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Nagase K, Watanabe T, Nomura A, Nagase FN, Iwasaki K, Nakamura Y, Ikai H, Yamamoto M, Murai Y, Yokoyama-Kokuryo W, Takizawa N, Shimizu H, Fujita Y. Predictive correction of serum sodium concentration with formulas derived from the Edelman equation in patients with severe hyponatremia. Sci Rep 2023; 13:1783. [PMID: 36720979 PMCID: PMC9889706 DOI: 10.1038/s41598-023-28380-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 01/17/2023] [Indexed: 02/02/2023] Open
Abstract
Severe hyponatremia can cause life-threatening cerebral edema. Treatment comprises rapid elevation of serum sodium concentration; however, overcorrection can result in osmotic demyelination. This study investigated potential factors, including predictive correction based on the Edelman equation, associated with appropriate correction in 221 patients with a serum sodium concentration ≤ 120 mEq/L who were admitted to a hospital in Nagoya, Japan. Appropriate correction was defined as an elevation in serum sodium concentration in the range of 4-10 mEq/L in the first 24 h and within 18 mEq/L in the first 48 h after the start of the correction. Appropriate corrections were made in 132 (59.7%) of the 221 patients. Multivariate analysis revealed that predictive correction with an infusate and fluid loss formula derived from the Edelman equation was associated with appropriate correction of serum sodium concentration (adjusted odds ratio, 7.84; 95% confidence interval, 2.97-20.64). Relative without its use, the predictive equation results in a lower proportion of undercorrection (14.3% vs. 48.0%, respectively) and overcorrection (1.0% vs. 12.2%, respectively). These results suggest that predictive correction of serum sodium concentrations using the formula derived from the Edelman equation can play an essential role in the appropriate management of patients with severe hyponatremia.
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Affiliation(s)
- Koya Nagase
- Department of Nephrology, Chubu Rosai Hospital, 1-10-6, Komei-cho, Minato-ku, Nagoya, Aichi, 455-8530, Japan
| | - Tsuyoshi Watanabe
- Department of Rheumatology, Chubu Rosai Hospital, 1-10-6, Komei-cho, Minato-ku, Nagoya, Aichi, 455-8530, Japan.
| | - Akihiro Nomura
- Department of Rheumatology, Chubu Rosai Hospital, 1-10-6, Komei-cho, Minato-ku, Nagoya, Aichi, 455-8530, Japan
| | - Fumika N Nagase
- Department of Rheumatology, Chubu Rosai Hospital, 1-10-6, Komei-cho, Minato-ku, Nagoya, Aichi, 455-8530, Japan
| | - Keita Iwasaki
- Department of Rheumatology, Chubu Rosai Hospital, 1-10-6, Komei-cho, Minato-ku, Nagoya, Aichi, 455-8530, Japan
| | - Yoshihiro Nakamura
- Department of Nephrology, Nagoya University Graduate School of Medicine, 65, Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Hiroki Ikai
- Department of Rheumatology, Chubu Rosai Hospital, 1-10-6, Komei-cho, Minato-ku, Nagoya, Aichi, 455-8530, Japan
| | - Mari Yamamoto
- Department of Rheumatology, Chubu Rosai Hospital, 1-10-6, Komei-cho, Minato-ku, Nagoya, Aichi, 455-8530, Japan
| | - Yukari Murai
- Department of Nephrology, Chubu Rosai Hospital, 1-10-6, Komei-cho, Minato-ku, Nagoya, Aichi, 455-8530, Japan
| | - Waka Yokoyama-Kokuryo
- Department of Rheumatology, Chubu Rosai Hospital, 1-10-6, Komei-cho, Minato-ku, Nagoya, Aichi, 455-8530, Japan
| | - Naoho Takizawa
- Department of Rheumatology, Chubu Rosai Hospital, 1-10-6, Komei-cho, Minato-ku, Nagoya, Aichi, 455-8530, Japan
| | - Hideaki Shimizu
- Department of Nephrology and Renal Replacement, Daido Hospital, 9, Hakusui-cho, Minami-ku, Nagoya, Aichi, 457-8511, Japan
| | - Yoshiro Fujita
- Department of Nephrology, Chubu Rosai Hospital, 1-10-6, Komei-cho, Minato-ku, Nagoya, Aichi, 455-8530, Japan
- Department of Rheumatology, Chubu Rosai Hospital, 1-10-6, Komei-cho, Minato-ku, Nagoya, Aichi, 455-8530, Japan
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Abzalova DI, Sinkin MV, Yakovlev AA, Prirodov AV, Guekht AB. [Risk factors for de novo generalized tonic-clonic seizures in patients with supratentorial meningiomas after neurosurgical treatment]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:69-74. [PMID: 37966442 DOI: 10.17116/jnevro202312310169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
OBJECTIVE To identify risk factors for de novo epileptic seizures in the early postoperative period in patients with supratentorial meningiomas. MATERIAL AND METHODS A retrospective case-control study was conducted in a ratio of 3 to 1. The case histories of all patients with supratentorial meningiomas that met the inclusion and exclusion criteria, who underwent surgical removal of the neoplasm in 01.01.17 to 12.31.20, were studied in the neurosurgical department of the Research Institute of Emergency Medicine named after N.V. Sklifosovsky. Of 133 patients without epileptic seizures and a history of taking antiepileptic drugs before surgery, 10% (n=14) had a de novo generalized tonic-clonic seizure in the early postoperative period. Among the remaining 119 patients, 42 patients were selected to form the control group, similar in age, localization and volume of the tumor with patients in the main group. In all patients, the clinical condition, the results of preoperative and postoperative neuroimaging with contrast enhancement, the course of the intraoperative period, as well as the duration and outcomes of hospitalization were assessed. RESULTS The risk factors for the development of de novo seizures were an increase in the volume of cerebral edema compared with the preoperative one according to postoperative CT data and the development of hemorrhagic transformation of cerebral edema. CONCLUSION A prospective study is needed to determine risk factors for de novo seizures and determine prophylactic treatment.
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Affiliation(s)
- D I Abzalova
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - M V Sinkin
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - A A Yakovlev
- Scientific and Practical Psychoneurological Center, Moscow, Russia
| | - A V Prirodov
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - A B Guekht
- Scientific and Practical Psychoneurological Center, Moscow, Russia
- Pirogov Russian National Research Medical University, Moscow, Russia
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Lin YW, Yeh SJ, Tang SC, Tsai LK, Jeng JS. Improvement After Celecoxib Treatment in Patients with Thalamic Hemorrhage - A Case Report. Acta Neurol Taiwan 2022; 31(4):84-89. [PMID: 35470409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE Perihematomal edema of intracerebral hemorrhage (ICH) is caused by a hematoma-induced inflammatory reaction, which usually contributes to delayed deterioration of neurological function and poor outcomes. Celecoxib is a commonly used nonsteroidal anti-inflammatory drug that selectively inhibits cyclooxygenase-2. High-dose celecoxib (400 mg twice daily) for 14 days has been shown to reduce perihematomal edema and hematoma enlargement in patients with ICH, but without improvement in long-term functional outcome, which may be confounded by the heterogeneity of hematoma location. Low-dose celecoxib may be an effective management for symptoms caused by perihematomal edema in patients with ICH, particularly those involving the thalamus. CASE REPORT We reported two patients with acute thalamic ICH; a common symptom between the two was delayed onset of drowsiness caused by perihematomal edema involving the thalamus. Their consciousness improved after low-dose celecoxib (200 mg once daily) administration for 3 and 2 days in case A and B, respectively. Furthermore, other symptoms that concomitantly improved included poor appetite caused by perihematomal edema involving the left hypothalamus in case A, and limb weakness caused by perihematomal edema of the internal capsule in case B. CONCLUSION These cases revealed that low-dose celecoxib may be an effective management for symptoms caused by perihematomal edema in patients with ICH, particularly those involving the thalamus.
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Affiliation(s)
- Yu-Wei Lin
- School of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shin-Joe Yeh
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Sung-Chun Tang
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Li-Kai Tsai
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Jiann-Shing Jeng
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
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Lopez AJ, ElSaadani M, Culkin MC, Jacovides CL, Georges AP, Song H, Kaplan LJ, Kumar MA, Smith DH, Pascual JL. Persistent Blunting of Penumbral Leukocyte Mobilization by Beta Blockade Administered for Two Weeks After Traumatic Brain Injury. J Surg Res 2022; 280:196-203. [PMID: 35994981 DOI: 10.1016/j.jss.2022.06.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 06/20/2022] [Accepted: 06/30/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Beta-blockers (BB) after traumatic brain injury (TBI) accelerate cognitive recovery weeks after injury. BBs also inhibit leukocyte (LEU) mobilization to the penumbral blood brain barrier (BBB) 48-h after TBI. It is unclear whether the latter effects persist longer and accompany the persistent cognitive improvement. We hypothesized that 2 wk of BB after TBI reduce penumbral BBB leukocyte-endothelial interactions. METHODS Thirty CD1 mice underwent TBI (controlled cortical impact, CCI: 6 m/s velocity, 1 mm depth, 3 mm diameter) or sham craniotomy followed by i.p. saline (NS) or propranolol (1, 2, 4 mg/kg) every 12 h for 14 d. On day 14, in vivo pial intravital microscopy visualized endothelial-LEU interactions and BBB microvascular leakage. Day 14 Garcia neurological test scores and animal weights were compared to preinjury levels reflecting concurrent clinical recovery. RESULTS LEU rolling was greatest in CCI + NS when compared to sham (P = 0.03). 4 mg/kg propranolol significantly reduced postCCI LEU rolling down to uninjured sham levels (P = 0.03). LEU adhesion and microvascular permeability were not impacted at this time interval. Untreated injured animals (CCI + NS) scored lower Garcia neurological test and greater weight loss recovery at day 14 when compared to preinjury (P < 0.05). Treatment with higher doses of propranolol (2, 4 mg/kg), improved weight loss recovery (P < 0.001). CONCLUSIONS LEU rolling alone, was influenced by BB therapy 14 d after TBI suggesting that certain penumbral neuroinflammatory cellular effects of BB therapy after TBI persist up to 2 wk after injury potentially explaining the pervasive beneficial effects of BBs on learning and memory.
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Affiliation(s)
- Alfonso J Lopez
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Brain Injury and Repair, Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mohamed ElSaadani
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Brain Injury and Repair, Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Matthew C Culkin
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Brain Injury and Repair, Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christina L Jacovides
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Brain Injury and Repair, Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Anastasia P Georges
- Center for Brain Injury and Repair, Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Hailong Song
- Center for Brain Injury and Repair, Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lewis J Kaplan
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Monisha A Kumar
- Center for Brain Injury and Repair, Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Douglas H Smith
- Center for Brain Injury and Repair, Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jose L Pascual
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Brain Injury and Repair, Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
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Zhang T, Zuo G, Zhang H. GPR18 Agonist Resolvin D2 Reduces Early Brain Injury in a Rat Model of Subarachnoid Hemorrhage by Multiple Protective Mechanisms. Cell Mol Neurobiol 2022; 42:2379-2392. [PMID: 34089427 DOI: 10.1007/s10571-021-01114-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 05/31/2021] [Indexed: 10/21/2022]
Abstract
Early brain injury (EBI) is the early phase of secondary complications arising from subarachnoid hemorrhage (SAH). G protein-coupled receptor 18 (GPR18) can exert neuroprotective effects during ischemia. In this study, we investigated the roles of GPR18 in different brain regions during EBI using a GPR18 agonist, resolvin D2 (RvD2). Location and dynamics of GPR18 expression were assessed by immunohistochemistry and western blotting in a rat model of SAH based on endovascular perforation. RvD2 was given intranasally at 1 h after SAH, and SAH grade, brain water content and behavior were assayed before sacrifice. TUNEL and dihydroethidium staining of the cortex were performed at 24 h after SAH. Selected brain regions were also examined for pathway related proteins using immunofluorescence and Western blotting. We found that GPR18 was expressed in meninges, hypothalamus, cortex and white matter before EBI. After SAH, GPR18 expression was increased in meninges and hypothalamus but decreased in cortex and white matter. RvD2 improved neurological scores and brain edema after SAH. RvD2 attenuated mast cell degranulation and reduced expression of chymase and tryptase expression in the meninges. In the hypothalamus, RvD2 attenuated inflammation, increased expression of proopiomelanocortin and interleukin-10, as well as decreased expression of nerve peptide Y and tumor necrosis factor-α. In cortex, RvD2 alleviated oxidative stress and apoptosis, and protected the blood-brain barrier. RvD2 also ameliorated white matter injury by elevating myelin basic protein and suppressing amyloid precursor protein. Our results suggest that GPR18 may help protect multiple brain regions during EBI, particularly in the cortex and hypothalamus. Upregulating GPR18 by RvD2 may improve neurological functions in different brain regions via multiple mechanisms.
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Affiliation(s)
- Tongyu Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, 45 Changchun St., Beijing, 100053, China
| | - Gang Zuo
- Department of Neurosurgery, The Affiliated Taicang Hospital, Soochow University, Taicang, Suzhou, 215400, Jiangsu, China
| | - Hongqi Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, 45 Changchun St., Beijing, 100053, China.
