT TM can provide neurologic protection to some patients who have suffered brain injury. Although numerous potential injury pathways are affected by TTM, it remains to be determined which of these are causally related to neuroprotective effects of TTM. Using cardiac arrest as an example, there are three distinct phases of injury: intraarrest ischemic injury resulting from a no-fl ow state, immediate reperfu-sion injury (beginning with ROSC and lasting about 20 min), and delayed postreperfusion injury (beginning several hours after ROSC and lasting for several days) ( F ig 1) .T he fi rst phase of injury is characterized by energy failure, ischemic depolarization of cell mem-branes, release of excitatory amino acids, and cytosolic calcium overload. These events can cause irreversible injury if ischemia is prolonged, and they set the stage for further injury if reperfusion is achieved. With ROSC, the cascade of injury initiated during ischemia is amplifi ed: Resumption of oxidative phosphorylation is associated with reactive oxygen species production, mitochondrial calcium overload, and mitochondrial permeability transition triggering cell death signaling. The later stages of reperfusion are characterized by secondary neuronal calcium overload, activation of pathologic proteases, and altered gene expression and infl ammation, among other mechanisms. 7Each of these three separate phases of injury is a potential target for TTM, and their corresponding therapeutic windows will likely vary with different organs and mechanisms of injury. Applying TTM within the therapeutic win-dow allows injured cells time to recover and regain function.I n TBI and spinal cord injury, many of the mecha-nisms by which TTM is likely to be effective are similar to those of brain ischemia; however, the therapeutic window and optimal duration of therapy might differ. This could be particularly true for mechanisms such as excitotoxicity, blood-brain-barrier disruption, and infl ammation. In addition, injury mechanisms unique to trauma, such as mechanical axonal injury, might also be attenuated by hypothermia in ways that are distinct from other forms of brain injury.R educing a patient’s body temperature provides multimodal protection. Hypothermia decreases metab-olism 6% to 7% per 1°C decrease in temperature, 8 protecting the brain from further injury during the early timeframe postanoxic injury. 9Hypothermia also affects the two major pathways for apoptotic cell death: the intrinsic pathway, under mitochondrial control, and the extrinsic pathway, signaled by an extracel-lular receptor. 10Furthermore, infl ammation and free radical production are attenuated by hypothermia. 11 Reperfusion injury can produce decreased blood-brain-barrier integrity and increased vascular perme-ability, resulting in brain edema, both treatable by TTM. 12,13P rotocols and Adverse EventsT TM is best implemented as a protocol-driven therapy.14,15Various methods can be used to induce and maintain hypothermia. 16Surface cooling devices include ice packs, cooling blankets, and wraps. Core-cooling devices include endovascular catheters, heart-lung bypass machines, and hemofiltration devices. Continuous core-temperature monitoring with a feed-back mechanism is essential to prevent overshoot. 17 Preferred methods include esophageal or bladder tem-perature probes. 18For other clinical indications, pro-tocols may differ in the depth (target temperature) and duration of temperature management.R egardless of the clinical condition being treated, there are three commonly recognized phases to TTM: induction, maintenance, and rewarming ( F ig 2) .T he induction phase extends from initiation of active cool-ing to when the patient reaches target temperature, which, in patients with PCAS, is typically between 32°C and 34°C. The maintenance phase extends from arrival at goal temperature until rewarming begins. For patients with PCAS, the maintenance phase ranges from 12 to 24 h. Depending on the indication for TTM, the patient may be maintained at target temperature for several days. The rewarming phase is the period during which the patient is gradually rewarmed to normothermia. After rewarming, normothermia should be maintained because pyrexia is associated with adverse outcomes in various forms of brain injury. 