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Elballal MS, Mohammed OA, Zaki MB, Abulsoud AI, Tabaa MME, Elazazy O, Abd-Elmawla MA, El-Dakroury WA, Abdel Mageed SS, Rashad AA, Abdelmaksoud NM, Elrebehy MA, Nomier Y, Abdel-Reheim MA, Oraby MA, Doghish AS. miRNAs as modulators of neuroinflammation and excitotoxicity: Implications for stroke therapeutics. Pathol Res Pract 2024; 253:155093. [PMID: 38184962 DOI: 10.1016/j.prp.2024.155093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 12/29/2023] [Accepted: 01/02/2024] [Indexed: 01/09/2024]
Abstract
Stroke is a widespread neurological disorder associated with physical disabilities, mortality, and economic burden. In recent decades, substantial progress has been achieved in reducing the impact of this public health problem. However, further understanding of the pathophysiology of stroke and the underlying genetic pathways is required. The pathological mechanisms of stroke comprise multifaceted molecular cascades regulated by various microRNAs (miRNAs). An increasing number of studies have highlighted the role of miRNAs, which have received much attention during the last decades as an important class of post-transcriptional regulators. It was shown that miRNAs exert their role in the etiology of stroke via mediating excitotoxicity and neuroinflammation. Additionally, miRNAs could be helpful as non-invasive or minimally invasive biomarkers and therapeutic agents. Thus, the current review focused on the interplay of these miRNAs in stroke pathology to upgrade the existing therapeutic strategies.
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Affiliation(s)
- Mohammed S Elballal
- Department of Biochemistry, Faculty of Pharmacy, Badr University in Cairo (BUC), Badr City, Cairo 11829, Egypt
| | - Osama A Mohammed
- Department of Pharmacology, College of Medicine, University of Bisha, Bisha 61922, Saudi Arabia
| | - Mohamed Bakr Zaki
- Department of Biochemistry, Faculty of Pharmacy, University of Sadat City, Menoufia 32897, Egypt
| | - Ahmed I Abulsoud
- Biochemistry and Molecular Biology Department, Faculty of Pharmacy (Boys), Al-Azhar University, Nasr City 11231, Cairo, Egypt; Biochemistry Department, Faculty of Pharmacy, Heliopolis University, Cairo 11785, Egypt.
| | - Manar Mohammed El Tabaa
- Pharmacology & Environmental Toxicology, Environmental Studies & Research Institute (ESRI), University of Sadat City, Sadat City 32897, Menoufia, Egypt
| | - Ola Elazazy
- Department of Biochemistry, Faculty of Pharmacy, Badr University in Cairo (BUC), Badr City, Cairo 11829, Egypt
| | - Mai A Abd-Elmawla
- Department of Biochemistry, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Walaa A El-Dakroury
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Badr University in Cairo (BUC), Badr City, Cairo 11829, Egypt
| | - Sherif S Abdel Mageed
- Pharmacology and Toxicology Department, Faculty of Pharmacy, Badr University in Cairo (BUC), Badr City, Cairo 11829, Egypt
| | - Ahmed A Rashad
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Badr University in Cairo (BUC), Badr City, Cairo 11829, Egypt
| | | | - Mahmoud A Elrebehy
- Department of Biochemistry, Faculty of Pharmacy, Badr University in Cairo (BUC), Badr City, Cairo 11829, Egypt
| | - Yousra Nomier
- Department of Pharmacology and Clinical Pharmacy, College of Medicine and health sciences, Sultan Qaboos University, Egypt
| | - Mustafa Ahmed Abdel-Reheim
- Department of Pharmaceutical Sciences, College of Pharmacy, Shaqra University, Shaqra 11961, Saudi Arabia; Department of Pharmacology and Toxicology, Faculty of Pharmacy, Beni-Suef University, Beni Suef 62521, Egypt.
| | - Mamdouh A Oraby
- Pharmacology and Toxicology Department, Faculty of Pharmacy, Badr University in Cairo (BUC), Badr City, Cairo 11829, Egypt
| | - Ahmed S Doghish
- Department of Biochemistry, Faculty of Pharmacy, Badr University in Cairo (BUC), Badr City, Cairo 11829, Egypt; Biochemistry and Molecular Biology Department, Faculty of Pharmacy (Boys), Al-Azhar University, Nasr City 11231, Cairo, Egypt.
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Cardona S, Baqai H, Mikdashi F, Aligabi A, Solomon J, Frederick H, Seyoum N, Olexa J, Stokum JA, Sharma A, Pergakis MB, Tran QK. Intracranial and Blood Pressure Variability and In-Hospital Outcomes in Intracranial Device-Monitored Patients with Spontaneous Intracerebral Hemorrhage. Neurocrit Care 2023; 39:357-367. [PMID: 36759420 DOI: 10.1007/s12028-023-01677-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 01/09/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND Spontaneous intracerebral hemorrhage (sICH) is a major health concern and has high mortality rates up to 52%. Despite a decrease in its incidence, fatality rates remain unchanged; understanding and preventing of factors associated with mortality and treatments for these are needed. Blood pressure variability (BPV) has been shown to be a potential modifiable factor associated with clinical outcomes in patients with traumatic intracerebral hemorrhage and sICH. Few data are available on the effect of intracranial pressure (ICP) variability (ICPV) and outcomes in patients with sICH. The goal of our study was to investigate the association between ICPV and BPV during the first 24 h of intensive care unit (ICU) admission and external ventricular drain (EVD) placement, and mortality in patients with sICH who were monitored with an EVD. METHODS We conducted a single-center retrospective study of adult patients admitted to an ICU with a diagnosis of sICH who required EVD placement during hospitalization. We excluded patients with ICH secondary to other pathological conditions such as trauma, underlying malignancy, or arteriovenous malformation. Blood pressure and ICP measurements were collected and recorded hourly during the first 24 h of ICU admission and EVD placement, respectively. Measures of variability used were standard deviation (SD) and successive variation (SV). Primary outcome of interest was in-hospital mortality, and secondary outcomes were hematoma expansion and discharge home (a surrogate for good functional outcome at discharge). Descriptive statistics and multivariable logistic regressions were performed. RESULTS We identified 179 patients with sICH who required EVD placement. Of these, 52 (29%) patients died, 121 (68%) patients had hematoma expansion, and 12 (7%) patients were discharged home. Patient's mean age (± SD) was 56 (± 14), and 87 (49%) were women. The mean opening ICP (± SD) was 21 (± 8) and median ICH score (interquartile range) was 2 (2-3). Multivariable logistic regression found an association between ICP-SV and ICP-SD and hematoma expansion (odds ratio 1.6 [1.03-2.30], p = 0.035 and odds ratio 0.77 [0.63-0.93] p = 0.009, respectively). CONCLUSIONS Our study found an association between ICPV and hematoma expansion in patients with sICH monitored with an EVD. Measures of ICPV relating to rapid changes in ICP (ICP-SV) were associated with a higher odds of hematoma expansion, whereas measures relating to tight control of ICP (ICP-SD) were associated with a lower odds of hematoma expansion. One measure of BPV, sytolic blood pressure maximum-minimum (SBP max-min), was found to be weakly associated with discharge home (a surrogate for good functional outcome at hospital discharge). More research is needed to support these findings.
