Application of a neuroscience research model to study neuroprotection in children with congenital heart disease.
Application of a neuroscience research model to study neuroprotection in children with congenital heart disease.
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应用神经科学研究模型研究先天性心脏病儿童的神经保护。
DOI：
10.1016/j.jtcvs.2018.06.067
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发表时间：
2018
期刊：
影响因子：
--
通讯作者：
Jonas,RichardA
中科院分区：
文献类型：
--
作者：
Ishibashi,Nobuyuki;Jonas,RichardA
在过去的 10 到 20 年里，人们已经清楚地认识到，与先天性心脏病 (CHD) 相关的神经功能缺陷不仅仅是手术和体外循环造成的结果。事实上，原因是累积的、多因素的。 1 它们包括产前事件，例如普遍存在的拷贝数变异或胎儿脑血流紊乱等遗传改变。 2, 3 患有先天性心脏病的胎儿的大脑发育通常会延迟，导致即使足月出生的新生儿大脑也不成熟。不成熟的大脑似乎非常容易受到手术引起的炎症（例如全身炎症反应综合征）和缺氧/缺血的影响。 4 目前对正常发育的大脑进行最佳保护的心肺转流 (CPB) 和深低温停循环 (DHCA) 管理策略可能会对不成熟和术前损伤的大脑造成损害。上海儿童医学中心的黄及其同事 5 描述了一项创新研究，使用暴露于氧糖剥夺的温控新生大鼠脑切片来模拟 DHCA。作者发现，通过深低温或应用米诺环素可以减少前少突胶质细胞的损伤。前少突胶质细胞损伤在临床上与心脏外科医生相关，因为它可能导致白质损伤，这是先天性心脏病婴儿在手术前观察到的一种标志性损伤，并且在手术后会加剧。白质损伤可能表现为运动缺陷，例如不协调，以及行为问题，例如注意力缺陷多动障碍，类似于超早产人群中出现的问题。
Over the past 10 to 20 years, it has become clear that neurologic deficits associated with congenital heart disease (CHD) are not simply a consequence of surgery and exposure to cardiopulmonary bypass. The causes are in fact cumulative and multifactorial. 1 They include prenatal events such as genetic alterations such as ubiquitous copy number variants or disturbances of fetal cerebral blood flow. 2, 3 Brain development is often delayed in a fetus with CHD resulting in an immature brain even in a newborn infant born at full term. And an immature brain appears to be exquisitely susceptible to the inflammation (eg, systemic inflammatory response syndrome) and hypoxia/ischemia that can be a consequence of surgery. 4 It is possible that current management strategies of cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest (DHCA) that are optimal for protection in a normally developing brain are damaging to a brain with immaturity and preoperative injury.Huang and colleagues5 from Shanghai Children’s Medical Center describe an innovative study using temperature-controlled neonatal rat brain slices exposed to oxygen glucose deprivation to simulate DHCA. The authors found that injury to preoligodendrocytes could be reduced either by deep hypothermia or application of minocycline. Injury to preoligodendrocytes is clinically relevant to cardiac surgeons because it can result in white matter injury that has been a signature insult observed in babies with CHD before surgery with exacerbation after surgery. White matter injury can become manifest as motor deficits, such as incoordination, as well as behavior problems such as attention deficit hyperactivity disorder, similar to the problems seen in ultrapremature populations.
影响因子：
20.1
作者：
Morton PD;Ishibashi N;Jonas RA
通讯作者：
Jonas RA
影响因子：
158.5
作者：
Miller, Steven P.;McQuillen, Patrick S.;Vigneron, Daniel B.
通讯作者：
Vigneron, Daniel B.
影响因子：
37.8
作者：
Beca, John;Gunn, Julia K.;Shekerdemian, Lara S.
通讯作者：
Shekerdemian, Lara S.