16 P hase-specifi c side effects can be anticipated. Dur-ing the induction and rewarming phases, defi ned by active transitions in core body temperature, shivering is frequently observed as the hypothalamus tries to maintain thermoregulatory control. Shivering increasesM anuscript received December 17, 2012; revision accepted July 31, 2013.A ffi liations:From the Department of Emergency Medicine (Drs Perman and Gaieski), Center for Resuscitation Science, Department of Emergency Medicine (Drs Perman and Gaieski), and Department of Pediatric Critical Care Medicine, Children’s Hospital of Philadelphia (Dr Topjian), Perelman School of Medi-cine at the University of Pennsylvania, Philadelphia, PA; Depart-ment of Emergency Medicine (Dr Goyal), Medstar Health System, Washington Hospital Healthcare System, Washington, DC; and Department of Emergency Medicine (Dr Neumar), University of Michigan School of Medicine, Ann Arbor, MI.D r Perman is currently at the University of Colorado School of Medicine (Aurora, CO).C orrespondence to:D avid F. Gaieski, MD, Center for Resusci-tation Science, Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, 34th and Spruce St, Ground Ravdin, Philadelphia, PA 19104; e-mail: gaieskid@ © 2014 American College of Chest Physicians.Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.D OI: 10.1378/chest.12-3025to infection, as hypothermia inhibits leukocyte migra-tion and phagocytosis, which becomes more relevant in patients cooled for longer durations; however, increased infection has not correlated to worse out-comes.7 During the rewarming phase, hypothermia-induced vasoconstriction decreases, and hypovolemia with associated hypotension can be observed ( F ig 3) .C linical Applications of TTMP ostcardiac Arrest Syndrome For adult patients with PCAS, after out-of-hospital cardiac arrest (OHCA) from a shockable rhythm, TTMis standard of care. 19,20 Bernard et al5found that 49% of patients who received TTM (33°C, 12 h) had favorable neurologic outcomes at hospital discharge vs 26% of patients receiving standard postarrest care ( P 5 .046). The Hypothermia After Cardiac Arrest Study Group reported that at 6 months after hospital discharge, 55% of patients who received TTM (range, 32-34°C, 24 h) had a favorable neurologic outcome vs 39% of patients receiving standard postar r est care( P 5 .009). 6 Multiple subsequent investigations havesuggested comatose survivors of nonshockable rhythmsmay benefi t from TTM as well. 21-24M ost widely used algorithms for postarrest TTM adhere closely to the protocols used in the two land-mark trials but various details are being actively investi-gated. Animal studies suggest that more rapid induction of TTM after arrest results in better neurologic out-comes.25 However, in human studies, time to target temperature has been associated with confl icting out-comes.26,27 The appropriate duration of TTM is also being studied, as animal studies have shown improvedoutcomes when the cooling duration was 48 h vs 24 h. 25Traditionally, TTM has been reserved for patients who have ROSC but investigators have also conducted a randomized controlled trial of intraarrest, transna-sal cooling, demonstrating that the technique was fea-sible, safe, and decreased time to goal temperature. In a post hoc analysis of patients receiving early resus-citation (within 10 min of collapse), the intraarrest cooling group had a higher proportion of neurologi-cally intact survivors vs the post-ROSC cooling group (43.5% vs 17.6%, P 5 .03). 28 A dult TBITBI produces a large burden of disease in adults, with 51,000 deaths and 90,000 patients suffering signifi -cant neurologic injury annually in the United States. 29 Brain edema and increased intracranial pressure (ICP) are associated with poor neurologic outcomes. Adult TBI trials have used TTM for neuroprotection and to decrease ICP with mostly disappointing results.metabolic demand, producing a large amount of heat. Control of shivering with neuromuscular blocking agents, sedatives, magnesium, or opioids protects the brain and facilitates temperature transition. During the maintenance phase, mild hypothermia can cause various physiologic disturbances, including bradycar-dia, hyperglycemia secondary to increased insulin resistance, and polyuria. Mild hypothermia has been associated with a relative coagulopathy, secondary to decreased platelet function, and a mild decline in plate-let count. At lower temperatures, abnormalities in the coagulation cascade can be anticipated. Potassium shifts intracellularly, and renal reabsorption of elec-trolytes including magnesium is inhibited, all of which can contribute to cardiac arrhythmias during TTM. Additionally, hypothermia affects the cardiovascular system by lowering the heart rate and increasing myo-cardial contractility. 