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Kuo LT, Lu HY, Chen YH. Traumatic brain injury-induced disruption of the circadian clock. J Mol Med (Berl) 2024; 102:403-414. [PMID: 38285094 PMCID: PMC10879350 DOI: 10.1007/s00109-024-02416-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 12/16/2023] [Accepted: 01/03/2024] [Indexed: 01/30/2024]
Abstract
Disturbances in the circadian rhythm have been reported in patients following traumatic brain injury (TBI). However, the rhythmic expression of circadian genes in peripheral blood leukocytes (PBL) following TBI has not yet been studied. The messenger ribonucleic acid (mRNA) expression of period 1 (Per1), Per2, Per3, cryptochrome 1 (Cry1), Cry2, brain and muscle aryl hydrocarbon receptor nuclear translocator-like 1 (Bmal1), and circadian locomotor output cycles kaput (Clock) was quantified in PBLs from sham-operated rats and rats with acute subdural hematoma (ASDH) over a 48-h period. The rectal temperature of the animals was measured every 4 h over 2 days. The mesor, rhythm, amplitude, and acrophase were estimated using cosinor analysis. Cosinor analysis revealed that Per2, Cry1, and Bmal1 mRNAs were rhythmically expressed in the PBLs of sham-operated rats. In contrast, fluctuations in rhythmic expression were not observed following ASDH. The rectal temperature of sham-operated rats also exhibited rhythmicity. ASDH rats had a disrupted rectal temperature rhythm, a diminished amplitude, and an acrophase shift. TBI with ASDH results in dysregulated expression of some circadian genes and changes in body temperature rhythm. Further research is required to understand the pathophysiology of altered circadian networks following TBI. KEY MESSAGES: First to investigate the mRNA expression of circadian genes in PBLs of ASDH rats. ASDH rats had disrupted rhythmicity of Per2, Cry1, and Bmal1 mRNA expression. Cosinor analysis showed that ASDH rats had a disrupted rectal temperature rhythm.
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Affiliation(s)
- Lu-Ting Kuo
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, 7 Chun-Shan South Road, Taipei, 100, Taiwan.
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Yun-Lin Branch, Douliu, Yunlin, 640, Taiwan.
| | - Hsueh-Yi Lu
- Department of Industrial Engineering and Management, National Yunlin University of Science and Technology, Douliu, Yunlin, 640, Taiwan
| | - Yi-Hsing Chen
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, 7 Chun-Shan South Road, Taipei, 100, Taiwan
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Boots R, Xue G, Tromp D, Rawashdeh O, Bellapart J, Townsend S, Rudd M, Winter C, Mitchell G, Garner N, Clement P, Karamujic N, Zappala C. Circadian Rhythmicity of Vital Signs at Intensive Care Unit Discharge and Outcome of Traumatic Brain Injury. Am J Crit Care 2022; 31:472-482. [PMID: 36316179 DOI: 10.4037/ajcc2022821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Physiological functions with circadian rhythmicity are often disrupted during illness. OBJECTIVE To assess the utility of circadian rhythmicity of vital signs in predicting outcome of traumatic brain injury (TBI). METHODS A retrospective single-center cohort study of adult intensive care unit (ICU) patients with largely isolated TBI to explore the relationship between the circadian rhythmicity of vital signs during the last 24 hours before ICU discharge and clinical markers of TBI severity and score on the Glasgow Outcome Scale 6 months after injury (GOS-6). RESULTS The 130 study participants had a median age of 39.0 years (IQR, 23.0-59.0 years), a median Glasgow Coma Scale score at the scene of 8.0 (IQR, 3.0-13.0), and a median Rotterdam score on computed tomography of the head of 3 (IQR, 3-3), with 105 patients (80.8%) surviving to hospital discharge. Rhythmicity was present for heart rate (30.8% of patients), systolic blood pressure (26.2%), diastolic blood pressure (20.0%), and body temperature (26.9%). Independent predictors of a dichotomized GOS-6 ≥4 were the Rotterdam score (odds ratio [OR], 0.38 [95% CI, 0.18-0.81]; P = .01), Glasgow Coma Scale score at the scene (OR, 1.22 [95% CI, 1.05-1.41]; P = .008), age (OR, 0.95 [95% CI, 0.92-0.98]; P = .003), oxygen saturation <90% in the first 24 hours (OR, 0.19 [95% CI, 0.05-0.73]; P = .02), serum sodium level <130 mmol/L (OR, 0.20 [95% CI, 0.05-0.70]; P = .01), and active intracranial pressure management (OR, 0.16 [95% CI, 0.04-0.62]; P = .008), but not rhythmicity of any vital sign. CONCLUSION Circadian rhythmicity of vital signs at ICU discharge is not predictive of GOS-6 in patients with TBI.