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Gao X, Li R, Luo L, Zhang D, Liu Q, Zhang J, Mao S. Alpha-asarone ameliorates neurological deterioration of intracerebral hemorrhagic rats by alleviating secondary brain injury via anti-excitotoxicity pathways. Phytomedicine 2022; 105:154363. [PMID: 35926378 DOI: 10.1016/j.phymed.2022.154363] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/14/2022] [Accepted: 07/26/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Secondary brain injury (SBI) has been confirmed as a leading cause for the poor prognosis of patients suffering from intracerebral hemorrhage (ICH). SBI co-exists in ischemia and hemorrhagic stroke. Neuro-excitotoxicity is considered the initiating factor of ICH-induced SBI. Our previous research has revealed alpha-asarone (ASA)'s efficacy against cerebral ischemia-reperfusion stroke by mitigating neuro-excitotoxicity. It is not yet known if ASA exhibit neuroprotection against ICH. PURPOSE This work aimed to investigate ASA's therapeutic effects and potential mechanisms of action against ICH in a classic rat model induced by collagenase Ⅶ injection. METHODS An in vivo ICH model of Sprague-Dawley rats was established by collagenase Ⅶ injection. We administrated different ASA doses (10, 20, or 40 mg/kg, i.p.) at 2 h post-ICH. Then, rats' short- and long-term neurobehavioral function, bodyweight change, and learning and memory ability were blindly evaluated. Histological, Nissl, and flow cytometry were applied to assess the neuronal damage post-ICH. The wet/dry method and Evans blue extravasation estimated brain edema and blood-brain barrier function. Pathway-related proteins were investigated by immunofluorescence staining, enzyme-linked immunosorbent assay, and Western-blot analysis. RESULTS The results demonstrated that ASA ameliorated neurological deterioration, bodyweight loss, and learning and memory ability of ICH rats. Histological, Nissl, and flow cytometry analyses showed that ASA reduced neuronal damage and apoptosis post-ICH. Besides, ASA probably mitigated brain edema and blood-brain barrier dysfunction via inhibiting astrocyte activation and consequent pro-inflammatory response. The mechanism investigation attributed ASA's efficacy to the following aspects: 1) promoting sodium ion excretion, thus blocking excitatory signal transduction along the axon; 2) preventing glutamate-involved pathways, i.e., decrease of N-methyl-d-aspartic acid receptor subunit 2B, increase of glutamate transporter-1, and alleviation of calcium-related cascades, mitochondrion-associated apoptosis, and neuronal autophagy; 3) enhancing the expression of GABAARs, thus abating neuronal excitotoxicity. CONCLUSION Our study first confirmed the effect of ASA on ameliorating the neurobehavioral deterioration of ICH rats, possibly via alleviation of glutamate-involved neuro-excitotoxicity, i.e., calcium cascades, mitochondrion-involved apoptosis, neuronal autophagy, and astrocyte-related inflammation. These findings not only provided a promising drug candidate for clinical treatment of ICH but also shed light on the future drug discovery against ICH.
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Affiliation(s)
- Xiaofeng Gao
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu, 610041, China
| | - Rui Li
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu, 610041, China
| | - Lijun Luo
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu, 610041, China
| | - Di Zhang
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu, 610041, China
| | - Qi Liu
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu, 610041, China
| | - Jian Zhang
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu, 610041, China
| | - Shengjun Mao
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu, 610041, China.
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Chen Z, Ding J, Wu X, Cao X, Liu H, Yin X, Ding Y, Ji X, Meng R. Anatomic Asymmetry of Transverse Sinus May Be Irrelevant to the Prognosis of Intracerebral Hemorrhage. Neurologist 2022; 27:235-239. [PMID: 34873112 PMCID: PMC9439688 DOI: 10.1097/nrl.0000000000000396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND We investigate the probable effect of anatomic asymmetry of transverse sinus (TS) on the outcomes of acute intracerebral hemorrhage (ICH), to provide reference for customized treatment. METHODS Consecutive patients with imaging-confirmed acute ICH were enrolled from October 2015 through October 2019, and divided into 2 groups: symmetrical and unilateral (left or right) slender TS groups, based on the status of TS in imaging maps. Brain computed tomography (CT) maps of all patients at baseline and half-month post-ICH were obtained, and the volumes of hematoma and the perihematomal edemas (PHE), as well as the modified Rankin Scale (mRS) scores at the month-3 post-ICH between the 2 groups were assessed and analyzed. RESULTS A total of 46 eligible patients entered into final analysis, including 18 cases in the slender TS group (14 cases involved the left side while 4 cases involved the right side), and 28 cases in the symmetrical TS group. The mRS scores, hematoma absorption rates, and the residual volumes of PHE of all patients in the 2 groups at half-month post-ICH showed no statistical significance (all P >0.05), and all of the items mentioned above were related to the hematoma volume at baseline (all P <0.001). At the month-3 follow-up post-ICH, the mRS scores between the 2 groups showed no statistical significance as well ( P =0.551). CONCLUSIONS Anatomic asymmetry of TS may not affect the prognosis of PHE and clinical outcome after ICH.
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Affiliation(s)
- Zhiying Chen
- Department of Neurology, Xuanwu Hospital, Capital Medical University
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing
- Department of Neurology, Affiliated Hospital of Jiujiang University, Jiangxi
| | - Jiayue Ding
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
| | - Xiaoqin Wu
- Department of Neurology, Xuanwu Hospital, Capital Medical University
| | - Xianming Cao
- Department of Neurology, Affiliated Hospital of Jiujiang University, Jiangxi
| | - Hao Liu
- Department of Neurology, Affiliated Hospital of Jiujiang University, Jiangxi
| | - Xiaoping Yin
- Department of Neurology, Affiliated Hospital of Jiujiang University, Jiangxi
| | - Yuchuan Ding
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI
| | - Xunming Ji
- Department of Neurology, Xuanwu Hospital, Capital Medical University
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing
| | - Ran Meng
- Department of Neurology, Xuanwu Hospital, Capital Medical University
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing
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Abstract
PURPOSE OF REVIEW To discuss the neurological complications and pathophysiology of organ damage following malaria infection. RECENT FINDINGS The principal advancement made in malaria research has been a better understanding of the pathogenesis of cerebral malaria (CM), the most dreaded neurological complication generally caused by Plasmodium falciparum infection. However, no definitive treatment has yet been evolved other than the use of antimalarial drugs and supportive care. The development of severe cerebral edema in CM results from two distinct pathophysiologic mechanisms. First, the development of "sticky" red blood cells (RBCs) leads to cytoadherence, where red blood cells (RBCs) get stuck to the endothelial walls and between themselves, resulting in clogging of the brain microvasculature with resultant hypoxemia and cerebral edema. In addition, the P. falciparum-infected erythrocyte membrane protein 1 (PfEMP1) molecules protrude from the raised knob structures on the RBCs walls and are in themselves made of a combination of human and parasite proteins in a tight complex. Antibodies to surfins, rifins, and stevors from the parasite are also located in the RBC membrane. On the human microvascular side, a range of molecules involved in host-parasite interactions, including CD36 and intracellular adhesion molecule 1, is activated during interaction with other molecules such as endothelial protein C receptor and thrombospondin. As a result, an inflammatory response occurs with the dysregulated release of cytokines (TNF, interleukins 1 and 10) which damage the blood-brain barrier (BBB), causing plasma leakage and brain edema. This second mechanism of CNS injury often involves multiple organs in adult patients in endemic areas but remains localized only to the central nervous system (CNS) among African children. Neurological sequelae may follow both P. falciparum and P. vivax infections. The major brain pathology of CM is brain edema with diffuse brain swelling resulting from the combined effects of reduced perfusion and hypoxemia of cerebral neurons due to blockage of the microvasculature by parasitized RBCs as well as the neurotoxic effect of released cytokines from a hyper-acute immune host reaction. A plethora of additional neurological manifestations have been associated with malaria, including posterior reversible encephalopathy syndrome (PRES), reversible cerebral vasoconstriction syndrome (RCVS), malarial retinopathy, post-malarial neurological syndrome (PMNS), acute disseminated encephalomyelitis (ADEM), Guillain-Barré syndrome (GBS), and cerebellar ataxia. Lastly, the impact of the COVID-19 pandemic on worldwide malaria control programs and the possible threat from co-infections is briefly discussed.
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Affiliation(s)
- Sweety Trivedi
- Department of Neurology, Sanjay Gandhi Post-graduate Institute of Medical Science, Lucknow, India
| | - Ambar Chakravarty
- Department of Neurology, Vivekananda Institute of Medical Science, Kolkata, India.
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Starr MC, Cater DT, Wilson AC, Wallace S, Bennett WE, Hains DS. Association Between Continuous Kidney Replacement Therapy Clearance and Outcome in Pediatric Patients With Hyperammonemia Not Due to Inborn Error of Metabolism. Pediatr Crit Care Med 2022; 23:e356-e360. [PMID: 35383692 DOI: 10.1097/pcc.0000000000002949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To describe a single-center experience of pediatric patients with hyperammonemia not due to inborn errors of metabolism and determine the association between use of continuous kidney replacement therapy (CKRT) treatment and outcomes. DESIGN Retrospective cohort study. SETTING Tertiary-care children's hospital. PATIENTS All children less than 21 years old admitted to the hospital with hyperammonemia defined as an elevated ammonia levels (>100 µmol/L) not due to inborn error of metabolism. INTERVENTIONS None. MEASURES AND MAIN RESULTS Of 135 children with hyperammonemia, the most common reason for admission was infection in 57 of 135 (42%), congenital heart disease in 20 of 135 (14%), and bone marrow transplantation in 10 of 135 (7%). The overall mortality was 61% (82 of 135), which increased with degree of hyperammonemia (17 of 23 [74%] in those with ammonia >250 µmol/L). After multivariable regression, hyperammonemia severity was not associated with mortality (aOR, 1.4; 95% CI, 0.92-2.1; p = 0.11). Of the 43 patients (32%) receiving CKRT, 21 were prescribed standard clearance and 22 high clearance. The most common indications for CKRT were fluid overload in 17 of 43 (42%) and acute kidney injury or uremia in 16 of 43 (37%). Mean CKRT duration was 13 days. There was no difference between standard and high clearance groups in risk of death (76% vs 86%; p = 0.39), cerebral edema on CT scan (19% vs 27%; p = 0.52), nor decrease in ammonia levels after 24 or 48 hours of CKRT ( p = 0.20, p = 0.94). Among those receiving CKRT, we failed to find an association between high clearance and decreased risk of death in multivariable analysis (aOR, 1.2; 95% CI, 0.64-2.3; p = 0.55). CONCLUSIONS In our single-center retrospective study, we failed to find an association between clearance on CKRT and improved survival nor decreased cerebral edema on head imaging. In fact, we failed to find an association between ammonia level and mortality, after controlling for illness severity.
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Affiliation(s)
- Michelle C Starr
- Division of Pediatric Nephrology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
- Center for Pediatric and Adolescent Comparative Effectiveness Research, Department of Pediatrics, Indiana University, Indianapolis, IN
| | - Daniel T Cater
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
| | - Amy C Wilson
- Division of Pediatric Nephrology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
| | - Samantha Wallace
- Center for Pediatric and Adolescent Comparative Effectiveness Research, Department of Pediatrics, Indiana University, Indianapolis, IN
| | - William E Bennett
- Center for Pediatric and Adolescent Comparative Effectiveness Research, Department of Pediatrics, Indiana University, Indianapolis, IN
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
| | - David S Hains
- Division of Pediatric Nephrology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
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Mehtani R, Garg S, Kajal K, Soni SL, Premkumar M. Neurological monitoring and sedation protocols in the Liver Intensive Care Unit. Metab Brain Dis 2022; 37:1291-1307. [PMID: 35460476 DOI: 10.1007/s11011-022-00986-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 04/10/2022] [Indexed: 11/25/2022]
Abstract
Patients with liver disease often have alteration of neurological status which requires admission to an intensive care unit. Patients with acute liver failure (ALF), acute-on-chronic liver failure (ACLF) and rarely cirrhosis are at risk of cerebral edema. These patients require prompt assessment of neurological status including assessment of intra-cranial pressure (ICP) and monitoring metabolic parameters like arterial/venous ammonia levels, serum creatinine and serum electrolytes so that timely specific therapy for raised ICP can be instituted to prevent permanent neurological dysfunction. The overall aims of neuromonitoring and sedation protocols in a liver intensive care unit are to identify the level of multifactorial metabolic encephalopathy, individualize sedation and analgesia requirements for patients on mechanical ventilation, institute specific therapy to correct the neurological insult in ALF and ACLF, provide clear physiological data for guided therapy of drugs like muscle relaxants, antiepileptics, and cerebral edema reducing agents, and assist with overall prognostication. In this review article we will outline the clinical scenarios related to liver disease requiring intensive care and neuromonitoring, current techniques of neurological assessment, sedation protocols and point of care tests which enable the treating physician and intensivist guide therapy for raised ICP.
