No to hattatsu. Brain and development
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The Nobel Prize was created in 1901, according to the will of Alfred Nobel who left tremendous estate by inventing of dynamite. In the fields of natural science, prizes are given to distinguished scientists in three categories, namely physics, chemistry, and physiology or medicine. During the past 100 years, the Nobel Prize have become undoubtedly the most prestigious international prize. ⋯ In particular, Japanese laureates, including Drs. Ezaki, Tonegawa, Shirakawa and Noyori met together at the Symposium, and discussed what is creativity and how it is nurtured? At about the same time the Centennial Exhibition of the Nobel Prize was held in the National Science Museum in Tokyo. From these two commemorative events, informative messages were extracted and given to young colleagues of the Japanese Society of Child Neurology.
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Although brain death of children has recently been hotly discussed in Japan, there still remain uncertainty and confusion. A pediatrician's diagnosis that a child is brain-dead entails delicate and emotional issues. ⋯ It is most important to be aware of these problems and to seek consensus in the community. Pediatricians should provide their best care to both the patients and their families.
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In Japan, "brain death" has been discussed exclusively in connection with organ transplantation. However, the concept of brain death, which emerged with the progress in intensive care medicine, should be discussed in the context of palliative care in the ICU. It should be recognized that intensive care medicine includes not only life-saving high-tech therapeutic modalities, but also ethical and psycho-social aspects of modern medicine. In order to find out a decent solution to pediatric brain death issues, it is essential to develop pediatric intensive care in Japan.
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In the management of severe pediatric brain injury, attention has previously been paid to brain edema, ICP elevation and low cerebral perfusion pressure (CPP). However, in the acute stage within 3-6 hours after trauma, brain hypoxia and hyperglycemia associated with diffuse brain injury are often observed. We have pointed out brain thermo-pooling (elevation of brain tissue temperature) and brain hypoxia caused by defective release of oxygen from hemoglobin (due to decrease in red blood cell enzyme (DPG)) as a new mechanism of brain injury. ⋯ Another problem is immune crisis associated with secondary pulmonary infections. To prevent them, early enteral nutrition and replacement of L-arginine were most useful, as well as preconditioning for rewarming as follows: serum albumin > 3.0 g/dl; lymphocyte > 1500/mm3; T-H (CD4) lymphocytes > 55%; serum glucose, 120-140 mg/dl; vitamin A > 50 mg/dl; Hb > 12 g/dl and 2,3 DPG, 10-15 mumol/gHb; O2 ER, 23-25% and AT-III, > 100%. The clinical benefit of this therapy is still controversial.
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Trauma victims are directly transferred to a level I trauma center bypassing local hospitals. First, airways and cervical stability are secured. Intracranial hematoma should be promptly evacuated. ⋯ The goal of intracranial pressure (ICP) management is to maintain the ICP at less than 15 mmHg and to maintain minimum cerebral perfusion pressure at 45-55 mmHg. External ventricular drainage provides direct control of the ICP by allowing intermittent drainage of the CSF (5-10 ml/hour). Mannitol is effective but hyperventilation is not recommended.