51
|
Huang Q, Qi J, Gao Z, Li L, Wang N, Seto S, Yao M, Zhang Q, Wang L, Tong R, Chen Y, Chen X, Hou J. Chemical composition and protective effect of cerebrospinal fluid of Dan-Deng-Tong-Nao capsules on brain microvascular endothelial cells injured by OGD/R. JOURNAL OF ETHNOPHARMACOLOGY 2022; 283:114705. [PMID: 34655669 DOI: 10.1016/j.jep.2021.114705] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 09/29/2021] [Accepted: 09/30/2021] [Indexed: 06/13/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Dan-Deng-Tong-Nao Capsules (DDTNC) is a Chinese patent medicine and has been used in treating cerebral ischemic stroke (IS) for a long time in China, protection of brain microvascular endothelial cells (BMECs) is the main treatment strategy. But the holistic chemical information and potential bioactive components of DDTNC on protecting BMECs and its underlying mechanism is still unclear. AIM OF THE STUDY To identify the active ingredients of DDTNC and to explore the protective effects of DDTNC on BMECs associated with Wnt/β-catenin pathway. MATERIALS AND METHODS The components of DDTNC and cerebrospinal fluid containing composition of DDTNC (DDTNC-CSF) were detected by High performance liquid chromatography combined with Diode array detector (HPLC-DAD) and Ultra-high performance liquid chromatography with quadrupole time-of-flight mass spectrometry (UPLC-Q-TOF-MS), respectively. The experiment rat model was established with middle cerebral artery occlusion (MCAO), the therapeutic effects of DDTNC were assessed by Longa assay and TTC staining. The cerebral micro vessel density was determined by immunofluorescence staining. The injured BMECs caused by oxygen-glucose deprivation and reperfusion (OGD/R) was used to evaluate the protective effect of cerebrospinal fluid containing composition of DDTNC (DDTNC-CSF). The cell survival rate was detected by the method of CCK-8, the intracellular Ca2+ and reactive oxygen species (ROS) was estimated by Fluo-3. Moreover, the proteins of Bax, Bcl-2, Wnt, β-catenin, GSK-3β was determined by Western blotting. RESULTS The RSD values of all methodological studies were less than 3.0%. A total of 20 compounds were detected under the optimized HPLC-DAD chromatographic condition. In the UPLC-Q-TOF-MS negative mode, peak 1 and peak 2 were detecteted in DDTNC-CSF and was identified as Danshensu and Puerarin, respectively. In the UPLC-Q-TOF-MS positive mode, peak 1 and peak 3 were detecteted in DDTNC-CSF and was identified as Danshensu and Scutellarin, respectively. DDTNC significantly decreased the Longa values and infarct volume and significantly increased the cerebral microvessel density of the MCAO rats. The accumulation of intracellular Ca2+ and ROS in BMECs injured by OGD/R decreased significantly in DDTNC-CSF group. The expression of Bcl-2, β-catenin, wnt-1 was upregulated by DDTNC-CSF and the level of Bax and GSK3β could be downregulated by DDTNC-CSF. CONCLUSION The present study provided a scientific basis for revealing the mechanism of DDTNC in the treatment of IS and DDTNC is expected to be an effective drug for the treatment of IS.
Collapse
Affiliation(s)
- Qi Huang
- Department of Pharmacy, Anhui University of Chinese Medicine, Hefei, 230012, PR China.
| | - Jiajia Qi
- Department of Pharmacy, Anhui University of Chinese Medicine, Hefei, 230012, PR China.
| | - Ziru Gao
- Department of Pharmacy, Anhui University of Chinese Medicine, Hefei, 230012, PR China.
| | - Lili Li
- Department of Pharmacy, Anhui University of Chinese Medicine, Hefei, 230012, PR China; Anhui Province Key Laboratory of Chinese Medicinal Formula, Anhui University of Chinese Medicine, Hefei, 230012, PR China; Institute of Traditional Chinese Medicine Resources Protection and Development, Anhui Academy of Chinese Medicine, Hefei, 230012, PR China.
| | - Ning Wang
- Department of Pharmacy, Anhui University of Chinese Medicine, Hefei, 230012, PR China; Anhui Province Key Laboratory of Chinese Medicinal Formula, Anhui University of Chinese Medicine, Hefei, 230012, PR China; Institute for Pharmacodynamics and Safety Evaluation of Chinese Medicine, Anhui Academy of Traditional Chinese Medicine, Hefei, 230012, PR China.
| | - Saiwang Seto
- Department of Applied Biology and Chemical Technology, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong Special Administrative Region
| | - Min Yao
- Department of Pharmacy, Anhui University of Chinese Medicine, Hefei, 230012, PR China.
| | - Qianqian Zhang
- Department of Pharmacy, Anhui University of Chinese Medicine, Hefei, 230012, PR China.
| | - Lei Wang
- Department of Pharmacy, Anhui University of Chinese Medicine, Hefei, 230012, PR China.
| | - Ruonan Tong
- Department of Pharmacy, Anhui University of Chinese Medicine, Hefei, 230012, PR China
| | - Yuyang Chen
- Department of Pharmacy, Anhui University of Chinese Medicine, Hefei, 230012, PR China.
| | - Xiaoya Chen
- Department of Pharmacy, Anhui University of Chinese Medicine, Hefei, 230012, PR China.
| | - Jincai Hou
- Jing-Jin-Ji Joint Innovation Pharmaceutical (Beijing) Co., Ltd., Beijing, 100083, China.
| |
Collapse
|
52
|
Kannarkat GT, Darrow J, Moghekar A. Reassessing accuracy of blood cell correction factor for traumatic lumbar puncture. J Neurol Sci 2022; 432:120097. [PMID: 34929498 DOI: 10.1016/j.jns.2021.120097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/08/2021] [Accepted: 12/13/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE This study assessed the utility of correction formulas for procedural peripheral blood admixture with cerebrospinal fluid (CSF) in adult patients using in vitro addition of peripheral blood. METHODS Participants from the Johns Hopkins CSF Disorders Center were recruited if greater than 18 years old, not acutely ill, and able to tolerate lumbar puncture (LP). Peripheral blood was added in vitro to acellular CSF and then cellular concentration and protein were quantified. RESULTS Correction formulas for white blood cell (WBC) count determined by linear regression for samples with more than 100,000 RBCs per uL were inaccurate. Linear correction formulas close to 1 WBC per 1000 red blood cells (RBCs) were more precise than the formula based on peripheral blood WBC to RBC ratio. Correction formulas for protein level derived by linear regression had minimal error. DISCUSSION This study confirms in a controlled manner that CSF admixture with peripheral blood cannot always be reliably corrected for in a predictable manner. Use of correction formulas for protein level and for WBC count when CSF admixture with peripheral blood has RBCs less than 10,000 per microliter is possibly useful but will need to be assessed in larger studies that can confirm diagnostic utility.
Collapse
Affiliation(s)
- George T Kannarkat
- Department of Neurology, Johns Hopkins Hospital, Baltimore, MD 21287, United States of America.
| | - Jacqueline Darrow
- Department of Neurology, Johns Hopkins Hospital, Baltimore, MD 21287, United States of America
| | - Abhay Moghekar
- Department of Neurology, Johns Hopkins Hospital, Baltimore, MD 21287, United States of America
| |
Collapse
|
53
|
Cousins O, Hodges A, Schubert J, Veronese M, Turkheimer F, Miyan J, Engelhardt B, Roncaroli F. The Blood‐CSF‐Brain Route of Neurological Disease: The Indirect Pathway into the Brain. Neuropathol Appl Neurobiol 2021; 48:e12789. [DOI: 10.1111/nan.12789] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 12/08/2021] [Accepted: 12/14/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Oliver Cousins
- Department of Neuroimaging, IoPPN, King’s College London London United Kingdom
| | - Angela Hodges
- Department of Old Age Psychiatry, IoPPN, King’s College London London United Kingdom
| | - Julia Schubert
- Department of Neuroimaging, IoPPN, King’s College London London United Kingdom
| | - Mattia Veronese
- Department of Neuroimaging, IoPPN, King’s College London London United Kingdom
| | - Federico Turkheimer
- Department of Neuroimaging, IoPPN, King’s College London London United Kingdom
| | - Jaleel Miyan
- Division of Neuroscience and Experimental Psychology School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, M13 9PL
| | | | - Federico Roncaroli
- Division of Neuroscience and Experimental Psychology School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, M13 9PL
- Geoffrey Jefferson Brain Research Centre; Manchester Academic Health Science Centre Manchester UK
| |
Collapse
|
54
|
Mahmoudvand G, Ebrahimzadeh F, Mahmoudvand B, Tarhani F. Epidemiology of findings of lumbar puncture among pediatric patients. Ann Med Surg (Lond) 2021; 72:103093. [PMID: 34876982 PMCID: PMC8632850 DOI: 10.1016/j.amsu.2021.103093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/17/2021] [Accepted: 11/20/2021] [Indexed: 11/25/2022] Open
Abstract
Objective Lumbar Puncture (LP) is a common invasive procedure where cerebrospinal fluid is obtained for the diagnosis of neurological anomalies. The purpose of this study was to evaluate the results of CSF analysis in patients admitted to pediatric wards. Methods In this retrospective descriptive study, records of the pediatric patients (aged <18 years) who were referred to our centers for lumbar puncture were evaluated. A checklist was prepared for all the patients where demographic data, findings of CSF and blood analysis and clinical presentations were recorded. The data obtained was analyzed using SPSSv22. Results In this study a total number of 247 patients were included where 57.9% of the cases were of boys. 55.8% patients aged under 1 year and 62.3% of patients had a body temperature of 38 °C and above. 15.3% of the children were diagnosed with meningitis, 27.1% had febrile seizures, 9.3% had neonatal sepsis and for 48.2% cases other clinical diagnoses were made. There was a significant relationship between the diagnosis and the number of WBCs seen in CSF (P < 0.001). Also, there was a significant relationship between the diagnosis and amount of protein (P < 0.001) and glucose in CSF (P = 0.005). The age group and the type of fever and seizure were also significantly correlated, (P < 0.001). Conclusion Lumbar puncture is an important procedure for the diagnosis of several neurological diseases. Further studies including neuroimaging and therapeutic measures are recommended in this regard.
Collapse
Affiliation(s)
- Golnaz Mahmoudvand
- Student Research Committee, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Farzad Ebrahimzadeh
- Department of Biostatistics, School of Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran.,Nutritional Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Behnaz Mahmoudvand
- Student Research Committee, Iran University of Medical Sciences, Tehran, Iran
| | - Fariba Tarhani
- Department of Pediatrics, School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| |
Collapse
|
55
|
Raggi A, Bianchi Marzoli S, Ciasca P, Cammarata G, Melzi L, Chiapparini L, Erbetta A, Ciceri E, Faragò G, Gioppo A, Usai S, D'Amico D. The Pre-Lumbar puncture Intracranial Hypertension Scale (PLIHS): A practical scale to identify subjects with normal cerebrospinal fluid pressure in the management of idiopathic intracranial hypertension. J Neurol Sci 2021; 429:118058. [PMID: 34461550 DOI: 10.1016/j.jns.2021.118058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/05/2021] [Accepted: 08/24/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Idiopathic Intracranial Hypertension (IIH) diagnosis requires lumbar puncture to measure cerebrospinal fluid (CSF) pressure. The Pre-Lumbar puncture Intracranial Hypertension Scale (PLIHS) is aimed to detect cases that will show raised or normal CSF opening pressure. METHODS Retrospective analysis of records of patients who underwent lumbar puncture for suspect IIH. The target was CSF opening pressure ≥ 250 mmH2O, whereas a set of known neurological, neuro-ophthalmological and neuro-radiological parameters, plus obesity, were used as predictors in a logistic regression model. The PLIHS was based on significant predictors and a cut-off was validated using chi-squared test around CSF opening pressure ≥ 250 and < 200 mmH2O. RESULTS Records of 162 patients were included: CSF opening pressure was <200 mmH2O in 40 and ≥ 250 mmH2O in 95 patients; 85 fulfilled IIH diagnosis. PLIHS is based on Frisén grade 2 or higher papilledema, tinnitus, empty sella, perioptic subarachnoid space distension, and obesity. Score range is 0-7: correlation with CSF opening pressure is 0.508 (p < .001), and PLIHS score is different between subjects not diagnosed with IIH, and those diagnosed with IIH both with and without papilledema (p < .001). PLIHS score ≤ 2 identifies cerebrospinal fluid pressure < 200 mmH2O; PLIHS score ≥ 3 identifies CSF opening pressure ≥ 250 mmH2O, IIH diagnosis, visual acuity ≤0.7, and optic nerve atrophy. CONCLUSIONS The PLIHS, can be used to identify patients who will particularly need LP, thus helping with the organization of the diagnostic work-up by optimising healthcare resources and potentially limit the likelihood to incur in LP-related adverse events.
