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Cai Y, Guo H, Fan Z, Zhang X, Wu D, Tang W, Gu T, Wang S, Yin A, Tao L, Ji X, Dong H, Li Y, Xiong L. Glycogenolysis Is Crucial for Astrocytic Glycogen Accumulation and Brain Damage after Reperfusion in Ischemic Stroke. iScience 2020; 23:101136. [PMID: 32446205 PMCID: PMC7240195 DOI: 10.1016/j.isci.2020.101136] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 02/27/2020] [Accepted: 04/30/2020] [Indexed: 12/23/2022] Open
Abstract
Astrocytic glycogen is an important energy reserve in the brain and is believed to supply fuel during energy crisis. However, the pattern of glycogen metabolism in ischemic stroke and its potential therapeutic impact on neurological outcomes are still unknown. Here, we found extensive brain glycogen accumulation after reperfusion in ischemic stroke patients and primates. Glycogenolytic dysfunction in astrocytes is responsible for glycogen accumulation, caused by inactivation of the protein kinase A (PKA)-glycogen phosphorylase kinase (PhK)-glycogen phosphorylase (GP) cascade accompanied by the activation of glycogen synthase kinase-3β (GSK3β). Genetic or pharmacological augmentation of astrocytic GP could promote astrocyte and neuron survival and improve neurological behaviors. In addition, we found that insulin exerted a neuroprotective effect, at least in part by rescuing the PKA-PhK-GP cascade to maintain homeostasis of glycogen metabolism during reperfusion. Together, our findings suggest a promising intervention for undesirable outcomes in ischemic stroke.
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Affiliation(s)
- Yanhui Cai
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, China
| | - Haiyun Guo
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, China
| | - Ze Fan
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, China
| | - Xinlei Zhang
- Department of Medicinal Chemistry, School of Pharmacy, Fourth Military Medical University, Xi'an, Shaanxi 710032, China
| | - Di Wu
- China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Wenhong Tang
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, China
| | - Tingting Gu
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, China
| | - Shiquan Wang
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, China
| | - Anqi Yin
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, China
| | - Liang Tao
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, China
| | - Xunming Ji
- China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Hailong Dong
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, China
| | - Yan Li
- Center for Brain Science & Department of Anesthesiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
| | - Lize Xiong
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, China
- Translational Research Institute of Brain and Brain-Like Intelligence & Department of Anesthesiology and Perioperative Medicine, Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine, Shanghai 200081, China
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Vachha BA, Schaefer PW. Imaging Patterns and Management Algorithms in Acute Stroke: An Update for the Emergency Radiologist. Radiol Clin North Am 2015; 53:801-26, ix. [PMID: 26046512 DOI: 10.1016/j.rcl.2015.02.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Neuroimaging plays a key role in the initial work-up of patients with symptoms of acute stroke. Understanding the advantages and limitations of available CT and MR imaging techniques and how to use them optimally in the emergency setting is crucial for accurately making the diagnosis of acute stroke and for rapidly determining appropriate treatment.
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Affiliation(s)
- Behroze A Vachha
- Neuroradiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Pamela W Schaefer
- Neuroradiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
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3
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Atalar MH, Salk I, Egilmez H. Classical signs and appearances in pediatric neuroradiology: a pictorial review. Pol J Radiol 2014; 79:479-89. [PMID: 25538798 PMCID: PMC4274733 DOI: 10.12659/pjr.891107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 07/17/2014] [Indexed: 11/15/2022] Open
Abstract
Radiological practice includes classification of illnesses with similar characteristics through recognizable signs. In this report, twenty-eight important and frequently seen neuroradiological signs in childhood are presented and described using X-rays, computed tomography (CT), magnetic resonance (MR) images, illustrations and photographs.
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Affiliation(s)
- Mehmet Haydar Atalar
- Department of Radiology, Cumhuriyet University, School of Medicine, Sivas, Turkey
| | - Ismail Salk
- Department of Radiology, Cumhuriyet University, School of Medicine, Sivas, Turkey
| | - Hulusi Egilmez
- Department of Radiology, Cumhuriyet University, School of Medicine, Sivas, Turkey
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Nadathur SG, Warren JR. Emergency department triaging of admitted stroke patients--a Bayesian Network analysis. Health Informatics J 2012; 17:294-312. [PMID: 22193829 DOI: 10.1177/1460458211424475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This study uses hospital administrative data to ascertain the differences in the patient characteristics, process and outcomes of care between the Emergency Department (ED) triage categories of patients admitted from an ED presentation into a large metropolitan teaching hospital with a Stroke Care Unit. Bayesian Networks (BNs) derived from the administrative data were used to provide the descriptive models. Nearly half the patients in each stroke subtype were triaged as 'Urgent' (to be seen within 30 minutes). With a decrease in the urgency of triage categories, the proportion admitted within 8 hours decreased dramatically and the proportion of formal discharge increased. Notably, 45% of transient ischaemic attacks (TIAs) were categorized as 'Semi-urgent' (to be attended within 60 minutes), indicating an opportunity to improve emergency assessment of TIAs. The results illustrate the utility of hospital administrative data and the applicability of BNs for review of the current triage practices and subsequent impact.