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Affiliation(s)
- Stephanie Cardona
- Department of Critical Care Medicine, The Mount Sinai Hospital, 1468 Madison Ave, New York, NY, 10029, USA.
| | - Hammad Baqai
- Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Fatima Mikdashi
- Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ayah Aligabi
- Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Julianna Solomon
- Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Hannah Frederick
- Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Nahom Seyoum
- Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Joshua Olexa
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jesse A Stokum
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ashish Sharma
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Melissa B Pergakis
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Quincy K Tran
- Program in Trauma, The R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA
- University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
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Chen L, Chen S, Yang XF, Min JW. Antioxidants attenuate mitochondrial oxidative damage through the Nrf2 pathway: A promising therapeutic strategy for stroke. J Neurosci Res 2023. [PMID: 36977650 DOI: 10.1002/jnr.25194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 02/05/2023] [Accepted: 03/10/2023] [Indexed: 03/30/2023]
Abstract
Stroke represents one of the leading causes of disability and death worldwide. Reactive oxygen species overproduction-induced oxidative stress in mitochondria results in mitochondrial DNA damage, mitochondrial autophagy (mitophagy), inflammation, and apoptosis during the pathologic progression of stroke. Nuclear factor erythroid 2-related factor 2 (Nrf2) is a master regulator that induces the transcription of a wide range of antioxidant genes to attenuate mitochondrial oxidative stress. Different antioxidative compounds, including polyphenols, mitochondrial antioxidants, triterpenoids, and others, have been shown to be able to activate Nrf2 and, thus, exert neuroprotective effects on stroke by ameliorating mitochondrial oxidative damage. In this review, we briefly discussed the role of mitochondrial oxidative stress in the pathophysiology of stroke and focused on the protective effects of antioxidative compounds through attenuating mitochondrial oxidative damage by activating Nrf2 in stroke. In conclusion, these antioxidants may represent novel therapeutic strategies against stroke.
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Affiliation(s)
- Ling Chen
- Key Laboratory of Cognitive Science, Laboratory of Membrane Ion Channels and Medicine, Hubei Key Laboratory of Medical Information Analysis and Tumor Diagnosis and Treatment, College of Biomedical Engineering, South-Central Minzu University, Wuhan, China
| | - Su Chen
- Key Laboratory of Cognitive Science, Laboratory of Membrane Ion Channels and Medicine, Hubei Key Laboratory of Medical Information Analysis and Tumor Diagnosis and Treatment, College of Biomedical Engineering, South-Central Minzu University, Wuhan, China
| | - Xiao-Fei Yang
- Key Laboratory of Cognitive Science, Laboratory of Membrane Ion Channels and Medicine, Hubei Key Laboratory of Medical Information Analysis and Tumor Diagnosis and Treatment, College of Biomedical Engineering, South-Central Minzu University, Wuhan, China
| | - Jia-Wei Min
- Key Laboratory of Cognitive Science, Laboratory of Membrane Ion Channels and Medicine, Hubei Key Laboratory of Medical Information Analysis and Tumor Diagnosis and Treatment, College of Biomedical Engineering, South-Central Minzu University, Wuhan, China
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Jelinek M, Duris K. Inflammatory Response in Sepsis and Hemorrhagic Stroke. BRAIN HEMORRHAGES 2022. [DOI: 10.1016/j.hest.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Chen KH, Chai HT, Lin KC, Chiang JY, Sung PH, Chen CH, Yip HK. Dose-dependent benefits of iron-magnetic nanoparticle-coated human umbilical-derived mesenchymal stem cell treatment in rat intracranial hemorrhage model. Stem Cell Res Ther 2022; 13:265. [PMID: 35729660 PMCID: PMC9210819 DOI: 10.1186/s13287-022-02939-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 06/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study tested whether two doses of human umbilical-derived mesenchymal stem cells (hUC-MSCs) were superior to one dose for protecting the brain against intracranial hemorrhage (ICH) induced by intracranial injection collagenase and the capacity of ironic-magnetic-nanoparticles (Ir-MNa) coated hUC-MSCs tracked by MRI. METHODS AND RESULTS Adult male SD rats (n = 40) were equally categorized into group 1 (sham-operated-control), group 2 (ICH), group 3 [ICH + Ir-MNa-coated hUC-MSCs/1.2 × 106 cells with an extracorporeal magnet over rat head (eCMag)/administered by left internal carotid artery (LICA) at post-3 h ICH], and group 4 (ICH + Ir-MNa-coated hUC-MSCs/1.2 × 106 cells with an eCMag/administered post-3 h ICH by LICA and 24 h by IV) and euthanized by day 28. The result showed that by day 28 after ICH induction the neurological function was severely impaired in group 2 than in group 1 that was significantly improved in group 3 and further significantly improved in group 4, whereas ICH volume exhibited an opposite pattern of neurological impairment among the groups (all p < 0.0001). Brain MRI demonstrated that by 4 h after ICH, Ir-MNa-coated hUC-MSCs were abundantly identified in ischemic area in group 4. The protein expressions of inflammatory (TNF-α/MMP-9/IL-1ß/iNOS)/oxidative-stress (NOX-1/NOX-2/oxidized protein)/apoptotic (caspase-3/mitochondrial Bax/PARP)/fibrotic (Smad3/TGF-ß)/mitochondrial-damaged (cytosolic-cytochrome-C) biomarkers displayed an identical pattern of neurological impairment among the groups (all p < 0.0001). The cellular expressions of inflammation (CD68+/CD11b+)/brain edema (AQP4+) biomarkers exhibited an identical pattern, whereas the neuronal-myelin (Doublecortin+/NeuN/nestin) biomarkers displayed an opposite pattern of neurological impairment (all p < 0.0001). CONCLUSION Two doses of hUC-MSCs were superior to just one dose for protecting the brain against ICH-induced damage and Ir-MNa-coated hUC-MSCs offered a well adopted method for tracking hUC-MSCs homing into the brain.
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Affiliation(s)
- Kuan-Hung Chen
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83301, Taiwan, ROC.,Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83301, Taiwan, ROC
| | - Han-Tan Chai
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83301, Taiwan, ROC
| | - Kun-Chen Lin
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83301, Taiwan, ROC
| | - John Y Chiang
- Department of Computer Science and Engineering, National Sun Yat-Sen University, Kaohsiung, 80424, Taiwan, ROC
| | - Pei-Hsun Sung
- Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83301, Taiwan, ROC.,Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83301, Taiwan, ROC.,Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, 83301, Taiwan, ROC
| | - Chih-Hung Chen
- Divisions of General Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83301, Taiwan, ROC
| | - Hon-Kan Yip
- Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83301, Taiwan, ROC. .,Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83301, Taiwan, ROC. .,Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, 83301, Taiwan, ROC. .,School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC. .,Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, 40402, Taiwan, ROC. .,Department of Nursing, Asia University, Taichung, 41354, Taiwan, ROC. .,Division of Cardiology, Department of Internal Medicine, Xiamen Chang Gung Hospital, Xiamen, 361028, Fujian, China.