Collapse
Affiliation(s)
- Alberto Raggi
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Neurology, Public Health and Disability Unit, Milano, Italy.
| | - Stefania Bianchi Marzoli
- Istituto Auxologico Italiano IRCCS, Neuro-ophthalmology Center - Scientific Institute Capitanio Hospital, Milano, Italy.
| | - Paola Ciasca
- Istituto Auxologico Italiano IRCCS, Neuro-ophthalmology Center - Scientific Institute Capitanio Hospital, Milano, Italy.
| | - Gabriella Cammarata
- Istituto Auxologico Italiano IRCCS, Neuro-ophthalmology Center - Scientific Institute Capitanio Hospital, Milano, Italy.
| | - Lisa Melzi
- Istituto Auxologico Italiano IRCCS, Neuro-ophthalmology Center - Scientific Institute Capitanio Hospital, Milano, Italy.
| | - Luisa Chiapparini
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Neuroradiology Unit, Milano, Italy.
| | - Alessandra Erbetta
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Neuroradiology Unit, Milano, Italy.
| | - Elisa Ciceri
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Radiodiagnostic and Interventional Neuroradiology, Milano, Italy.
| | - Giuseppe Faragò
- Papa Giovanni XXII Hospital, Neuroradiology Department, Bergamo, Italy.
| | - Andrea Gioppo
- ASST Santi Paolo e Carlo, P.O San Carlo, Radiologia II - Neurodiagnostica-Neurointerventistica, Milano, Italy.
| | - Susanna Usai
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Neuroalgology Unit, Milano, Italy.
| | - Domenico D'Amico
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Neuroalgology Unit, Milano, Italy.
| |
Collapse
|
56
|
Resting State Functional Magnetic Resonance Imaging Elucidates Neurotransmitter Deficiency in Autism Spectrum Disorder. J Pers Med 2021; 11:jpm11100969. [PMID: 34683111 PMCID: PMC8537605 DOI: 10.3390/jpm11100969] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/23/2021] [Accepted: 09/27/2021] [Indexed: 12/18/2022] Open
Abstract
Resting-state functional magnetic resonance imaging provides dynamic insight into the functional organization of the brains' intrinsic activity at rest. The emergence of resting-state functional magnetic resonance imaging in both the clinical and research settings may be attributed to recent advancements in statistical techniques, non-invasiveness and enhanced spatiotemporal resolution compared to other neuroimaging modalities, and the capability to identify and characterize deep brain structures and networks. In this report we describe a 16-year-old female patient with autism spectrum disorder who underwent resting-state functional magnetic resonance imaging due to late regression. Imaging revealed deactivated networks in deep brain structures involved in monoamine synthesis. Monoamine neurotransmitter deficits were confirmed by cerebrospinal fluid analysis. This case suggests that resting-state functional magnetic resonance imaging may have clinical utility as a non-invasive biomarker of central nervous system neurochemical alterations by measuring the function of neurotransmitter-driven networks. Use of this technology can accelerate and increase the accuracy of selecting appropriate therapeutic agents for patients with neurological and neurodevelopmental disorders.
Collapse
|
57
|
Ahmed A, UlHaq MU, Mustansar Z, Shaukat A, Margetts L. How growing tumour impacts intracranial pressure and deformation mechanics of brain. ROYAL SOCIETY OPEN SCIENCE 2021; 8:210165. [PMID: 34631118 PMCID: PMC8479368 DOI: 10.1098/rsos.210165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 09/02/2021] [Indexed: 06/13/2023]
Abstract
Brain is an actuator for control and coordination. When a pathology arises in cranium, it may leave a degenerative, disfiguring and destabilizing impact on brain physiology. However, the leading consequences of the same may vary from case to case. Tumour, in this context, is a special type of pathology which deforms brain parenchyma permanently. From translational perspective, deformation mechanics and pressures, specifically the intracranial cerebral pressure (ICP) in a tumour-housed brain, have not been addressed holistically in literature. This is an important area to investigate in neuropathy prognosis. To address this, we aim to solve the pressure mystery in a tumour-based brain in this study and present a fairly workable methodology. Using image-based finite-element modelling, we reconstruct a tumour-based brain and probe resulting deformations and pressures (ICP). Tumour is grown by dilating the voxel region by 16 and 30 mm uniformly. Cumulatively three cases are studied including an existing stage of the tumour. Pressures of cerebrospinal fluid due to its flow inside the ventricle region are also provided to make the model anatomically realistic. Comparison of obtained results unequivocally shows that as the tumour region increases its area and size, deformation pattern changes extensively and spreads throughout the brain volume with a greater concentration in tumour vicinity. Second, we conclude that ICP pressures inside the cranium do increase substantially; however, they still remain under the normal values (15 mmHg). In the end, a correlation relationship of ICP mechanics and tumour is addressed. From a diagnostic purpose, this result also explains why generally a tumour in its initial stage does not show symptoms because the required ICP threshold has not been crossed. We finally conclude that even at low ICP values, substantial deformation progression inside the cranium is possible. This may result in plastic deformation, midline shift etc. in the brain.
Collapse
Affiliation(s)
- Ali Ahmed
- Department of Biomedical Engineering and Sciences, School of Mechanical and Manufacturing Engineering (SMME), National university of Sciences and Technology (NUST), Islamabad 44000, Pakistan
| | - Muhammad Uzair UlHaq
- Department of Biomedical Engineering and Sciences, School of Mechanical and Manufacturing Engineering (SMME), National university of Sciences and Technology (NUST), Islamabad 44000, Pakistan
| | - Zartasha Mustansar
- Department of Computational Engineering, Research Center of Modeling and Simulation (RCMS), National university of Sciences and Technology (NUST), Islamabad 44000, Pakistan
| | - Arslan Shaukat
- Department of Computer and Software Engineering, College of Electrical and Mechanical Engineering, National university of Sciences and Technology (NUST), Islamabad 44000, Pakistan
| | - Lee Margetts
- Department of Mechanical, Aerospace and Civil Engineering, University of Manchester, UK
| |
Collapse
|
58
|
An Insight into Pathophysiological Features and Therapeutic Advances on Ependymoma. Cancers (Basel) 2021; 13:cancers13133221. [PMID: 34203272 PMCID: PMC8269186 DOI: 10.3390/cancers13133221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/21/2021] [Accepted: 06/23/2021] [Indexed: 12/21/2022] Open
Abstract
Simple Summary Although biological information and the molecular classification of ependymoma have been studied, the treatment systems for ependymoma are still insufficient. In addition, because the disease occurs infrequently, it is difficult to obtain sufficient data to conduct large-scale or randomized clinical trials. Therefore, this study is intended to emphasize the importance of understanding its pathological characteristics and prognosis as well as developing treatments for ependymoma through multilateral studies. Abstract Glial cells comprise the non-sensory parts of the central nervous system as well as the peripheral nervous system. Glial cells, also known as neuroglia, constitute a significant portion of the mammalian nervous system and can be viewed simply as a matrix of neural cells. Despite being the “Nervenkitt” or “glue of the nerves”, they aptly serve multiple roles, including neuron repair, myelin sheath formation, and cerebrospinal fluid circulation. Ependymal cells are one of four kinds of glial cells that exert distinct functions. Tumorigenesis of a glial cell is termed a glioma, and in the case of an ependymal cell, it is called an ependymoma. Among the various gliomas, an ependymoma in children is one of the more challenging brain tumors to cure. Children are afflicted more severely by ependymal tumors than adults. It has appeared from several surveys that ependymoma comprises approximately six to ten percent of all tumors in children. Presently, the surgical removal of the tumor is considered a standard treatment for ependymomas. It has been conspicuously evident that a combination of irradiation therapy and surgery is much more efficacious in treating ependymomas. The main purpose of this review is to present the importance of both a deep understanding and ongoing research into histopathological features and prognoses of ependymomas to ensure that effective diagnostic methods and treatments can be developed.
Collapse
|
59
|
Fahmy LM, Chen Y, Xuan S, Haacke EM, Hu J, Jiang Q. All Central Nervous System Neuro- and Vascular-Communication Channels Are Surrounded With Cerebrospinal Fluid. Front Neurol 2021; 12:614636. [PMID: 34220663 PMCID: PMC8247447 DOI: 10.3389/fneur.2021.614636] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 04/29/2021] [Indexed: 12/15/2022] Open
Abstract
Background: Recent emerging evidence has highlighted the potential critical role of cerebrospinal fluid (CSF) in cerebral waste clearance and immunomodulation. It is already very well-established that the central nervous system (CNS) is completely submerged in CSF on a macro-level; but to what extent is this true on a micro-level? Specifically, within the peri-neural and peri-vascular spaces within the CNS parenchyma. Therefore, the objective of this study was to use magnetic resonance imaging (MRI) to simultaneously map the presence of CSF within all peri-neural (cranial and spinal nerves) and peri-vascular spaces in vivo in humans. Four MRI protocols each with five participants were used to image the CSF in the brain and spinal cord. Our findings indicated that all CNS neuro- and vascular-communication channels are surrounded with CSF. In other words, all peri-neural spaces surrounding the cranial and spinal nerves as well as all peri-vascular spaces surrounding MRI-visible vasculature were filled with CSF. These findings suggest that anatomically, substance exchange between the brain parenchyma and outside tissues including lymphatic ones can only occur through CSF pathways and/or vascular pathways, warranting further investigation into its implications in cerebral waste clearance and immunity.
Collapse
Affiliation(s)
- Lara M Fahmy
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, United States
| | - Yongsheng Chen
- Department of Neurology, Wayne State University, Detroit, MI, United States
| | - Stephanie Xuan
- Department of Radiology, Wayne State University, Detroit, MI, United States
| | - E Mark Haacke
- Department of Radiology, Wayne State University, Detroit, MI, United States
| | - Jiani Hu
- Department of Radiology, Wayne State University, Detroit, MI, United States
| | - Quan Jiang
- Department of Neurology, Henry Ford Health System, Detroit, MI, United States
| |
Collapse
|
60
|
Jolly K, Gupta KK, Banota A, Ahmed SK. The Effectiveness and Safety of Intrathecal Fluorescein in the Management of Cerebrospinal Fluid Leaks. Am J Rhinol Allergy 2021; 35:879-884. [PMID: 34074164 DOI: 10.1177/19458924211020564] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cerebrospinal fluid (CSF) leaks can be associated with significant morbidity such as meningitis. Surgical management has proven effective, with endoscopic approaches having become the gold standard due to success rates >90%. Inability to localise the leak site prior to surgery is associated with surgical failure. The use of intrathecal fluorescein (IF) to localise CSF fistulae sites was first demonstrated in 1960. Despite this, its use in this context is unlicensed. OBJECTIVE Evaluate the safety and efficacy of IF use in the management of CSF leak repairs in our centre. METHODS All patients who underwent endoscopic repair of CSF fistula by a single surgeon where IF was used between January 2010 - September 2019 at a single-centre (tertiary skull base referral unit in the United Kingdom) were retrospectively analysed. Primary outcome measures were localisation of CSF fistula with IF (efficacy) and peri-operative complications likely to be attributable to IF (safety). RESULTS There were 55 patients included (60 procedures) with a positive localisation rate of 90.0% with IF. The overall peri-operative complication rate was 8.3% (n = 5). It is likely that none were related to IF use. However, three complications may be linked giving a complication rate potentially related to IF of 5.0%. There were no peri-operative mortalities. CONCLUSION Many studies have demonstrated IF to be safe at low doses (<50mg) with a high sensitivity, specificity and positive predicative value. Our results demonstrate that the use of IF in our centre is safe and effective at identifying CSF fistulae. While we have reported some complications in our cohort, these were unlikely to be directly attributable IF use. We have described no serious complications such as seizures, limb weakness or death. We believe this study adds to the growing body of evidence that IF use in the management CSF fistula repairs is safe and effective.
Collapse
Affiliation(s)
- Karan Jolly
- Department of Otorhinolaryngology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Keshav Kumar Gupta
- Department of Otorhinolaryngology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Abishek Banota
- Department of Otorhinolaryngology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Shahzada K Ahmed
- Department of Otorhinolaryngology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| |
Collapse
|
61
|
Hampel H, Shaw LM, Aisen P, Chen C, Lleó A, Iwatsubo T, Iwata A, Yamada M, Ikeuchi T, Jia J, Wang H, Teunissen CE, Peskind E, Blennow K, Cummings J, Vergallo A. State-of-the-art of lumbar puncture and its place in the journey of patients with Alzheimer's disease. Alzheimers Dement 2021; 18:159-177. [PMID: 34043269 PMCID: PMC8626532 DOI: 10.1002/alz.12372] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/24/2021] [Accepted: 04/12/2021] [Indexed: 01/01/2023]
Abstract
Recent advances in developing disease‐modifying therapies (DMT) for Alzheimer's disease (AD), and the recognition that AD pathophysiology emerges decades before clinical symptoms, necessitate a paradigm shift of health‐care systems toward biomarker‐guided early detection, diagnosis, and therapeutic decision‐making. Appropriate incorporation of cerebrospinal fluid biomarker analysis in clinical practice is an essential step toward system readiness for accommodating the demand of AD diagnosis and proper use of DMTs—once they become available. However, the use of lumbar puncture (LP) in individuals with suspected neurodegenerative diseases such as AD is inconsistent, and the perception of its utility and safety differs considerably among medical specialties as well as among regions and countries. This review describes the state‐of‐the‐art evidence concerning the safety profile of LP in older adults, discusses the risk factors for LP‐associated adverse events, and provides recommendations and an outlook for optimized use and global implementation of LP in individuals with suspected AD.