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Affiliation(s)
- Rob Boots
- Rob Boots is an associate professor, Thoracic Medicine, Royal Brisbane and Women's Hospital, a senior specialist, Intensive Care, Bundaberg Hospital, Faculty of Medicine, The University of Queensland, Herston, and a professsor, Faculty of Medicine and Dentistry, Griffith University, Queensland, Australia
| | - George Xue
- George Xue is the medical registrar, Royal Brisbane and Women's Hospital
| | - Dirk Tromp
- Dirk Tromp is the senior radiology registrar, Royal Brisbane and Women's Hospital
| | - Oliver Rawashdeh
- Oliver Rawashdeh is director, Chronobiology and Sleep Research, School of Biomedical Sciences, Faculty of Medicine, The University of Queensland
| | - Judith Bellapart
- Judith Bellapart is a senior specialist, Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, and Burns, Trauma, and Critical Care, The University of Queensland
| | - Shane Townsend
- Shane Townsend is director, Intensive Care Services, Royal Brisbane and Women's Hospital
| | - Michael Rudd
- Michael Rudd is acting director, Trauma, Royal Brisbane and Women's Hospital
| | - Craig Winter
- Craig Winter is a staff specialist neurosurgeon, Royal Brisbane and Women's Hospital
| | - Gary Mitchell
- Gary Mitchell is a staff specialist, Emergency Medicine, Royal Brisbane and Women's Hospital
| | - Nicholas Garner
- Nicholas Garner is a PhD student, Chronobiology and Sleep Research Lab, School of Biomedical Sciences, Faculty of Medicine, The University of Queensland
| | - Pierre Clement
- Pierre Clement is a clinical information systems manager, Intensive Care Services, Royal Brisbane and Women's Hospital
| | - Nermin Karamujic
- Nermin Karamujic is a data manager and clinical information systems manager, Intensive Care Services, Royal Brisbane and Women's Hospital
| | - Christopher Zappala
- Christopher Zappala is a senior staff specialist, Thoracic Medicine, Royal Brisbane and Women's Hospital
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Gong Y, Zhang G, Li B, Cao C, Cao D, Li X, Li H, Ye M, Shen H, Chen G. BMAL1 attenuates intracerebral hemorrhage-induced secondary brain injury in rats by regulating the Nrf2 signaling pathway. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1617. [PMID: 34926661 PMCID: PMC8640921 DOI: 10.21037/atm-21-1863] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 08/31/2021] [Indexed: 12/12/2022]
Abstract
Background Intracerebral hemorrhage (ICH) is a severe cerebrovascular disease with high morbidity and mortality rates. Oxidative stress and inflammation are important pathological mechanisms of secondary brain injury (SBI) after ICH. Brain and muscle Arnt-like protein 1 (BMAL1), which forms the core component of the circadian clock, was previously shown to be involved in many diseases and to participate in oxidative stress and inflammatory responses. However, the role of BMAL1 in SBI following ICH is unknown. In addition, treatments targeting miR-155 and its downstream signaling pathway may exert a beneficial effect on SBI after ICH, while miR-155 may regulate Bmal1 mRNA stability and translation. Nevertheless, researchers have not clearly determined whetheantagomir-155 upregulates BMAL1 expression and subsequently attenuates ICH-induced brain injury in rats. Methods After establishing an ICH rat model by injecting autologous blood, the time course of changes in levels of the BMAL1 protein after ICH was analyzed. Subsequently, this study was designed to investigate the potential role and mechanisms of BMAL1 in SBI following ICH using lentiviral overexpression and antagomir-155 treatments. Results BMAL1 protein levels were significantly decreased in the ICH group compared to the sham group. Genetic overexpression of BMAL1 alleviated oxidative stress, inflammation, brain edema, blood-brain barrier injury, neuronal death, and neurological dysfunction induced by ICH. On the other hand, we observed that inhibiting miRNA-155 using antagomir-155 promoted the expression of BMAL1 and further activated the nuclear factor erythroid 2-related factor 2 (Nrf2) signaling pathway to attenuate brain injury after ICH. Conclusions These results reveal that BMAL1 serves as a neuroprotective agent in ICH and upregulation of BMAL1 attenuates ICH-induced SBI. Therefore, BMAL1 may be a promising therapeutic target for SBI following ICH.