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Affiliation(s)
- Rohit Mehtani
- Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Shankey Garg
- Department of Anesthesiology and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Kamal Kajal
- Department of Anesthesiology and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Shiv Lal Soni
- Department of Anesthesiology and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Madhumita Premkumar
- Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
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Huang R, Su S, Yang Z, Wang H, Hong L, Chen L, Wu X, Zheng Y, Zhuang R, Liu Y. Neuroradiologic Findings and Clinical Features of Meningiomas With Spontaneous Hemorrhagic Onset: A Single-center 10-year Experience. World Neurosurg 2022; 162:e605-e615. [PMID: 35338017 DOI: 10.1016/j.wneu.2022.03.080] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/17/2022] [Accepted: 03/17/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVE This study aimed to elucidate the clinicoradiologic features of spontaneous hemorrhagic meningiomas (HMs) and examine risk factors associated with meningioma hemorrhage. METHODS We retrospectively reviewed 651 consecutive meningioma patients who underwent surgical resection in our hospital between January 2011 and January 2021. After exclusions, 169 patients were included for analysis. Patients were grouped according to presence of hemorrhage in the meningioma: the HM group (n = 19) and non-HM group (n = 150). Clinicoradiologic patient data were examined and compared using univariate and multivariate analysis. RESULTS HMs accounted for 2.9% of the entire series of meningiomas. HMs were mainly located at the convexity (63.2%). Mean diameter of HMs was 4.8 cm. On computed tomography, most HMs appeared as mixed isodensity and hyperdensity (84.2%). On magnetic resonance imaging, most appeared as mixed isointensity and hyperintensity on T1-weighted imaging and mixed hypointesity and hyperintensity on T2-weighted imaging (52.6%). Seventeen tumors exhibited heterogeneous enhancement, a dural tail, and peritumoral brain edema. Thirteen showed intratumoral cystic change. The misdiagnosis rate was significantly higher in HMs than non-HMs (31.6% vs. 7.3%; P = 0.005). Intratumoral cystic change was the only independent predictor of meningioma hemorrhage in multivariate analysis (odds ratio 4.116; 95% confidence interval 1.138-14.894; P = 0.031). CONCLUSIONS Mixed isodensity/intensity and hyperdensity/intensity on computed tomography/magnetic resonance imaging in conjunction with heterogenous enhancement, a dural tail, and varying degrees of peritumoral brain edema suggest a high possibility of HM. Presence of intratumoral cystic change was an independent risk factor associated with meningioma hemorrhage.
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Affiliation(s)
- Ruibin Huang
- Department of Radiology, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, P.R.China
| | - Shuyan Su
- Department of Radiology, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, P.R.China
| | - Zhiqi Yang
- Department of Radiology, Meizhou People's Hospital, Meizhou, Guangdong, P.R.China
| | - Huanpeng Wang
- Department of Radiology, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, P.R.China
| | - Liangli Hong
- Department of Pathology, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, P.R.China
| | - Liujiang Chen
- Department of Radiology, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, P.R.China
| | - Xiaojia Wu
- Department of Radiology, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, P.R.China
| | - Yungui Zheng
- Department of Neurosurgery, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, P.R.China
| | - Ruyao Zhuang
- Department of Radiology, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, P.R.China
| | - Yuan Liu
- Department of Radiology, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, P.R.China
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dos Santos EC, Silva LS, Pinheiro AS, Teixeira DE, Peruchetti DB, Silva-Aguiar RP, Wendt CHC, Miranda KR, Coelho-de-Souza AN, Leal-Cardoso JH, Caruso-Neves C, Pinheiro AAS. The monoterpene 1,8-cineole prevents cerebral edema in a murine model of severe malaria. PLoS One 2022; 17:e0268347. [PMID: 35550638 PMCID: PMC9098050 DOI: 10.1371/journal.pone.0268347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 04/27/2022] [Indexed: 11/18/2022] Open
Abstract
1,8-Cineole is a naturally occurring compound found in essential oils of different plants and has well-known anti-inflammatory and antimicrobial activities. In the present work, we aimed to investigate its potential antimalarial effect, using the following experimental models: (1) the erythrocytic cycle of Plasmodium falciparum; (2) an adhesion assay using brain microvascular endothelial cells; and (3) an experimental cerebral malaria animal model induced by Plasmodium berghei ANKA infection in susceptible mice. Using the erythrocytic cycle of Plasmodium falciparum, we characterized the schizonticidal effect of 1,8-cineole. This compound decreased parasitemia in a dose-dependent manner with a half maximal inhibitory concentration of 1045.53 ± 63.30 μM. The inhibitory effect of 972 μM 1,8-cineole was irreversible and independent of parasitemia. Moreover, 1,8-cineole reduced the progression of intracellular development of the parasite over 2 cycles, inducing important morphological changes. Ultrastructure analysis revealed a massive loss of integrity of endomembranes and hemozoin crystals in infected erythrocytes treated with 1,8-cineole. The monoterpene reduced the adhesion index of infected erythrocytes to brain microvascular endothelial cells by 60%. Using the experimental cerebral malaria model, treatment of infected mice for 6 consecutive days with 100 mg/kg/day 1,8-cineole reduced cerebral edema with a 50% reduction in parasitemia. Our data suggest a potential antimalarial effect of 1,8-cineole with an impact on the parasite erythrocytic cycle and severe disease.
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Affiliation(s)
- Edgleyson C. dos Santos
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Instituto de Ciências Biomédicas, Universidade Estadual do Ceará, Fortaleza, Brazil
| | - Leandro S. Silva
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Alessandro S. Pinheiro
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Douglas E. Teixeira
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Diogo B. Peruchetti
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rodrigo P. Silva-Aguiar
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Camila H. C. Wendt
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Kildare R. Miranda
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Centro Nacional de Biologia Estrutural e Bioimagem, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Instituto Nacional de Ciência e Tecnologia em Biologia Estrutural e Bioimagem, Conselho Nacional de Desenvolvimento Científico e Tecnológico, Rio de Janeiro, Brazil
| | | | | | - Celso Caruso-Neves
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Instituto Nacional de Ciência e Tecnologia em Medicina Regenerativa, Conselho Nacional de Desenvolvimento Científico e Tecnológico, Rio de Janeiro, Brazil
- Rio de Janeiro Innovation Network in Nanosystems for Health, Rio de Janeiro, Brazil
| | - Ana Acacia S. Pinheiro
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Rio de Janeiro Innovation Network in Nanosystems for Health, Rio de Janeiro, Brazil
- * E-mail:
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Liu C, Li F, Liu S, Chen Q, Sang H, Yang Q, Zhou K, Zi W. Neutrophil Count Predicts Malignant Cerebellar Edema and Poor Outcome in Acute Basilar Artery Occlusion Receiving Endovascular Treatment: A Nationwide Registry-Based Study. Front Immunol 2022; 13:835915. [PMID: 35592334 PMCID: PMC9111017 DOI: 10.3389/fimmu.2022.835915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 04/01/2022] [Indexed: 11/13/2022] Open
Abstract
Background Acute basilar artery occlusion (ABAO) is known to have a poor outcome with a high rate of morbidity and mortality despite endovascular treatment (EVT), highlighting the necessities of exploring factors to limit the efficacy of EVT in these patients. Cerebellar infarctions in ABAO might progress to malignant cerebellar edema (MCE), a life-threatening complication after reperfusion, posing a secondary injury to the brainstem by mass effects. Therefore, the present research aimed to explore the impacts of MCE on a long-term outcome and investigate the prognostic factors for MCE among ABAO after EVT. Methods In the national BASILAR registry, a total of 329 ABO patients with cerebellar infarctions treated by EVT met the inclusion criteria. The presence of MCE defined by the Jauss scale ≥4 points, was evaluated on the computed tomography performed 72 h after EVT. The adjusted odds ratio and 95% CI were obtained by logistic regression models. A favorable outcome was defined as a 90-day modified Rankin Scale score of 0-3. Results MCE was statistically associated with the decreased incidence of a favorable outcome [adjusted odds ratio, 0.35(95% CI, 0.18-0.68), P=0.002]. The baseline National Institutes of Health Stroke Scale score, collateral circulation, neutrophil count at admission, and recanalization status were predictors for MCE and a favorable functional status at 90 days (all P<0.05). Among all inflammatory factors, the neutrophil count achieved the highest accuracy, sensitivity, and specificity for MCE. Adding the neutrophil count status into the baseline model obviously enhanced its prediction ability for MCE and favorable outcome by increasing the area under curve and achieving both net reclassification and integrated discrimination improvement (all P<0.05). Mediation analysis indicated that MCE mediated the association between the increased neutrophil count and worse functional outcome (P=0.026). Discussion MCE acted essential roles in worsening prognosis for ABAO after EVT. A high neutrophil count at admission was linked to MCE and a poor outcome among ABAO patients, which could be further incorporated into the clinical decision-making system and guide immunomodulation therapy.
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Affiliation(s)
- Chang Liu
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Fengli Li
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Shuai Liu
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Qiong Chen
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Hongfei Sang
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
- Department of Neurology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qingwu Yang
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Kai Zhou
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Wenji Zi
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
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Duan T, Li L, Yu Y, Li T, Han R, Sun X, Cui Y, Liu T, Wang X, Wang Y, Fan X, Liu Y, Zhang H. Traditional Chinese medicine use in the pathophysiological processes of intracerebral hemorrhage and comparison with conventional therapy. Pharmacol Res 2022; 179:106200. [PMID: 35367344 DOI: 10.1016/j.phrs.2022.106200] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/21/2022] [Accepted: 03/28/2022] [Indexed: 12/12/2022]
Abstract
Intracerebral hemorrhage (ICH) refers to hemorrhage caused by non-traumatic vascular rupture in the brain parenchyma, which is characterized by acute onset, severe illness, and high mortality and disability. The influx of blood into the brain tissue after cerebrovascular rupture causes severe brain damage, including primary injury caused by persistent hemorrhage and secondary brain injury (SBI) induced by hematoma. The mechanism of brain injury is complicated and is a significant cause of disability after ICH. Therefore, it is essential to understand the mechanism of brain injury after ICH to develop drugs to prevent and treat ICH. Studies have confirmed that many traditional Chinese medicines (TCM) can reduce brain injury by improving neurotoxicity, inflammation, oxidative stress (OS), blood-brain barrier (BBB), apoptosis, and neurological dysfunction after ICH. Starting from the pathophysiological process of brain injury after ICH, this paper summarizes the mechanisms by which TCM improves cerebral injury after ICH and its comparison with conventional western medicine, so as to provide clues and a reference for the clinical application of TCM in the prevention and treatment of hemorrhagic stroke and further research and development of new drugs.
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Affiliation(s)
- Tian Duan
- State Key Laboratory of Component-based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China; Key Laboratory of Pharmacology of Traditional Chinese Medical Formulae, Ministry of Education, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China; Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
| | - Lin Li
- State Key Laboratory of Component-based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China; Key Laboratory of Pharmacology of Traditional Chinese Medical Formulae, Ministry of Education, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China; Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
| | - Yajun Yu
- State Key Laboratory of Component-based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China; Key Laboratory of Pharmacology of Traditional Chinese Medical Formulae, Ministry of Education, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China; Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
| | - Tiantian Li
- State Key Laboratory of Component-based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China; Key Laboratory of Pharmacology of Traditional Chinese Medical Formulae, Ministry of Education, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China; Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
| | - Rui Han
- State Key Laboratory of Component-based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China; Key Laboratory of Pharmacology of Traditional Chinese Medical Formulae, Ministry of Education, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China; Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
| | - Xingyi Sun
- State Key Laboratory of Component-based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China; Key Laboratory of Pharmacology of Traditional Chinese Medical Formulae, Ministry of Education, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China; Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
| | - Yan Cui
- State Key Laboratory of Component-based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China; Key Laboratory of Pharmacology of Traditional Chinese Medical Formulae, Ministry of Education, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China; Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
| | - Tao Liu
- State Key Laboratory of Component-based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China; Key Laboratory of Pharmacology of Traditional Chinese Medical Formulae, Ministry of Education, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China; Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
| | - Xiaoying Wang
- State Key Laboratory of Component-based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China; Key Laboratory of Pharmacology of Traditional Chinese Medical Formulae, Ministry of Education, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China; Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
| | - Yu Wang
- State Key Laboratory of Component-based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China; School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
| | - Xiang Fan
- School of Basic Medical Sciences, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yang Liu
- Key Laboratory of Pharmacology of Traditional Chinese Medical Formulae, Ministry of Education, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China; Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
| | - Han Zhang
- State Key Laboratory of Component-based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China; Key Laboratory of Pharmacology of Traditional Chinese Medical Formulae, Ministry of Education, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China; Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China.