Collapse
Affiliation(s)
- Harald Hampel
- Eisai Inc., Neurology Business Group, Woodcliff Lake, New Jersey, USA
| | - Leslie M Shaw
- Perelman School of Medicine, Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Paul Aisen
- USC Alzheimer's Therapeutic Research Institute, San Diego, California, USA
| | - Christopher Chen
- Memory Aging and Cognition Centre, Departments of Pharmacology and Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Alberto Lleó
- Sant Pau Memory Unit, Hospital de la Santa Creu i Sant Pau-Biomedical Research Institute Sant Pau-Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Takeshi Iwatsubo
- Department of Neuropathology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Atsushi Iwata
- Tokyo Metropolitan Geriatric Hospital, 35-2 Sakaecho, Itabashi-ku, Tokyo, Japan
| | - Masahito Yamada
- Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Takeshi Ikeuchi
- Department of Molecular Genetics, Brain Research Institute, Niigata University, Asahimachi, Niigata, Japan
| | - Jianping Jia
- Innovation Center for Neurological Disorders, Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Huali Wang
- Dementia Care and Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing Dementia Key Lab, National Clinical Research Center for Mental Disorders, Beijing, China
| | - Charlotte E Teunissen
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Elaine Peskind
- VA Northwest Mental Illness Research, Education and Clinical Center, VA Puget Sound Health Care System, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jeffrey Cummings
- Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas (UNLV), Las Vegas, Nevada, USA
| | - Andrea Vergallo
- Eisai Inc., Neurology Business Group, Woodcliff Lake, New Jersey, USA
| |
Collapse
|
62
|
Viscosity Measurement Sensor: A Prototype for a Novel Medical Diagnostic Method Based on Quartz Crystal Resonator. SENSORS 2021; 21:s21082743. [PMID: 33924605 PMCID: PMC8070455 DOI: 10.3390/s21082743] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/08/2021] [Accepted: 04/09/2021] [Indexed: 12/26/2022]
Abstract
Viscosity variation in human fluids, such as Synovial Fluid (SF) or Cerebrospinal Fluid (CSF), can be used as a diagnostic factor; however, the sample volume obtained for analysis is usually small, making it difficult to measure its viscosity. On the other hand, Quartz Crystal Resonators (QCR) have been used widely in sensing applications due to their accuracy, cost, and size. This work provides the design and validation of a new viscosity measurement system based on quartz crystal resonators for low volume fluids, leading to the development of a sensor called “ViSQCT” as a prototype for a new medical diagnostic tool. The proposed method is based on measuring the resonance frequency at the crystal’s maximum conductance point through a frequency sweep, where crystals with 10 MHz fundamental resonance frequency were used. For validation purposes, artificial fluids were developed to simulate SFs and CFs in healthy and pathological conditions as experiment phantoms. A commercial QCR based system was also used for validation since its methodology differs from ours. A conventional rotational viscometer was used as a reference for calibration purposes. ViSQCT demonstrates the capability to measure the sample’s viscosity differentiation between healthy and pathological fluid phantoms and shows that it can be used as a basis for a diagnostic method of several pathologies related to the studied biological fluids. However, some performance differences between both QCR-based systems compared to the reference system deserves further investigation.
Collapse
|
63
|
Tsamis KI, Sakkas H, Giannakis A, Ryu HS, Gartzonika C, Nikas IP. Evaluating Infectious, Neoplastic, Immunological, and Degenerative Diseases of the Central Nervous System with Cerebrospinal Fluid-Based Next-Generation Sequencing. Mol Diagn Ther 2021; 25:207-229. [PMID: 33646562 PMCID: PMC7917176 DOI: 10.1007/s40291-021-00513-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2021] [Indexed: 12/24/2022]
Abstract
Cerebrospinal fluid (CSF) is a clear and paucicellular fluid that circulates within the ventricular system and the subarachnoid space of the central nervous system (CNS), and diverse CNS disorders can impact its composition, volume, and flow. As conventional CSF testing suffers from suboptimal sensitivity, this review aimed to evaluate the role of next-generation sequencing (NGS) in the work-up of infectious, neoplastic, neuroimmunological, and neurodegenerative CNS diseases. Metagenomic NGS showed improved sensitivity—compared to traditional methods—to detect bacterial, viral, parasitic, and fungal infections, while the overall performance was maximized in some studies when all diagnostic modalities were used. In patients with primary CNS cancer, NGS findings in the CSF were largely concordant with the molecular signatures derived from tissue-based molecular analysis; of interest, additional mutations were identified in the CSF in some glioma studies, reflecting intratumoral heterogeneity. In patients with metastasis to the CNS, NGS facilitated diagnosis, prognosis, therapeutic management, and monitoring, exhibiting higher sensitivity than neuroimaging, cytology, and plasma-based molecular analysis. Although evidence is still rudimentary, NGS could enhance the diagnosis and pathogenetic understanding of multiple sclerosis in addition to Alzheimer and Parkinson disease. To conclude, NGS has shown potential to aid the research, facilitate the diagnostic approach, and improve the management outcomes of all the aforementioned CNS diseases. However, to establish its role in clinical practice, the clinical validity and utility of each NGS protocol should be determined. Lastly, as most evidence has been derived from small and retrospective studies, results from randomized control trials could be of significant value.
Collapse
Affiliation(s)
- Konstantinos I Tsamis
- Department of Neurology, University Hospital of Ioannina, 45500, Ioannina, Greece. .,School of Medicine, European University Cyprus, 2404, Nicosia, Cyprus.
| | - Hercules Sakkas
- Microbiology Department, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110, Ioannina, Greece
| | - Alexandros Giannakis
- Department of Neurology, University Hospital of Ioannina, 45500, Ioannina, Greece
| | - Han Suk Ryu
- Department of Pathology, Seoul National University Hospital, Seoul, 03080, Korea
| | - Constantina Gartzonika
- Microbiology Department, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110, Ioannina, Greece
| | - Ilias P Nikas
- School of Medicine, European University Cyprus, 2404, Nicosia, Cyprus
| |
Collapse
|
64
|
Li H, Wang Y, Li Y, Zhang J. A novel manipulator with needle insertion forces feedback for robot-assisted lumbar puncture. Int J Med Robot 2021; 17:e2226. [PMID: 33452700 DOI: 10.1002/rcs.2226] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 01/07/2021] [Accepted: 01/08/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND The use of lumbar puncture for paediatric diagnosis and treatment, such as cerebrospinal fluid sampling and intracranial pressure measurements, is steadily increasing. However, the standard 'blind' technique makes it difficult to attain accurate needle insertion. METHODS In this study, we developed a robot-assisted system to improve the precision of needle insertion during lumbar puncture. The manipulator can perform orientation, insertion and rotation of the needle as well as linear motion at targeted locations. We focused on accurately sensing the puncture forces during the needle insertion phase and evaluated the piercing force perception of the operator. RESULTS The main features of the robot, such as backdrivable joints, physical human-robot cooperation, actuation system with low friction and remote centre of motion mechanism, can enhance overall safety. CONCLUSIONS Experimental results using a lumbar puncture phantom proved that the manipulator could position the needle tip at targeted locations with good accuracy. The data obtained from the test system also showed that the loss of resistance and peak forces for stiff tissues were accurately perceived by the operator.
Collapse
Affiliation(s)
- Hongbing Li
- Department of Instrument Science and Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Yiyun Wang
- Department of Instrument Science and Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Yuling Li
- Department of Instrument Science and Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Jing Zhang
- Department of Hematology and Oncology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
65
|
Liu X, Khodeiry MM, Lin D, Sun Y, Lin C, Feng W, Li J, Wang Y, Zhang Q, Cao K, Wang J, Wang N. The Association of Acute Cerebrospinal Fluid Pressure Reduction with Choroidal Thickness. Curr Eye Res 2021; 46:1193-1200. [PMID: 33517795 DOI: 10.1080/02713683.2021.1874024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE To investigate the changes in choroidal thickness (CT) after acute cerebrospinal fluid pressure (CSFP) reduction in human subjects. METHODS Before and 15 minutes after diagnostic lumbar puncture (LP), 44 patients underwent measurement of CT by swept-source optical coherence tomography. Thirty-two healthy volunteers imitated the body posture of LP procedure and underwent the same measurement before and 15 minutes after body posture change. RESULTS After CSFP reduction from 10.9 ± 2.1 mmHg at baseline to 8.1 ± 1.5 mmHg (p < 0.001), CT decreased in subfoveal region (p = 0.005), small to medium vessel layer (SMVL, p < 0.001), peripapillary regions in temporal (p = 0.001), nasal (p < 0.001), superior (p < 0.001) and inferior (p < 0.001), respectively. However, no significant change in CT in the control group after body posture change (all p > 0.05). A significant association between CSFP and the ratio of small to medium vessel layer to total choroidal thickness was found (p = 0.009). The CSFP reduction rate was associated with the change rate of SMVL to total CT portion, for each percent decrease in CSFP was associated with a decrease by 0.22% in the rate of SMVL to total CT portion (R2 = 0.125, p = 0.018). CONCLUSIONS A significant decrease in subfoveal CT, small to medium vessel layer and peripapillary region were observed following acute CSFP reduction. The CSFP reduction rate was associated with the change rate of small to medium vessel layer to total CT portion.
Collapse
Affiliation(s)
- Xiangxiang Liu
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Mohamed M Khodeiry
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA.,Research Institute of Ophthalamology, Giza, Egypt
| | - Danting Lin
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yunxiao Sun
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Caixia Lin
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Wei Feng
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.,Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Jing Li
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Beijing Eye Institute, Beijing Ophthalmology and Visual Science Key Laboratory, Beijing, China
| | - Yaxing Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Beijing Eye Institute, Beijing Ophthalmology and Visual Science Key Laboratory, Beijing, China
| | - Qing Zhang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Beijing Eye Institute, Beijing Ophthalmology and Visual Science Key Laboratory, Beijing, China
| | - Kai Cao
- Beijing Eye Institute, Beijing Ophthalmology and Visual Science Key Laboratory, Beijing, China
| | - Jiawei Wang
- Department of Neurology and Medical Research Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ningli Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Beijing Eye Institute, Beijing Ophthalmology and Visual Science Key Laboratory, Beijing, China
| |
Collapse
|
66
|
Tarumi T, Yamabe T, Fukuie M, Zhu DC, Zhang R, Ogoh S, Sugawara J. Brain blood and cerebrospinal fluid flow dynamics during rhythmic handgrip exercise in young healthy men and women. J Physiol 2021; 599:1799-1813. [PMID: 33481257 DOI: 10.1113/jp281063] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 01/12/2021] [Indexed: 01/06/2023] Open
Abstract
KEY POINTS The cerebral fluid response to exercise, including the arterial and venous cerebral blood flow (CBF) and cerebrospinal fluid (CSF), currently remains unknown. We used time-resolved phase-contrast magnetic resonance imaging to assess changes in CBF and CSF flow dynamics during moderate-intensity rhythmic handgrip (RHG) exercise in young healthy men and women. Our data demonstrated that RHG increases the cerebral arterial inflow and venous outflow while decreasing the pulsatile CSF flow during RHG. Furthermore, changes in blood stroke volume at the measured arteries, veins, and sinuses and CSF stroke volume at the cerebral aqueduct were positively correlated with each other during RHG. Male and female participants exhibited distinct blood pressure responses to RHG, but their cerebral fluid responses were similar. These results collectively suggest that RHG influences both CBF and CSF flow dynamics in a way that is consistent with the Monro-Kellie hypothesis to maintain intracranial volume-pressure homeostasis in young healthy adults. ABSTRACT Cerebral blood flow (CBF) increases during exercise, but its impact on cerebrospinal fluid (CSF) flow remains unknown. This study investigated CBF and CSF flow dynamics during moderate-intensity rhythmic handgrip (RHG) exercise in young healthy men and women. Twenty-six participants (12 women) underwent the RHG and resting control conditions in random order. Participants performed 3 sets of RHG, during which cine phase-contrast magnetic resonance imaging (PC-MRI) was performed to measure blood stroke volume (SV) and flow rate in the internal carotid (ICA) and vertebral (VA) arteries, the internal jugular vein (IJV), the superior sagittal (SSS) and straight sinuses (SRS), and CSF SV and flow rate in the cerebral aqueduct of Sylvius. Blood pressure, end-tidal CO2 (EtCO2 ), heart rate (HR), and respiratory rate were simultaneously measured during cine PC-MRI scans. Compared with control conditions, RHG showed significant elevations of HR, mean arterial pressure, and respiratory rate with a mild reduction of EtCO2 (all P < 0.05). RHG decreased blood SV in the measured arteries, veins, and sinuses and CSF SV in the aqueduct (all P < 0.05). Conversely, RHG increased blood flow in the ICA, VA, and IJV (all P < 0.05). At the aqueduct, RHG decreased the absolute CSF flow rate (P = 0.0307), which was calculated as a sum of the caudal and cranial CSF flow rates. Change in the ICA SV was positively correlated with changes in the IJV, SSS, SRS, and aqueductal SV during RHG (all P < 0.05). These findings demonstrate a close coupling between the CBF and CSF flow dynamics during RHG in young healthy adults.
