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Boulila C, Ben Abdallah S, Marincamp A, Coic V, Lauverjat R, Ericher N, Bougouin W, Mira JP, Cariou A, Geri G. Use of Neuromuscular Blockers During Therapeutic Hypothermia After Cardiac Arrest: A Nursing Protocol. Crit Care Nurse 2018; 36:33-40. [PMID: 27908944 DOI: 10.4037/ccn2016387] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Neuromuscular blockers used to prevent shivering during therapeutic hypothermia in comatose patients after out-of-hospital cardiac arrest are associated with adverse events. OBJECTIVE To assess the influence of a nurse-implemented protocol on use of neuromuscular blockers in patients treated with 24-hour therapeutic hypothermia after out-of-hospital cardiac arrest. METHODS A before and after study was done in a 24-bed cardiac arrest center. During the before period, paralysis was maintained by continuous infusion of vecuronium during therapeutic hypothermia. During the after period, a nurse-implemented protocol was used to strictly control use of neuromuscular blockers. The primary outcome measure was duration of infusion of neuromuscular blockers; secondary end points included rates of ventilator-associated pneumonia and intensive care unit mortality. RESULTS Among the 22 patients in the before group and the 23 patients in the after group, most were men (78%) with a median age of 66 years. Baseline characteristics were similar between the 2 groups. Median duration of sedation was 36 hours, shorter in the after group (34 hours) than in the before group (38 hours; P = .02). Median duration of infusion of neuromuscular blockers was significantly shorter in the after group (6 hours) than in the before group (33 hours; P < .001). Ventilator-associated pneumonia occurred more frequently in the before group (45%) than in the after group (13%; P = .02). Overall intensive care unit mortality rate was 58%, similar in both groups (P = .44). CONCLUSION Use of a nurse-implemented protocol to reduce use of neuromuscular blockers is feasible.
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Affiliation(s)
- Coraline Boulila
- Coraline Boulila, Samia Ben Abdallah, Aude Marincamp, Vincent Coic, and Romuald Lauverjat are research nurses and Nicole Ericher is the charge nurse, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.,Wulfran Bougouin is a critical care physician, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, a clinical fellow, Paris Descartes University, and a scientist, Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research, Paris, France.,Jean-Paul Mira is a critical care physician and head, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris and a professor of critical care medicine, Paris Descartes University.,Alain Cariou is a critical care physician, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, a professor of critical care medicine, Paris Descartes University, and a scientist, Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research.,Guillaume Geri is a critical care physician, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, a clinical fellow, Paris Descartes University, and a scientist, Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research
| | - Samia Ben Abdallah
- Coraline Boulila, Samia Ben Abdallah, Aude Marincamp, Vincent Coic, and Romuald Lauverjat are research nurses and Nicole Ericher is the charge nurse, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.,Wulfran Bougouin is a critical care physician, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, a clinical fellow, Paris Descartes University, and a scientist, Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research, Paris, France.,Jean-Paul Mira is a critical care physician and head, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris and a professor of critical care medicine, Paris Descartes University.,Alain Cariou is a critical care physician, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, a professor of critical care medicine, Paris Descartes University, and a scientist, Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research.,Guillaume Geri is a critical care physician, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, a clinical fellow, Paris Descartes University, and a scientist, Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research
| | - Aude Marincamp
- Coraline Boulila, Samia Ben Abdallah, Aude Marincamp, Vincent Coic, and Romuald Lauverjat are research nurses and Nicole Ericher is the charge nurse, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.,Wulfran Bougouin is a critical care physician, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, a clinical fellow, Paris Descartes University, and a scientist, Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research, Paris, France.,Jean-Paul Mira is a critical care physician and head, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris and a professor of critical care medicine, Paris Descartes University.,Alain Cariou is a critical care physician, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, a professor of critical care medicine, Paris Descartes University, and a scientist, Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research.,Guillaume Geri is a critical care physician, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, a clinical fellow, Paris Descartes University, and a scientist, Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research
| | - Vincent Coic
- Coraline Boulila, Samia Ben Abdallah, Aude Marincamp, Vincent Coic, and Romuald Lauverjat are research nurses and Nicole Ericher is the charge nurse, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.,Wulfran Bougouin is a critical care physician, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, a clinical fellow, Paris Descartes University, and a scientist, Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research, Paris, France.,Jean-Paul Mira is a critical care physician and head, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris and a professor of critical care medicine, Paris Descartes University.,Alain Cariou is a critical care physician, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, a professor of critical care medicine, Paris Descartes University, and a scientist, Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research.,Guillaume Geri is a critical care physician, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, a clinical fellow, Paris Descartes University, and a scientist, Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research