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Affiliation(s)
- Yan Gong
- Department of Neurosurgery& Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Guoguo Zhang
- Department of Neurosurgery& Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Bing Li
- Department of Neurosurgery& Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Cheng Cao
- Department of Neurosurgery& Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Demao Cao
- Department of Neurosurgery& Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiang Li
- Department of Neurosurgery& Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Haiying Li
- Department of Neurosurgery& Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Ming Ye
- Department of Neurosurgery& Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Haitao Shen
- Department of Neurosurgery& Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Gang Chen
- Department of Neurosurgery& Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
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Prognostic Value of Circadian Brain Temperature Rhythm in Basal Ganglia Hemorrhage After Surgery. Neurol Ther 2021; 10:1045-1059. [PMID: 34561832 PMCID: PMC8571467 DOI: 10.1007/s40120-021-00283-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/07/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Intracerebral hemorrhage (ICH) is associated with high mortality and morbidity rates. However, both the rhythmic variation and prognostic value of brain temperature after ICH remain unknown. In this study, we investigated brain temperature rhythm and its prognostic value for post-operative mortality and long-term functional outcomes in patients with ICH. Methods Post-operative diurnal brain temperature patterns at the basal ganglion are described. Following surgery for ICH, 78 patients were enrolled, and intracranial pressure and brain temperature were monitored using a fiber optic device. Brain temperature mesor, amplitude, and acrophase were estimated from the recorded temperature measurements, using cosinor analysis, and the association between these patterns and clinical parameters, mortality, and functional outcomes at the 12-month follow-up were examined. Results According to cosinor analysis, brain temperature in 55.1% of patients showed a circadian rhythm within 72 h post-surgery. The rhythm-adjusted mesor of brain temperature (± standard deviation) was 37.6 (± 0.7) °C, with a diminished mean amplitude. A temperature acrophase shift was also observed. Multivariate logistic regression analysis revealed that initial age and circadian rhythm of brain temperature appeared to be predictive and prognostic of functional outcomes. Further, patients with higher brain temperature mesor were more likely to survive than those with a lower mesor. Conclusion For patients with ICH, brain temperature rhythm analysis is an improved prognostic tool for mortality and functional outcome predictions.
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Kuo LT, Lu HY, Huang APH. Prognostic Value of Circadian Rhythm of Brain Temperature in Traumatic Brain Injury. J Pers Med 2021; 11:jpm11070620. [PMID: 34208924 PMCID: PMC8307466 DOI: 10.3390/jpm11070620] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/21/2021] [Accepted: 06/28/2021] [Indexed: 11/16/2022] Open
Abstract
Hypothermia has been used in postoperative management of traumatic brain injury (TBI); however, the rhythmic variation and prognostic value of brain temperature after TBI have never been studied. This study describes diurnal brain temperature patterns in comatose patients with TBI. Mesors of brain temperature, amplitude, and acrophase were estimated from recorded temperature measurements using cosinor analysis. The association of these patterns with clinical parameters, mortality, and functional outcomes in a 12-month follow-up was examined. According to the cosinor analysis, 59.3% of patients presented with circadian rhythms of brain temperature in the first 72 h postoperatively. The rhythm-adjusted mesor of brain temperature was 37.39 ± 1.21 °C, with a diminished mean amplitude of 0.28 (±0.25) °C; a shift of temperature acrophase was also observed. Multivariate logistic regression analysis revealed that initial Glasgow coma scale score, age, elevated blood glucose level, and circadian rhythm of brain temperature seemed to be predictive and prognostic factors of patients' functional outcomes. For the prediction of survival status, younger patients or those patients with mesor within the middle 50% of brain temperature were more likely to survive. The analysis of brain temperature rhythms in patients with moderate and severe TBI provided additional predictive information related to mortality and functional outcomes.