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Jiang F, Liu J, Yu X, Li R, Zhou R, Ren J, Liu X, Zhao S, Yang B. The Monocyte-to-Lymphocyte Ratio Predicts Acute Kidney Injury After Acute Hemorrhagic Stroke. Front Neurol 2022; 13:904249. [PMID: 35795792 PMCID: PMC9251466 DOI: 10.3389/fneur.2022.904249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/18/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives Acute kidney injury (AKI) is a serious complication of acute hemorrhagic stroke (AHS). Early detection and early treatment are crucial for patients with AKI. We conducted a study to analyze the role of the monocyte-to-lymphocyte ratio (MLR) in predicting the development of AKI after AHS. Methods This retrospective observational study enrolled all subjects with AHS who attended the neurosurgical intensive care unit (NSICU) at the First Affiliated University of South China between 2018 and 2021. Patient demographics, laboratory data, treatment details, and clinical outcomes were recorded. Results Of the 771 enrolled patients, 180 (23.3%) patients developed AKI. Compared to patients without AKI, those with AKI had a higher MLR and the neutrophil-lymphocyte ratio (NLR) at admission (P < 0.001). The MLR and the NLR at admission were associated with an increased AKI risk, with odds ratios (ORs) of 8.27 (95% CI: 4.23, 16.17, p < 0.001) and 1.17 (95% CI: 1.12, 1.22, p < 0.001), respectively. The receiver operating characteristic curve (ROC) analysis was conducted to analyze the ability of the MLR and NLR to predict AKI, and the areas under the curve (AUCs) of the MLR and the NLR were 0.73 (95% CI: 0.69, 0.77, p < 0.001) and 0.67 (95% CI: 0.62, 0.72, p < 0.001), with optimal cutoff values of 0.5556 and 11.65, respectively. The MLR and the NLR at admission were associated with an increased in-hospital mortality risk, with ORs of 3.13 (95% CI: 1.08, 9.04) and 1.07 (95% CI: 1.00, 1.14), respectively. The AUCs of the MLR and the NLR for predicting in-hospital mortality were 0.62 (95% CI: 0.54, 0.71, p = 0.004) and 0.52 (95% CI: 0.43, 0.62, p = 0.568), respectively. The optimal cutoff value for the MLR was 0.7059, with a sensitivity of 51% and a specificity of 73.3%. Conclusions MLR and NLR measurements in patients with AHS at admission could be valuable tools for identifying patients at high risk of early AKI. The MLR was positively associated with in-hospital mortality and the NLR showed a weak ability for the prediction of in-hospital mortality.
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Affiliation(s)
- Fen Jiang
- Department of Nephrology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Jialing Liu
- Department of Nephrology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Xin Yu
- Department of Nephrology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Rui Li
- Department of Nephrology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Run Zhou
- Department of Gastroenterology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Jianke Ren
- Department of Nephrology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Xiangyang Liu
- Department of Clinical Medicine, Xiangnan University, Chenzhou, China
| | - Saili Zhao
- Department of Nursing, Hengyang Medical School, The First Affiliated Hospital, University of South China, Hengyang, China
| | - Bo Yang
- Department of Nephrology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
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7
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Emergency department and transport predictors of neurological deterioration in patients with spontaneous intracranial hemorrhage. Am J Emerg Med 2022; 53:154-160. [DOI: 10.1016/j.ajem.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/25/2021] [Accepted: 01/02/2022] [Indexed: 11/20/2022] Open
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Chen KH, Shao PL, Li YC, Chiang JY, Sung PH, Chien HW, Shih FY, Lee MS, Chen WF, Yip HK. Human Umbilical Cord-Derived Mesenchymal Stem Cell Therapy Effectively Protected the Brain Architecture and Neurological Function in Rat After Acute Traumatic Brain Injury. Cell Transplant 2021; 29:963689720929313. [PMID: 33169616 PMCID: PMC7784577 DOI: 10.1177/0963689720929313] [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] [Indexed: 12/30/2022] Open
Abstract
Intracranial hemorrhage from stroke and head trauma elicits a cascade of inflammatory and immune reactions detrimental to neurological integrity and function at cellular and molecular levels. This study tested the hypothesis that human umbilical cord–derived mesenchymal stem cell (HUCDMSC) therapy effectively protected the brain integrity and neurological function in rat after acute traumatic brain injury (TBI). Adult male Sprague-Dawley rats (n = 30) were equally divided into group 1 (sham-operated control), group 2 (TBI), and group 3 [TBI + HUCDMSC (1.2 × 106 cells/intravenous injection at 3 h after TBI)] and euthanized by day 28 after TBI procedure. The results of corner test and inclined plane test showed the neurological function was significantly progressively improved from days 3, 7, 14, and 28 in groups 1 and 3 than in group 2, and group 1 than in group 3 (all P < 0.001). By day 28, brain magnetic resonance imaging brain ischemic volume was significantly increased in group 2 than in group 3 (P < 0.001). The protein expressions of apoptosis [mitochondrial-bax positive cells (Bax)/cleaved-caspase3/cleaved-poly(adenosine diphosphate (ADP)-ribose) polymerase], fibrosis (Smad3 positive cells (Smad3)/transforming growth factor-β), oxidative stress (NADPH Oxidase 1 (NOX-1)/NADPH Oxidase 2 (NOX-2)/oxidized-protein/cytochrome b-245 alpha chain (p22phox)), and brain-edema/deoxyribonucleic acid (DNA)–damaged biomarkers (Aquaporin-4/gamma H2A histone family member X ( (γ-H2AX)) displayed an identical pattern to neurological function among the three groups (all P < 0.0001), whereas the protein expressions of angiogenesis biomarkers (vascular endothelial growth factor/stromal cell–derived factor-1α/C-X-C chemokine receptor type 4 (CXCR4)) significantly increased from groups 1 to 3 (all P < 0.0001). The cellular expressions of inflammatory biomarkers (cluster of differentiation 14 (+) cells (CD14+)/glial fibrillary acidic protein positive cells (GFAP+)/ a member of a new family of EGF-TM7 molecules positive cells (F4/80+)) and DNA-damaged parameter (γ-H2AX) exhibited an identical pattern, whereas cellular expressions of neural integrity (hexaribonucleotide Binding Protein-3 positive cells (NeuN+)/nestin+/doublecortin+) exhibited an opposite pattern of neurological function among the three groups (all P < 0.0001). Xenogeneic HUCDMSC therapy was safe and it significantly preserved neurological function and brain architecture in rat after TBI.