| | - Romuald Lauverjat
- Coraline Boulila, Samia Ben Abdallah, Aude Marincamp, Vincent Coic, and Romuald Lauverjat are research nurses and Nicole Ericher is the charge nurse, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.,Wulfran Bougouin is a critical care physician, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, a clinical fellow, Paris Descartes University, and a scientist, Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research, Paris, France.,Jean-Paul Mira is a critical care physician and head, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris and a professor of critical care medicine, Paris Descartes University.,Alain Cariou is a critical care physician, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, a professor of critical care medicine, Paris Descartes University, and a scientist, Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research.,Guillaume Geri is a critical care physician, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, a clinical fellow, Paris Descartes University, and a scientist, Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research
| | - Nicole Ericher
- Coraline Boulila, Samia Ben Abdallah, Aude Marincamp, Vincent Coic, and Romuald Lauverjat are research nurses and Nicole Ericher is the charge nurse, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.,Wulfran Bougouin is a critical care physician, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, a clinical fellow, Paris Descartes University, and a scientist, Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research, Paris, France.,Jean-Paul Mira is a critical care physician and head, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris and a professor of critical care medicine, Paris Descartes University.,Alain Cariou is a critical care physician, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, a professor of critical care medicine, Paris Descartes University, and a scientist, Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research.,Guillaume Geri is a critical care physician, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, a clinical fellow, Paris Descartes University, and a scientist, Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research
| | - Wulfran Bougouin
- Coraline Boulila, Samia Ben Abdallah, Aude Marincamp, Vincent Coic, and Romuald Lauverjat are research nurses and Nicole Ericher is the charge nurse, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.,Wulfran Bougouin is a critical care physician, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, a clinical fellow, Paris Descartes University, and a scientist, Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research, Paris, France.,Jean-Paul Mira is a critical care physician and head, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris and a professor of critical care medicine, Paris Descartes University.,Alain Cariou is a critical care physician, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, a professor of critical care medicine, Paris Descartes University, and a scientist, Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research.,Guillaume Geri is a critical care physician, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, a clinical fellow, Paris Descartes University, and a scientist, Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research
| | - Jean-Paul Mira
- Coraline Boulila, Samia Ben Abdallah, Aude Marincamp, Vincent Coic, and Romuald Lauverjat are research nurses and Nicole Ericher is the charge nurse, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.,Wulfran Bougouin is a critical care physician, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, a clinical fellow, Paris Descartes University, and a scientist, Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research, Paris, France.,Jean-Paul Mira is a critical care physician and head, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris and a professor of critical care medicine, Paris Descartes University.,Alain Cariou is a critical care physician, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, a professor of critical care medicine, Paris Descartes University, and a scientist, Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research.,Guillaume Geri is a critical care physician, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, a clinical fellow, Paris Descartes University, and a scientist, Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research
| | - Alain Cariou
- Coraline Boulila, Samia Ben Abdallah, Aude Marincamp, Vincent Coic, and Romuald Lauverjat are research nurses and Nicole Ericher is the charge nurse, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris, France. .,Wulfran Bougouin is a critical care physician, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, a clinical fellow, Paris Descartes University, and a scientist, Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research, Paris, France. .,Jean-Paul Mira is a critical care physician and head, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris and a professor of critical care medicine, Paris Descartes University. .,Alain Cariou is a critical care physician, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, a professor of critical care medicine, Paris Descartes University, and a scientist, Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research. .,Guillaume Geri is a critical care physician, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, a clinical fellow, Paris Descartes University, and a scientist, Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research.