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Affiliation(s)
- Lu-Ting Kuo
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, No. 7 Chung San South Road, Taipei 100, Taiwan;
| | - Hsueh-Yi Lu
- Department of Industrial Engineering and Management, National Yunlin University of Science and Technology, Yunlin 64002, Taiwan;
| | - Abel Po-Hao Huang
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, No. 7 Chung San South Road, Taipei 100, Taiwan;
- Institute of Polymer Science and Engineering, National Taiwan University, Taipei 100, Taiwan
- Correspondence: ; Tel.: +886-2-2312-3456
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Li X, Guan J, Hou W, Cheng S, Jiang Z, Wang Y, Liu Y, Wang Z. The circadian intracranial pressure would be a prognostic factor in traumatic brain injury? BIOL RHYTHM RES 2016. [DOI: 10.1080/09291016.2016.1197515] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Xuepei Li
- China Health Ministry Key Lab of Chronobiology, Sichuan University, Chengdu, China
| | - Junwen Guan
- Nurosurgery Department, West China Hospital, Sichuan University, Chengdu, China
| | - Wang Hou
- China Health Ministry Key Lab of Chronobiology, Sichuan University, Chengdu, China
| | - Shuting Cheng
- China Health Ministry Key Lab of Chronobiology, Sichuan University, Chengdu, China
| | - Zhou Jiang
- China Health Ministry Key Lab of Chronobiology, Sichuan University, Chengdu, China
| | - Yuhui Wang
- China Health Ministry Key Lab of Chronobiology, Sichuan University, Chengdu, China
| | - Yangyou Liu
- China Health Ministry Key Lab of Chronobiology, Sichuan University, Chengdu, China
| | - Zhengrong Wang
- China Health Ministry Key Lab of Chronobiology, Sichuan University, Chengdu, China
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Zhu Y, Jiang Z, Xiao G, Cheng S, Wen Y, Wan C. Circadian rhythm disruption was observed in hand, foot, and mouth disease patients. Medicine (Baltimore) 2015; 94:e601. [PMID: 25761178 PMCID: PMC4602470 DOI: 10.1097/md.0000000000000601] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Hand, foot, and mouth disease (HFMD) with central nerve system complications may rapidly progress to fulminated cardiorespiratory failure, with higher mortality and worse prognosis. It has been reported that circadian rhythms of heart rate (HR) and respiratory rate are useful in predicting prognosis of severe cardiovascular and neurological diseases. The present study aims to investigate the characteristics of the circadian rhythms of HR, respiratory rate, and temperature in HFMD patients with neurological complications. Hospitalized HFMD patients including 33 common cases (common group), 61 severe cases (severe group), and 9 critical cases (critical group) were contrasted retrospectively. Their HR, respiratory rate, and temperatures were measured every 4 hours during the first 48-hour in the hospital. Data were analyzed with the least-squares fit of a 24-hour cosine function by the single cosinor and population-mean cosinor method. Results of population-mean cosinor analysis demonstrated that the circadian rhythm of HR, respiratory rate, and temperature was present in the common and severe group, but absent in the critical group. The midline-estimating statistic of rhythm (MESOR) (P = 0.016) and acrophase (P < 0.01) of temperature and respiratory rate were significantly different among 3 groups. But no statistical difference of amplitude in temperature and respiratory rate was observed among the 3 groups (P = 0.14). MESOR value of HR (P < 0.001) was significantly different in 3 groups. However, amplitude and acrophase revealed no statistical difference in circadian characteristics of HR among 3 groups. Compared with the common group, the MESOR of temperature and respiratory rate was significantly higher, and acrophase of temperature and respiratory rate was 2 hours ahead in the severe group, critical HFMD patients lost their population-circadian rhythm of temperature, HR, and respiratory rate. The high values of temperature and respiratory rate for the common group were concentrated between 3 and 9 PM, whereas those for the severe group were more dispersive. And the high values for the critical group were equally distributed in 24 hours of the day. Circadian rhythm of patients' temperature in the common group was the same as the normal rhythm of human body temperature. Circadian rhythm of patients' temperature, HR and respiratory rate in 3 groups were significantly different.
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Affiliation(s)
- Yu Zhu
- From the Department of Pediatrics, West China Second Hospital (YZ, GX, YW, CW); and Key Laboratory of Chronobiology, Ministry of Health, Sichuan University, Chengdu, PR China (ZJ, SC)
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Guan J, You C, Liu Y, Liu Y, Zhang R, Wang Z. Characteristics of infradian and circadian rhythms in the persistent vegetative state. J Int Med Res 2012; 39:2281-7. [PMID: 22289544 DOI: 10.1177/147323001103900625] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
This retrospective study investigated the circadian and infradian characteristics of blood pressure and heart rate in 26 patients with traumatic head injury in a persistent vegetative state (PVS). Systolic and diastolic blood pressures and heart rate were measured every hour for the first 240 h (10 days) following hospital admission. These data were analysed for the presence of circadian and infradian rhythms using the least-squares fit of the cosine function with the single cosinor method. Infradian rhythms were defined as biological rhythms with a period of approximately 7 days (circaseptan rhythms). All the patients studied had circadian and circaseptan rhythms of systolic and diastolic blood pressures and heart rate. The amplitudes of all the circaseptan rhythms were significantly greater than those of the corresponding circadian rhythms. It was concluded that there was an altered association between circadian and infradian blood pressure and heart rate rhythms in patients in a PVS. Circadian and infradian rhythms were present, but the infradian rhythm had a greater amplitude than the circadian rhythm.
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Affiliation(s)
- J Guan
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
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