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Affiliation(s)
- Kuan-Hung Chen
- Department of Anesthesiology, 63328Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine
| | - Pei-Lin Shao
- Department of Nursing, 63267Asia University, Taichung
| | - Yi-Chen Li
- Division of Cardiology, Department of Internal Medicine, 63328Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine
| | - John Y Chiang
- Department of Computer Science and Engineering, 34874National Sun Yat-sen University, Kaohsiung.,Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University
| | - Pei-Hsun Sung
- Division of Cardiology, Department of Internal Medicine, 63328Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine
| | - Hui-Wen Chien
- Department of Nursing, 63267Asia University, Taichung
| | - Fu-Yuan Shih
- Department of Neurosurgery, 63328Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine
| | - Mel S Lee
- Department of Orthopedics, 63328Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine
| | - Wu-Fu Chen
- Department of Neurosurgery, 63328Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine.,Department of Neurosurgery, Xiamen Chang Gung Hospital, Fujian, China.,Department of Marine Biotechnology and Resources, 34874National Sun Yat-sen University, Kaohsiung
| | - Hon-Kan Yip
- Department of Nursing, 63267Asia University, Taichung.,Division of Cardiology, Department of Internal Medicine, 63328Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine.,Institute for Translational Research in Biomedicine, 63328Kaohsiung Chang Gung Memorial Hospital.,Center for Shockwave Medicine and Tissue Engineering, 63328Kaohsiung Chang Gung Memorial Hospital.,Department of Medical Research, China Medical University Hospital, China Medical University, Taichung.,Division of Cardiology, Department of Internal Medicine, Xiamen Chang Gung Hospital, Fujian, China
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9
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Tran QK, Najafali D, Tiffany L, Tanveer S, Andersen B, Dawson M, Hausladen R, Jackson M, Matta A, Mitchell J, Yum C, Kuhn D. Effect of Blood Pressure Variability on Outcomes in Emergency Patients with Intracranial Hemorrhage. West J Emerg Med 2021; 22:177-185. [PMID: 33856298 PMCID: PMC7972364 DOI: 10.5811/westjem.2020.9.48072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 09/26/2020] [Indexed: 12/02/2022] Open
Abstract
Introduction Patients with spontaneous intracranial hemorrhage (sICH) have high mortality and morbidity, which are associated with blood pressure variability. Additionally, blood pressure variability is associated with acute kidney injury (AKI) in critically ill patients, but its association with sICH patients in emergency departments (ED) is unclear. Our study investigated the association between blood pressure variability in the ED and the risk of developing AKI during sICH patients’ hospital stay. Methods We retrospectively analyzed patients with sICH, including those with subarachnoid and intraparenchymal hemorrhage, who were admitted from any ED and who received an external ventricular drain at our academic center. Patients were identified by the International Classification of Diseases, Ninth Revision (ICD-9). Outcomes were the development of AKI, mortality, and being discharged home. We performed multivariable logistic regressions to measure the association of clinical factors and interventions with outcomes. Results We analyzed the records of 259 patients: 71 (27%) patients developed AKI, and 59 (23%) patients died. Mean age (± standard deviation [SD]) was 58 (14) years, and 150 (58%) were female. Patients with AKI had significantly higher blood pressure variability than patients without AKI. Each millimeter of mercury increment in one component of blood pressure variability, SD in systolic blood pressure (SBPSD), was significantly associated with 2% increased likelihood of developing AKI (odds ratio [OR] 1.02, 95% confidence interval [CI], 1.005–1.03, p = 0.007). Initiating nicardipine infusion in the ED (OR 0.35, 95% CI, 0.15–0.77, p = 0.01) was associated with lower odds of in-hospital mortality. No ED interventions or blood pressure variability components were associated with patients’ likelihood to be discharged home. Conclusion Our study suggests that greater SBPSD during patients’ ED stay is associated with higher likelihood of AKI, while starting nicardipine infusion is associated with lower odds of in-hospital mortality. Further studies about interventions and outcomes of patients with sICH in the ED are needed to confirm our observations.
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Affiliation(s)
- Quincy K Tran
- University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland.,University of Maryland School of Medicine, The R Adams Cowley Shock Trauma Center, Department of Emergency Medicine, Baltimore, Maryland.,University of Maryland School of Medicine, The Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, Baltimore, Maryland
| | - Daniel Najafali
- University of Maryland School of Medicine, The Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, Baltimore, Maryland
| | - Laura Tiffany
- University of Maryland School of Medicine, The Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, Baltimore, Maryland
| | - Safura Tanveer
- University of Maryland School of Medicine, The Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, Baltimore, Maryland
| | - Brooke Andersen
- University of Maryland School of Medicine, The R Adams Cowley Shock Trauma Center, Department of Emergency Medicine, Baltimore, Maryland
| | - Michelle Dawson
- University of Maryland School of Medicine, The R Adams Cowley Shock Trauma Center, Department of Emergency Medicine, Baltimore, Maryland
| | - Rachel Hausladen
- University of Maryland Medical Center, Department of Neurology, Baltimore, Maryland
| | - Matthew Jackson
- University of Maryland School of Medicine, The Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, Baltimore, Maryland
| | - Ann Matta
- University of Maryland School of Medicine, The R Adams Cowley Shock Trauma Center, Department of Emergency Medicine, Baltimore, Maryland
| | - Jordan Mitchell
- University of Maryland School of Medicine, The Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, Baltimore, Maryland
| | - Christopher Yum
- University of Maryland School of Medicine, The Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, Baltimore, Maryland
| | - Diane Kuhn
- University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland
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10
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Tiffany L, Haase DJ, Boswell K, Dietrich ME, Najafali D, Olexa J, Rea J, Sapru M, Scalea T, Tran QK. Care intensity of spontaneous intracranial hemorrhage: Effectiveness of the critical care resuscitation unit. Am J Emerg Med 2020; 46:437-444. [PMID: 33172747 DOI: 10.1016/j.ajem.2020.10.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/22/2020] [Accepted: 10/22/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Laura Tiffany
- Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Daniel J Haase
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA; Program in Trauma, The R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA; The Critical Care Resuscitation Unit, University of Maryland Medical Center, Baltimore, MD, USA.
| | - Kimberly Boswell
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA; Program in Trauma, The R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA; The Critical Care Resuscitation Unit, University of Maryland Medical Center, Baltimore, MD, USA.
| | - Mary Ellen Dietrich
- The Critical Care Resuscitation Unit, University of Maryland Medical Center, Baltimore, MD, USA.
| | - Daniel Najafali
- Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Joshua Olexa
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Jeffrey Rea
- Program in Trauma, The R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA; The Critical Care Resuscitation Unit, University of Maryland Medical Center, Baltimore, MD, USA.
| | - Mayga Sapru
- Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Thomas Scalea
- Program in Trauma, The R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA; Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Quincy K Tran
- Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA; Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA; Program in Trauma, The R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA; The Critical Care Resuscitation Unit, University of Maryland Medical Center, Baltimore, MD, USA.
