PURPOSESuicide becomes a serious problem in today's society and hanging is a common method of suicide. We want to find the factors which can predict the final functional outcomes of these cases.

METHODSAll patients who presented to Accident and Emergency Department (ED) of the National Cheng Kung University Hospital from 1st January 2005 to 31th December 2013 with a hanging injury were included in this study. All cases were divided into good outcome group and bad outcome group according to Glasgow Outcome Scale (GOS). Data was analyzed by Mann-Whitney test and chi-square test.

RESULTSGlasgow Coma Scale (GCS) < 3, pupil dilation and no pupillary light reflex both at the scene and ED were the factors to indicate poor functional outcome. Out-hospital cardiac arrest (OHCA), acidosis (pH < 7.2) and the need for intubation once arriving at ED were also related to poor functional outcome. OHCA cases all had poor functional outcome.

CONCLUSIONGCS, pupil size, pupillary light reflex, OHCA and acidosis are useful as prognostic factors. GCS = 3 lead to a very poor outcome. However, the functional outcome seems good in patients with GCS>3. There parameters can help to predict the outcome before treatment.

Adult ; Aged ; Asphyxia ; complications ; physiopathology ; Emergency Service, Hospital ; Female ; Glasgow Coma Scale ; Humans ; Male ; Middle Aged ; Suicide

Under hypoxia condition, microRNA （miRNA） can interact with transcription factors for regulating the cell metabolism, angiogenesis, erythropoiesis, cellular proliferation, differentiation and apoptosis. The biological processes above may play an important role in mechanical asphyxia death. This article reviews the regulating function of miRNA under hypoxia condition and the influence of hypoxia to biosynthesis of miRNA, which may provide some new ideas to the research of miRNA on determining the cause of mechanical asphyxia death in the field of forensic medicine.
Accidents ; Airway Obstruction/physiopathology* ; Apoptosis ; Asphyxia/pathology* ; Cause of Death ; Death ; Forensic Medicine ; Humans ; Hypoxia/physiopathology* ; MicroRNAs/metabolism* ; Oxygen

OJBECTIVETo investigate the predictive value of the qualitative assessment of general movements (GMs) for adverse outcomes at 24 months of age in full-term infants with asphyxia.

METHODSA total of 114 full-term asphyxiated infants, who were admitted to the neonatal intensive care unit between 2009 and 2012 and took part in follow-ups after discharge were included in the study. All of them received the qualitative assessment of GMs within 3 months after birth. The development quotient was determined with the Bayley Scales of Infant Development at 24 months of age.

RESULTSThe results of the qualitative assessment of GMs within 3 months after birth showed that among 114 infants, 20 (17.5%) had poor repertoire movements and 7 (6.1%) had cramped-synchronized movements during the writhing movements period; 8 infants (7.0%) had the absence of fidgety movements during the fidgety movements period. The results of development quotient at 24 months of age showed that 7 infants (6.1%) had adverse developmental outcomes: 6 cases of cerebral palsy and mental retardation and 1 case of mental retardation. There was a poor consistency between poor repertoire movements during the writhing movements period and the developmental outcomes at 24 months of age (Kappa=-0.019; P>0.05). There was a high consistency between cramped-synchronized movements during the writhing movements period and the developmental outcomes at 24 months of age (Kappa=0.848; P<0.05), and the results of predictive values of cramped-synchronized movements were shown as follows: predictive validity 98.2%, sensitivity 85.7%, specificity 99.1%, positive predictive value 85.7%, and negative predictive value 99.1%. There was a high consistency between the absence of fidgety movements during the fidgety movements period and the developmental outcomes at 24 months of age (Kappa=0.786; P<0.05), and its predictive values were expressed as follows: predictive validity 97.4%, sensitivity 85.7%, specificity 98.1%, positive predictive value 75.0%, and negative predictive value 99.1%.

CONCLUSIONSCramped-synchronized movements and absence of fidgety movements can predict adverse developmental outcomes at 24 months of age in full-term infants with asphyxia.