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Abstract
As the principal water channel in the brain, aquaporin-4 (AQP4) plays a vital role in brain edema, but its role in blast brain edema is unclear. On the basis of molecular simulations, we reveal the atomically detailed picture of AQP4 in response to blast shockwaves. The results show that the shockwave alone closes the AQP4 channel; however, shock-induced bubble collapse opens it. The jet from bubble collapse forcefully increases the distance between helices and the tilt angles of six helices relative to the membrane vertical direction in a very short time. The average channel size increases about 2.6 times, and the water flux rate is nearly 20 times higher than for normal states. It is responsible for abnormal water transport and a potential cause of acute blast brain edema. Additionally, the open AQP4 channel quickly returns to its normal state, which is in turn helpful for edema absorption. Thus, a novel gating mechanism for AQP4 related to the secondary structure change has been provided, which is different from the previous residue-mediated gating mechanism.
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Affiliation(s)
- Tong Wei
- Institute of Chemical Materials, China Academy of Engineering and Physics, Mianyang 621900, China
- CAS Key Laboratory of Mechanical Behavior and Design of Materials, Department of Modern Mechanics, University of Science and Technology of China, Hefei 230026, China
| | - Mi Zhou
- Institute of Chemical Materials, China Academy of Engineering and Physics, Mianyang 621900, China
| | - Lingzhi Gu
- Institute of Chemical Materials, China Academy of Engineering and Physics, Mianyang 621900, China
| | - Hong Yang
- Institute of Chemical Materials, China Academy of Engineering and Physics, Mianyang 621900, China
| | - Yang Zhou
- Institute of Chemical Materials, China Academy of Engineering and Physics, Mianyang 621900, China
| | - Ming Li
- Institute of Chemical Materials, China Academy of Engineering and Physics, Mianyang 621900, China
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Yang Q, Zhang S, Xu Z, Liu L, Fan S, Wu S, Ma C. The Effectiveness of Trigeminal Nerve Stimulation on Traumatic Brain Injury. Neuromodulation 2022; 25:1330-1337. [PMID: 35088758 DOI: 10.1016/j.neurom.2021.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 09/10/2021] [Accepted: 10/12/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Trigeminal nerve stimulation (TNS) is a promising strategy in treating diseases of the nervous system. In this study, the effects of TNS on traumatic brain injury (TBI) were investigated in a mouse model. MATERIALS AND METHODS TBI was induced using a weight-drop device, and TNS treatment was delivered in the first hour after the TBI. Twenty-four hours later, the mice's behavior, brain edema, and expression of inflammatory factors were tested. Functional magnetic resonance imaging also was used to explore the possible effects of TNS on brain activity. RESULTS TNS alleviates TBI-induced neurological dysfunction in animal behavior tests, besides protecting the blood-brain barrier and reducing the level of brain edema. TNS also effectively reduces the level of tumor necrosis factor-α and interleukin 6 and downregulates the cleaved caspase-3 signaling pathway. A series of brain areas was found to be possibly regulated by TNS, thus affecting the neural functions of animals. CONCLUSION This study elucidates the role of TNS as an effective treatment for TBI by inhibiting the occurrence of a secondary brain injury.
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Affiliation(s)
- Qian Yang
- Department of Rehabilitation, Sun Yat-sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Subo Zhang
- Department of Rehabilitation, Sun Yat-sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Zhen Xu
- Department of Rehabilitation, Sun Yat-sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Lijiaqi Liu
- Department of Rehabilitation, Sun Yat-sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Shengnuo Fan
- Department of Rehabilitation, Sun Yat-sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Shaoling Wu
- Department of Rehabilitation, Sun Yat-sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Chao Ma
- Department of Rehabilitation, Sun Yat-sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.
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Al-Mufti F, Mayer SA, Kaur G, Bassily D, Li B, Holstein ML, Ani J, Matluck NE, Kamal H, Nuoman R, Bowers CA, S Ali F, Al-Shammari H, El-Ghanem M, Gandhi C, Amuluru K. Neurocritical care management of poor-grade subarachnoid hemorrhage: Unjustified nihilism to reasonable optimism. Neuroradiol J 2021; 34:542-551. [PMID: 34476991 PMCID: PMC8649190 DOI: 10.1177/19714009211024633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND AND PURPOSE Historically, overall outcomes for patients with high-grade subarachnoid hemorrhage (SAH) have been poor. Generally, between physicians, either reluctance to treat, or selectivity in treating such patients has been the paradigm. Recent studies have shown that early and aggressive care leads to significant improvement in survival rates and favorable outcomes of grade V SAH patients. With advancements in both neurocritical care and end-of-life care, non-treatment or selective treatment of grade V SAH patients is rarely justified. Current paradigm shifts towards early and aggressive care in such cases may lead to improved outcomes for many more patients. MATERIALS AND METHODS We performed a detailed review of the current literature regarding neurointensive management strategies in high-grade SAH, discussing multiple aspects. We discussed the neurointensive care management protocols for grade V SAH patients. RESULTS Acutely, intracranial pressure control is of utmost importance with external ventricular drain placement, sedation, optimization of cerebral perfusion pressure, osmotherapy and hyperventilation, as well as cardiopulmonary support through management of hypotension and hypertension. CONCLUSIONS Advancements of care in SAH patients make it unethical to deny treatment to poor Hunt and Hess grade patients. Early and aggressive treatment results in a significant improvement in survival rate and favorable outcome in such patients.
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Affiliation(s)
- Fawaz Al-Mufti
- Department of Neurology, Westchester Medical Center, Westchester Medical Center, Valhalla, USA
- Department of Neurosurgery, Westchester Medical Center, Westchester Medical Center, Valhalla, USA
| | - Stephan A Mayer
- Department of Neurosurgery, Westchester Medical Center, Westchester Medical Center, Valhalla, USA
| | - Gurmeen Kaur
- Department of Neurology, Westchester Medical Center, Westchester Medical Center, Valhalla, USA
- Department of Neurosurgery, Westchester Medical Center, Westchester Medical Center, Valhalla, USA
| | - Daniel Bassily
- School of Medicine, New York Medical College, New York Medical College, Valhalla, USA
| | - Boyi Li
- School of Medicine, New York Medical College, New York Medical College, Valhalla, USA
| | - Matthew L Holstein
- School of Medicine, New York Medical College, New York Medical College, Valhalla, USA
| | - Jood Ani
- School of Medicine, New York Medical College, New York Medical College, Valhalla, USA
| | - Nicole E Matluck
- School of Medicine, New York Medical College, New York Medical College, Valhalla, USA
| | - Haris Kamal
- Department of Neurosurgery, Westchester Medical Center, Westchester Medical Center, Valhalla, USA
| | - Rolla Nuoman
- Department of Neurology, Westchester Medical Center, Maria Fareri Children’s Hospital, Westchester Medical Center, Valhalla, USA
| | | | - Faizan S Ali
- Department of Neurology, Westchester Medical Center, Westchester Medical Center, Valhalla, USA
| | - Hussein Al-Shammari
- Department of Neurology, Westchester Medical Center, Westchester Medical Center, Valhalla, USA
| | - Mohammad El-Ghanem
- Department of Neurology, Neurosurgery and Medical Imaging, University of Arizona, Tucson, USA
| | - Chirag Gandhi
- Department of Neurosurgery, Westchester Medical Center, Westchester Medical Center, Valhalla, USA
| | - Krishna Amuluru
- Goodman Campbell Brain and Spine, Ascension St. Vincent Medical Center, Indianapolis, USA
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Abboud T, Hahn G, Just A, Paidhungat M, Nazarenus A, Mielke D, Rohde V. An insight into electrical resistivity of white matter and brain tumors. Brain Stimul 2021; 14:1307-1316. [PMID: 34481094 DOI: 10.1016/j.brs.2021.08.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 08/27/2021] [Accepted: 08/31/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND There is a lack of information regarding electrical properties of white matter and brain tumors. OBJECTIVE To investigate the feasibility of in-vivo measurement of electrical resistivity during brain surgery and establish a better understanding of the resistivity patterns of brain tumors in correlation to the white matter. METHODS A bipolar probe was used to measure electrical resistivity during surgery in a prospective cohort of patients with brain tumors. For impedance measurement, the probe applied a constant current of 0.7 μA with a frequency of 140 Hz. The measurement was performed in the white matter within and outside peritumoral edema as well as in non-enhancing, enhancing and necrotic tumor areas. Resistivity values expressed in ohmmeter (Ω∗m) were compared between different intracranial tissues and brain tumors. RESULTS Ninety-two patients (gliomas WHO II:16, WHO III:10, WHO IV:33, metastasis:33) were included. White matter outside peritumoral edema had higher resistivity values (13.3 ± 1.7 Ω∗m) than within peritumoral edema (8.5 ± 1.6 Ω∗m), and both had higher values than brain tumors including non-enhancing (WHO II:6.4 ± 1.3 Ω∗m, WHO III:6.3 ± 0.9 Ω∗m), enhancing (WHO IV:5 ± 1 Ω∗m, metastasis:5.4 ± 1.3 Ω∗m) and necrotic tumor areas (WHO IV:3.9 ± 1.1 Ω∗m, metastasis:4.3 ± 1.3 Ω∗m), p=<0.001. No difference was found between low-grade and anaplastic gliomas, p = 0.808, while resistivity values in both were higher than the highest values found in glioblastomas, p = 0.003 and p = 0.004, respectively. CONCLUSIONS The technique we applied enabled us to measure electrical resistivity of white matter and brain tumors in-vivo presumably with a significant effect with regard to dielectric polarization. Our results suggest that there are significant differences within different areas and subtypes of brain tumors and that white matter exhibits higher electrical resistivity than brain tumors.
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Affiliation(s)
- Tammam Abboud
- Department of Neurosurgery, University Medical Center Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany.
| | - Günter Hahn
- Department of Anesthesiology, EIT Research Unit, University Medical Center Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany
| | - Anita Just
- Department of Anesthesiology, EIT Research Unit, University Medical Center Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany
| | - Mihika Paidhungat
- Department of Neurosurgery, University Medical Center Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany
| | - Angelina Nazarenus
- Department of Neurosurgery, University Medical Center Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany
| | - Dorothee Mielke
- Department of Neurosurgery, University Medical Center Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany
| | - Veit Rohde
- Department of Neurosurgery, University Medical Center Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany
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De Kegel D, Musigazi GU, Menichetti A, Hellings PW, Sciot R, Demaerel P, Famaey N, Vander Sloten J, Depreitere B. Investigation of tissue level tolerance for cerebral contusion in a controlled cortical impact porcine model. Traffic Inj Prev 2021; 22:616-622. [PMID: 34477471 DOI: 10.1080/15389588.2021.1957856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 07/09/2021] [Accepted: 07/16/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Cerebral contusions (CC) represent a frequent lesion in traumatic brain injury, with potential morbidity from mass effect and tissue loss. Better understanding of the mechanical etiology will help to improve head protection. The goal of this study is to investigate the threshold for mechanical impact parameters to induce CC in an in vivo porcine controlled cortical impact model. METHODS Thirty-four adult male pigs underwent craniotomy and controlled cortical impact with a hemispherical tip on intact dura under general anesthesia. Peak impact depth varied between 1.1 and 12.6 mm, and impact velocity between 0.4 and 2.2 m/s while the dwell time was kept at 200 ms. Two days following impact, the animals underwent magnetic resonance (MR) imaging of the brain, and were subsequently sacrificed for brain extraction. CC damage was investigated by magnetic resonance imaging and histology. RESULTS All animals recovered from the impact without overt neurological deficit. Provoked injuries were histologically confirmed to be CC. Decreasing probability of cortical damage and white matter edema volume was observed with decreasing impact depth and velocity. No CC could be demonstrated below a product of impact depth and velocity of 0.8 mm*m/s, whereas the probability for CC was one third below 15 mm*m/s. The threshold for CC development as estimated from the current series of experiments, was situated at an impact depth of 2.0 mm and impact velocity of 0.4 m/s. CONCLUSION Mechanical thresholds for CC development could be explored in the current porcine controlled cortical impact model. Findings will be used to further refine a cerebral contusion porcine model with volumetric histology data in light of future finite element cerebral contusion validation studies.
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Affiliation(s)
| | | | | | | | - Raf Sciot
- Translation Cell and Tissue Research, KULeuven, Leuven, Belgium
| | | | - Nele Famaey
- Biomechanics section, KULeuven, Heverlee, Belgium
| | | | - Bart Depreitere
- Experimental Neurosurgery and Neuroanatomy, KULeuven, Leuven, Belgium
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70
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Morotti A, Busto G, Scola E, Carlesi E, Di Pasquale F, Casetta I, Fainardi E. Association between perihematomal perfusion and intracerebral hemorrhage shape. Neuroradiology 2021; 63:1563-1567. [PMID: 33855584 DOI: 10.1007/s00234-021-02709-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 03/31/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The pathophysiological determinants of irregular intracerebral hemorrhage (ICH) shape are unclear. We aimed at characterizing the relationship between perihematomal perfusion and ICH shape. METHODS A single-center cohort of patients with primary ICH was analyzed. Patients underwent computed tomography perfusion within 6 h from onset. Cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time (MTT) were calculated in the manually outlined perihematomal low-density region. ICH shape was rated on baseline non-contrast CT following international consensus criteria, and predictors of irregular shape were explored with logistic regression. RESULTS A total of 150 patients were included, of whom 66 (44%) had irregular shape. Perihematomal CBF was lower in irregular ICH (median 23 vs 35 mL/100 g/min, p<0.001). CBF<20 mL/100 g/min was independently associated with irregular shape (odds ratio 9.67, 95% CI 2.42-38.69, p=0.001). CONCLUSION Our findings suggest that perihematomal hypoperfusion may contribute to the CT appearance of acute ICH.