7 TTM can also predispose patientsF i gure 1. Time course of neuronal injury mechanisms duringand after cardiac arrest and the different phases during which injury occurs. The shapes of the individual curves schematically depict the severity and duration of injury during each phase. ROSC 5return of spontaneous circulation.F i gure 2. Phases of targeted temperature management (TTM).An example of a temperature curve for a patient undergoing TTM postcardiac arrest, demonstrating initiation of cooling shortly after ROSC, temperature drop during the induction phase, slight vari-ability around target temperature during the maintenance phase, and gradual increase in temperature during controlled rewarming phase. The patient was a 69-year-old woman who had an out-of-hospital ventricular fi brillation arrest treated with defi brillation and epinephrine with ROSC 16 min after arrest. She was comatose on arrival and a rapid decision was made to initiate therapeutic hypothermia. T 5 temperature. See Figure 1 legend for expansionof other abbreviation.In 1997, Marion et al 30 divided patients into twocohorts based upon initial Glasgow Coma Score (GCS) (3-4 vs 5-7), then randomized each cohort to TTM (32-33°C) vs controlled normothermia (37-38.5°C). Patients in the GCS 5-7 TTM cohort had improved neurologic outcomes. Subsequent studies have failed to reproduce these results. In the North American BrainInjury Study: Hypothermia (NABISH)-I, Clifton et al 31randomized 392 patients with TBI to controlled nor-mothermia (37°C) vs TTM (33°C) initiated within 6 h of injury and maintained for 48 h. There was no dif-ference in 6-month postdischarge GCS between the two groups. A possible signal of benefi t in patients who reached target temperature early informed the study design for NABISH-II, which investigated theeffi cacy of very early cooling for patients with TBI. 32However, NABISH-II was stopped after an interim analysis showed no possibility of benefi t. An inter-national trial (Eurotherm3235) is underway to eval-uate the effi cacy of TTM (32-35°C, Ն 48 h) in patients with TBI with ICPs . 20 mm Hg resistant to initialICP-lowering therapies. 33 In summary, currently TTMcannot be considered standard of care for TBI but may be used as part of a multimodal, stepwise approach.I schemic StrokeStroke is the third leading cause of death in indus-trialized countries but , 10% of all patients who sufferstroke are eligible for thrombolytic therapy. 34Variousneuroprotective strategies aimed at reducing the size of the ischemic penumbra have demonstrated sig-nificant benefit. 35 An early trial by Guluma et al,36 showed the feasibility of TTM (33°C, 24 h) in awake,nonintubated stroke patients. Schwab et al 37applied TTM (33°C, 48-72 h) to stroke patients with middle cerebral artery occlusion and were able to manage elevated ICP while producing few side effects. A ran-domized controlled trial (EuroHYP-1) evaluating the effi cacy of TTM (34-35°C, 24 h) in ischemic stroke has completed enrollment but preliminary data arenot yet available. 38 C ardioprotectionIn animal models, TTM reduces myocardial infarct size when initiated prior to reperfusion. 39These find-ings have proven difficult to translate to humans.Ly et al 40 published a pilot study showing that surfacecooling was safe and feasible in patients who had ST segment-elevation myocardial infarction (STEMI) treated with percutaneous coronary intervention (PCI).Similarly, Dixon et al 41 found that endovascular coolingcould be performed safely alongside PCI. Adequately powered clinical trials evaluating the effi cacy of TTM in STEMI are needed. An initial trial, Intravascular Cooling Adjunctive to Percutaneous Coronary Inter-vention (Part 1) (ICE-IT-1) showed no signifi cant dif-ference with respect to door-to-balloon times or infarct size in patients who had STEMI treated with PCI andrandomized to TTM vs normothermia. 42Additional studies are ongoing in the United States and Europe. S epsisTTM is used as an organ-protective strategy and has been used for fever management with the goal ofF i gure 3. TTM-induced physiologic changes and resuscitation opportunities. Phase-specifi c physio-logic fi ndings have been observed in patients undergoing TTM and reported in multiple studies. These physiologic changes provide resuscitation opportunities but also may be detrimental to the patient’s out-come if not anticipated and appropriately managed. See Figure 2 legend for expansion of abbreviation.neuroprotection. These insights have led investigators to examine the utility of TTM in sepsis. Beurskens et al, 43 in a rat model of pneumococcal pneumonia, demon-strated that TTM did not affect the rate of bacterial growth but