Collapse
Affiliation(s)
- Takashi Tarumi
- Human Informatics and Interaction Research Institute, National Institute of Advanced Industrial Science and Technology, Tsukuba, Ibaraki, Japan.,Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan.,Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Texas, USA
| | - Takayuki Yamabe
- Human Informatics and Interaction Research Institute, National Institute of Advanced Industrial Science and Technology, Tsukuba, Ibaraki, Japan.,Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan
| | - Marina Fukuie
- Human Informatics and Interaction Research Institute, National Institute of Advanced Industrial Science and Technology, Tsukuba, Ibaraki, Japan.,Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan
| | - David C Zhu
- Department of Radiology and Cognitive Imaging Research Center, Michigan State University, East Lansing, Michigan, USA
| | - Rong Zhang
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Texas, USA.,Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Shigehiko Ogoh
- Department of Biomedical Engineering, Toyo University, Kawagoe-shi, Saitama, Japan
| | - Jun Sugawara
- Human Informatics and Interaction Research Institute, National Institute of Advanced Industrial Science and Technology, Tsukuba, Ibaraki, Japan.,Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan
| |
Collapse
|
67
|
Zahoor I, Rui B, Khan J, Datta I, Giri S. An emerging potential of metabolomics in multiple sclerosis: a comprehensive overview. Cell Mol Life Sci 2021; 78:3181-3203. [PMID: 33449145 PMCID: PMC8038957 DOI: 10.1007/s00018-020-03733-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 11/14/2020] [Accepted: 12/07/2020] [Indexed: 02/08/2023]
Abstract
Multiple sclerosis (MS) is an inflammatory demyelinating disease of the nervous system that primarily affects young adults. Although the exact etiology of the disease remains obscure, it is clear that alterations in the metabolome contribute to this process. As such, defining a reliable and disease-specific metabolome has tremendous potential as a diagnostic and therapeutic strategy for MS. Here, we provide an overview of studies aimed at identifying the role of metabolomics in MS. These offer new insights into disease pathophysiology and the contributions of metabolic pathways to this process, identify unique markers indicative of treatment responses, and demonstrate the therapeutic effects of drug-like metabolites in cellular and animal models of MS. By and large, the commonly perturbed pathways in MS and its preclinical model include lipid metabolism involving alpha-linoleic acid pathway, nucleotide metabolism, amino acid metabolism, tricarboxylic acid cycle, d-ornithine and d-arginine pathways with collective role in signaling and energy supply. The metabolomics studies suggest that metabolic profiling of MS patient samples may uncover biomarkers that will advance our understanding of disease pathogenesis and progression, reduce delays and mistakes in diagnosis, monitor the course of disease, and detect better drug targets, all of which will improve early therapeutic interventions and improve evaluation of response to these treatments.
Collapse
Affiliation(s)
- Insha Zahoor
- Department of Neurology, Henry Ford Hospital, Detroit, MI, 48202, USA. .,Department of Neurology, Henry Ford Hospital, Education & Research Building, Room 4023, 2799 W Grand Blvd, Detroit, MI, 48202, USA.
| | - Bin Rui
- Department of Neurology, Henry Ford Hospital, Detroit, MI, 48202, USA
| | - Junaid Khan
- Department of Neurology, Henry Ford Hospital, Detroit, MI, 48202, USA
| | - Indrani Datta
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Shailendra Giri
- Department of Neurology, Henry Ford Hospital, Detroit, MI, 48202, USA. .,Department of Neurology, Henry Ford Hospital, Education & Research Building, Room 4051, 2799 W Grand Blvd, Detroit, MI, 48202, USA.
| |
Collapse
|
68
|
Barpujari A, Pierre K, Dodd W, Dagra A, Small C, Williams E, Clark A, Lucke-Wold B. Lessons from NATURE: methods for traumatic brain injury prevention. ARCHIVES OF CLINICAL TOXICOLOGY 2021; 3:34-41. [PMID: 34993525 PMCID: PMC8730289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Multiple species obtain repetitive head collisions throughout the course of their lifetimes with minimal neurologic deficit. Nature has allowed the unique development of multiple protective mechanisms to help prevent neurotrauma. In this review, we examine the concept of rapid brain movement within the skull 'Slosh' and what nature teaches on how to prevent this from occurring. We look at individual animals and the protective mechanisms at play. Marching from macroscopic down to the molecular level, we pinpoint key elements of neuroprotection that are likely contributing. We also introduce new concepts for neuroprotection and address avenues of further discovery.
Collapse
Affiliation(s)
- Arnav Barpujari
- Department of Neurosurgery, University of Florida, Gainesville, USA
| | - Kevin Pierre
- Department of Neurosurgery, University of Florida, Gainesville, USA
| | - William Dodd
- Department of Neurosurgery, University of Florida, Gainesville, USA
| | - Abeer Dagra
- Department of Neurosurgery, University of Florida, Gainesville, USA
| | - Coulter Small
- Department of Neurosurgery, University of Florida, Gainesville, USA
| | - Eric Williams
- Department of Neurosurgery, University of Florida, Gainesville, USA
| | - Alec Clark
- Department of Neurosurgery, University of Florida, Gainesville, USA
| | | |
Collapse
|
69
|
Mollan SP, Grech O, Alimajstorovic Z, Wakerley BR, Sinclair AJ. New horizons for idiopathic intracranial hypertension: advances and challenges. Br Med Bull 2020; 136:118-126. [PMID: 33200788 DOI: 10.1093/bmb/ldaa034] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/28/2020] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Idiopathic intracranial hypertension (IIH) is becoming a recognized condition due to the increasing incidence linked to a global obesity epidemic. SOURCES OF DATA All English papers on PubMed, Cochrane and Scholar between inception until 1 March 2020 were considered. AREAS OF AGREEMENT Studies suggest central adiposity has a pathogenic role. Recent weight gain is a risk factor and weight loss has a key role in management. AREAS OF CONTROVERSY Interpretation of abnormal lumbar puncture opening pressure is debated. There is an increasing recognition of obesity stigma and how this should be approached. GROWING POINTS Further evidence is required for the choice of surgical intervention for fulminant IIH. Education regarding IIH should be evidence based. AREAS TIMELY FOR DEVELOPING RESEARCH Novel research of the pathology of IIH is influencing development of therapies such as glucagon-like peptide-1 receptor agonists and targeting unique androgen signatures. The newly discovered cardiovascular risk requires further attention.
Collapse
Affiliation(s)
- Susan P Mollan
- Birmingham Neuro-Ophthalmology, Queen Elizabeth Hospital, Birmingham, UK
| | - Olivia Grech
- Metabolic Neurology, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK.,Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham B15 2TH, UK
| | - Zerin Alimajstorovic
- Metabolic Neurology, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK.,Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham B15 2TH, UK
| | | | - Alexandra J Sinclair
- Metabolic Neurology, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK.,Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham B15 2TH, UK.,Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham B15 2WB, UK
| |
Collapse
|
70
|
Jalusic KO, Hempel G, Arnemann PH, Spiekermann C, Kampmeier TG, Ertmer C, Gastine S, Hessler M. Population pharmacokinetics of vancomycin in patients with external ventricular drain-associated ventriculitis. Br J Clin Pharmacol 2020; 87:2502-2510. [PMID: 33202067 DOI: 10.1111/bcp.14657] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 10/27/2020] [Accepted: 11/05/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND To determine the distribution of vancomycin into the cerebrospinal fluid (CSF) in patients with external ventricular drain (EVD)-associated ventriculitis, the pharmacokinetics of vancomycin were evaluated and covariate relationships explored. METHODS For the population pharmacokinetic model patients were recruited in a neurocritical care unit at the University Hospital of Muenster in the period between January 2014 and June 2015. All patients had a clinical evidence of EVD-associated ventriculitis. Population pharmacokinetic analysis of vancomycin was performed using NONMEM. RESULTS A total of 184 blood and 133 CSF samples were collected from 29 patients. The final population pharmacokinetic model is a three-compartment model with linear elimination. Creatinine clearance (ClCr ) and CSF-lactate were detected as significant covariates, showing that the total vancomycin plasma clearance (Cl) depends on ClCr and furthermore the clearance (Cldif ) between the central and CSF compartment correlates with CSF lactate concentration. Based on the final model, the following values were estimated by NONMEM: Cl = 5.15 L/h, Q (intercompartmental clearance) = 3.31 L/h, Cldif = 0.0031 L/h, Vcentral = 42.1 L, VCSF = 0.32 L and the value of Vperipheral was fixed to 86.2 L. With the developed pharmacokinetic model, area under the curve (AUC) values as well as CSF trough levels were simulated. CONCLUSION Based on our analysis, the dosing of vancomycin should be referred to the degree of inflammation (derived from the CSF lactate concentration) and renal function (derived from ClCr ).
Collapse
Affiliation(s)
- Kris Oliver Jalusic
- Department of Pharmaceutical and Medical Chemistry, Clinical Pharmacy, University of Muenster, Muenster, Germany.,Institute of Epidemiology and Social Medicine, Faculty of Medicine, University of Muenster, Muenster, Germany
| | - Georg Hempel
- Department of Pharmaceutical and Medical Chemistry, Clinical Pharmacy, University of Muenster, Muenster, Germany
| | - Philip-Helge Arnemann
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital of Muenster, Muenster, Germany
| | - Christina Spiekermann
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital of Muenster, Muenster, Germany
| | - Tim-Gerald Kampmeier
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital of Muenster, Muenster, Germany
| | - Christian Ertmer
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital of Muenster, Muenster, Germany
| | - Silke Gastine
- Department of Pharmaceutical and Medical Chemistry, Clinical Pharmacy, University of Muenster, Muenster, Germany.,Infection, Immunity & Inflammation Research & Teaching Department, GOS Institute of Child Health, University College London, London, UK
| | - Michael Hessler
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital of Muenster, Muenster, Germany
| |
Collapse
|
71
|
Ferdosian F, Kheyrabadi AE, Nafei Z. Frequency Distribution of Antibiotic Therapy Intervention According to Lumbar Puncture Cerebrospinal Fluid Outcome in Hospitalized Children. MAEDICA 2020; 15:454-460. [PMID: 33603902 PMCID: PMC7879365 DOI: 10.26574/maedica.2020.15.4.454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background: The aim of this study was to evaluate the frequency distribution of antibiotic therapy according to lumbar puncture outcome in hospitalized children. Methods:This study was conducted on 94 children undergoing lumbar puncture. All data were extracted from medical records. Administration of primary treatments and initial diagnosis including febrile convulsion, meningitis, and encephalitis in these patients were based on a physician's opinion. Results:The majority of subjects were diagnosed with febrile convulsion. Antibiotic treatment before lumbar puncture was taken by 58 children. After lumbar puncture, 35 children discontinued antibiotic therapy, two patients were switched to another antibiotic treatment and 21 subjects continued antibiotic medication. In addition, 36 children did not take antibiotics. Positive PCR was found in four cases from the encephalitis group. Conclusion: After lumbar puncture, antibiotic treatment was continued in 23 cases, whereas administration of antibiotics could be justified only in four cases based on positive PCR. Given that antibiotic treatment of our subjects was initiated prior to lumbar puncture but it was changed in two cases and continued in 21 cases after the medical procedure, conducting lumbar puncture seemed to be not very useful in these patients, assuming that laboratory signs or symptoms could justify an antibiotic treatment.
Collapse
Affiliation(s)
- Farzad Ferdosian
- Department of Pediatrics, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | | | - Zahra Nafei
- Children Growth Disorder Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| |
Collapse
|
72
|
Avila J, Perry G. A Multilevel View of the Development of Alzheimer's Disease. Neuroscience 2020; 457:283-293. [PMID: 33246061 DOI: 10.1016/j.neuroscience.2020.11.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/28/2020] [Accepted: 11/10/2020] [Indexed: 12/12/2022]
Abstract
Every year the Alzheimer's Association publishes a report that provides facts and figures indicating the public health, social and economic impact of Alzheimer's disease (AD). In addition, there are a number of reviews on the disease for general readers. Also, at congresses, AD is analyzed at different but not always related levels, leading to an "elephant as seen by blind men situation" for many of the participants. The review presented herein seeks to provide readers with a holistic view of how AD develops from various perspectives: the whole human organism, brain, circuits, neurons, cellular hallmarks, and molecular level.
Collapse
Affiliation(s)
- Jesús Avila
- Centro de Biología Molecular Severo Ochoa (CSIC-UAM), 28049 Madrid, Spain; Network Centre for Biomedical Research in Neurodegenerative Diseases (CIBERNED), 28031 Madrid, Spain.
| | - George Perry
- College of Sciences, University of Texas at San Antonio, San Antonio, TX, USA.
| |
Collapse
|
73
|
Grigoryan R, Costas-Rodríguez M, Santens P, Vanhaecke F. Multicollector Inductively Coupled Plasma-Mass Spectrometry with 10 13 Ω Faraday Cup Amplifiers for Ultrasensitive Mg Isotopic Analysis of Cerebrospinal Fluid Microsamples. Anal Chem 2020; 92:15975-15981. [PMID: 33226203 DOI: 10.1021/acs.analchem.0c03431] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Magnesium isotopic analysis of cerebrospinal fluid (CSF) is a potentially interesting approach for studies on neurodegeneration. However, this type of analysis is challenging because of the invasiveness of the sampling and small sample volume. In this work, a novel analytical method was developed for ultrasensitive Mg isotopic analysis of CSF microsamples via multicollector inductively coupled plasma-mass spectrometry (MC-ICP-MS) using high-gain 1013 Ω Faraday cup amplifiers. The intermediate and internal errors on the δ26Mg value were improved up to fourfold using 1013 Ω resistors for the monitoring of both the 24Mg and 26Mg isotopes and up to twofold using a 1011 Ω resistor for the most abundant 24Mg isotope and a 1013 Ω resistor for the 26Mg isotope. Magnesium isotope ratios measured at a concentration level of 7-10 μg L-1 were in good agreement with those obtained using the conventional method at a concentration level of 150 μg L-1. The expanded uncertainty for the quality control CSF material obtained at the ultratrace level was ±0.16‰. Ultrasensitive Mg isotopic analysis was carried out for CSF from hydrocephalus patients using only 5 μL of sample. δMg values thus obtained were not significantly different from those obtained using the conventional method using a sample volume of 400 μL instead (p ≤ 0.05). The Mg isotopic composition of the CSF from hydrocephalus patients ranged between -0.65 and 0.30‰, with a mean δ26Mg value of -0.14 ± 0.27‰.
