Despite its poor outcomes, therapeutic hypothermia (TH) is the current standard treatment for neonatal hypoxic-ischaemic encephalopathy (HIE). In this study, due to its antioxidant, anti-inflammatory, and antiapoptotic properties, the effectiveness of molecular hydrogen (H2) combined with TH was evaluated by means of neurological and histological assessments. Piglets were divided into three groups: hypoxic-ischaemic insult with normothermia (NT), insult with hypothermia (TH, 33.5 ± 0.5 °C), and insult with hypothermia with H2 ventilation (TH-H2, 2.1–2.7%). H2 ventilation and TH were administered for 24 h. After ventilator weaning, neurological assessment was performed every 6 h for 5 days. On day 5, the brains of the piglets were harvested for histopathological analysis. Regarding the neurological score, the piglets in the TH-H2 group consistently had the highest score from day 2 to 5 and showed a significantly higher neurological score from day 3 compared with the NT group. Most piglets in the TH-H2 group could walk at day 3 of recovery, whereas walking ability was delayed in the two other groups. The histological results revealed that TH-H2 tended to improve the status of cortical gray matter and subcortical white matter, with a considerable reduction in cell death. In this study, the combination of TH and H2 improved short-term neurological outcomes in neonatal hypoxic-ischaemic piglets.

The aim of this study was to use near-infrared time-resolved spectroscopy (TRS) to determine the absolute values of cerebral blood volume (CBV) and cerebral hemoglobin oxygen saturation (ScO2) during the immediate transition period in term neonates and the changes in optical properties such as the differential pathlength factor (DPF) and reduced scattering coefficient (μs’). CBV and ScO2 were measured using TRS during the first 15 min after birth by vaginal delivery in term neonates who did not need resuscitation. Within 2–3 min after birth, CBV showed various changes such as increases or decreases, followed by a gradual decrease until 15 min and then stability (mean (SD) mL/100 g brain: 2 min, 3.09 (0.74); 3 min, 3.01 (0.77); 5 min, 2.69 (0.77); 10 min, 2.40 (0.61), 15 min, 2.08 (0.47)). ScO2 showed a gradual increase, then kept increasing or became a stable reading. The DPF and μs’ values (mean (SD) at 762, 800, and 836 nm) were stable during the first 15 min after birth (DPF: 4.47 (0.38), 4.41 (0.32), and 4.06 (0.28)/cm; μs’: 6.54 (0.67), 5.82 (0.84), and 5.43 (0.95)/cm). Accordingly, we proved that TRS can stably measure cerebral hemodynamics, despite the dramatic physiological changes occurring at this time in the labor room.

<b><i>Background:</i></b> Therapeutic hypothermia (TH) is a standard therapy for neonatal hypoxic-ischaemic encephalopathy. One potential additional therapy is the free radical scavenger edaravone (EV; 3-methyl-1-phenyl-2-pyrazolin-5-one). <b><i>Objectives and Methods:</i></b> This study aimed to compare the neuroprotective effects of edaravone plus therapeutic hypothermia (TH + EV) with those of TH alone after a hypoxic-ischaemic insult in the newborn piglet. Anaesthetized piglets were subjected to 40 min of hypoxia (3–5% inspired oxygen), and cerebral ischaemia was assessed using cerebral blood volume. Body temperature was maintained at 39.0 ± 0.5°C in the normothermia group (NT, <i>n</i> = 8) and at 33.5 ± 0.5°C (24 h after the insult) in the TH (<i>n</i> = 7) and TH + EV (3 mg/kg intravenous every 12 h for 3 days after the insult; <i>n</i> = 6) groups under mechanical ventilation. <b><i>Results:</i></b> Five days after the insult, the mean (standard deviation) neurological scores were 10.9 (5.7) in the NT group, 17.0 (0.4) in the TH group (<i>p</i> = 0.025 vs. NT), and 15.0 (3.9) in the TH + EV group. The histopathological score of the TH + EV group showed no significant improvement compared with that of the other groups. <b><i>Conclusion:</i></b> TH + EV had no additive neuroprotective effects after hypoxia-ischaemia in neurological and histopathological assessments.

Dubin-Johnson syndrome (DJS) is an autosomal recessive inherited disorder characterized by conjugated hyperbilirubinemia. Neonatal-onset DJS is rare. It is caused by dysfunction of adenosine triphosphate-binding cassette, sub-family C, member 2 (ABCC2). We found a novel compound heterozygous mutation of DJS-related gene: W709R (T2145C): a missense mutation in exon 17, and R768W (C2302T), a missense mutation in exon 18. Serum diglucuronosyl bilirubin/monoglucuronosyl bilirubin ratio was high. ABCC2 may excrete diglucuronosyl bilirubin preferentially over monoglucuronosyl bilirubin.

Application of over-the-scope clip for massive duodenal ulcer bleeding in a 4-year-old boy weighing 7.8 kg Efficacy of the over-the-scope clip (OTSC; Ovesco Endoscopy GmbH, Tübingen, Germany) system has been described in the adult population [1 -4], very rarely in pediatric patients. Wright et al. reported a first-ever application of OTSC for pediatric patients weighing over 10 kg with gastrocutaneous fistula [5]. However, its indication for younger patients, those with lower weight, or other situations, such as refractory bleeding, remains unclear. Here, we describe the effective application of OTSC for temporary hemostasis of massive duodenal bleeding in a 4-year-old boy with the lowest weight ever reported (▶ Video 1). The patient presented with growth impairment since birth. At age 4 years, he received steroid treatment for mesalazine-resistant ulcerative colitis. His physical status was fragile (height 85.1 cm, weight 7.8 kg). Upper gastrointestinal endoscopy was performed because of presence of tarry stools and severe anemia (hemoglobin 6.3 g/dL), and revealed massive bleeding of an open ulcer located in the duodenal bulb (▶ Fig. 1 a). Although conventional endoscopic therapies were effective for temporary hemostasis (▶ Fig. 1 b), arterial bleeding with hemorrhagic shock subsequently recurred five times. Enhanced computed tomography and open surgery were contraindicated owing to the child's poor physical status. Thus, OTSC was applied for the fifth recurrent bleeding episode after written informed consent had been obtained.All procedures were performed under general anesthesia using an adult gastroscope with a waterjet function (GIF-Q260J; Olympus, Tokyo, Japan). An OTSC (9 mm t-type) was successfully deployed at the bleeding site without any delivery difficulties in the duodenum (▶ Fig. 1c).Video 1 An over-the-scope clip (9 mm t-type) was successfully deployed in a 4-yearold boy to treat intractable arterial bleeding from the anterior wall of the duodenal bulb, whereas conventional endoscopic therapies were only able to achieve temporary hemostasis.▶ Fig. 1 Endoscopy images from 4-year-old boy with duodenal ulcer bleeding. a Endoscopy revealed a massive bleeding ulcer in the duodenal bulb. b Conventional endoscopic therapies were effective only for temporary hemostasis. c The over-the-scope clip was successfully deployed at the bleeding site without any delivery difficulties in the duodenum. E-Videos E46Kondo Takeo et al. OTSC for massive duodenal ulcer bleed in 4-year-old child … Endoscopy 2018; 50: E46-E47