reduced bacterial dissemination and lung injury, perhaps by altering mitochondrial respiration. Léon et al 44induced sepsis in a cecal ligation rat model, demonstrating that TTM resulted in increased duration of survival and hemoglobin-oxygen binding capacity. In a human trial, Schortgen et al 45randomized vasopressor-dependent patients in septic shock to standard temper-ature management vs TTM (36.5-37°C) via surface cooling. They demonstrated the feasibility of surface cooling in patients in septic shock, lowering mean temperature from 39°C to under 38°C in ,2 h. Vaso-pressor dependence at 12 h was reduced twofold from the standard care group to the TTM group, and 14-day mortality decreased from 34% to 19% ( P5.01). These provocative preliminary fi ndings need further valida-tion in a study where the primary end point is 28-day mortality. 45A cute Respiratory Distress SyndromeI n 1993, Villar and Slutsky 46published a pilot study investigating TTM for refractory ARDS. Nineteen patients were randomized to conventional therapy vs TTM (32-35°C, up to several days), and mortality was lowered from 100% to 67%. 46This study has sev-eral limitations, including small sample size, enrollment in pre-low tidal volume ventilation era, and excess over-all mortality; therefore, it can only be considered hypothesis generating. Additional trials are needed to investigate the potential for TTM as either a preven-tive or therapeutic strategy in patients with ARDS. 46 H epatic EncephalopathyH epatic encephalopathy is often complicated by increased ICP, and the potential of using TTM to lower ICP has been explored. In three case series (36 patients total), clinicians have demonstrated the feasibility of using TTM to lower ICP and provide a bridge to transplant. 47-49Randomized controlled trials are needed before this can be considered standard of care.P ediatric Cardiac ArrestT he 2010 American Heart Association (AHA) recom-mendation for TTM in pediatric cardiac arrest states 50: T herapeutic hypothermia (32°C to 34°C) may be consid-ered for children who remain comatose after resuscitationfrom cardiac arrest. It is reasonable for adolescents resus-citated from sudden, witnessed, out-of-hospital VF cardiacarrest.T his statement is, in large part, extrapolated from adult data.T wo additional retrospective studies compared TTM to normothermia in children successfully resuscitated from cardiac arrest. 51,52Doherty et al 51performed a study across fi ve centers, three of which used TTM, in a cohort where 88% had underlying heart disease and 94% of the arrests were in-hospital. After con-trolling for multiple variables, there was no difference in outcomes between the two groups. In a markedly different patient population (single center; 8% with underlying heart disease; 91% OHCA), Fink et al 52 evaluated TTM for primarily asphyxia-associated car-diac arrests. No signifi cant difference in outcome was observed but patients who received TTM, on average, suffered more severe injury (eg, longer ischemic time; higher total epinephrine doses). 52These studies pro-vide important initial assessments of TTM following pediatric cardiac arrest but are limited by their ret-rospective approach and lack of standard protocols. To address these shortcomings, a multicenter ran-domized clinical trial (Therapeutic Hypothermia After Pediatric Cardiac Arrest [THAPCA]) is underway comparing TTM (32-34°C) to controlled normo-thermia (36-37.5°C). 53H ypoxic Ischemic EncephalopathyT TM has been rigorously studied in the neonatal population following birth asphyxia. Shankaran et al 54 randomized moderately or severely encephalopathic neonates to hypothermia (33.5°C, 72 h) vs usual care. Forty-four percent of patients who received TTM had a poor outcome (death or disability at 18-22 months) vs 62% of control patients (relative risk, 0.72 [95% CI: 0.54, 0.95], P5.01). 54Another study compared selec-tive head cooling (34-35°C, 72 h) vs usual care for neonates with moderate or severe encephalopathy, stratifi ed based on amplitude EEG recordings obtained within 5.5 h of birth. Fifty-fi ve percent of patients who received TTM had a poor outcome (death or dis-ability at 18 months) vs 66% of control patients ( P5.1). 55 An a priori subgroup analysis of patients with moder-ately abnormal EEG background patterns showed fewer poor outcomes for the TTM cohort vs usual care (48% vs 66% [OR, 0.47; 95% CI: 0.22, 0.8; P5.009]). Most recently, a third trial, randomizing 325 infants with HIE to TTM or usual care, demonstrated no dif-ference in the primary outcome of severe disability or death. 