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Affiliation(s)
- Andrea Morotti
- Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, Brescia, Italy.
| | - Giorgio Busto
- Neuroradiology Unit, Department of Radiology, Careggi University Hospital, Florence, Italy
| | - Elisa Scola
- Neuroradiology Unit, Department of Radiology, Careggi University Hospital, Florence, Italy
| | - Edoardo Carlesi
- Neuroradiology Unit, Department of Radiology, Careggi University Hospital, Florence, Italy
| | - Francesca Di Pasquale
- Diagnostic Imaging Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Ilaria Casetta
- Section of Neurology, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Enrico Fainardi
- Neuroradiology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
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Rugg-Gunn CEM, Deakin M, Hawcutt DB. Update and harmonisation of guidance for the management of diabetic ketoacidosis in children and young people in the UK. BMJ Paediatr Open 2021; 5:e001079. [PMID: 34151029 PMCID: PMC8183192 DOI: 10.1136/bmjpo-2021-001079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/21/2021] [Indexed: 11/04/2022] Open
Abstract
Diabetic ketoacidosis (DKA) is a life-threatening complication of type 1 diabetes mellitus. Careful and timely intervention is required to optimise glycaemic control and reduce the risk of mortality and devastating complications. Of these, cerebral oedema is the leading cause of death, with a mortality rate of approximately 25%. This article highlights the recent updates to UK fluid therapy guidelines for DKA and provides clinical context for the benefit of paediatricians and junior doctors in light of this new guidance.
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Affiliation(s)
- Charlotte EM Rugg-Gunn
- University of Liverpool School of Medicine, Liverpool, UK
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - Mark Deakin
- Alder Hey Children’s Hospital, Liverpool, UK
| | - Daniel B Hawcutt
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
- NIHR Alder Hey Clinical Research Facility, Liverpool, UK
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Cortes MX, Siaron KB, Nadim HT, Ahmed KM, Romito JW. Neurological Pupil Index as an Indicator of Irreversible Cerebral Edema: A Case Series. J Neurosci Nurs 2021; 53:145-148. [PMID: 33782353 DOI: 10.1097/jnn.0000000000000584] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT BACKGROUND: Assessing the pupillary light reflex is a core component of neurological assessments. Pupil size and reactivity can provide early warning about early neurological decline. Automated infrared pupillometry is noninvasive and easy to use and has greater reliability compared with manual assessments to obtain objective and consistent measurements of pupillary size and reactivity to light. METHODS: This is a case series of 3 patients who had poor baseline clinical neurological examinations. Because it would be more difficult to detect acute neurological deterioration, automated infrared pupillometry and the Neurological Pupil index (NPi) were used in addition to the clinical neurological examination. NPi values < 3.0 prompted further imaging. RESULTS: In each case, abnormal NPi values prompted emergent imaging that confirmed acute cerebral edema and resulted in a change in management and treatment plan. CONCLUSION: The automated infrared pupillometry is a noninvasive monitor that can provide additional objective data in patients with a poor baseline neurological examination in whom it may otherwise be difficult to detect neurological deterioration.
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Abstract
BACKGROUND The aim of this study is to assess the adherence of Austrian physicians to International Society for Pediatric and Adolescent Diabetes guidelines 2009 concerning treatment in diabetic ketoacidosis and whether there is a difference between specialty (endocrinologists or intensivists) or clinical experience. PATIENTS AND METHODS An online questionnaire was sent to members of the working groups of the Austrian Society of Pediatric and Adolescent Medicine. RESULTS Of 106 questionnaires, 56 were included in the analysis. The mean ± SD overall adherence was 60 ± 23.5%. Endocrinologists showed a nonsignificant higher result, related to a significant higher adherence regarding the amount of fluids (P < 0.05) and tendency to bicarbonate use (P = 0.052) respectively. No differences were found between participants with different clinical experience. All gave crystalloids, 55% administered initial bolus of 10 to 20 mL/kg per hour, 58% used 1.5 to 2 times fluid maintenance, 87% started insulin after first fluid bolus, 28% gave 0.05 and 0.1 IE/kg per hour to infants and children respectively, and 43% 0.05 IE/kg per hour to all patients. When blood glucose falls, 53% gave glucose and 47% reduced insulin. In cerebral edema, 46% gave at least 2 of 3 recommended measures (fluid reduction, mannitol, or hypertonic saline). In acidosis (pH <6.9), 25% administered bicarbonate (as per guideline) and 52.9% never gave bicarbonate. CONCLUSIONS Adherence to the actual guidelines is 60% and does neither depend on speciality nor on clinical routine. Essential treatment measures (eg, amount of fluids, consequence of rapid glucose fall, bicarbonate use) are not commonly known.
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Affiliation(s)
- Katharina Weinberger
- From the Department of Pediatrics, Academic Teaching Hospital, Landeskrankenhaus Feldkirch, Feldkirch, Austria
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Chen SY, Thompson-Leduc P, Sawyer RN, Fakih I, Cheung HC, Macheca M, Kirson NY, Torbey M. Outcomes and resource use of patients with large hemispheric infarction and cerebral edema: analysis of real-world data. Curr Med Res Opin 2021; 37:781-788. [PMID: 33685308 DOI: 10.1080/03007995.2021.1900090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Large hemispheric infarction (LHI) is associated with a high likelihood of the evolution of life-threatening edema. Few studies have assessed real-world clinical outcomes and management strategies among patients with LHI. The objective of this study was to describe the management, in-hospital outcomes, and direct healthcare resource burden of patients with LHI, as well as those of patients with subsequent cerebral edema. METHODS This observational, retrospective cohort study analyzed de-identified data from US adult patients using the IBM MarketScan Hospital Drug Database (Q4-2015 to Q4-2017). Patients were included in the "Possible LHI" or the "Other Ischemic Strokes" cohorts using ICD-10 diagnosis codes. Patients with possible LHI were further categorized into "LHI with Edema" and "LHI without Edema" subgroups using diagnosis and procedure codes. Select clinical and economic outcomes were compared between cohorts and subgroups using multivariable regressions. RESULTS Of 79,201 eligible encounters with ischemic strokes, 11,772 unique patients were assigned to the Possible LHI cohort while 67,429 were assigned to the Other Ischemic Strokes cohort. Among patients with possible LHI, 869 (7%) were assigned to the LHI with Edema subgroup and 10,903 (93%) were assigned to the LHI without Edema subgroup. Patients in the Possible LHI cohort had longer hospital stays (mean difference [MD] [95%CI] = 2.6 [2.4;2.8] days), higher total facility charges (MD [95%CI] = $28,656 [26,794;30,524]), and higher odds of death (odds ratio [95%CI] = 2.2 [2.0;2.4]) than the Other Ischemic Strokes cohort. Among patients with possible LHI, the incremental clinical and resource burden was further exacerbated in the subgroup of patients with edema (hospital days: MD [95%CI] = 5.0 [3.9;6.2] days; total facility charges: MD [95%CI] = $59,585 [50,816;67,583]; mortality: odds ratio [95%CI] = 10.3 [8.5;12.4]). CONCLUSIONS Among patients with ischemic strokes, LHI was associated with increased clinical management and direct healthcare resource burden in real-world hospital settings. The burden was substantially increased among patients who developed cerebral edema.
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Affiliation(s)
| | | | - Robert N Sawyer
- Department of Neurology, University at Buffalo, Buffalo, NY, USA
| | | | | | | | | | - Michel Torbey
- Department of Neurology, University of New Mexico, Albuquerque, NM, USA
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Gomez A, Batson C, Froese L, Zeiler FA. Genetic Variation and Impact on Outcome in Traumatic Brain Injury: an Overview of Recent Discoveries. Curr Neurol Neurosci Rep 2021; 21:19. [PMID: 33694085 DOI: 10.1007/s11910-021-01106-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Traumatic brain injury (TBI) has a significant burden of disease worldwide and outcomes vary widely. Current prognostic tools fail to fully account for this variability despite incorporating clinical, radiographic, and biochemical data. This variance could possibly be explained by genotypic differences in the patient population. In this review, we explore single nucleotide polymorphism (SNP) TBI outcome association studies. RECENT FINDINGS In recent years, SNP association studies in TBI have focused on global, neurocognitive/neuropsychiatric, and physiologic outcomes. While the APOE gene has been the most extensively studied, other genes associated with neural repair, cell death, the blood-brain barrier, cerebral edema, neurotransmitters, mitochondria, and inflammatory cytokines have all been examined for their association with various outcomes following TBI. The results have been mixed across studies and even within genes. SNP association studies provide insight into mechanisms by which outcomes may vary following TBI. Their individual clinical utility, however, is often limited by small sample sizes and poor reproducibility. In the future, they may serve as hypothesis generating for future therapeutic targets.
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Affiliation(s)
- Alwyn Gomez
- Section of Neurosurgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Human Anatomy and Cell Science, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Carleen Batson
- Department of Human Anatomy and Cell Science, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Logan Froese
- Biomedical Engineering, Faculty of Engineering, University of Manitoba, Winnipeg, MB, Canada
| | - Frederick A Zeiler
- Section of Neurosurgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
- Department of Human Anatomy and Cell Science, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
- Biomedical Engineering, Faculty of Engineering, University of Manitoba, Winnipeg, MB, Canada.
- Centre on Aging, University of Manitoba, Winnipeg, MB, Canada.
- Division of Anaesthesia, Department of Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.
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Ide S, Kiyosue H. [Dural Arteriovenous Fistula]. No Shinkei Geka 2021; 49:362-367. [PMID: 33762458 DOI: 10.11477/mf.1436204399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Dural arteriovenous fistulas(dAVFs), which are arteriovenous shunts between the dural/epidural artery and dural vein and/or dural venous sinus, can cause various symptoms, and the risk of aggressive symptoms such as cerebral hemorrhage and venous infarction mainly depends on venous drainage patterns in patients. Patients with dAVFs with cortical venous reflux have a high risk of aggressive symptoms due to cerebral venous congestion or varix rupture, and they often develop brain edema and/or hemorrhage. In some cases, patients with dAVFs may have CT and MRI findings similar to those of patients with brain tumors. Key MRI findings suggesting dAVFs include multiple small flow voids representing cortical venous reflux adjacent to the hemorrhage or edematous lesion on T2WI and dot-like high-signal-intensity patterns of the feeding arteries and draining veins on time-of-flight MR angiography source images. Cerebral angiography should be performed quickly when dAVFs are suspected with careful assessment using CT/MRI to prevent further worsening of symptoms, particularly for lesions involving the brain stem and cerebellum.
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Affiliation(s)
- Satomi Ide
- Department of Radiology, Faculty of Medicine, Oita University
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Chen X, Xiang X, Xie T, Chen Z, Mou Y, Gao Z, Xie X, Song M, Huang H, Gao Z, Chen M. Memantine protects blood-brain barrier integrity and attenuates neurological deficits through inhibiting nitric oxide synthase ser1412 phosphorylation in intracerebral hemorrhage rats: involvement of peroxynitrite-related matrix metalloproteinase-9/NLRP3 inflammasome activation. Neuroreport 2021; 32:228-237. [PMID: 33470757 PMCID: PMC7870044 DOI: 10.1097/wnr.0000000000001577] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 10/05/2020] [Indexed: 01/08/2023]
Abstract
Memantine has demonstrated beneficial effects on several types of brain insults via therapeutic mechanisms mainly related to its activity as a receptor antagonist of N-methyl-d-aspartate. However, the influences of memantine on intracerebral hemorrhage (ICH) remain obscure. This research probed into the neurovascular protective mechanisms of memantine after ICH and its impacts on neuronal nitric oxide synthase (nNOS) ser1412 phosphorylation. ICH model was established by employing intrastriatal collagenase injection in rats. After modeling, rats were then allocated randomly into sham-operated (sham), vehicle-treated (ICH+V), and memantine-administrated (ICH+M) groups. Memantine (20 mg/kg/day) was intraperitoneally administered 30 min after ICH and thenceforth once daily. Rats were dedicated at 0.25, 6, 12, 24 h, 3 and 7 d post-ICH for measurement of corresponding indexes. Behavioral changes, brain edema, levels of nNOS ser1412 phosphorylation, peroxynitrite, matrix metalloproteinase (MMP)-9, NLRP3, IL-1β and numbers of dying neurons, as well as the cellular localization of gelatinolytic activity, were detected among the groups. Memantine improved the neurologic deficits and mitigated brain water content, levels of MMP-9, NLRP3, IL-1β and dying neurons. Additionally, treatment with memantine also reduced nNOS ser1412 phosphorylation and peroxynitrite formation compared with the ICH+V group at 24 h after ICH. In situ zymography simultaneously revealed that gelatinase activity was primarily colocalized with vessel walls and neurons. We concluded that memantine ameliorated blood-brain barrier disruption and neurologic dysfunction in an ICH rat model. The underlying mechanism might involve repression of nNOS ser1412 phosphorylation, as well as peroxynitrite-related MMP-9 and NLRP3 inflammasome activation.