| | - Guillaume Geri
- Coraline Boulila, Samia Ben Abdallah, Aude Marincamp, Vincent Coic, and Romuald Lauverjat are research nurses and Nicole Ericher is the charge nurse, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.,Wulfran Bougouin is a critical care physician, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, a clinical fellow, Paris Descartes University, and a scientist, Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research, Paris, France.,Jean-Paul Mira is a critical care physician and head, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris and a professor of critical care medicine, Paris Descartes University.,Alain Cariou is a critical care physician, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, a professor of critical care medicine, Paris Descartes University, and a scientist, Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research.,Guillaume Geri is a critical care physician, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, a clinical fellow, Paris Descartes University, and a scientist, Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research
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Sundar R, Bandla A, Tan SSH, Liao LD, Kumarakulasinghe NB, Jeyasekharan AD, Ow SGW, Ho J, Tan DSP, Lim JSJ, Vijayan J, Therimadasamy AK, Hairom Z, Ang E, Ang S, Thakor NV, Lee SC, Wilder-Smith EPV. Limb Hypothermia for Preventing Paclitaxel-Induced Peripheral Neuropathy in Breast Cancer Patients: A Pilot Study. Front Oncol 2017; 6:274. [PMID: 28119855 PMCID: PMC5222823 DOI: 10.3389/fonc.2016.00274] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 12/23/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Peripheral neuropathy (PN) due to paclitaxel is a common dose-limiting toxicity with no effective prevention or treatment. We hypothesize that continuous-flow limb hypothermia can reduce paclitaxel-induced PN. PATIENTS AND METHODS An internally controlled pilot trial was conducted to investigate the neuroprotective effect of continuous-flow limb hypothermia in breast cancer patients receiving weekly paclitaxel. Patients underwent limb hypothermia of one limb for a duration of 3 h with every paclitaxel infusion, with the contralateral limb used as control. PN was primarily assessed using nerve conduction studies (NCSs) before the start of chemotherapy, and after 1, 3, and 6 months. Skin temperature and tolerability to hypothermia were monitored using validated scores. RESULTS Twenty patients underwent a total of 218 cycles of continuous-flow limb hypothermia at a coolant temperature of 22°C. Continuous-flow limb hypothermia achieved mean skin temperature reduction of 1.5 ± 0.7°C and was well tolerated, with no premature termination of cooling due to intolerance. Grade 3 PN occurred in 2 patients (10%), grade 2 in 2 (10%), and grade 1 in 12 (60%). Significant correlation was observed between amount of skin cooling and motor nerve amplitude preservation at 6 months (p < 0.0005). Sensory velocity and amplitude in the cooled limbs were less preserved than in the control limbs, but the difference did not attain statistical significance. One patient with a history of diabetes mellitus had significant preservation of compound muscle action potential in the cooled limb on NCS analysis. CONCLUSION This study suggests that continuous limb hypothermia accompanying paclitaxel infusion may reduce paclitaxel-induced PN and have therapeutic potential in select patients and warrants further investigation. The method is safe and well tolerated.
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Affiliation(s)
- Raghav Sundar
- Department of Haematology-Oncology, National University Health System , Singapore , Singapore
| | - Aishwarya Bandla
- Singapore Institute for Neurotechnology, National University of Singapore, Singapore, Singapore; Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore
| | - Stacey Sze Hui Tan
- Singapore Institute for Neurotechnology, National University of Singapore , Singapore , Singapore
| | - Lun-De Liao
- Singapore Institute for Neurotechnology, National University of Singapore, Singapore, Singapore; Institute of Biomedical Engineering and Nanomedicine, National Health Research Institutes, Zhunan Township, Taiwan
| | | | - Anand D Jeyasekharan
- Department of Haematology-Oncology, National University Health System , Singapore , Singapore
| | - Samuel Guan Wei Ow
- Department of Haematology-Oncology, National University Health System , Singapore , Singapore
| | - Jingshan Ho
- Department of Haematology-Oncology, National University Health System , Singapore , Singapore
| | - David Shao Peng Tan
- Department of Haematology-Oncology, National University Health System , Singapore , Singapore
| | - Joline Si Jing Lim
- Department of Haematology-Oncology, National University Health System , Singapore , Singapore
| | - Joy Vijayan
- Department of Medicine, National University Health System , Singapore , Singapore
| | | | - Zarinah Hairom
- National University Cancer Institute, National University Health System , Singapore , Singapore
| | - Emily Ang
- National University Cancer Institute, National University Health System , Singapore , Singapore
| | - Sally Ang
- Department of Haematology-Oncology, National University Health System , Singapore , Singapore
| | - Nitish V Thakor
- Singapore Institute for Neurotechnology, National University of Singapore, Singapore, Singapore; Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore; Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Soo-Chin Lee
- Department of Haematology-Oncology, National University Health System, Singapore, Singapore; Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - Einar P V Wilder-Smith
- Singapore Institute for Neurotechnology, National University of Singapore, Singapore, Singapore; Department of Medicine, National University Health System, Singapore, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Lee JH, Wei L, Gu X, Won S, Wei ZZ, Dix TA, Yu SP. Improved Therapeutic Benefits by Combining Physical Cooling With Pharmacological Hypothermia After Severe Stroke in Rats. Stroke 2016; 47:1907-13. [PMID: 27301934 PMCID: PMC4927220 DOI: 10.1161/strokeaha.116.013061] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 05/03/2016] [Indexed: 11/25/2022]
Abstract
Supplemental Digital Content is available in the text. Background and Purpose— Therapeutic hypothermia is a promising strategy for treatment of acute stroke. Clinical translation of therapeutic hypothermia, however, has been hindered because of the lack of efficiency and adverse effects. We sought to enhance the clinical potential of therapeutic hypothermia by combining physical cooling (PC) with pharmacologically induced hypothermia after ischemic stroke. Methods— Wistar rats were subjected to 90-minute middle cerebral artery occlusion by insertion of an intraluminal filament. Mild-to-moderate hypothermia was induced 120 minutes after the onset of stroke by PC alone, a neurotensin receptor 1 (NTR1) agonist HPI-201 (formally ABS-201) alone or the combination of both. The outcomes of stroke were evaluated at 3 and 21 days after stroke. Results— PC or HPI-201 each showed hypothermic effect and neuroprotection in stroke rats. The combination of PC and HPI-201 exhibited synergistic effects in cooling process, reduced infarct formation, cell death, and blood-brain barrier damages and improved functional recovery after stroke. Importantly, coapplied HPI-201 completely inhibited PC-associated shivering and tachycardia. Conclusions— The centrally acting hypothermic drug HPI-201 greatly enhanced the efficiency and efficacy of conventional PC; this combined cooling therapy may facilitate clinical translation of hypothermic treatment for stroke.