Asphyxia Neonatorum ; physiopathology ; Child Development ; Humans ; Infant ; Infant, Newborn ; Movement ; Predictive Value of Tests ; Qualitative Research

BACKGROUNDMorbidity and mortality after resuscitation largely depend on the recovery of brain function. Ventricular fibrillation cardiac arrest (VFCA) and asphyxial cardiac arrest (ACA) are the two most prevalent causes of sudden cardiac death. Up to now, most studies have focused on VFCA. However, results from the two models have been largely variable. So, it is necessary to characterize the features of postresuscitation cerebral metabolism of both models.

METHODSForty-four Wuzhishan miniature inbred pigs were randomly divided into three groups: 18 for VFCA group, ACA group, respectively, and other 8 for sham-operated group (SHAM). VFCA was induced by programmed electric stimulation, and ACA was induced by endotracheal tube clamping. After 8 min without treatment, standard cardiopulmonary resuscitation (CPR) was initiated. Following neurological deficit scores (NDS) were evaluated at 24 h after achievement of spontaneous circulation, cerebral metabolism showed as the maximum standardized uptake value (SUVmax) was measured by 18 F-fluorodeoxyglucose positron emission tomography/computed tomography. Levels of serum markers of brain injury, neuron specific enolase (NSE), and S100β were quantified with an enzyme-linked immunosorbent assay.

RESULTSCompared with VFCA group, fewer ACA animals achieved restoration of spontaneous circulation (61.1% vs. 94.4%, P < 0.01) and survived 24-h after resuscitation (38.9% vs. 77.8%, P < 0.01) with worse neurological outcome (NDS: 244.3 ± 15.3 vs. 168.8 ± 9.71, P < 0.01). The CPR duration of ACA group was longer than that of VFCA group (8.1 ± 1.2 min vs. 4.5 ± 1.1 min, P < 0.01). Cerebral energy metabolism showed as SUVmax in ACA was lower than in VFCA (P < 0.05 or P < 0.01). Higher serum biomarkers of brain damage (NSE, S100β) were found in ACA than VFCA after resuscitation (P < 0.01).

CONCLUSIONSCompared with VFCA, ACA causes more severe cerebral metabolism injuries with less successful resuscitation and worse neurological outcome.

Animals ; Asphyxia ; complications ; physiopathology ; Brain ; metabolism ; Cardiopulmonary Resuscitation ; Heart Arrest ; metabolism ; pathology ; therapy ; Positron-Emission Tomography ; Swine ; Ventricular Fibrillation ; metabolism ; pathology ; therapy

OBJECTIVETo study the application of positron emission tomography (PET) in detection of myocardial metabolism in pig ventricular fibrillation and asphyxiation cardiac arrest models after resuscitation.

METHODSThirty-two healthy miniature pigs were randomized into a ventricular fibrillation cardiac arrest (VFCA) group (n=16) and an asphyxiation cardiac arrest (ACA) group (n=16). Cardiac arrest (CA) was induced by programmed electric stimulation or endotracheal tube clamping followed by cardiopulmonary resuscitation (CPR) and defibrillation. At four hours and 24 h after spontaneous circulation was achieved, myocardial metabolism was assessed by PET. 18F-FDG myocardial uptake in PET was analyzed and the maximum standardized uptake value (SUVmax) was measured.

RESULTSSpontaneous circulation was 100% and 62.5% in VFCA group and ACA group, respectively. PET demonstrated that the myocardial metabolism injuries was more severe and widespread after ACA than after VFCA. The SUVmax was higher in VFCA group than in ACA group (P<0.01). In VFCA group, SUVmax at 24 h after spontaneous circulation increased to the level of baseline.

CONCLUSIONACA causes more severe cardiac metabolism injuries than VFCA. Myocardial dysfunction is associated with less successful resuscitation. Myocardial stunning does occur with VFCA but not with ACA.