Collapse
Affiliation(s)
- Rosa Grigoryan
- Department of Chemistry, Atomic & Mass Spectrometry-A&MS Research Unit, Ghent University, Campus Sterre, Krijgslaan 281-S12, Ghent 9000, Belgium
| | - Marta Costas-Rodríguez
- Department of Chemistry, Atomic & Mass Spectrometry-A&MS Research Unit, Ghent University, Campus Sterre, Krijgslaan 281-S12, Ghent 9000, Belgium
| | - Patrick Santens
- Department of Neurology, Ghent University Hospital, C. Heymanslaan 10, Ghent 9000, Belgium
| | - Frank Vanhaecke
- Department of Chemistry, Atomic & Mass Spectrometry-A&MS Research Unit, Ghent University, Campus Sterre, Krijgslaan 281-S12, Ghent 9000, Belgium
| |
Collapse
|
74
|
Wulff AB, Højgaard JLS, Hilsted L. Spectrophotometry of cerebrospinal fluid for xanthochromia is a sensitive and specific test for subarachnoid bleeding but adds little to computed tomography. Scandinavian Journal of Clinical and Laboratory Investigation 2020; 80:681-686. [PMID: 33186071 DOI: 10.1080/00365513.2020.1846208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Subarachnoid hemorrhage (SAH) is a serious neurological event associated with high morbidity and mortality. Computed tomography of the cerebrum (CTC) is the diagnostic method of choice, but in case of negative CTC but strong suspicion of SAH, lumbar puncture with spectrophotometric analysis of cerebrospinal fluid (CSF) for xanthochromia is performed. We wanted to examine the diagnostic properties of CSF spectrophotometry for xanthochromia testing. We performed a retrospective study of the diagnostic properties of CSF analysis for xanthochromia using spectrophotometry in the diagnosis of SAH. A total of 489 CSF samples were analyzed for xanthochromia, according to international guidelines, from 2009 until 2014 and for 411 of these the patient files were retrieved and examined for final clinical diagnosis and result of CTC. One patient with SAH did not have a positive spectrophotometry report and another patient with SAH had an equivocal report. In four patients did initial CTC not correctly identify SAH. For patients with a negative CTC within six hours of symptom onset spectrophotometry for xanthochromia in the CSF had a diagnostic sensitivity of 100% and a diagnostic specificity of 98.5%. The positive predictive value was 16.7% and the negative predictive value 100%. We conclude that spectrophotometry of CSF for xanthochromia is a sensitive and specific test for diagnosing SAH. However, it seems that an initial CTC identifies almost all patients with SAH. This suggests that in our and similar diagnostic settings, lumbar puncture and testing for xanthochromia might only be relevant in very few cases, if not obsolete.
Collapse
Affiliation(s)
- Anders Berg Wulff
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | | | - Linda Hilsted
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| |
Collapse
|
75
|
Livingston AJ, Laing B, Zwagerman NT, Harris MS. Lumbar drains: Practical understanding and application for the otolaryngologist. Am J Otolaryngol 2020; 41:102740. [PMID: 32979671 DOI: 10.1016/j.amjoto.2020.102740] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 09/13/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Lumbar drains are frequently used in patients with otolaryngologic concerns. These can be used therapeutically or prophylactically with the primary purpose being to modulate CSF pressure. Within otolaryngology, lumbar drains are most frequently used for cerebrospinal fluid leaks - either due to cerebrospinal fluid fistulas or in skull base surgery as these allow for potential healing of the defect. While not typically placed by otolaryngologists, a basic understanding of lumbar drains is beneficial in the context of patient management. MANAGEMENT A lumbar drain is inserted into the intrathecal space in a patient's lumbar spine. Though considered to be a benign procedure, complications are relatively frequent, and adjustment or replacement of the drain may be required. Complications include infection, epidural bleeding, retained hardware, sequelae of relative immobility, or may relate to over-drainage, ranging from mild headache to cranial neuropathies, altered mental status, pneumocephalus, intracranial hemorrhage, and death. While in place, neurologic exams should be performed routinely and should include motor and sensory exams of the lower extremities. A patient should be monitored for fevers, nuchal rigidity, and other signs of infection or meningitis. The CSF fluid should be grossly examined to identify changes, but routine laboratory tests are not typically run on the fluid itself. Drainage rates will vary usually between 5 and 20 mL per hour and must be frequently reassessed and adjusted based upon signs of intracranial hypotension. Drains should be removed when appropriate and should not be left in more than 5 days due to the increased infectious risk. CONCLUSION Lumbar drains are important tools used in patients with otolaryngologic pathologies. Otolaryngologists and otolaryngology residents should be familiar with these catheters to determine if they are working correctly and to identify adverse effects as early as possible.
Collapse
Affiliation(s)
| | - Brandon Laing
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Nathan T Zwagerman
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States of America; Department of Otolaryngology & Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Michael S Harris
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States of America; Department of Otolaryngology & Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, United States of America
| |
Collapse
|
76
|
Didier-Laurent A, De Gaalon S, Ferhat S, Mihailescu SD, Maltete D, Laplaud D, Lefaucheur R, Guegan-Massardier E, Grangeon L. Does post dural puncture headache exist in idiopathic intracranial hypertension? A pilot study. Rev Neurol (Paris) 2020; 177:676-682. [PMID: 33069377 DOI: 10.1016/j.neurol.2020.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/08/2020] [Accepted: 06/16/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND/OBJECTIVE Occurrence of post-dural puncture headache (PDPH) after diagnostic lumbar puncture (LP) for idiopathic intracranial hypertension (IIH) may seem very unlikely in clinical practice. Nevertheless, it has been suggested by several studies, mainly in sub-group analyses. We aimed to evaluate the prevalence of PDPH in an IIH population and determine any eventual predictive factors of PDPH occurrence. METHODS We conducted a retrospective multiple-center observational study. All newly diagnosed IIH patients who met the International Classification of Headache Disorders (ICHD-3) or the Dandy modified criteria were included from three different French hospitals. They all underwent LP following the same process with the same type of needle. We recorded PDPH occurring within five days after LP, as defined by ICHD-3 criteria. RESULTS Seventy-four IIH patients were recruited, of whom 23 (31%) presented with PDPH. Neither classical risk factors for PDPH such as body mass index, age or gender, nor cerebrospinal fluid opening pressure, or specific IIH features were associated with occurrence of PDPH. CONCLUSION PDPH can occur after LP in IIH patients. Clinicians should be aware of this possible event during the IIH diagnosis assessment and should not automatically reconsider IIH diagnosis. PDPH prevention using an atraumatic needle and dedicated PDPH treatment seem relevant in IIH patients.
Collapse
Affiliation(s)
- A Didier-Laurent
- Department of Neurology, Rouen University Hospital, 76031 Rouen, France.
| | - S De Gaalon
- Department of Neurology, Nantes University Hospital, Nantes, France
| | - S Ferhat
- Department of Neurology, Evreux Hospital, Evreux, France
| | - S-D Mihailescu
- Department of Biostatistics, Rouen University Hospital, 76031 Rouen, France
| | - D Maltete
- Department of Neurology, Rouen University Hospital, 76031 Rouen, France
| | - D Laplaud
- Department of Neurology, Nantes University Hospital, Nantes, France
| | - R Lefaucheur
- Department of Neurology, Rouen University Hospital, 76031 Rouen, France
| | | | - L Grangeon
- Department of Neurology, Rouen University Hospital, 76031 Rouen, France.
| |
Collapse
|
77
|
Ljubisavljevic S. Postdural puncture headache as a complication of lumbar puncture: clinical manifestations, pathophysiology, and treatment. Neurol Sci 2020; 41:3563-3568. [PMID: 32997283 DOI: 10.1007/s10072-020-04757-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 09/23/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE This manuscript is a narrative review of peer-reviewed studies of postdural puncture headache (PDPH) as the most common complication of a diagnostic and therapeutic lumbar puncture (LP) and LP due to the damage of the dura mater in epidural anesthesia. METHODS Author searched articles related to the PDPH and its risk factors, pathophysiology diagnosis, differential diagnosis, and therapy. All studies according to the analyzed parameters and their relevance to the clinical practice, as well as quality of the study methods, were selected for further analysis. RESULTS The review presents the clinical and paraclinical prediction criteria for the onset, clinical features, course, and efficiency of specific therapeutic interventions which are of a particular clinical benefit for the prevention, pathogenetic treatment, and differential diagnosis of PDPH. The analysis of prediction parameters for the onset, clinical course, and associated symptoms and signs of PDPH is a contribution to the understanding of pathophysiology of intracranial hypotension, since PDPH can be considered a clinical model of intracranial hypotension. CONCLUSIONS Given that LP is a common procedure in clinical practice, it is necessary to have a comprehensive knowledge of the risk factors, pathophysiological, diagnostic, differentially diagnostic, and therapeutic aspects of PDPH.
Collapse
Affiliation(s)
- Srdjan Ljubisavljevic
- Department for Neurology, Faculty of Medicine, University of Nis, Nis, Serbia. .,Department for Cerebrovascular Diseases and Headache, Clinic for Neurology, Clinical Center of Nis, Blvd. Dr Zorana Djindjica 81, Nis, 18000, Serbia.
| |
Collapse
|
78
|
[The spinal catheter in aortic surgery : Implications for anesthesia]. Anaesthesist 2020; 69:765-778. [PMID: 32975587 DOI: 10.1007/s00101-020-00836-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
During surgical repair of aortic pathologies (e.g. dissection, aneurysms), cross-clamping of the aorta or overstenting of critical segmental arteries can lead to ischemia- and edema-related spinal cord damage with subsequent paraplegia. By regulating cerebrospinal fluid pressure, the spinal catheter is an effective method for prophylaxis and treatment of spinal cord ischemia. Due to the high complication rate of the spinal catheter a detailed risk-benefit assessment is obligatory: besides cerebrospinal fluid leakage, postpuncture headaches and local infections, feared complications, such as intracranial bleeding, meningitis and neuraxial hematomas can also occur, sometimes with a significant latent period after termination of the procedure. Adequate training of personnel in the perioperative handling of spinal catheters and meticulous adherence to drainage parameters are important components for increasing procedural safety. This is particularly true since the clinical aspects of catheter-associated complications only slightly differ from that of ischemic spinal cord injury.
Collapse
|
79
|
Protein Biomarkers for the Diagnosis of Alzheimer's Disease at Different Stages of Neurodegeneration. Int J Mol Sci 2020; 21:ijms21186749. [PMID: 32942527 PMCID: PMC7554800 DOI: 10.3390/ijms21186749] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/08/2020] [Accepted: 09/11/2020] [Indexed: 12/24/2022] Open
Abstract
Mainly obtained from familial Alzheimer’s disease patients’ data, we know that some features of the neurodegenerative start several years before the appearance of clinical symptoms. In this brief review, we comment on some molecular and cellular markers appearing at different stages of the disease, before or once the clinical symptoms are evident. These markers are present in biological fluids or could be identified by image techniques. The combined use of molecular and cellular markers will be of interest to determine the development of the different phases of the disease.
Collapse
|
80
|
Camilieri-Asch V, Shaw JA, Yopak KE, Chapuis L, Partridge JC, Collin SP. Volumetric analysis and morphological assessment of the ascending olfactory pathway in an elasmobranch and a teleost using diceCT. Brain Struct Funct 2020; 225:2347-2375. [PMID: 32870419 DOI: 10.1007/s00429-020-02127-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 07/31/2020] [Indexed: 11/26/2022]
Abstract
The size (volume or mass) of the olfactory bulbs in relation to the whole brain has been used as a neuroanatomical proxy for olfactory capability in a range of vertebrates, including fishes. Here, we use diffusible iodine-based contrast-enhanced computed tomography (diceCT) to test the value of this novel bioimaging technique for generating accurate measurements of the relative volume of the main olfactory brain areas (olfactory bulbs, peduncles, and telencephalon) and to describe the morphological organisation of the ascending olfactory pathway in model fish species from two taxa, the brownbanded bamboo shark Chiloscyllium punctatum and the common goldfish Carassius auratus. We also describe the arrangement of primary projections to the olfactory bulb and secondary projections to the telencephalon in both species. Our results identified substantially larger olfactory bulbs and telencephalon in C. punctatum compared to C. auratus (comprising approximately 5.2% vs. 1.8%, and 51.8% vs. 11.8% of the total brain volume, respectively), reflecting differences between taxa, but also possibly in the role of olfaction in the sensory ecology of these species. We identified segregated primary projections to the bulbs, associated with a compartmentalised olfactory bulb in C. punctatum, which supports previous findings in elasmobranch fishes. DiceCT imaging has been crucial for visualising differences in the morphological organisation of the olfactory system of both model species. We consider comparative neuroanatomical studies between representative species of both elasmobranch and teleost fish groups are fundamental to further our understanding of the evolution of the olfactory system in early vertebrates and the neural basis of olfactory abilities.