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Affiliation(s)
- Xiaowei Chen
- Department of Neurosurgery, the First People’s Hospital of Jingmen City
| | - Xu Xiang
- Department of Neurosurgery, Jingmen Clinical Medical School, Hubei Minzu University, Hubei Province
| | - Teng Xie
- Department of Neurosurgery, the First People’s Hospital of Jingmen City
| | - Zhijun Chen
- Department of Neurosurgery, the First People’s Hospital of Jingmen City
| | - Yu Mou
- Department of Neurosurgery, Jingmen Clinical Medical School, Hubei Minzu University, Hubei Province
| | - Zixu Gao
- The Second Clinical Medical College of Nanchang University
| | - Xun Xie
- The Second Clinical Medical College of Nanchang University
| | - Min Song
- The Second Clinical Medical College of Nanchang University
| | - Hui Huang
- Department of Neurosurgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - Ziyun Gao
- Department of Neurosurgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - Min Chen
- The Second Clinical Medical College of Nanchang University
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Sato T, Nishiyama Y, Suda S, Shimoyama T, Takahashi S, Sakamoto Y, Aoki J, Suzuki K, Sekine T, Kumita SI, Kimura K. "Computed Tomography Perihematomal Rims": A Perihematomal Low-Density Area Is a Part of an Acute Brain Hemorrhage. Intern Med 2021; 60:2395-2403. [PMID: 34334590 PMCID: PMC8381191 DOI: 10.2169/internalmedicine.6653-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective Computed tomography (CT) can be used for visualizing acute intracerebral hemorrhages (ICHs) as distinct hyperdense areas and cerebral edema as perihematomal low-density areas (LDAs). We observed a perihematomal LDA on CT, which appeared to be part of a hemorrhage on magnetic resonance imaging (MRI) in acute ICH. We named this "CT perihematomal rim" and evaluated its characteristics and clinical significance. Methods We stratified patients with acute ICH according to the presence or absence of a CT perihematomal rim and then compared their radiologic findings. Logistic regression analyses were performed to assess whether the CT findings can predict the presence of a CT perihematomal rim. Patients Patients within 24 hours of ICH onset who were admitted between September 1, 2014, and October 31, 2018, were registered. Results Overall, 139 patients (91 men; mean age, 66 years) were investigated. CT perihematomal rims were observed in 40 patients (29%). ICH volumes on CT were 30% smaller than those on MRI in patients with CT perihematomal rims. On a multivariate analysis, the presence of a CT perihematomal rim was independently associated with the maximum diameter of the perihematomal LDA. According to a receiver operating characteristic analysis, the maximum LDA diameter threshold was 7.5 mm (sensitivity, 85%; specificity, 83%). Conclusion CT perihematomal rims were observed in 29% of the patients with acute ICH. A perihematomal LDA (>7.5 mm) in acute ICH cases should be considered a CT perihematomal rim. Clinicians should be aware that the ICH volume on CT may be underestimated by 30%.
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Affiliation(s)
- Takahiro Sato
- Department of Neurology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Yasuhiro Nishiyama
- Department of Neurology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Satoshi Suda
- Department of Neurology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Takashi Shimoyama
- Department of Neurology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Shiro Takahashi
- Department of Neurology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Yuki Sakamoto
- Department of Neurology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Junya Aoki
- Department of Neurology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Kentaro Suzuki
- Department of Neurology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Tetsuro Sekine
- Department of Radiology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Shin-Ichiro Kumita
- Department of Radiology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Kazumi Kimura
- Department of Neurology, Graduate School of Medicine, Nippon Medical School, Japan
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Loggini A, Tangonan R, El Ammar F, Mansour A, Kramer CL, Lazaridis C, Goldenberg FD. Neuroendocrine Dysfunction in the Acute Setting of Penetrating Brain Injury: A Systematic Review. World Neurosurg 2020; 147:172-180.e1. [PMID: 33346052 DOI: 10.1016/j.wneu.2020.12.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 12/09/2020] [Accepted: 12/10/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Data on neuroendocrine dysfunction (NED) in the acute setting of penetrating brain injury (PBI) are scarce, and the clinical approach to diagnosis and treatment remains extrapolated from the literature on blunt head trauma. METHODS Three databases were searched (PubMed, Scopus, and Cochrane). Risk of bias was computed using the Newcastle-Ottawa Scale, or the methodological quality of case series and case reports, as indicated. This systematic review was registered in PROSPERO (42020172163). RESULTS Six relevant studies involving 58 patients with PBI were included. Two studies were prospective cohort analyses, whereas 4 were case reports. The onset of NED was acute in all studies, by the first postinjury day. Risk factors for NED included worse injury severity and the presence of cerebral edema on imaging. Dysfunction of the anterior hypophysis involved the hypothalamic-pituitary-thyroid axis, treated with hormonal replacement, and hypocortisolism, treated with hydrocortisone. The prevalence of central diabetes insipidus was up to 41%. Most patients showed persistent NED months after injury. In separate reports, diabetes insipidus and hypocortisolism showed an association with higher mortality. The available literature for this review is poor, and the studies included had overall low quality with high risk of bias. CONCLUSIONS NED seems to be prevalent in the acute phase of PBI, equally involving both anterior and posterior hypophysis. Despite a potential association between NED and mortality, data on the optimal management of NED are limited. This situation defines the need for prospective studies to better characterize the clinical features and optimal therapeutic interventions for NED in PBI.
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Affiliation(s)
- Andrea Loggini
- Neuroscience Intensive Care Unit, Department of Neurology, University of Chicago Medical Center, Chicago, Illinois, USA.
| | - Ruth Tangonan
- Neuroscience Intensive Care Unit, Department of Neurology, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Faten El Ammar
- Neuroscience Intensive Care Unit, Department of Neurology, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Ali Mansour
- Neuroscience Intensive Care Unit, Department of Neurology, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Christopher L Kramer
- Neuroscience Intensive Care Unit, Department of Neurology, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Christos Lazaridis
- Neuroscience Intensive Care Unit, Department of Neurology, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Fernando D Goldenberg
- Neuroscience Intensive Care Unit, Department of Neurology, University of Chicago Medical Center, Chicago, Illinois, USA
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80
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Abstract
AIM To investigate the changes of water content in brain tissue, the expression of AQP4mRNA after cerebral hemorrhage in rats, and the intervention effect of Protease activated receptor 1 inhibitor (PAR1 inhibitor) on both. METHODS Establish sham operation group (Sham group), ICH group, ICH+PAR1 inhibitor high-dose group (PI(H)group), ICH+PAR1 inhibitor low-dose group (PI(L)group), 25 in each group. Neural dysfunction scores were performed at 1d, 3d, 7d, 14d, and 21d after surgery, and brain water content and AQP4mRNA content were measured. RESULTS Results: The neurological dysfunction and cerebral edema of rats with cerebral hemorrhage reached the peak at 3 days after operation. With the increase of time, the water content and AQP4mRNA content in the PL(H)group were higher than those in the PI(L)group. The differences were statistically significant. CONCLUSIONS Appropriate inhibition of PAR1 can alleviate cerebral edema around the hematoma and play a role in improving the function of nerve defects. The mechanism may be realized by down-regulating the expression of AQP4mRNA in brain tissue (Tab. 3, Fig. 3, Ref. 25).
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81
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唐 兆, 王 文, 刘 自, 孙 晓, 廖 正, 陈 飞, 蒋 光, 霍 钢. [Blocking ERK signaling pathway lowers MMP-9 expression to alleviate brain edema after traumatic brain injury in rats]. Nan Fang Yi Ke Da Xue Xue Bao 2020; 40:1018-1022. [PMID: 32895167 PMCID: PMC7386209 DOI: 10.12122/j.issn.1673-4254.2020.07.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To investigate the effects of blocking the activation of ERK pathway on the expression of matrix metalloproteinase-9 (MMP-9) and the formation of cerebral edema in SD rats after brain injury. METHODS Ninety SD rats were randomly divided into 3 equal groups, including a sham-operated group, modified Feeney's traumatic brain injury model group, and ERK inhibition group where the ERK inhibitor SCH772984 (500 μg/kg) was injected via the femoral vein 15 min before brain trauma. At 2 h and 2 days after brain trauma, the permeability of blood-brain barrier was assessed by Evans blue method, the water content of the brain tissue was determined, and the phosphorylation level of ERK and the expression level of MMP-9 mRNA and protein were measured by RT-PCR and Western blotting. RESULTS Compared with the sham-operated group, the rats with brain trauma exhibited significantly increased level of ERK phosphorylation at 2 h and significantly increased expression of MMP-9 mRNA and protein 2 days after the injury (P < 0.01). Treatment with the ERK inhibitor significantly decreased the phosphorylation level of ERK after the injury (P < 0.01), suppressed over-expression of MMP-9 mRNA and protein 2 days after the injury (P < 0.01). The permeability of blood-brain barrier increased significantly 2 h after brain trauma (P < 0.05) and increased further at 2 days (P < 0.01); the water content of the brain did not change significantly at 2 h (P > 0.05) but increased significantly 2 d after the injury (P < 0.01). Treatment with the ERK inhibitor significantly lowered the permeability of blood-brain barrier and brain water content after brain trauma (P < 0.01). CONCLUSIONS Blocking the activation of ERK pathway significantly reduced the over-expression of MMP-9 and alleviates the damage of blood-brain barrier and traumatic brain edema, suggesting that ERK signaling pathway plays an important role in traumatic brain edema by regulating the expression of MMP-9.
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Affiliation(s)
- 兆华 唐
- 重庆医科大学附属第一医院神经外科,重庆 400016Department of Neurosurgery, First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - 文涛 王
- 西北大学附属医院神经外科,陕西 西安 710018Department of Neurosurgery, Affiliated Hospital of Northwest University, Xi'an, 710018, China
| | - 自力 刘
- 重庆医科大学附属第一医院神经外科,重庆 400016Department of Neurosurgery, First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - 晓川 孙
- 重庆医科大学附属第一医院神经外科,重庆 400016Department of Neurosurgery, First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - 正步 廖
- 重庆医科大学附属第一医院神经外科,重庆 400016Department of Neurosurgery, First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - 飞兰 陈
- 重庆医科大学附属第一医院神经外科,重庆 400016Department of Neurosurgery, First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - 光远 蒋
- 重庆 市中医院神经外科,重庆 400021Department of Neurosurgery, Chongqing Traditional Chinese Medicine Hospital, Chongqing 400021, China
| | - 钢 霍
- 重庆医科大学附属第一医院神经外科,重庆 400016Department of Neurosurgery, First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
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82
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Haque A, Khalilullah I, Ahmed M, Haque MM, Nancy C, Ullah MF, Tusher SM, Jahan K, Abedin S. A Comparative Study Between 20% Mannitol and 3% Hypertonic Saline for Brain Oedema Reduction during Elective Brain Tumour Surgery. Mymensingh Med J 2020; 29:646-651. [PMID: 32844807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Cerebral oedema is an important manifestation of brain tumour. The significant reduction of cerebral oedema can show rapid improvement of the patients. Hypertonic saline solution and mannitol both are commonly used for this action. It is now time to choose the better one. This was a prospective randomized comparative study designed to evaluate the efficacy of 3% hypertonic saline (NaCl) in reduction of brain oedema during brain tumour surgery and compare it with that of 20% Mannitol. The study was conducted in the department of Anaesthesiology, Combined Military Hospital, Dhaka, Bangladesh from July 2016 to December 2016. A total number of 47 patients for brain tumour surgery were selected. After screening 40 patients were finalized. Then the patients were divided into 2 equal groups 20 patients in each. Patients of Group A received 3% hypertonic saline and Group B 20% mannitol. Uniform anaesthetic technique applied for all patients, fixed surgeon/group of surgeons carried out the surgery. Heart rate and noninvasive blood pressure were monitored and kept with in ±20% baseline values different means. ETCO2 were kept in between 28-32mm of Hg by adjusting ventilator setting. Reduction of brain oedema was monitored by subjective assessment of surgeons using a 3 point scale of brain relaxation. The data were recorded in preformed data sheet. The results were tested by chi-square test to see their level of significance i.e. p value <0.05 was considered as significant. At the opening of dura, the number of brain conditions classified as soft, adequate and tight were statistically non-significant between groups. After 0.5 hour and 1.0 hour 10% patient's brain was tight in Group A whereas it was 35% and 40% in Group B respectively. Reduction of brain oedema or brain relaxation was significantly better in Group A compared to Group B (p<0.05). Urine output was higher with mannitol than hypertonic saline (p<0.05). Duration of ICU and hospital stay in both Group A and Group B were statistically similar (p>0.05). Compared to mannitol, hypertonic saline caused an increase in serum sodium concentration over time (p<0.05). From the available data, use of 20% mannitol and 3% hypertonic saline for brain oedema reduction, it is suggested that hypertonic saline significantly reduces the risk of tight brain and produce the brain more soft than mannitol during brain tumour surgery.