Animals ; Asphyxia ; physiopathology ; Cardiopulmonary Resuscitation ; Gene Expression Regulation ; Heart Arrest ; etiology ; metabolism ; therapy ; Myocardium ; metabolism ; Positron-Emission Tomography ; methods ; Random Allocation ; Swine ; Ventricular Fibrillation ; metabolism

Aged ; Animals ; Asphyxia ; etiology ; Asthma ; physiopathology ; Catheter Ablation ; Female ; Fundoplication ; Gastroesophageal Reflux ; complications ; surgery ; Humans ; Laryngismus ; etiology ; Male ; Middle Aged ; Rats ; Rats, Sprague-Dawley ; Respiration Disorders ; etiology ; physiopathology ; Treatment Outcome

OBJECTIVETo explore the value of electroencephalogram (EEG) in early diagnosis of brain injury in neonates with asphyxia.

METHODSEEG examination was performed in 49 neonates with asphyxia (mild: n=9; severe: n=40) within 6 hrs of their births. Of the 49 asphyxiated neonates, 33 had concurrent HIE, including 20 cases of mild, 9 cases of moderate and 4 cases of severe HIE.

RESULTSTwenty-one (63.6%) out of the 33 patients with HIE showed abnormal EEG, but only one (6.3%) in the asphyxia group without HIE. All of 13 patients with moderate-severe HIE showed abnormal EEG. The degree of EEG abnormality in neonates with HIE was consistent with the clinical grading of HIE. The neonates whose EEG showed electrical silence and burst suppression and the abnormalities were kept unrecoverable for more than 2 weeks had very poor prognosis.

CONCLUSIONSEEG can reflect brain injury caused by neonatal asphyxia and the severity of brain injury. It may be useful for early diagnosis of brain injury following asphyxia in neonates.

Asphyxia Neonatorum ; complications ; physiopathology ; Early Diagnosis ; Electroencephalography ; Female ; Humans ; Hypoxia-Ischemia, Brain ; diagnosis ; Infant, Newborn ; Male

OBJECTIVETo study the correlation between brainstem auditory evoked potential (BAEP) and serum neuron-specific enolase (NSE) in neonates with asphyxia and explore the role of NSE in the evaluation of hearing impairment following asphyxia.

METHODSFifty-two term neonates with asphyxia, including 38 cases of simple asphyxia (mild: 23 cases; severe: 15 cases) and 14 cases of asphyxia complicated by hypoxic-ischemic encephalopathy (HIE), were enrolled. In the double-blind trial, BAEP and NSE were simultaneously detected 7 days after birth. The patients who did not pass BAEP test received another BAEP and NSE examinations 3 months after birth. Thirty healthy term neonates served as normal control group.

RESULTSOf the 52 neonates with asphyxia, 50.0% and 21.2% of patients failed the initial and the second BAEP tests, respectively. The detection rates of BAEP anomalies in the simple severe asphyxia group in the initial and the second tests (63.3% and 26.3%, respectively) were significantly higher than those in the simple mild asphyxia group (36.9% and 5.9%, respectively)(P<0.05). The neonates with asphyxia complicated by HIE showed a higher detection rate of BAEP anomalies in the second test compared with the asphyxiated neonates without HIE (31.3% vs 16.7%; P<0.05). Mean serum NSE levels in asphyxiated neonates were significantly higher than those in normal controls (<0.01). There were significant differences in serum NSE levels between the neonates with mild and severe asphyxia (26.70+/-2.34 microg/L vs 17.18+/-3.16 microg/L; P<0.01). The asphyxiated neonates with HIE had serum NSE levels similar to the simple severely asphyxiated neonates. Serum NSE levels in patients who failed the initial BAEP test were significantly higher than those who passed the test (25.69+/-4.12 microg/L vs 17.15+/-3.09 microg/L; <0.01). Serum NSE levels had a positive correlation with wave V reaction threshold detected in the BAFP test (<0.05).

CONCLUSIONSThe serum level of NSE is closely correlated with BAEP, and it may be useful to the evaluation of the hearing impairment and the outcome in neonates with asphyxia.