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11
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Kuriakose D, Xiao Z. Pathophysiology and Treatment of Stroke: Present Status and Future Perspectives. Int J Mol Sci 2020; 21:E7609. [PMID: 33076218 PMCID: PMC7589849 DOI: 10.3390/ijms21207609] [Citation(s) in RCA: 377] [Impact Index Per Article: 94.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 10/08/2020] [Accepted: 10/13/2020] [Indexed: 12/14/2022] Open
Abstract
Stroke is the second leading cause of death and a major contributor to disability worldwide. The prevalence of stroke is highest in developing countries, with ischemic stroke being the most common type. Considerable progress has been made in our understanding of the pathophysiology of stroke and the underlying mechanisms leading to ischemic insult. Stroke therapy primarily focuses on restoring blood flow to the brain and treating stroke-induced neurological damage. Lack of success in recent clinical trials has led to significant refinement of animal models, focus-driven study design and use of new technologies in stroke research. Simultaneously, despite progress in stroke management, post-stroke care exerts a substantial impact on families, the healthcare system and the economy. Improvements in pre-clinical and clinical care are likely to underpin successful stroke treatment, recovery, rehabilitation and prevention. In this review, we focus on the pathophysiology of stroke, major advances in the identification of therapeutic targets and recent trends in stroke research.
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Affiliation(s)
| | - Zhicheng Xiao
- Development and Stem Cells Program, Monash Biomedicine Discovery Institute and Department of Anatomy and Developmental Biology, Monash University, Melbourne, VIC 3800, Australia;
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12
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Gurshawn T, Jackson M, Barr J, Cao-Pham M, Capobianco P, Kuhn D, Motley K, Pope K, Strong J, Kole MJ, Wessell A, Thom SR, Tran QK. Transportation Management Affecting Outcomes of Patients With Spontaneous Intracranial Hemorrhage. Air Med J 2020; 39:189-195. [PMID: 32540110 DOI: 10.1016/j.amj.2019.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 11/21/2019] [Accepted: 12/05/2019] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Patients with spontaneous intracranial hemorrhage (sICH) have poor outcomes, in part because of blood pressure variability (BPV). Patients with sICH causing elevated intracranial pressure (ICP) are frequently transferred to tertiary centers for neurosurgical interventions. We hypothesized that BPV and care intensity during transport would correlate with outcomes in patients with sICH and elevated ICP. METHODS We analyzed charts from adult sICH patients who were transferred from emergency departments to a quaternary academic center from January 1, 2011, to September 30, 2015, and received external ventricular drainage. Outcomes were in-hospital mortality and the Glasgow Coma Scale on day 5 (HD5GCS). Multivariable and ordinal logistic regressions were used for associations between clinical factors and outcomes. RESULTS We analyzed 154 patients, 103 (67%) had subarachnoid hemorrhage and 51 (33%) intraparenchymal hemorrhage; 38 (25%) died. BPV components were similar between survivors and nonsurvivors and not associated with mortality. Each additional intervention during transport was associated with a 5-fold increase in likelihood to achieve a higher HD5GCS (odds ratio = 5.4; 95% confidence interval, 1.7-16; P = .004). CONCLUSION BPV during transport was not associated with mortality. However, high standard deviation in systolic blood pressure during transport was associated with lower HD5GCS in patients with intraparenchymal hemorrhage. Further studies are needed to confirm our observations.
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Affiliation(s)
| | - Matthew Jackson
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Jackson Barr
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Mimi Cao-Pham
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Paul Capobianco
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Diane Kuhn
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD
| | | | - Kanisha Pope
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Jonathan Strong
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Matthew J Kole
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD
| | - Aaron Wessell
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD
| | - Stephen R Thom
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Quincy K Tran
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD; Program in Trauma, The R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD.
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13
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Liu Z, Zhang R, Chen X, Yao P, Yan T, Liu W, Yao J, Sokhatskii A, Gareev I, Zhao S. Identification of hub genes and small-molecule compounds related to intracerebral hemorrhage with bioinformatics analysis. PeerJ 2019; 7:e7782. [PMID: 31667013 PMCID: PMC6816389 DOI: 10.7717/peerj.7782] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 08/28/2019] [Indexed: 01/02/2023] Open
Abstract
Background Because of the complex mechanisms of injury, conventional surgical treatment and early blood pressure control does not significantly reduce mortality or improve patient prognosis in cases of intracerebral hemorrhage (ICH). We aimed to identify the hub genes associated with intracerebral hemorrhage, to act as therapeutic targets, and to identify potential small-molecule compounds for treating ICH. Methods The GSE24265 dataset, consisting of data from four perihematomal brain tissues and seven contralateral brain tissues, was downloaded from the Gene Expression Omnibus (GEO) database and screened for differentially expressed genes (DEGs) in ICH, with a fold change (FC) value of (|log2FC|) > 2 and a P-value of <0.05 set as cut-offs. The functional annotation of DEGs was performed using Gene Ontology (GO) resources, and the cell signaling pathway analysis of DEGs was performed using the Kyoto Encyclopedia of Genes and Genomes (KEGG), with a P-value of <0.05 set as the cut-off. We constructed a protein-protein interaction (PPI) network to clarify the interrelationships between the different DEGs and to select the hub genes with significant interactions. Next, the DEGs were analyzed using the CMap tool to identify small-molecule compounds with potential therapeutic effects. Finally, we verified the expression levels of the hub genes by RT-qPCR on the rat ICH model. Result A total of 59 up-regulated genes and eight down-regulated genes associated with ICH were identified. The biological functions of DEGs associated with ICH are mainly involved in the inflammatory response, chemokine activity, and immune response. The KEGG analysis identified several pathways significantly associated with ICH, including but not limited to HIF-1, TNF, toll-like receptor, cytokine-cytokine receptor interaction, and chemokine molecules. A PPI network consisting of 57 nodes and 373 edges was constructed using STRING, and 10 hub genes were identified with Cytoscape software. These hub genes are closely related to secondary brain injury induced by ICH. RT-qPCR results showed that the expression of ten hub genes was significantly increased in the rat model of ICH. In addition, a CMap analysis of three small-molecule compounds revealed their therapeutic potential. Conclusion In this study we obtained ten hub genes, such as IL6, TLR2, CXCL1, TIMP1, PLAUR, SERPINE1, SELE, CCL4, CCL20, and CD163, which play an important role in the pathology of ICH. At the same time, the ten hub genes obtained through PPI network analysis were verified in the rat model of ICH. In addition, we obtained three small molecule compounds that will have therapeutic effects on ICH, including Hecogenin, Lidocaine, and NU-1025.