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Affiliation(s)
- Jin Hwan Lee
- From the Departments of Anesthesiology (J.H.L., L.W., X.G., S.W., Z.Z.W., S.P.Y.) and Neurology (L.W.), Emory University School of Medicine, Atlanta, GA; Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Medical Center, Decatur, GA (J.H.L., L.W., X.G., Z.Z.W., S.P.Y.); JT Pharmaceuticals, Mt. Pleasant, SC (T.A.D.); and Department of Drug Discovery and Biomedical Sciences, Medical University of South Carolina, Charleston (T.A.D.)
| | - Ling Wei
- From the Departments of Anesthesiology (J.H.L., L.W., X.G., S.W., Z.Z.W., S.P.Y.) and Neurology (L.W.), Emory University School of Medicine, Atlanta, GA; Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Medical Center, Decatur, GA (J.H.L., L.W., X.G., Z.Z.W., S.P.Y.); JT Pharmaceuticals, Mt. Pleasant, SC (T.A.D.); and Department of Drug Discovery and Biomedical Sciences, Medical University of South Carolina, Charleston (T.A.D.)
| | - Xiaohuan Gu
- From the Departments of Anesthesiology (J.H.L., L.W., X.G., S.W., Z.Z.W., S.P.Y.) and Neurology (L.W.), Emory University School of Medicine, Atlanta, GA; Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Medical Center, Decatur, GA (J.H.L., L.W., X.G., Z.Z.W., S.P.Y.); JT Pharmaceuticals, Mt. Pleasant, SC (T.A.D.); and Department of Drug Discovery and Biomedical Sciences, Medical University of South Carolina, Charleston (T.A.D.)
| | - Soonmi Won
- From the Departments of Anesthesiology (J.H.L., L.W., X.G., S.W., Z.Z.W., S.P.Y.) and Neurology (L.W.), Emory University School of Medicine, Atlanta, GA; Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Medical Center, Decatur, GA (J.H.L., L.W., X.G., Z.Z.W., S.P.Y.); JT Pharmaceuticals, Mt. Pleasant, SC (T.A.D.); and Department of Drug Discovery and Biomedical Sciences, Medical University of South Carolina, Charleston (T.A.D.)
| | - Zheng Zachory Wei
- From the Departments of Anesthesiology (J.H.L., L.W., X.G., S.W., Z.Z.W., S.P.Y.) and Neurology (L.W.), Emory University School of Medicine, Atlanta, GA; Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Medical Center, Decatur, GA (J.H.L., L.W., X.G., Z.Z.W., S.P.Y.); JT Pharmaceuticals, Mt. Pleasant, SC (T.A.D.); and Department of Drug Discovery and Biomedical Sciences, Medical University of South Carolina, Charleston (T.A.D.)
| | - Thomas A Dix
- From the Departments of Anesthesiology (J.H.L., L.W., X.G., S.W., Z.Z.W., S.P.Y.) and Neurology (L.W.), Emory University School of Medicine, Atlanta, GA; Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Medical Center, Decatur, GA (J.H.L., L.W., X.G., Z.Z.W., S.P.Y.); JT Pharmaceuticals, Mt. Pleasant, SC (T.A.D.); and Department of Drug Discovery and Biomedical Sciences, Medical University of South Carolina, Charleston (T.A.D.)
| | - Shan Ping Yu
- From the Departments of Anesthesiology (J.H.L., L.W., X.G., S.W., Z.Z.W., S.P.Y.) and Neurology (L.W.), Emory University School of Medicine, Atlanta, GA; Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Medical Center, Decatur, GA (J.H.L., L.W., X.G., Z.Z.W., S.P.Y.); JT Pharmaceuticals, Mt. Pleasant, SC (T.A.D.); and Department of Drug Discovery and Biomedical Sciences, Medical University of South Carolina, Charleston (T.A.D.).
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