Asphyxia Neonatorum ; blood ; complications ; physiopathology ; Double-Blind Method ; Evoked Potentials, Auditory, Brain Stem ; Hearing Disorders ; etiology ; Humans ; Hypoxia-Ischemia, Brain ; etiology ; Infant ; Infant, Newborn ; Phosphopyruvate Hydratase ; blood

OBJECTIVETo study the value of a new technique, maximum length sequences brainstem auditory evoked potential (MLS BAEP), in the assessment of the severity of brain damage following asphyxia in term neonates.

METHODSOne hundred and three neonates with perinatal asphyxia and 26 normal term neonates were eligible for the study. Conventional and MLS BAEP examinations were performed within three days after birth. Of the 103 neonates with asphyxia, 17 did not suffer from HIE, 37 had mild HIE, 31 had moderate HIE, and 18 had severe HIE. The latencies and amplitudes of waves I, III and V, and the inter-peak intervals of I-III, III-V, and I-V were analyzed.

RESULTSThe latencies of wave V and the inter-peak intervals of I-III, III-V and I-V prolonged gradually with the more severe HIE in both the MLS and the conventional BAEP (P<0.05 or 0.01). The differences among groups were more significant with the increasing repetition rate of click in the MLS BAEP. Compared with the normal controls, conventional BAEP did not show prolonged intervals of I-III and III-V in the mild HIE subgroup, and a prolonged inter-peak interval of III-V in the moderate HIE subgroup, while the MLS BAEP showed significantly prolonged inter-peak intervals of I-III and III-V in the three HIE subgroups and the differences were more and more significant as an increase in the repetition rate of click from 91 to 910 times/seconds.

CONCLUSIONSMLS BAEP is more sensitive and valuable than the conventional one in detecting hypoxic-ischemic brain damage following asphyxia by increasing the repetition rate of click. MLS BAEP provides a new measurement in quantity to assess the severity of HIE in neonates with perinatal asphyxia.

Asphyxia Neonatorum ; physiopathology ; Evoked Potentials, Auditory, Brain Stem ; Female ; Humans ; Hypoxia, Brain ; diagnosis ; Infant, Newborn ; Male

OBJECTIVESevere asphyxia during peripartum may lead to some sequela of the nervous system. Currently the neurologic outcome of asphyxiated neonates is assessed by using imaging techniques such as cranial ultrasound, CT and MRI except for evaluating perinatal abnormal factors and routine physical examinations of nervous system. These assessment approaches are based on the changes of anatomic structures of neonates. Electroencephalography (EEG) can show early abnormal cerebral functions. This study examined the EEG background activity and investigated the parameters associated with the prognostic assessment in full-term neonates with asphyxia.

METHODSA standard EEG was recorded in 49 asphyxiated full-term neonates aged from 24 hrs to 8 days. Of the 49 neonates, 14 had concurrent mild, 5 had moderate and 9 had severe hypoxic-ischemic encephalopathy (HIE). Thirty-one aged-matched full-term neonates without asphyxia severed as the control group. Forty-three of 49 asphyxiated neonates were followed-up for neurological development for 6-12 months. Important parameters associated with neurological prognosis were evaluated by the principle of data statistics.

RESULTSThe mean interburst intervals was prolonged, the amplitude of brain electrical activity during all the states were lower, and the incidence of brief burst and sleep-wake cycle disturbance was higher in the asphyxiated group when compared with the control group (P < 0.05). In the follow-up, 4 infants had poor fine motor function and 7 showed retarded psychomotor development in the asphyxiated group. Gestational age, birth weightamplitude of brain electrical activity, severity of HIE, occurrence of sleep-wake cycle disturbance and imaging abnormality were shown as important parameters for predicting neurological outcomes in asphyxiated neonates. The infants who EEG showed isoelectric tracings or isoelectric tracings accompanied with much abnormal discharge had very poor prognosis.

CONCLUSIONSEEG background pattern is valuable in predicting neurological outcomes for term neonates with asphyxia. EEG in combination with clinic data such as gestational age, birth weight, imaging examination, and severity of HIE may provide an accurate evaluation of neurological outcome.

Asphyxia Neonatorum ; mortality ; physiopathology ; Electroencephalography ; methods ; Humans ; Infant, Newborn ; Prognosis