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Affiliation(s)
- Zhendong Liu
- The First Affiliated Hospital of Harbin Medical University, Department of Neurosurgery, Harbin, Heilongjiang Province, People's Republic of China.,Harbin Medical University, Institute of Brain Science, Harbin, Heilongjiang Province, People's Republic of China
| | - Ruotian Zhang
- The First Affiliated Hospital of Harbin Medical University, Department of Neurosurgery, Harbin, Heilongjiang Province, People's Republic of China.,Harbin Medical University, Institute of Brain Science, Harbin, Heilongjiang Province, People's Republic of China
| | - Xin Chen
- The First Affiliated Hospital of Harbin Medical University, Department of Neurosurgery, Harbin, Heilongjiang Province, People's Republic of China.,Harbin Medical University, Institute of Brain Science, Harbin, Heilongjiang Province, People's Republic of China
| | - Penglei Yao
- The First Affiliated Hospital of Harbin Medical University, Department of Neurosurgery, Harbin, Heilongjiang Province, People's Republic of China.,Harbin Medical University, Institute of Brain Science, Harbin, Heilongjiang Province, People's Republic of China
| | - Tao Yan
- The First Affiliated Hospital of Harbin Medical University, Department of Neurosurgery, Harbin, Heilongjiang Province, People's Republic of China.,Harbin Medical University, Institute of Brain Science, Harbin, Heilongjiang Province, People's Republic of China
| | - Wenwu Liu
- The First Affiliated Hospital of Harbin Medical University, Department of Neurosurgery, Harbin, Heilongjiang Province, People's Republic of China.,Harbin Medical University, Institute of Brain Science, Harbin, Heilongjiang Province, People's Republic of China
| | - Jiawei Yao
- The First Affiliated Hospital of Harbin Medical University, Department of Neurosurgery, Harbin, Heilongjiang Province, People's Republic of China.,Harbin Medical University, Institute of Brain Science, Harbin, Heilongjiang Province, People's Republic of China
| | | | | | - Shiguang Zhao
- The First Affiliated Hospital of Harbin Medical University, Department of Neurosurgery, Harbin, Heilongjiang Province, People's Republic of China.,Harbin Medical University, Institute of Brain Science, Harbin, Heilongjiang Province, People's Republic of China
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14
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Krel M, Brazdzionis J, Podkovik S, Miulli DE, Wacker MR, Beamer Y. Safety and Efficacy of Transcatheter Administration of Tissue Plasminogen Activating Factor as Adjuvant Therapy for Intraventricular Hemorrhage. Cureus 2019; 11:e5785. [PMID: 31723544 PMCID: PMC6825502 DOI: 10.7759/cureus.5785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective Stroke is the fifth leading cause of death in the United States and the leading cause of disability. Hemorrhagic stroke has higher risks of mortality and neurologic deficit. Higher still, acute intraventricular hemorrhage (IVH) has mortality between 50% and 80% while complicating subarachnoid hemorrhage in 15% of cases and intracerebral hemorrhage in 40% of cases. We sought to demonstrate that early adjuvant intraventricular recombinant tissue plasminogen activating factor (rt-PA) improved outcomes. Methods Retrospective chart review was performed on patients aged 18-95 years with external ventricular drain (EVD) and intraventricular rt-PA for clot evacuation in IVH between 2005 and 2015. In total, 22 patients met the inclusion criteria. Generalized linear modeling was performed with factorial analysis using the Glasgow Coma Score (GCS) on arrival, GCS at EVD placement, EVD day of onset of rt-PA administration, GCS at onset of rt-PA administration, total duration of EVD, necessity of ventriculoperitoneal (VP) shunt, occurrence of ventriculitis, day of ventriculitis, GCS after rt-PA, length of stay (LOS) in the intensive care unit (ICU), and hospital disposition. Results Presenting GCS affected LOS significantly. Ventriculitis only significantly affected ICU LOS. GCS after rt-PA only significantly affected discharge GCS. EVD day of rt-PA protocol commencement demonstrated significant effects on EVD duration and cerebrospinal fluid (CSF) diversion requirement. Age affected ICU and hospital LOS. Conclusion These findings argue for larger prospective trials of EVD day two rt-PA protocol inception in acute IVH. Reported ventriculitis rates with EVDs are 8.8%, while we demonstrated a rate of 18% without significant effects except in ICU LOS. Transcatheter intraventricular rt-PA is safe and effective as an adjuvant in acute spontaneous intraventricular hemorrhage with the greatest benefit of rt-PA protocol at EVD day two.
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Affiliation(s)
- Mark Krel
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - James Brazdzionis
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Stacey Podkovik
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Dan E Miulli
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | | | - Yancey Beamer
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
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15
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Tuteja G, Uppal A, Strong J, Nguyen T, Pope K, Jenkins R, Al Rebh H, Gatz D, Chang WT, Tran QK. Interventions affecting blood pressure variability and outcomes after intubating patients with spontaneous intracranial hemorrhage. Am J Emerg Med 2018; 37:1665-1671. [PMID: 30528041 DOI: 10.1016/j.ajem.2018.11.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 11/23/2018] [Accepted: 11/28/2018] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Spontaneous intracranial hemorrhage (sICH) that increases intracranial pressure (ICP) is a life-threatening emergency often requiring intubation in Emergency Departments (ED). A previous study of intubated ED patients found that providing ≥5 interventions after initiating mechanical ventilation (pMVI) reduced mortality rate. We hypothesized that pMVIs would lower blood pressure variability (BPV) in patients with sICH and thus improve survival rates and neurologic outcomes. METHOD We performed a retrospective study of adults, who were transferred to a quaternary medical center between 01/01/2011 and 09/30/2015 for sICH, received an extraventricular drain during hospitalization. They were identified by International Classification of Diseases, version 9 (430.XX, 431.XX), and procedure code 02.21. Outcomes were BPV indices, death, and being discharged home. RESULTS We analyzed records from 147 intubated patients transferred from 40 EDs. Forty-one percent of patients received ≥5 pMVIs and was associated with lower median successive variation in systolic blood pressure (BPSV) (31,[IQR 18-45) compared with those receiving 4 or less pMVIs (38[IQR 16-70]], p = 0.040). Three pMVIs, appropriate tidal volume, sedative infusion, and capnography were significantly associated with lower BPV. In addition to clinical factors, BPSV (OR 26; 95% CI 1.2, >100) and chest radiography (OR 0.3; 95% CI 0.09, 0.9) were associated with mortality rate. Use of quantitative capnography (OR 8.3; 95%CI, 4.7, 8.8) was associated with increased likelihood of being discharged home. CONCLUSIONS In addition to disease severity, individual pMVIs were significantly associated with BPV and patient outcomes. Emergency physicians should perform pMVIs more frequently to prevent BPV and improve patients' outcomes.