56Despite these somewhat confl icting fi ndings, TTM is considered standard of care for the treatment of HIE.P ediatric TBIT BI is the leading cause of morbidity and mortal-ity in children. In the United States, approximately 475,000 children under the age of 14 years sustain TBI annually. Three early-phase clinical trials showedTTM to be feasible 57and safe58,59in pediatric TBI, but none was powered for effi cacy. Subsequently, a randomized controlled trial of TTM (32-33°C) vs nor-mothermia for pediatric patients with severe TBI dem-onstrated no difference in neurologic outcomes and a trend toward higher mortality in the TTM group. 60B arriers to Use of TTMD espite signifi cant advances in the understanding and application of TTM and demonstration of its effi -cacy in a few disease states (cardiac arrest; neonatal ischemic encephalopathy), there are signifi cant bar-riers to its implementation in diverse clinical settings, limiting its clinical effectiveness. 61In a 2006 survey of critical care, cardiology and emergency medicine physicians, Merchant et al 62found that 74% of US physicians had never used TTM for a patient with PCAS. Physicians cited “not enough data,” “not part of Advanced Cardiac Life Support guidelines,” and “too technically diffi cult to use” as reasons for not using TTM. However, these fi ndings were published prior to inclusion of TTM in the 2010 AHA guide-lines for PCAS management. In 2011, Kremens et al 63 administered a telephone survey to all critical care physicians in one US state regarding the use of TTM in patients with PCAS and found that only 17 of 27 hos-pitals (63%) caring for patients with PCAS used TTM. Physicians cited lack of resources and the cost as rea-sons for its limited use. In October 2012, the American Medical Association held the annual Current Pro-cedural Terminology (CPT) Code Editors’ Meeting, where two CPT codes were approved for accurate billing of TTM. The new CPT codes will allow for the billing of either total body hypothermia (0260T) or selective head hypothermia (with CPT codes 0260T and 0261T).C onclusionD espite a solid basic science rationale for applying TTM in a variety of disease processes, human effi cacy data are limited and vary greatly from disease to dis-ease. Ten years ago, two landmark investigations yielded high-quality data supporting the application of TTM in comatose survivors of OHCA from shockable rhythms, and TTM is now considered standard of care for these patients. However, implementation remains inconsis-tent, limiting the effectiveness of the therapy. Addi-tionally, TTM has been demonstrated to improve outcomes for neonatal patients with HIE and is stan-dard of care in that population. Trials are currently under way to examine the effi cacy of TTM in the treatment of ischemic stroke, TBI, and acute myocardial infarction; the actual breadth and scope of TTM’s clinical appli-cations remain to be elucidated. Systematic, protocol-driven implementation programs are needed to deliver TTM to the highest percentage of eligible patients for those conditions where it is now standard of care.A cknowledgmentsF inancial/nonfi nancial disclosures:The authors have reported to C HEST that no potential confl icts of interest exist with any companies/organizations whose products or services may be dis-cussed in this article.R eferences1.L iss H P.A history of resuscitation.A nn Emerg Med.1986;15 (1): 65 -72 .2.F ay T.O bservations on prolonged human refrigeration .N YState J Med.1940 ;40 :1351 -1354 .3.W illiams G R J r ,S pencer F C .T he clinical use of hypothermiafollowing cardiac arrest .A nn Surg.1958 ;148 (3): 462 -468 .4.S afar P.C ommunity-wide cardiopulmonary resuscitation.J Iowa Med Soc.1964 ;54 :629 -635 .5.B ernard S A ,G ray T W ,B uist M D ,e t al .T reatment of coma-tose survivors of out-of-hospital cardiac arrest with induced hypothermia .N Engl J Med.2002 ;346 (8): 557 -563 .6.H ypothermia after Cardiac Arrest Study Group .M ild thera-peutic hypothermia to improve the neurologic outcome after cardiac arrest [published correction appears in N Engl J Med.2002;346(22):1756] .N Engl J Med.2002 ;346 (8): 549 -556 .7.P olderman K H .M echanisms of action, physiological effects,and complications of hypothermia .C rit Care Med.2009;37 (s uppl 7 ): S186 -S202 .8.R osomoff H L,H oladay D A.C erebral bloodfl ow and cere-bral oxygen consumption during hypothermia .A m J Physiol.1954 ;179 (1): 85 -88 .9.P olderman K H.A pplication of therapeutic hypothermia inthe ICU: opportunities and pitfalls of a promising treatment modality. 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