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Affiliation(s)
- A Haque
- Major Dr Ariful Haque, Major, Classified Anaesthesiologist, Department of Anaesthesiology, CMH Savar, Savar Cantonment, Dhaka, Bangladesh; E-mail:
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83
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Mahmood S, Talha KA, Mahmood W. Clinical Features and Location of Intracranial Edema in Posterior Reversible Encephalopathy Syndrome (PRES) Patients. Mymensingh Med J 2020; 29:633-637. [PMID: 32844805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This is an observational analytic study on clinical features and location of intracranial edema in case of posterior reversible encephalopathy syndrome (PRES). Place of study was Square Hospitals Ltd. Dhaka, Bangladesh. Study period was 1 year (from January 2010 to January 2011). Number of total cases was 5. Mean age of patients was 21 years. Common clinical features were headache, seizure and visual disturbance. Mean time of developing clinical feature(s) was 4.6 days after NVD or LUCS. Intracranial edema was common in occipital, frontal and parietal lobes.
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Affiliation(s)
- S Mahmood
- Dr Shagufta Mahmood, Consultant, Radiology and Imaging, Square Hospitals Ltd. Dhaka, Bangladesh; E-mail:
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84
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Klocker E, Pietsch C, Pietsch U. [Treatment options for acute respiratory distress syndrome in neurointensive care. Individual management due to enhanced neuromonitoring? : A case report series]. Anaesthesist 2020; 69:421-431. [PMID: 32303783 DOI: 10.1007/s00101-020-00769-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 01/14/2020] [Accepted: 03/19/2020] [Indexed: 11/25/2022]
Abstract
Severe pulmonary impairment can occur after traumatic brain injury or stroke. The resulting brain-lung interactions represent key points for the treatment and the subsequent outcome of the patient. Established treatment approaches, such as permissive hypercapnia and prone positioning, present the intensive care physician with divergent treatment goals in these patients with partially increased intracranial pressure. This case report series shows the instrument-based and noninstrument-based options for the treatment of acute respiratory distress syndrome (ARDS) in the simultaneous presence of intracranial pathologies. This includes equipment based therapies using extracorporeal CO2 elimination, special positioning maneuvers in specially designed hospital beds and positional maneuvers, such as prone positioning. With enhanced neuromonitoring it is possible to optimally adapt treatment measures focused on the lungs early and before secondary damage to the brain.
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Affiliation(s)
- E Klocker
- Klinik für Anästhesiologie, Intensiv‑, Rettungs- und Schmerzmedizin, Kantonsspital St. Gallen, 9007, St. Gallen, Schweiz.
| | - C Pietsch
- Klinik für Neurochirurgie, Kantonsspital St. Gallen, St. Gallen, Schweiz
| | - U Pietsch
- Klinik für Anästhesiologie, Intensiv‑, Rettungs- und Schmerzmedizin, Kantonsspital St. Gallen, 9007, St. Gallen, Schweiz
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85
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Araya A, Menon RK. Cerebral Edema in Diabetic Ketoacidosis - Fluid Shifts and Shifting Paradigms. Indian Pediatr 2020; 57:294-295. [PMID: 32284474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Adrian Araya
- Pediatric Endocrinology, CS Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan, USA
| | - Ram K Menon
- Pediatric Endocrinology, CS Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan, USA.
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86
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Wang L, Zheng S, Zhang L, Xiao H, Gan H, Chen H, Zhai X, Liang P, Zhao J, Li Y. Histone Deacetylation 10 Alleviates Inflammation After Intracerebral Hemorrhage via the PTPN22/NLRP3 Pathway in Rats. Neuroscience 2020; 432:247-259. [PMID: 32112918 DOI: 10.1016/j.neuroscience.2020.02.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 02/15/2020] [Accepted: 02/18/2020] [Indexed: 01/30/2023]
Abstract
The NOD-like receptor family Pyrin domain-containing 3 (NLRP3) inflammasome has a crucial role in the inflammatory process that occurs during intracerebral hemorrhage (ICH)-induced injury. Histone deacetylase 10 (HDAC10) is a newly identified class II histone deacetylase involved in immune responses. However, how HDAC10 affects the inflammatory response after ICH remains unknown. In this study, we investigated whether HDAC10 relieves ICH injury by suppressing NLRP3 inflammasome activation through the protein tyrosine phosphatase, nonreceptor type 22 (PTPN22) pathway. We induced ICH in Sprague-Dawley rats (healthy, male adult) with a single infusion of autologous blood. To knockdown HDAC10, we injected siRNA into the rats. To further explore the mechanisms underlying the role of HDAC10 in ICH injury, PTPN22 was silenced. HDAC10 levels were upregulated after ICH in humans and rats, and reached peak levels 24 h after ICH induction in rats. HDAC10 silencing aggravated ICH injury, as demonstrated by increased modified neurological severity scores, brain water content, Evans blue extravasation, and number of myeloperoxidase (MPO) cells, and the results of Nissl and H&E staining. Furthermore, HDAC10 knockdown increased the expression of PTPN22 and accentuated inflammatory responses mediated by the NLRP3 inflammasome. HDAC10 silencing increased NLRP3 inflammasome activation, and this was effectively reversed by PTPN22 knockdown using siRNA. Furthermore, HDAC10 silencing also promoted the interaction of PTPN22 and NLRP3. Our study demonstrated that HDAC10 silencing aggravated NLRP3-mediated inflammatory responses after ICH in rats via the PTPN22 pathway. These results suggest that regulating the NLRP3 inflammasome may be a novel method to ameliorate ICH injury.
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Affiliation(s)
- Lu Wang
- Department of Neurosurgery, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing 400010, PR China
| | - Shuyue Zheng
- Department of Neurosurgery, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing 400010, PR China
| | - Li Zhang
- Department of Neurosurgery, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing 400010, PR China
| | - Han Xiao
- Department of Neurosurgery, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing 400010, PR China
| | - Hui Gan
- Department of Neurosurgery, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing 400010, PR China
| | - Hui Chen
- Department of Neurosurgery, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing 400010, PR China
| | - Xuan Zhai
- Department of Neurosurgery, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing 400010, PR China
| | - Ping Liang
- Department of Neurosurgery, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing 400010, PR China
| | - Jing Zhao
- Department of Pathophysiology, Chongqing Medical University, Chongqing 400010, PR China; Institute of Neuroscience, Chongqing Medical University, Chongqing 400010, PR China.
| | - Yingliang Li
- Department of Neurosurgery, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing 400010, PR China.
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87
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Affiliation(s)
- Priyanka Madaan
- Pediatric Neurology Division, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Lokesh Saini
- Pediatric Neurology Division, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
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88
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Li Y, Wu P, Bihl JC, Shi H. Underlying Mechanisms and Potential Therapeutic Molecular Targets in Blood-Brain Barrier Disruption after Subarachnoid Hemorrhage. Curr Neuropharmacol 2020; 18:1168-1179. [PMID: 31903882 PMCID: PMC7770641 DOI: 10.2174/1570159x18666200106154203] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 12/18/2019] [Accepted: 01/04/2020] [Indexed: 01/01/2023] Open
Abstract
Aneurysmal subarachnoid hemorrhage (aSAH) is a subtype of hemorrhagic stroke with significant morbidity and mortality. Aneurysmal bleeding causes elevated intracranial pressure, decreased cerebral blood flow, global cerebral ischemia, brain edema, blood component extravasation, and accumulation of breakdown products. These post-SAH injuries can disrupt the integrity and function of the blood-brain barrier (BBB), and brain tissues are directly exposed to the neurotoxic blood contents and immune cells, which leads to secondary brain injuries including inflammation and oxidative stress, and other cascades. Though the exact mechanisms are not fully clarified, multiple interconnected and/or independent signaling pathways have been reported to be involved in BBB disruption after SAH. In addition, alleviation of BBB disruption through various pathways or chemicals has a neuroprotective effect on SAH. Hence, BBB permeability plays an important role in the pathological course and outcomes of SAH. This review discusses the recent understandings of the underlying mechanisms and potential therapeutic targets in BBB disruption after SAH, emphasizing the dysfunction of tight junctions and endothelial cells in the development of BBB disruption. The emerging molecular targets, including toll-like receptor 4, netrin-1, lipocalin-2, tropomyosin-related kinase receptor B, and receptor tyrosine kinase ErbB4, are also summarized in detail. Finally, we discussed the emerging treatments for BBB disruption after SAH and put forward our perspectives on future research.
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Affiliation(s)
| | | | - Ji C. Bihl
- Address correspondence to these authors at the Department of Pharmacology & Toxicology, Boonshoft School of Medicine, Wright State University, Dayton, Ohio, 45435, USA; Tel: 011-01-9377755243; Fax: 011-01-9377757221; E-mail: and Department of Neurosurgery, First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China; Tel: +86-15545107889; E-mail:
| | - Huaizhang Shi
- Address correspondence to these authors at the Department of Pharmacology & Toxicology, Boonshoft School of Medicine, Wright State University, Dayton, Ohio, 45435, USA; Tel: 011-01-9377755243; Fax: 011-01-9377757221; E-mail: and Department of Neurosurgery, First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China; Tel: +86-15545107889; E-mail:
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89
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De Bernardo M, Cembalo G, Rosa N. Corneal thickness, optic nerve sheath diameter, and retinal nerve fiber layer evaluation to assess the risk of cerebral edema in type 1 diabetes in children. Acta Diabetol 2019; 56:485-486. [PMID: 30635717 DOI: 10.1007/s00592-018-1274-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 12/12/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Maddalena De Bernardo
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Via S. Allende, 84081, Baronissi, Salerno, Italy.
| | - Giovanni Cembalo
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Via S. Allende, 84081, Baronissi, Salerno, Italy
| | - Nicola Rosa
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Via S. Allende, 84081, Baronissi, Salerno, Italy
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90
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Jeziorny K, Waszczykowska A, Baranska D, Mlynarski W, Zmyslowska A. Response to the Letter to the Editor: "Corneal thickness, optic nerve sheath diameter and retinal nerve fiber layer evaluation to assess the risk of cerebral edema in type 1 diabetes in children". Acta Diabetol 2019; 56:487-488. [PMID: 30663026 PMCID: PMC6420477 DOI: 10.1007/s00592-018-1275-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 12/12/2018] [Indexed: 11/22/2022]
Affiliation(s)
- Krzysztof Jeziorny
- Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Lodz, Poland
| | - Arleta Waszczykowska
- Department of Ophthalmology and Vision Rehabilitation, Medical University of Lodz, Lodz, Poland
| | - Dobromiła Baranska
- Department of Diagnostic Imaging, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
| | - Wojciech Mlynarski
- Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Lodz, Poland
| | - Agnieszka Zmyslowska
- Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Lodz, Poland.
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91
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Affiliation(s)
- Mark A Sperling
- From the Department of Pediatrics, Division of Endocrinology and Diabetes, Icahn School of Medicine at Mt. Sinai, New York
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92
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Xu HL, Wang JC, Zhang Y, Liu SL, He WW, Qin XT, Cao GQ, Yang YJ, Zhuge QC, Chen WJ. [CT perfusion analysis on the association of permeability surface with hematoma and edema volume in acute spontaneous putaminal and thalamic hematoma]. Zhonghua Yi Xue Za Zhi 2017; 97:2898-2902. [PMID: 29050158 DOI: 10.3760/cma.j.issn.0376-2491.2017.37.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Objective: To discuss the correlation of permeability surface (PS) with hematoma and edema volume in acute spontaneous putaminal and thalamic hematoma using CT perfusion imaging. Methods: A total of 48 acute spontaneous putaminal and thalamic hemorrhage patients were enrolled in this study during October 2015 and December 2016 at the First Affiliated Hospital of Wenzhou Medical University. At the image slice with maximum size of hematoma, PS was measured by drawing various regions of interest (ROI) including"hot spots", perihematomal regions, outward regions, hemisphere regions and contralateral mirror regions. The relative PS (rPS) was calculated as the ratio of ipsilateral to contralateral PS value in each ROI. Hematoma and edema volumes were traced and obtained with commercial software. Results: The"hot spots"PS ((2.8±1.5) ml·100 g(-1)·min(-1)) and perihematomal PS ((2.1±1.4) ml·100 g(-1)·min(-1)) were both significantly higher than the PS of the contralateral mirror regions ((1.1±0.5) ml·100 g(-1)·min(-1)) (P<0.001). There was no significant difference in outward regions PS and contralateral mirror regions PS (P>0.05), nor in hemisphere regions PS and contralateral mirror regions PS (P>0.05). There was no significant difference in"hot spots"rPS and perihematomal rPS (P=0.218). The"hot spots"rPS and Perihematomal rPS were both higher than the rPS of the outward and hemisphere regions (P<0.01). There was no significant difference in the outward and hemisphere regions (P<0.01). The median hematoma volume was 12.63 ml and the median edema volume was 12.36 ml. The edema volume had a positive association with the hematoma volume(r=0.799, P<0.001) and perihematomal PS(r=0.465, P=0.001). Perihematomal PS had a positive association with the hematoma volume (r=0.386, P=0.007). Conclusion: The damage of blood-brain barrier around acute spontaneous hematoma can be measured via CT perfusion imaging. Perihematomal PS was associated with the hematoma and edema volume.