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Affiliation(s)
- Gurshawn Tuteja
- John Hopkins University, Baltimore, MD, United States of America.
| | - Angad Uppal
- John Hopkins University, Baltimore, MD, United States of America.
| | - Jonathan Strong
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, United States of America.
| | - Tina Nguyen
- University of Maryland at College Park, College Park, MD, United States of America.
| | - Kanisha Pope
- University of Maryland at College Park, College Park, MD, United States of America
| | - Ryne Jenkins
- R Adams Cowley Shock Trauma Center, Program in Trauma, University of Maryland School of Medicine, Baltimore, MD, United States of America.
| | - Heba Al Rebh
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, United States of America.
| | - David Gatz
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, United States of America.
| | - Wan-Tsu Chang
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, United States of America; R Adams Cowley Shock Trauma Center, Program in Trauma, University of Maryland School of Medicine, Baltimore, MD, United States of America.
| | - Quincy K Tran
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, United States of America; R Adams Cowley Shock Trauma Center, Program in Trauma, University of Maryland School of Medicine, Baltimore, MD, United States of America.
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16
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Muscular Atrophy in Cardiovascular Disease. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1088:369-391. [DOI: 10.1007/978-981-13-1435-3_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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17
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Wowk S, Fagan KJ, Ma Y, Nichol H, Colbourne F. Examining potential side effects of therapeutic hypothermia in experimental intracerebral hemorrhage. J Cereb Blood Flow Metab 2017; 37:2975-2986. [PMID: 27899766 PMCID: PMC5536807 DOI: 10.1177/0271678x16681312] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 10/27/2016] [Accepted: 10/30/2016] [Indexed: 11/16/2022]
Abstract
Studies treating intracerebral hemorrhage (ICH) with therapeutic hypothermia (TH) have shown inconsistent benefits. We hypothesized that TH's anti-inflammatory effects may be responsible as inflammatory cells are essential for removing degrading erythrocytes. Here, we subjected rats to a collagenase-induced striatal ICH followed by whole-body TH (∼33℃ for 11-72 h) or normothermia. We used X-ray fluorescence imaging to spatially quantify total and peri-hematoma iron three days post-injury. At three and seven days, we measured non-heme iron levels. Finally, hematoma volume was quantified on one, three, and seven days. In the injured hemisphere, total iron levels were elevated ( p < 0.001) with iron increasing in the peri-hematoma region ( p = 0.007). Non-heme iron increased from three to seven days (p < 0.001). TH had no effect on any measure of iron ( p ≥ 0.479). At one and three days, TH did not affect hematoma volume ( p ≥ 0.264); however, at seven days there was a four-fold increase in hematoma volume in 40% of treated animals ( p = 0.032). Thus, even when TH does not interfere with initial increases in total and non-heme iron or its containment, TH can cause re-bleeding post-treatment. This serious complication could partly account for the intermittent protection previously observed. This also raises serious concerns for clinical usage of TH for ICH.
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Affiliation(s)
- Shannon Wowk
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Kelly J Fagan
- Department of Biology, MacEwan University, Edmonton, Canada
| | - Yonglie Ma
- Department of Psychology, University of Alberta, Edmonton, Alberta, Canada
| | - Helen Nichol
- Department of Anatomy and Cell Biology, University of Saskatchewan, Saskatoon, Canada
| | - Frederick Colbourne
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada
- Department of Psychology, University of Alberta, Edmonton, Alberta, Canada
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18
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A Case Report of Maternal Cerebral Hemorrhage in Preterm Pregnancy. J Obstet Gynecol Neonatal Nurs 2017; 46:609-616. [PMID: 28599120 DOI: 10.1016/j.jogn.2017.04.135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2017] [Indexed: 11/20/2022] Open
Abstract
Intracerebral hemorrhage is a rare event during pregnancy that can result in serious morbidity and mortality for the mother and infant. In this article, we describe a case involving a multiparous woman at 34 weeks gestation who presented with a 5-cm intracerebral bleed. Within 2 hours of presenting, she underwent an emergency cesarean and craniotomy to remove the hematoma. The woman's altered mental status fully abated, and she was discharged with minimal neurologic deficits. The newborn was born healthy.
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19
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Stanca DM, Mărginean IC, Sorițău O, Dragoș C, Mărginean M, Mureșanu DF, Vester JC, Rafila A. GFAP and antibodies against NMDA receptor subunit NR2 as biomarkers for acute cerebrovascular diseases. J Cell Mol Med 2015; 19:2253-61. [PMID: 26081945 PMCID: PMC4568929 DOI: 10.1111/jcmm.12614] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 04/09/2015] [Indexed: 11/29/2022] Open
Abstract
We studied whether the serum levels of glial fibrillary acidic protein (GFAP) and of antibodies against the N-methyl-d-aspartate receptor subunit NR2 (NR2 RNMDA) can discriminate between intracerebral haemorrhage (ICH) and ischaemic stroke (IS) in stroke patients. We prospectively recruited patients with suspected stroke (72 confirmed) and 52 healthy controls. The type of brain lesion (ICH or IS) was established using brain imaging. The levels of GFAP and of antibodies against NR2 RNMDA were measured in blood samples obtained within 12 hrs after stroke onset and 24, 48 and 72 hrs and 1 and 2 weeks later using ELISA immunoassay. Improvement in diagnostic performance was assessed in logistic regression models designed to predict the diagnosis and the type of stroke. GFAP peaks early during haemorrhagic brain lesions (at significantly higher levels), and late in ischaemic events, whereas antibodies against NR2 RNMDA have significantly higher levels during IS at all time-points. Neither of the two biomarkers used on its own could sufficiently discriminate patients, but when they are used in combination they can differentiate at 12 hrs after stroke, between ischaemic and haemorrhagic stroke with a sensitivity and specificity of 94% and 91%, respectively.