Collapse
Affiliation(s)
- Victoria Camilieri-Asch
- School of Biological Sciences, The University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia.
- Oceans Institute, Indian Ocean Marine Research Centre (IOMRC), The University of Western Australia, Cnr Fairway and Service Road 4, Crawley, WA, 6009, Australia.
- Centre for Transformative Biomimetics in Bioengineering, Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology, Q Block Level 7, 60 Musk Avenue, Kelvin Grove, QLD, 4059, Australia.
| | - Jeremy A Shaw
- Centre for Microscopy, Characterisation and Analysis (CMCA), The University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia
| | - Kara E Yopak
- Department of Biology and Marine Biology and the Center for Marine Science, University of North Carolina Wilmington, 5600 Marvin K Moss Lane, Wilmington, NC, 28409, USA
| | - Lucille Chapuis
- Biosciences, College of Life and Environmental Sciences, University of Exeter, Geoffrey Pope, Stocker Road, Exeter, EX4 4QD, UK
| | - Julian C Partridge
- Oceans Institute, Indian Ocean Marine Research Centre (IOMRC), The University of Western Australia, Cnr Fairway and Service Road 4, Crawley, WA, 6009, Australia
| | - Shaun P Collin
- Oceans Institute, Indian Ocean Marine Research Centre (IOMRC), The University of Western Australia, Cnr Fairway and Service Road 4, Crawley, WA, 6009, Australia
- Ocean Graduate School, IOMRC, The University of Western Australia, Cnr Fairway and Service Entrance 4, Crawley, WA, 6009, Australia
- School of Life Sciences, La Trobe University, Plenty Road and Kingsbury Drive, Bundoora, VIC, 3086, Australia
| |
Collapse
|
81
|
Tao J, Zhu Y, Zhao S, Chen P, Zhang S, Sun J, Shen X. A novel approach with glass needle enclosed movable probe for in vivo real-time detection of glucose in cisternal cerebrospinal fluid. J Electroanal Chem (Lausanne) 2020. [DOI: 10.1016/j.jelechem.2020.114440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
82
|
Kaur J, Davoodi-Bojd E, Fahmy LM, Zhang L, Ding G, Hu J, Zhang Z, Chopp M, Jiang Q. Magnetic Resonance Imaging and Modeling of the Glymphatic System. Diagnostics (Basel) 2020; 10:diagnostics10060344. [PMID: 32471025 PMCID: PMC7344900 DOI: 10.3390/diagnostics10060344] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/22/2020] [Accepted: 05/25/2020] [Indexed: 12/20/2022] Open
Abstract
The glymphatic system is a newly discovered waste drainage pathway in the brain; it plays an important role in many neurological diseases. Ongoing research utilizing various cerebrospinal fluid tracer infusions, either directly or indirectly into the brain parenchyma, is investigating clearance pathways by using distinct imaging techniques. In the present review, we discuss the role of the glymphatic system in various neurological diseases and efflux pathways of brain waste clearance based on current evidence and controversies. We mainly focus on new magnetic resonance imaging (MRI) modeling techniques, along with traditional computational modeling, for a better understanding of the glymphatic system function. Future sophisticated modeling techniques hold the potential to generate quantitative maps for glymphatic system parameters that could contribute to the diagnosis, monitoring, and prognosis of neurological diseases. The non-invasive nature of MRI may provide a safe and effective way to translate glymphatic system measurements from bench-to-bedside.
Collapse
Affiliation(s)
- Jasleen Kaur
- Department of Neurology, Henry Ford Health System, Detroit, MI 48202, USA; (J.K.); (E.D.-B.); (L.M.F.); (L.Z.); (G.D.); (Z.Z.); (M.C.)
- Department of Physics, Oakland University, Rochester, MI 48309, USA
| | - Esmaeil Davoodi-Bojd
- Department of Neurology, Henry Ford Health System, Detroit, MI 48202, USA; (J.K.); (E.D.-B.); (L.M.F.); (L.Z.); (G.D.); (Z.Z.); (M.C.)
- Department of Radiology, Henry Ford Health System, Detroit, MI 48202, USA
| | - Lara M Fahmy
- Department of Neurology, Henry Ford Health System, Detroit, MI 48202, USA; (J.K.); (E.D.-B.); (L.M.F.); (L.Z.); (G.D.); (Z.Z.); (M.C.)
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI 48201, USA
| | - Li Zhang
- Department of Neurology, Henry Ford Health System, Detroit, MI 48202, USA; (J.K.); (E.D.-B.); (L.M.F.); (L.Z.); (G.D.); (Z.Z.); (M.C.)
| | - Guangliang Ding
- Department of Neurology, Henry Ford Health System, Detroit, MI 48202, USA; (J.K.); (E.D.-B.); (L.M.F.); (L.Z.); (G.D.); (Z.Z.); (M.C.)
| | - Jiani Hu
- Department of Radiology, Wayne State University, Detroit, MI 48201, USA;
| | - Zhenggang Zhang
- Department of Neurology, Henry Ford Health System, Detroit, MI 48202, USA; (J.K.); (E.D.-B.); (L.M.F.); (L.Z.); (G.D.); (Z.Z.); (M.C.)
| | - Michael Chopp
- Department of Neurology, Henry Ford Health System, Detroit, MI 48202, USA; (J.K.); (E.D.-B.); (L.M.F.); (L.Z.); (G.D.); (Z.Z.); (M.C.)
- Department of Physics, Oakland University, Rochester, MI 48309, USA
| | - Quan Jiang
- Department of Neurology, Henry Ford Health System, Detroit, MI 48202, USA; (J.K.); (E.D.-B.); (L.M.F.); (L.Z.); (G.D.); (Z.Z.); (M.C.)
- Department of Physics, Oakland University, Rochester, MI 48309, USA
- Correspondence: ; Tel.: +1-313-916-8735; Fax: +1-313-916-1324
| |
Collapse
|
83
|
Angus L, Martens JWM, van den Bent MJ, Sillevis Smitt PAE, Sleijfer S, Jager A. Novel methods to diagnose leptomeningeal metastases in breast cancer. Neuro Oncol 2020; 21:428-439. [PMID: 30418595 DOI: 10.1093/neuonc/noy186] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Leptomeningeal metastases (LM) in breast cancer patients are rare but often accompanied by devastating neurological symptoms and carry a very poor prognosis, even if treated. To date, two diagnostic methods are clinically used to diagnose LM: gadolinium MRI of the brain and/or spinal cord and cytological examination of cerebrospinal fluid (CSF). Both techniques are, however, hampered by limited sensitivities, often leading to a long diagnostic process requiring repeated lumbar punctures and MRI examinations. To improve the detection rate of LM, numerous studies have assessed new techniques. In this review, we present the current workup to diagnose LM, set out an overview of novel techniques to diagnose LM, and give recommendations for future research.
Collapse
Affiliation(s)
- Lindsay Angus
- Erasmus MC Cancer Institute, Erasmus University Medical Center, Department of Medical Oncology, Rotterdam, the Netherlands
| | - John W M Martens
- Erasmus MC Cancer Institute, Erasmus University Medical Center, Department of Medical Oncology, Rotterdam, the Netherlands
| | - Martin J van den Bent
- The Brain Tumor Center at Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Peter A E Sillevis Smitt
- The Brain Tumor Center at Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Stefan Sleijfer
- Erasmus MC Cancer Institute, Erasmus University Medical Center, Department of Medical Oncology, Rotterdam, the Netherlands
| | - Agnes Jager
- Erasmus MC Cancer Institute, Erasmus University Medical Center, Department of Medical Oncology, Rotterdam, the Netherlands
| |
Collapse
|
84
|
MARTINS RT, TOSON B, SOUZA RKMD, KOWACS PA. Post-dural puncture headache incidence after cerebrospinal fluid aspiration. A prospective observational study. ARQUIVOS DE NEURO-PSIQUIATRIA 2020; 78:187-192. [DOI: 10.1590/0004-282x20190197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 11/28/2019] [Indexed: 12/15/2022]
Abstract
Abstract Background: Post-dural puncture headache (PDPH) is an iatrogenic condition following lumbar puncture (LP). Incidence is variable and often associated with young females. Technical features of the procedure (i.e. needle gauge) have been investigated; however there is no investigation on the method of cerebrospinal fluid (CSF) collection. Objective: To investigate whether mild CSF aspiration is associated with increased PDPH in selected patients. Methods: 336 subjects were eligible to the study. Data on 237 patients from a tertiary neurology hospital who underwent diagnostic LP from February 2010 to December 2012 were analysed. Patient demographics, lumbar puncture method, CSF biochemical characteristics, opening pressures, and a follow-up inquire on PDPH occurrence were collected. CSF was collected either by allowing free flow or by mild aspiration. Results: The aspiration arm (n=163) was comprised of 55.8% females with mean age of 52(35‒69) years. Sex distribution was not different between the two arms (p=0.191). A significant larger amount of CSF was obtained in the aspiration arm (p=0.011). The incidence of PDPH in the aspiration arm was 16.5% versus 20.2% in the free flow arm, not statistically significant (p=0.489). No relevant associations emerged from the analyses in the subgroup aged <65 years. Conclusions: Aspiration of the CSF during LP was not associated with increased rates of PDPH compared to the standard method, particularly when larger amounts of CSF are required and ideal conditions are met. This is the first study looking into this matter, aiming to add safety to the procedure. Further randomized trials are required.
Collapse
|
85
|
Khani M, Sass LR, Sharp MK, McCabe AR, Zitella Verbick LM, Lad SP, Martin BA. In vitro and numerical simulation of blood removal from cerebrospinal fluid: comparison of lumbar drain to Neurapheresis therapy. Fluids Barriers CNS 2020; 17:23. [PMID: 32178689 PMCID: PMC7077023 DOI: 10.1186/s12987-020-00185-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 03/06/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Blood removal from cerebrospinal fluid (CSF) in post-subarachnoid hemorrhage patients may reduce the risk of related secondary brain injury. We formulated a computational fluid dynamics (CFD) model to investigate the impact of a dual-lumen catheter-based CSF filtration system, called Neurapheresis™ therapy, on blood removal from CSF compared to lumbar drain. METHODS A subject-specific multiphase CFD model of CSF system-wide solute transport was constructed based on MRI measurements. The Neurapheresis catheter geometry was added to the model within the spinal subarachnoid space (SAS). Neurapheresis flow aspiration and return rate was 2.0 and 1.8 mL/min, versus 0.2 mL/min drainage for lumbar drain. Blood was modeled as a bulk fluid phase within CSF with a 10% initial tracer concentration and identical viscosity and density as CSF. Subject-specific oscillatory CSF flow was applied at the model inlet. The dura and spinal cord geometry were considered to be stationary. Spatial-temporal tracer concentration was quantified based on time-average steady-streaming velocities throughout the domain under Neurapheresis therapy and lumbar drain. To help verify CFD results, an optically clear in vitro CSF model was constructed with fluorescein used as a blood surrogate. Quantitative comparison of numerical and in vitro results was performed by linear regression of spatial-temporal tracer concentration over 24-h. RESULTS After 24-h, tracer concentration was reduced to 4.9% under Neurapheresis therapy compared to 6.5% under lumbar drain. Tracer clearance was most rapid between the catheter aspiration and return ports. Neurapheresis therapy was found to have a greater impact on steady-streaming compared to lumbar drain. Steady-streaming in the cranial SAS was ~ 50× smaller than in the spinal SAS for both cases. CFD results were strongly correlated with the in vitro spatial-temporal tracer concentration under Neurapheresis therapy (R2 = 0.89 with + 2.13% and - 1.93% tracer concentration confidence interval). CONCLUSION A subject-specific CFD model of CSF system-wide solute transport was used to investigate the impact of Neurapheresis therapy on tracer removal from CSF compared to lumbar drain over a 24-h period. Neurapheresis therapy was found to substantially increase tracer clearance compared to lumbar drain. The multiphase CFD results were verified by in vitro fluorescein tracer experiments.