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Affiliation(s)
- H L Xu
- Department of Radiology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
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93
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Joshi A, Shrestha PS, Dangol S, Shrestha NC, Poudyal P, Shrestha A. Hemiconvulsion-Hemiplegia-Epilepsy Syndrome in a Girl Presented with Complex Partial Seizures. Kathmandu Univ Med J (KUMJ) 2017; 15:256-260. [PMID: 30353904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The mechanisms underlying the Hemiconvulsion-Hemiplegia-Epilepsy syndrome remains unclear. The current proposed pathogenic mechanism is a neuronal injury induced by venous thrombosis and/or hypoxia. Children develop hemispheric brain atrophy with contralateral hemiplegia, epilepsy, and a variable degree of cognitive deficit. We report a 33 months old female child a case of hemiconvulsion-hemiplegia-epilepsy syndrome with right hemisphere unilateral brain edema and left sided hemiplegia and aphasia who presented with left upper extremities complex partial seizures with generalization to tonic clonic seizures and developed status epilepticus that posed diagnostic and therapeutic challenges. Progressive atrophy of the right cerebral hemisphere was noted after 3 months of follow up. Hemiconvulsion-Hemiplegia-Epilepsy syndrome should be suspected in a child with unilateral cerebral hemisphere brain edema and hemiplegia with cognitive deficit following status epilepticus to provide patients and families with an accurate prognosis regarding the subsequent development of epilepsy.
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Affiliation(s)
- A Joshi
- Department of Pediatrics, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - P S Shrestha
- Department of Pediatrics, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - S Dangol
- Department of Pediatrics, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - N C Shrestha
- Department of Pediatrics, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - P Poudyal
- Department of Pediatrics, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - A Shrestha
- Department of Pediatrics, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
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Wiwanitkit S, Wiwanitkit V. Dengue fever, takotsubo syndrome, cerebral edema, catecholamine monitoring, and serial echocardiography. J Formos Med Assoc 2017; 116:329. [PMID: 28161073 DOI: 10.1016/j.jfma.2017.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Accepted: 01/05/2017] [Indexed: 06/06/2023] Open
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96
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Hankey GJ. Glyburide for cerebral oedema: could an old dog have a new trick? Lancet Neurol 2016; 15:1109-11. [PMID: 27567242 DOI: 10.1016/s1474-4422(16)30198-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 08/03/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Graeme J Hankey
- School of Medicine and Pharmacology, University of Western Australia, Perkins Institute of Medical Research, QEII Medical Centre, Perth 6009, WA, Australia; Department of Neurology, Sir Charles Gairdner Hospital, Perth, WA, Australia; Western Australian Neuroscience Research Institute, Perth, WA, Australia.
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Tirakotai W, Mennel HD, Lapanich S, Sure U, Bertalanffy H, Celik I. The Possible Role of Mast Cells and VEGF in Peritumoural Oedema of Secretory Meningioma. J Med Assoc Thai 2016; 99 Suppl 3:S8-S115. [PMID: 29901331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Secretory meningiomas constitute a relatively rare subtype of meningiomas and present often with massive peritumoural oedema. From our previous report, a high number of mast cells were demonstrable in this subtype of meningiomas. The present study aimed to obtain more information about mast cell derived progangiogenic factors and mediators as well as VEGF receptors in secretory meningioma. Additionally, the correlation of histological factors such as the presence of mast cells and the radiological evidence of surrounding tumour oedema was analysed. MATERIAL AND METHOD Sixteen cases of secretory meningioma were examined. Relevant clinical information was obtained from the patient files. The peritumoural oedema was determined either by CT or MRI scans and graded as mild, moderate and severe. Immunohistochemical studies of histamine, substance P, serotonin, VEGF and VEGF receptors were performed. A double-blind quantitative evaluation of mast cells staining positively for VEGF in a comparison with total mast cells in secretory meningiomas was made by two histopathologists. RESULTS There was no immunoreactivity against histamine or substance P within the tumour tissue or in mast cells. Fine granules of serotonin were demonstrated within the mast cells and a coarse granular expression of VEGF was found within the mast cells. Our preliminary data demonstrated that tumours with moderate to severe degree of peritumoural oedema usually contained more than 50% of VEGF-staining positive mast cells. CONCLUSION Secretory meningiomas are characterized by a significantly increased number of mast cells. VEGF and serotonin might be involved in the pathophysiological process of this vasogenic brain oedema. The preliminary data demonstrated the potential relation between the radiological evidence of increasing oedema and the high numbers of mast cell staining positively for VEGF.
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Chen X, Wang D, Liu Y, Yuan J, Zhang H. [Effects of hydrogen-rich water on the expression of aquaporin 1 in the cerebral cortex of rat with traumatic brain injury]. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue 2016; 28:460-464. [PMID: 29923387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To investigate the effect of hydrogen-rich water on cerebral edema and aquaporin 1 (AQP1) expression in rats with traumatic brain injury (TBI). METHODS Ninety male Sprague-Dawley (SD) rats were randomly divided into sham operation group, TBI model group, hydrogen-rich water treatment group (H group),with 30 rats in each group. TBI model was reproduced by weight dropping method. The skulls of rats in sham operation group underwent only craniotomy without direct hit and with bone wax sealed suture.5 mL/kg of hydrogen-rich water injection was given intraperitoneally after model reproduction in H group, and equal amount of normal saline was given in sham and TBI groups, once a day for both groups for 5 days. Six rats from each group were sacrificed at 6,12,24,48 hours and 5 days after evaluating neurological severity scores (NSS).The cerebral cortex was harvested, and the pathological changes in morphology of brain tissue were observed with light microscope. The positive expression of AQP1 in cerebral cortex was observed with immunohistochemistry by light microscopy, the AQP1 mRNA expression in cerebral cortex was determined by real-time fluorescent quantization reverse transcription-polymerase chain reaction (RT-PCR),and the AQP1 protein expression in cerebral cortex was determined by Western Blot. RESULTS ① All rats in sham operation group had a NSS of zero at each time point. NSS of TBI group was obviously raised with time prolongation, and peaked at 24 hours followed by a lower tendency, while the score in H group was significantly lower than that of TBI group, and the difference was the most obvious at 24 hours as compared with TBI group (9.83 ± 2.78 vs.13.50± 2.42,P < 0.05).② It was shown by light microscope that in the TBI group there were pathological changes in cerebral cortex, including obvious irregular arrangement of nerve cells, cerebral edema, obvious bleeding, especially at 24 hours, then the cerebral edema became vanished gradually; and the positive expression of AQP1 in the pia mater at all the time points in the TBI group was significantly increased, and it was most obvious at 24 hours. Compared with TBI group, the pathological changes at time points of 12 hours to 5 days in H group was significantly lessened, and the positive expression of AQP1 in the cerebral pia mater was reduced obviously.③ Compared with sham operation group, the mRNA and protein expressions of AQP1 in cerebral cortex in TBI group were significantly elevated, peaked at 24 hours [AQP1 mRNA (2-△△Ct):7.50±0.26 vs.1,AQP1 protein (gray value):1.986±0.110 vs.0.336±0.034, both P < 0.05], then they gradually declined. The mRNA and protein expressions of AQP1 in cerebral cortex were significantly decreased after hydrogen-rich water treatment [24-hour AQP1 mRNA (2-△△Ct):5.40±0.21 vs.7.50±0.26, 24-hour AQP1 protein (gray value): 1.246±0.137 vs.1.986±0.110, both P < 0.05]. CONCLUSIONS The up-regulation of AQP1 mRNA and protein in rats' cerebral cortex after TBI perhaps participates in edema formation which might be involved in the pathophysiology of cerebral edema in TBI. Early treatment with an intraperitoneally injection of hydrogen-rich water is capable of attenuating the extent of TBI-induced up-regulation of AQP1 mRNA and protein, alleviating cerebral edema, and achieving its protective effects.
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Kuang Y, Chen W, Zheng K, Fu J, Hu Z, Yang Y, Dai Y. [CT perfusion imaging evaluation on hemodynamic changes of acute spontaneous intracerebral hemorrhage surrounding tissues]. Zhonghua Yi Xue Za Zhi 2015; 95:3514-3518. [PMID: 26813275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To discuss the hemodynamic changes in patients with acute supratentorial spontaneous intracerebral hemorrhage (within 72 hours) by using 320-slice of low-dose volume CT perfusion imaging. METHODS Twenty-six patients of The First Affiliated Hospital of Wenzhou Medical University during December 2012 to December 2013 with acute supratentorial SICH diagnosed by plain CT scanning and clinic were enrolled. With hematoma maximum level for reference, the hematoma volume, edema area and perfusion defect area were measured, and the perfusion parameters values of the marginal area and outer area of the intracerebral hematoma and contralateral mirror area were measured, including cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT) and time-to-peak (TTP), and rCBF, rCBV, rMTT and rTTP were calculated by ipsilateral/contralateral value. RESULTS The CBF, CBV of the marginal area were lower than the contralateral mirror area (tCBF=-8.125, tCBV=-8.671, PCBF, CBV<0.01); the MTT of the marginal area was shorter than the contralateral mirror area (tMTT=-3.246, PMTT<0.05); the TTP of the marginal area was longer than the contralateral mirror area (tTTP=5.027, PTTP<0.01). The CBV of the outer area was lower than the contralateral mirror area (tCBV=-2.337, PCBV<0.05); the MTT of the outer area was shorter than the contralateral mirror area (tMTT=-2.421, PMTT<0.05); the TTP of the outer area was longer than the contralateral mirror area (tTTP=2.077, PTTP<0.05). There was a siginificant relationship between the volume of acute hematoma and rCBV, rMTT, rTTP of the marginal area (rrCBV=-0.412, PrCBV<0.05, rrMTT=-0.437, PrMTT<0.05, rrTTP=0.475, PrMTT<0.05). Perihematomal CBF perfusion defect area showed a positive linear relation with the volume of acute hematoma (r=0.440, P<0.05). There was a positive linear relationship between the maximum level edema area and the hematoma volume, perihematomal CBF perfusion defect area (r=0.400, r=0.81, P<0.05). CONCLUSIONS 320-slice of low-dose and volume CT perfusion imaging can perfectly reflect the hemodynamic changes in brain tissuse after acute supratentorial SICH. Hypoperfusion was appeared in perihematomal area of acute supratentorial SICH. The perihematomal brain tissue may exists ischemic injury associated with the size of hematoma.The hematoma place holder effect, ischemic injury are the important cause of acute brain edema formation.
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Affiliation(s)
- Yi Kuang
- Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Weijian Chen
- Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China;
| | - Kuikui Zheng
- Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Jun Fu
- Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Zilong Hu
- Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Yunjun Yang
- Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Yichuan Dai
- Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
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Wu G, Li L, Liao D, Wang Z. [Protective effect of Apelin-13 on focal cerebral ischemia-reperfusion injury in rats]. Nan Fang Yi Ke Da Xue Xue Bao 2015; 35:1335-1339. [PMID: 26403750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To investigate the protective effect of Apelin-13 on focal cerebral ischemia-reperfusion injury in rats. METHODS Focal transient cerebral ischemia-reperfusion injury was induced in male SD rats using modified suture occlusion technique. The rats were randomly divided into 5 groups: Sham group, Model group, Apelin-low dose (A) group, Apelin-middle dose (B) group and Apelin-high dose (C) group. Apelin-13 was injected into lateral cerebral ventricle, and the neurological function score, brain edema, infarct volume, apoptosis, malondialdehyde (MDA), superoxide dismutase (SOD) and extracellular regulated kinase1/2 (ERK1/2) protein were measured. RESULTS Neurological function scores, percentage of brain water content, infarct volumes and TUNEL-positive cells in B and C groups were lower than those in Model group (P<0.05). The level of MDA in the tissue bomogenate of brain tissue in the surrounding area of ischemia of B and C groups was lower than that of Model group, while the activity of SOD was higher (P<0.05). There was no significant difference in ERK1/2 protein expression among the groups (P>0.05). P-ERK1/2 increased in Model group and A, B, and C groups compared with Sham group (P<0.05), and that of A, B, and C group was higher than that of Model group (P<0.05). CONCLUSION Apelin-13 may play an important role by inhibiting oxidative stress to protect against focal cerebral ischemia-reperfusion injury; ERK1/2 signaling pathway may be involved in the protective mechanism of Apelin-13.
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Affiliation(s)
- Guangyong Wu
- Department of Neurosurgery, the Third Xiangya Hospital of Central South University, Hunan Province, Changsha 410013, China.E-mail:
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