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Affiliation(s)
- Delia Maria Stanca
- Department of Neurosciences, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania
| | - Ioan Constantin Mărginean
- Department of Neurosciences, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania
| | - Olga Sorițău
- Department of Cancer Immunology of "Prof. dr. Ion Chiricuță" Oncologic Institute Cluj-Napoca, Cluj-Napoca, Romania
| | - Cristian Dragoș
- Department of Statistics, Babes-Bolyai University Cluj-Napoca, Cluj-Napoca, Romania
| | - Mariana Mărginean
- Department of Histology, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania
| | - Dafin Fior Mureșanu
- Department of Neurosciences, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania.,"RoNeuro" Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
| | - Johannes C Vester
- Department of Biometry and Clinical Research, IDV Data Analysis and Study Planning, Krailling, Germany
| | - Alexandru Rafila
- Department of Microbiology and Epidemiology, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
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20
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Otero-Rodriguez A, Gonçalves-Estella JM, Sanchez-Ledesma MJ, Perez-De la Cruz MA, Munoz-Martin MC. Evacuation of intracerebral hemorrhages by neuroendoscopy with transparent sheath. Experimental study. INTERDISCIPLINARY NEUROSURGERY 2015. [DOI: 10.1016/j.inat.2014.12.004] [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] Open
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21
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Pikija S, Trkulja V, Simundic AM, Vrcek E, Boskovic K, Bacani S. Is on-admission capillary blood beta-hydroxybutyrate concentration associated with the acute stroke severity and short-term functional outcome? Neurol Res 2013; 35:959-67. [DOI: 10.1179/1743132813y.0000000239] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- Slaven Pikija
- Department of NeurologyUniversity Hospital Center Maribor, Slovenia
| | | | - Ana-Maria Simundic
- Clinical Institute of ChemistryUniversity Hospital Center ‘Sestre Milosrdnice’, Zagreb, Croatia
| | - Emina Vrcek
- Department of NeurologyGeneral Hospital Varaždin, Croatia
| | | | - Suzana Bacani
- Department of NeurologyGeneral Hospital Varaždin, Croatia
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22
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Li Q, Yang CH, Xu JG, Li H, You C. Surgical treatment for large spontaneous basal ganglia hemorrhage: retrospective analysis of 253 cases. Br J Neurosurg 2013; 27:617-21. [DOI: 10.3109/02688697.2013.765938] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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23
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Gombet TR, Ossou-Nguiet PM, Gankama TN, Ellenga-Mbolla BF, Otiobanda GF, Obondzo-Aloba K, Longo-Mbenza B. Hypertension and intracerebral hemorrhage in Brazzaville. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/wjcd.2013.39083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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24
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Abstract
Stroke is a major cause of morbidity and mortality but the brain and other relevant tissues are often examined only cursorily when stroke patients come to autopsy. The pathological findings and clinical implications vary according to the type of stroke and its location and cause. Large ischaemic strokes are usually associated with atherosclerosis of extracranial or major intracranial arteries but can be caused by dissection. Most small cerebral infarcts are caused by arteriosclerosis or, in the elderly, cerebral amyloid angiopathy (CAA). However, vasculitides and coagulopathies can cause a range of different patterns of ischaemic (and, occasionally, haemorrhagic) stroke. Global brain ischaemia, caused by severe hypotension or raised intracranial pressure, produces damage that is accentuated in certain regions and neuronal populations and may be confused with hypoglycaemic injury. The main cause of subarachnoid haemorrhage is a ruptured berry aneurysm but CAA, arteriovenous malformations and infective aneurysms are occasionally responsible. These can also cause parenchymal brain haemorrhage, although this most often complicates hypertensive small vessel disease. Sometimes the haemorrhage arises from a neoplasm. Performing an adequate autopsy in stroke requires proper preparation, awareness of the likely pathological processes, familiarity with intracranial vascular anatomy, careful gross examination and dissection, and appropriate use of histology.
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Affiliation(s)
- Seth Love
- Department of Neuropathology, Institute of Clinical Neurosciences, Frenchay Hospital, Bristol, UK.
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25
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Intracranial hemorrhage surgery on patients on mechanical circulatory support: a case series. J Neurosurg Anesthesiol 2011; 23:30-4. [PMID: 20706140 DOI: 10.1097/ana.0b013e3181eee55e] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Cardiac disease is the leading cause of death in the United States and late-stage heart failure is associated with a high level of morbidity and mortality. The ventricular assist devices and extracorporeal membrane oxygenators are the mainstay of mechanical circulatory support devices for the patients with extremely low cardiac output. However, they come at a price of significant risk factors, including intracranial hemorrhage. The incidence of intracranial hemorrhage on extracorporeal membrane oxygenators and on ventricular assist devices is 37% and 13% to 14%, respectively. METHODS/RESULTS The cases in this series focus on the risks of ICH and the decompressive craniotomies that were carried out on patients while they were on mechanical circulatory support. The intraoperative anesthetic management for patients on mechanical circulatory support for the noncardiothoracic anesthesiologist is highlighted. CONCLUSIONS The results of recent cardiothoracic surgery trials have led to an increase of surgical management instead of medical management in the treatment of heart failure. Although most agree with the immediate reversal of anticoagulation and antiplatelet therapy, there is no standard protocol for restarting anticoagulation or antiplatelet therapy after craniotomy in this population. The standard practices of resuscitation and ACLS including inotropes, vasopressors, and vasodilators (with the exception of chest compressions that can dislodge the devices), can be used as needed. The identification of cardiothoracic surgeons and perfusionists who are available for immediate assistance as and when required during the surgery and transportation is an important factor.
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Parker D, Rhoney DH, Liu-DeRyke X. Management of spontaneous nontraumatic intracranial hemorrhage. J Pharm Pract 2010; 23:398-407. [PMID: 21507845 DOI: 10.1177/0897190010372320] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Intracerebral hemorrhage (ICH) is one of the most devastating subtypes of stroke and is characterized by spontaneous extravasation into the parenchymal tissue of the brain. Although advances in critical care have improved, there is no intervention currently available that has shown to alter the outcome of patients who have suffered acute ICH. Therefore, management is largely supportive. Treatment strategies are aimed at limiting hematoma enlargement, seizures, and cerebral edema, as well as other ICU-related complications such as deep venous thrombosis, hyperglycemia, and fever. This review will outline the key pharmacological management strategies in patients with ICH and highlight the most current American Heart Association/American Stroke Association (AHA/ASA) guidelines for management published in 2007.
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Affiliation(s)
- Dennis Parker
- Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI 48201, USA.
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Levis JT, Kiang C, Flint AC. Spontaneous Intracerebral Hemorrhage Following a Blood Pressure Surge During Emergency Department Evaluation. Neurocrit Care 2010; 13:109-12. [DOI: 10.1007/s12028-010-9352-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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28
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Saenger AK, Christenson RH. Stroke biomarkers: progress and challenges for diagnosis, prognosis, differentiation, and treatment. Clin Chem 2009; 56:21-33. [PMID: 19926776 DOI: 10.1373/clinchem.2009.133801] [Citation(s) in RCA: 153] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Stroke is a devastating condition encompassing a wide range of pathophysiological entities that include thrombosis, hemorrhage, and embolism. Current diagnosis of stroke relies on physician clinical examination and is further supplemented with various neuroimaging techniques. A single set or multiple sets of blood biomarkers that could be used in an acute setting to diagnosis stroke, differentiate between stroke types, or even predict an initial/reoccurring stroke would be extremely valuable. CONTENT We discuss the current classification, diagnosis, and treatment of stroke, focusing on use of novel biomarkers (either solitary markers or multiple markers within a panel) that have been studied in a variety of clinical settings. SUMMARY The current diagnosis of stroke remains hampered and delayed due to lack of a suitable mechanism for rapid (ideally point-of-care), accurate, and analytically sensitive biomarker-based testing. There is a clear need for further development and translational research in this area. Potential biomarkers identified need to be transitioned quickly into clinical validation testing for further evaluation in an acute stroke setting; to do so would impact and improve patient outcomes and quality of life.
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Affiliation(s)
- Amy K Saenger
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA.
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