Collapse
Affiliation(s)
- Mohammadreza Khani
- Department of Biological Engineering, The University of Idaho, 875 Perimeter Drive, MS 0904, Moscow, ID, 83844-0904, USA
| | - Lucas R Sass
- Department of Biological Engineering, The University of Idaho, 875 Perimeter Drive, MS 0904, Moscow, ID, 83844-0904, USA
| | - M Keith Sharp
- Department of Mechanical Engineering, University of Louisville, 332 Eastern Pkwy, Louisville, KY, 40292, USA
| | - Aaron R McCabe
- Minnetronix Neuro, Inc., 1635 Energy Park Dr, Saint Paul, MN, 55108, USA
| | | | - Shivanand P Lad
- Department of Neurosurgery, Duke University School of Medicine, 3100 Tower Blvd, Durham, NC, 27707, USA
| | - Bryn A Martin
- Department of Biological Engineering, The University of Idaho, 875 Perimeter Drive, MS 0904, Moscow, ID, 83844-0904, USA.
| |
Collapse
|
86
|
Steen NE, Dieset I, Hope S, Vedal TSJ, Smeland OB, Matson W, Kaddurah-Daouk R, Agartz I, Melle I, Djurovic S, Jönsson EG, Bogdanov M, Andreassen OA. Metabolic dysfunctions in the kynurenine pathway, noradrenergic and purine metabolism in schizophrenia and bipolar disorders. Psychol Med 2020; 50:595-606. [PMID: 30867076 DOI: 10.1017/s0033291719000400] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND We aimed at exploring potential pathophysiological processes across psychotic disorders, applying metabolomics in a large and well-characterized sample of patients and healthy controls. METHODS Patients with schizophrenia and bipolar disorders (N = 212) and healthy controls (N = 68) had blood sampling with subsequent metabolomics analyses using electrochemical coulometric array detection. Concentrations of 52 metabolites including tyrosine, tryptophan and purine pathways were compared between patients and controls while controlling for demographic and clinical characteristics. Significant findings were further tested in medication-free subsamples. RESULTS Significantly decreased plasma concentrations in patients compared to healthy controls were found for 3-hydroxykynurenine (3OHKY, p = 0.0008), xanthurenic acid (XANU, p = 1.5×10-5), vanillylmandelic acid (VMA, p = 4.5×10-5) and metanephrine (MN, p = 0.0001). Plasma concentration of xanthine (XAN) was increased in the patient group (p = 3.5×10-5). Differences of 3OHKY, XANU, VMA and XAN were replicated across schizophrenia spectrum disorders and bipolar disorders subsamples of medication-free individuals. CONCLUSIONS Although prone to residual confounding, the present results suggest the kynurenine pathway of tryptophan metabolism, noradrenergic and purinergic system dysfunction as trait factors in schizophrenia spectrum and bipolar disorders. Of special interest is XANU, a metabolite previously not found to be associated with bipolar disorders.
Collapse
Affiliation(s)
- Nils Eiel Steen
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ingrid Dieset
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Sigrun Hope
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Neurohabilitation, Oslo University Hospital, Oslo, Norway
| | - Trude S J Vedal
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Olav B Smeland
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Neuroscience, University of California San Diego, La Jolla, CA92093, USA
| | | | - Rima Kaddurah-Daouk
- Duke Molecular Physiology Institute, Duke University, Durham, NC, USA
- Duke Institute of Brain Sciences, Duke University, Durham, NC, USA
- Department of Medicine, Duke University, Durham, NC, USA
| | - Ingrid Agartz
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Ingrid Melle
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Srdjan Djurovic
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Erik G Jönsson
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Clinical Neuroscience, Centre for Psychiatric Research, Karolinska Institutet, Stockholm, Sweden
| | | | - Ole A Andreassen
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
87
|
Fellner A, Goldstein L, Lotan I, Keret O, Steiner I. Meningitis without meningeal irritation signs: What are the alerting clinical markers? J Neurol Sci 2020; 410:116663. [DOI: 10.1016/j.jns.2019.116663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 12/04/2019] [Accepted: 12/27/2019] [Indexed: 11/17/2022]
|
88
|
Management of Neuroinflammatory Responses to AAV-Mediated Gene Therapies for Neurodegenerative Diseases. Brain Sci 2020; 10:brainsci10020119. [PMID: 32098339 PMCID: PMC7071492 DOI: 10.3390/brainsci10020119] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 02/17/2020] [Accepted: 02/20/2020] [Indexed: 12/12/2022] Open
Abstract
Recently, adeno-associated virus (AAV)-mediated gene therapies have attracted clinical interest for treating neurodegenerative diseases including spinal muscular atrophy (SMA), Canavan disease (CD), Parkinson’s disease (PD), and Friedreich’s ataxia (FA). The influx of clinical findings led to the first approved gene therapy for neurodegenerative disorders in 2019 and highlighted new safety concerns for patients. Large doses of systemically administered AAV stimulate host immune responses, resulting in anti-capsid and anti-transgene immunity with implications for transgene expression, treatment longevity, and patient safety. Delivering lower doses directly to the central nervous system (CNS) is a promising alternative, resulting in higher transgene expression with decreased immune responses. However, neuroinflammatory responses after CNS-targeted delivery of AAV are a critical concern. Reported signs of AAV-associated neuroinflammation in preclinical studies include dorsal root ganglion (DRG) and spinal cord pathology with mononuclear cell infiltration. In this review, we discuss ways to manage neuroinflammation, including choice of AAV capsid serotypes, CNS-targeting routes of delivery, genetic modifications to the vector and/or transgene, and adding immunosuppressive strategies to clinical protocols. As additional gene therapies for neurodegenerative diseases enter clinics, tracking biomarkers of neuroinflammation will be important for understanding the impact immune reactions can have on treatment safety and efficacy.
Collapse
|
89
|
Stark DB, Willis AK, Eshelman Z, Kang YS, Ramachandra R, Bolte JH, McCrink M. Human Response and Injury Resulting from Head Impacts with Unmanned Aircraft Systems. STAPP CAR CRASH JOURNAL 2019; 63:29-64. [PMID: 32311051 DOI: 10.4271/2019-22-0002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Unmanned aircraft systems (UAS), commonly known as drones, are part of a new and budding industry in the United States. Economic and public benefits associated with UAS use across multiple commercial sectors are driving new regulations which alter the stringent laws currently restricting UAS flights over people. As new regulations are enacted and more UAS populate the national airspace, there is a need to both understand and quantify the risk associated with UAS impacts with the uninvolved public. The purpose of this study was to investigate the biomechanical response and injury outcomes of Post Mortem Human Surrogates (PMHS) subjected to UAS head impacts. For this work, PMHS were tested with differing UAS vehicles at multiple impact angles, locations and speeds. Using a custom designed launching device, UAS vehicles were accelerated into the frontal, parietal, or vertex portions of subjects' craniums at speeds up to 22 m/s. Of the 35 UAS impacts carried out, one AIS 2+ injury was observed: a 13 cm linear skull fracture resulting from a Phantom 3 impact. Additionally, injury risk curves used in automotive testing were found to over predict the risk of injury in UAS impact scenarios. Finally, localized skull deformation was observed during severe impacts; the effect that this deformation had on measured kinematics should be further evaluated. Overall, the study found that AIS 2+ head injuries may occur as a result of UAS impacts and that automotive injury metrics may not be able to accurately predict head injury risk in UAS impact scenarios.
Collapse
Affiliation(s)
- David B Stark
- Injury Biomechanics Research Center, The Ohio State University
| | | | - Zach Eshelman
- Injury Biomechanics Research Center, The Ohio State University
| | - Yun-Seok Kang
- Injury Biomechanics Research Center, The Ohio State University
| | | | - John H Bolte
- Injury Biomechanics Research Center, The Ohio State University
| | | |
Collapse
|
90
|
Torralva R, Janowsky A. Noradrenergic Mechanisms in Fentanyl-Mediated Rapid Death Explain Failure of Naloxone in the Opioid Crisis. J Pharmacol Exp Ther 2019; 371:453-475. [PMID: 31492824 DOI: 10.1124/jpet.119.258566] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 09/03/2019] [Indexed: 12/25/2022] Open
Abstract
In December 2018, the Centers for Disease Control declared fentanyl the deadliest drug in America. Opioid overdose is the single greatest cause of death in the United States adult population (ages 18-50), and fentanyl and its analogs [fentanyl/fentanyl analogs (F/FAs)] are currently involved in >50% of these deaths. Anesthesiologists in the United States were introduced to fentanyl in the early 1970s when it revolutionized surgical anesthesia by combining profound analgesia with hemodynamic stability. However, they quickly had to master its unique side effect. F/FAs can produce profound rigidity in the diaphragm, chest wall and upper airway within an extremely narrow dosing range. This clinical effect was called wooden chest syndrome (WCS) by anesthesiologists and is not commonly known outside of anesthesiology or to clinicians or researchers in addiction research/medicine. WCS is almost routinely fatal without expert airway management. This review provides relevant clinical human pharmacology and animal data demonstrating that the significant increase in the number of F/FA-induced deaths may involve α-adrenergic and cholinergic receptor-mediated mechanical failure of the respiratory and cardiovascular systems with rapid development of rigidity and airway closure. Although morphine and its prodrug, heroin, can cause mild rigidity in abdominal muscles at high doses, neither presents with the distinct and rapid respiratory failure seen with F/FA-induced WCS, separating F/FA overdose from the slower onset of respiratory depression caused by morphine-derived alkaloids. This distinction has significant consequences for the design and implementation of new pharmacologic strategies to effectively prevent F/FA-induced death. SIGNIFICANCE STATEMENT: Deaths from fentanyl and F/FAs are increasing in spite of availability and awareness of the opioid reversal drug naloxone. This article reviews literature suggesting that naloxone may be ineffective against centrally mediated noradrenergic and cholinergic effects of F/FAs, which clinically manifest as severe muscle rigidity and airway compromise (e.g., wooden chest syndrome) that is rapid and distinct from respiratory depression seen with morphine-derived alkaloids. A physiologic model is proposed and implications for new drug development and treatment are discussed.
Collapse
Affiliation(s)
- Randy Torralva
- CODA Inc., Research Department, Portland, Oregon (R.T.); Research Service, VA Portland Health Care System, Portland, Oregon (R.T., A.J.); and Department of Psychiatry, Oregon Health & Science University, Portland, Oregon (R.T., A.J.)
| | - Aaron Janowsky
- CODA Inc., Research Department, Portland, Oregon (R.T.); Research Service, VA Portland Health Care System, Portland, Oregon (R.T., A.J.); and Department of Psychiatry, Oregon Health & Science University, Portland, Oregon (R.T., A.J.)
| |
Collapse
|
91
|
Yuan E, Jarvis CA, Attenello FJ. Characterizing Glioma Genetics Using Cerebrospinal Fluid. Neurosurgery 2019; 85:E196-E197. [DOI: 10.1093/neuros/nyz177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 03/04/2019] [Indexed: 11/13/2022] Open
|
92
|
Long J, Lin H, Cao G, Wang MZ, Huang XJ, Xia J, Sun Z. Relationship between intracranial pressure and phase-contrast cine MRI-derived measures of cerebrospinal fluid parameters in communicating hydrocephalus. Quant Imaging Med Surg 2019; 9:1413-1420. [PMID: 31559170 DOI: 10.21037/qims.2019.08.04] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background To explore the correlation between intracranial pressure (ICP) and cerebrospinal fluid (CSF) parameters assessed by phase-contrast cine MRI (PC-MRI). Methods Fifteen normal people and 80 subjects with communicating hydrocephalus who underwent PC-MRI examinations from a single center were included in this cross-sectional study. In addition to recording patient's age, heart rate, blood pressure and body mass index (BMI), ICP and CSF hemodynamic parameters, such as flow velocity and aqueduct diameter, were measured for correlation analysis. Results The mean ICP and CSF aqueduct diameter in hydrocephalus patients were 151.05 mmH2O and 2.877 mm, respectively, and the maximum (6.938 cm/s) and mean (0.845 cm/s) CSF flow velocities were significantly higher in these patients compared with the controls (P<0.05). After adjusting for age, heart rate, blood pressure, and BMI, there was no significant relationship between peak velocity and ICP (P>0.05). Furthermore, a nonlinear relationship was observed between the ICP and the average velocity of CSF, and the ICP and aqueduct diameter. The ICP increased with the average velocity above 1.628 cm/s (P≤0.01), and the aqueduct diameter increased more than 3.6 mm (P<0.001). Conclusions This study found significant correlations between ICP and average velocity and aqueduct diameter. These findings can be useful in assisting clinicians in predicting ICP more effectively, thus improving patient management.
Collapse
Affiliation(s)
- Jia Long
- Department of Radiology, The First Affiliated Hospital of Shenzhen University/Shenzhen Second People's Hospital, Shenzhen University Health Science Center, Shenzhen 518035, China
| | - Hai Lin
- Department of Neurosurgery, The First Affiliated Hospital of Shenzhen University/Shenzhen Second People's Hospital, Shenzhen University Health Science Center, Shenzhen 518035, China
| | - Gan Cao
- Department of Radiology, Shenzhen Second People's Hospital, Clinical Medicine College of Anhui Medical University, Shenzhen 518000, China
| | - Meng-Zhu Wang
- MR Scientific Marketing, Siemens Healthineers, Guangzhou 510145, China
| | - Xian-Jian Huang
- Department of Neurosurgery, The First Affiliated Hospital of Shenzhen University/Shenzhen Second People's Hospital, Shenzhen University Health Science Center, Shenzhen 518035, China
| | - Jun Xia
- Department of Radiology, The First Affiliated Hospital of Shenzhen University/Shenzhen Second People's Hospital, Shenzhen University Health Science Center, Shenzhen 518035, China
| | - Zhonghua Sun
- Discipline of Medical Radiation Sciences, School of Molecular and Life Sciences, Curtin University, Perth, WA, Australia
| |
Collapse
|
93
|
Kucherenko D, Kucherenko I, Soldatkin O, Topolnikova Y, Dzyadevych S, Soldatkin A. A highly selective amperometric biosensor array for the simultaneous determination of glutamate, glucose, choline, acetylcholine, lactate and pyruvate. Bioelectrochemistry 2019; 128:100-108. [DOI: 10.1016/j.bioelechem.2019.03.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 03/29/2019] [Accepted: 03/29/2019] [Indexed: 10/27/2022]
|
94
|
Nanoformulation properties, characterization, and behavior in complex biological matrices: Challenges and opportunities for brain-targeted drug delivery applications and enhanced translational potential. Adv Drug Deliv Rev 2019; 148:146-180. [PMID: 30797956 DOI: 10.1016/j.addr.2019.02.008] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 01/08/2019] [Accepted: 02/12/2019] [Indexed: 12/20/2022]
Abstract
Nanocarriers (synthetic/cell-based have attracted enormous interest for various therapeutic indications, including neurodegenerative disorders. A broader understanding of the impact of nanomedicines design is now required to enhance their translational potential. Nanoformulations in vivo journey is significantly affected by their physicochemical properties including the size, shape, hydrophobicity, elasticity, and surface charge/chemistry/morphology, which play a role as an interface with the biological environment. Understanding protein corona formation is crucial in characterizing nanocarriers and evaluating their interactions with biological systems. In this review, the types and properties of the brain-targeted nanocarriers are discussed. The biological factors and nanocarriers properties affecting their in vivo behavior are elaborated. The compositional description of cell culture and biological matrices, including proteins potentially relevant to protein corona built-up on nanoformulation especially for brain administration, is provided. Analytical techniques of characterizing nanocarriers in complex matrices, their advantages, limitations, and implementation challenges in industrial GMP environment are discussed. The uses of orthogonal complementary characterization approaches of nanocarriers are also covered.
Collapse
|
95
|
In vivo proteomics identifies the competence regulon and AliB oligopeptide transporter as pathogenic factors in pneumococcal meningitis. PLoS Pathog 2019; 15:e1007987. [PMID: 31356624 PMCID: PMC6687184 DOI: 10.1371/journal.ppat.1007987] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 08/08/2019] [Accepted: 07/15/2019] [Indexed: 01/09/2023] Open
Abstract
Streptococcus pneumoniae (pneumococci) is a leading cause of severe bacterial meningitis in many countries worldwide. To characterize the repertoire of fitness and virulence factors predominantly expressed during meningitis we performed niche-specific analysis of the in vivo proteome in a mouse meningitis model, in which bacteria are directly inoculated into the cerebrospinal fluid (CSF) cisterna magna. We generated a comprehensive mass spectrometry (MS) spectra library enabling bacterial proteome analysis even in the presence of eukaryotic proteins. We recovered 200,000 pneumococci from CSF obtained from meningitis mice and by MS we identified 685 pneumococci proteins in samples from in vitro filter controls and 249 in CSF isolates. Strikingly, the regulatory two-component system ComDE and substrate-binding protein AliB of the oligopeptide transporter system were exclusively detected in pneumococci recovered from the CSF. In the mouse meningitis model, AliB-, ComDE-, or AliB-ComDE-deficiency resulted in attenuated meningeal inflammation and disease severity when compared to wild-type pneumococci indicating the crucial role of ComDE and AliB in pneumococcal meningitis. In conclusion, we show here mechanisms of pneumococcal adaptation to a defined host compartment by a proteome-based approach. Further, this study provides the basis of a promising strategy for the identification of protein antigens critical for invasive disease caused by pneumococci and other meningeal pathogens. Pneumococci are one of the most common and aggressive meningitis pathogens associated with mortality rates between 10% and 30%. Due to severe complications during therapeutic intervention, prevention strategies to combat pneumococcal meningitis (PM) are preferred. The vaccines available are so far suboptimal and inefficient to prevent serious PM. Hence, deciphering the mechanisms employed by pneumococci to encounter and survive in the cerebrospinal fluid (CSF) will pave the way for the development of new antimicrobial strategies. This work used an in vivo proteome-based approach to identify pneumococcal proteins expressed in the CSF during acute meningitis. This strategy identified a nutrient uptake system and regulatory system to be highly expressed in the CSF and being crucial for PM. Knocking out two of the highly in vivo expressed proteins (AliA and ComDE) in S. pneumoniae yields to a significant increase in survival and decrease in pathogen burden of infected mice. These host compartment specific expressed pneumococcal antigens represent promising candidates for antimicrobials or protein-based vaccines.
Collapse
|
96
|
Triarico S, Maurizi P, Mastrangelo S, Attinà G, Capozza MA, Ruggiero A. Improving the Brain Delivery of Chemotherapeutic Drugs in Childhood Brain Tumors. Cancers (Basel) 2019; 11:cancers11060824. [PMID: 31200562 PMCID: PMC6627959 DOI: 10.3390/cancers11060824] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 05/27/2019] [Accepted: 06/11/2019] [Indexed: 12/20/2022] Open
Abstract
The central nervous system (CNS) may be considered as a sanctuary site, protected from systemic chemotherapy by the meninges, the cerebrospinal fluid (CSF) and the blood-brain barrier (BBB). Consequently, parenchymal and CSF exposure of most antineoplastic agents following intravenous (IV) administration is lower than systemic exposure. In this review, we describe the different strategies developed to improve delivery of antineoplastic agents into the brain in primary and metastatic CNS tumors. We observed that several methods, such as BBB disruption (BBBD), intra-arterial (IA) and intracavitary chemotherapy, are not routinely used because of their invasiveness and potentially serious adverse effects. Conversely, intrathecal (IT) chemotherapy has been safely and widely practiced in the treatment of pediatric primary and metastatic tumors, replacing the neurotoxic cranial irradiation for the treatment of childhood lymphoma and acute lymphoblastic leukemia (ALL). IT chemotherapy may be achieved through lumbar puncture (LP) or across the Ommaya intraventricular reservoir, which are both described in this review. Additionally, we overviewed pharmacokinetics and toxic aspects of the main IT antineoplastic drugs employed for primary or metastatic childhood CNS tumors (such as methotrexate, cytosine arabinoside, hydrocortisone), with a concise focus on new and less used IT antineoplastic agents.
Collapse
Affiliation(s)
- Silvia Triarico
- Pediatric Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, 00168 Rome, Italy.
| | - Palma Maurizi
- Pediatric Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, 00168 Rome, Italy.
| | - Stefano Mastrangelo
- Pediatric Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, 00168 Rome, Italy.
| | - Giorgio Attinà
- Pediatric Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, 00168 Rome, Italy.
| | - Michele Antonio Capozza
- Pediatric Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, 00168 Rome, Italy.
| | - Antonio Ruggiero
- Pediatric Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, 00168 Rome, Italy.
| |
Collapse
|
97
|
Orlovska-Waast S, Köhler-Forsberg O, Brix SW, Nordentoft M, Kondziella D, Krogh J, Benros ME. Cerebrospinal fluid markers of inflammation and infections in schizophrenia and affective disorders: a systematic review and meta-analysis. Mol Psychiatry 2019; 24:869-887. [PMID: 30116031 PMCID: PMC6756288 DOI: 10.1038/s41380-018-0220-4] [Citation(s) in RCA: 139] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 06/01/2018] [Accepted: 07/09/2018] [Indexed: 01/27/2023]
Abstract
Infections and inflammatory processes have been associated with the development of schizophrenia and affective disorders; however, no study has yet systematically reviewed all available studies on cerebrospinal fluid (CSF) immune alterations. We aimed to systematically review the CSF immunological findings in schizophrenia spectrum and affective disorders. We identified all studies investigating CSF inflammatory markers in persons with schizophrenia or affective disorders published prior to March 23, 2017 searching PubMed, CENTRAL, EMBASE, Psychinfo, and LILACS. Literature search, data extraction and bias assessment were performed by two independent reviewers. Meta-analyses with standardized mean difference (SMD) including 95% confidence intervals (CI) were performed on case-healthy control studies. We identified 112 CSF studies published between 1942-2016, and 32 case-healthy control studies could be included in meta-analyses. Studies varied regarding gender distribution, age, disease duration, treatment, investigated biomarkers, and whether recruitment happened consecutively or based on clinical indication. The CSF/serum albumin ratio was increased in schizophrenia (1 study [54 patients]; SMD = 0.71; 95% CI 0.33-1.09) and affective disorders (4 studies [298 patients]; SMD = 0.41; 95% CI 0.23-0.60, I2 = 0%), compared to healthy controls. Total CSF protein was elevated in both schizophrenia (3 studies [97 patients]; SMD = 0.41; 95% CI 0.15-0.67, I2 = 0%) and affective disorders (2 studies [53 patients]; SMD = 0.80; 95% CI 0.39-1.21, I2 = 0%). The IgG ratio was increased in schizophrenia (1 study [54 patients]; SMD = 0.68; 95% CI 0.30-1.06), whereas the IgG Albumin ratio was decreased (1 study [32 patients]; SMD = -0.62; 95% CI -1.13 to -0.12). Interleukin-6 (IL-6) levels (7 studies [230 patients]; SMD = 0.55; 95% CI 0.35-0.76; I2 = 1%) and IL-8 levels (3 studies [95 patients]; SMD = 0.46; 95% CI 0.17-0.75, I2 = 0%) were increased in schizophrenia but not significantly increased in affective disorders. Most of the remaining inflammatory markers were not significantly different compared to healthy controls in the meta-analyses. However, in the studies which did not include healthy controls, CSF abnormalities were more common, and two studies found CSF dependent re-diagnosis in 3.2-6%. Current findings suggest that schizophrenia and affective disorders may have CSF abnormalities including signs of blood-brain barrier impairment and inflammation. However, the available evidence does not allow any firm conclusion since all studies showed at least some degree of bias and vastly lacked inclusion of confounding factors. Moreover, only few studies investigated the same parameters with healthy controls and high-quality longitudinal CSF studies are lacking, including impact of psychotropic medications, lifestyle factors and potential benefits of anti-inflammatory treatment in subgroups with CSF inflammation.
Collapse
Affiliation(s)
- Sonja Orlovska-Waast
- Mental Health Centre Copenhagen, University of Copenhagen, Faculty of Health Sciences, Copenhagen, Denmark
- iPSYCH The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
| | - Ole Köhler-Forsberg
- Mental Health Centre Copenhagen, University of Copenhagen, Faculty of Health Sciences, Copenhagen, Denmark
- Psychosis Research Unit, Aarhus University Hospital, Risskov, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Sophie Wiben Brix
- Mental Health Centre Copenhagen, University of Copenhagen, Faculty of Health Sciences, Copenhagen, Denmark
| | - Merete Nordentoft
- Mental Health Centre Copenhagen, University of Copenhagen, Faculty of Health Sciences, Copenhagen, Denmark
- iPSYCH The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
| | - Daniel Kondziella
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway
| | - Jesper Krogh
- Mental Health Centre Copenhagen, University of Copenhagen, Faculty of Health Sciences, Copenhagen, Denmark
| | - Michael Eriksen Benros
- Mental Health Centre Copenhagen, University of Copenhagen, Faculty of Health Sciences, Copenhagen, Denmark.
| |
Collapse
|
98
|
Lim M, Kheok SW, Lim KC, Venkatanarasimha N, Small JE, Chen RC. Subdural haematoma mimics. Clin Radiol 2019; 74:663-675. [PMID: 31109715 DOI: 10.1016/j.crad.2019.04.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 04/09/2019] [Indexed: 11/30/2022]
Abstract
A subdural haematoma (SDH) is a frequently encountered pathology seen on an emergency room computed tomography (CT) head scan. An extra-axial crescentic density along the convexity of the brain or within the interhemispheric fissure is generally thought to represent a SDH; however, SDH mimics are known to occur in nature, and can be broadly classified under the subcategories of normal anatomy, artefacts, tumour, inflammation, infection, ischaemia, trauma, and iatrogenic. Understanding the typical characteristics of a SDH, knowledge of normal anatomy, close inspection of the morphology of the subdural process, changes to the adjacent structures, and rigorous attention to clinical details may reveal subtle clues that distinguish a true SDH from a mimic. This is crucial in appropriately directing clinical management. This review amalgamates most of the rare subdural processes that have been reported to mimic SDH, and discusses the imaging and clinical features that help to differentiate between them. This topic is highly valuable for radiology trainees, general radiologists, and emergency room physicians, and may serve as a refresher for the practising neuroradiologist.
Collapse
Affiliation(s)
- M Lim
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore.
| | - S W Kheok
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
| | - K C Lim
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
| | - N Venkatanarasimha
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
| | - J E Small
- Neuroradiology, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - R C Chen
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
| |
Collapse
|
99
|
Giuliano C, Patel CR, Kale-Pradhan PB. A Guide to Bacterial Culture Identification And Results Interpretation. P & T : A PEER-REVIEWED JOURNAL FOR FORMULARY MANAGEMENT 2019; 44:192-200. [PMID: 30930604 PMCID: PMC6428495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PURPOSE To provide a guide to interpreting bacterial culture results. METHODS Studies were identified via a PubMed literature search (from 1966 to January 2018). Search terms included microbial sensitivity tests, microbial drug resistance, and anti-infective agents/pharmacology. Articles were included if they were published in English. References within identified articles were also reviewed. RESULTS This paper reviewed core concepts of interpreting bacterial culture results, including timing of cultures, common culture sites, potential for contamination, interpreting the Gram stain, role of rapid diagnostic tests, conventional antibiotic susceptibility testing, and automated testing. CONCLUSION This guide can assist pharmacists in their role as integral members of the antimicrobial stewardship team in an effort to improve patient care.
Collapse
|
100
|
Affiliation(s)
- Susan P Mollan
- Birmingham Neuro-Ophthalmology, University Hospitals Birmingham NHS Trust, Birmingham, UK
- Metabolic Neurology, University of Birmingham, Birmingham, UK
| | | | - Alexandra J Sinclair
- Metabolic Neurology, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| |
Collapse
|