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Turner PJ, Holdsworth G. Commentary. CT stroke window settings: an unfortunate misleading misnomer? Br J Radiol 2011; 84:1061-6. [PMID: 21976632 DOI: 10.1259/bjr/99730184] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
This commentary will discuss the use of the "stroke window" settings in the evaluation of CT head examinations and advocate their more widespread use in patients who present with neurological symptoms in addition to patients with suspected stroke. We present examples of the use of stroke windows, which revealed subtle abnormalities that were not readily apparent on default brain window settings and were subsequently confirmed on MRI or follow-up CT. As a result we suggest that stroke windows should be routine in the review of all CT head examinations.
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Affiliation(s)
- P J Turner
- Radiology Department, The Mid Yorkshire Hospitals NHS Trust, Pinderfields General Hospital, Wakefield, UK.
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Gouhar GK, Taha TF. MR exponential image in ischemic stroke: A preliminary evaluation. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2010. [DOI: 10.1016/j.ejrnm.2010.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Hage MCF, Iwasaki M, Rabbani SR, Kamikawa L, Cervantes HJ, Bombonato PP, Sterman FA, Otaduy MC. Imagem por ressonância magnética na investigação da cabeça de cães. PESQUISA VETERINÁRIA BRASILEIRA 2010. [DOI: 10.1590/s0100-736x2010000700014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A imagem por ressonância magnética (IRM) é o método de diagnóstico por imagem não invasivo mais sensível para avaliar as partes moles, particularmente o encéfalo, porém trata-se de uma técnica onerosa. O método fundamenta-se no fenômeno da ressonância magnética nuclear que ocorre quando núcleos atômicos com propriedades magnéticas presentes no corpo são submetidos a um campo magnético intenso, sendo posteriormente excitados por energia de radiofrequência e gerando, por sua vez, um sinal de onda de radiofrequência capaz de ser captado por uma antena receptora, passando por um processo matemático, chamado Transformada de Fourier, para posterior formação da imagem. Esse estudo objetivou realizar 10 exames completos da cabeça em cadáveres de cães normais à IRM e confeccionar um Atlas com as estruturas identificadas. As imagens foram adquiridas em um aparelho de ressonância magnética Gyroscan S15/HP Philips com campo magnético de 1,5Tesla. Os cadáveres foram posicionados com a cabeça no interior de uma bobina de cabeça humana e foram submetidos a cortes iniciais sagitais a partir de onde se planejou os cortes transversais e dorsais nas sequências de pulso spin-eco T1, T2 e DP. Em T1 utilizou-se TR=400ms e TE=30ms, T2 utilizou-se TR=2000ms e TE=80ms e na DP utilizou-se TR=2000ms e TE=30ms. A espessura do corte foi de 4mm, o número de médias foi igual a 2, a matriz foi de 256x256, o fator foi igual a 1,0 e o campo de visão foi de 14cm. A duração do exame completo da cabeça foi de 74,5minutos. As imagens obtidas com as sequências utilizadas e com a bobina de cabeça humana foram de boa qualidade. Em T1 a gordura tornou-se hiperintensa e o líquido hipointenso. Em T2 a gordura ficou menos hiperintensa e o líquido hiperintenso. A cortical óssea e o ar foram hipointensos em todas as sequências utilizadas devido a baixa densidade de prótons. A sequência DP mostrou o melhor contraste entre a substância branca e cinzenta quando comparada a T2 e a T1. T2 evidenciou o líquido cefalorraquidiano tornando possível a distinção dos sulcos e giros cerebrais. Através do exame de IRM foi possível, pelo contraste, identificar as estruturas ósseas componentes da arquitetura da região, músculos, grandes vasos venosos e arteriais e estruturas do sistema nervoso central, além de elementos do sistema digestório, respiratório e estruturas dos olhos entre outras. Nesse estudo as IRM adquiridas nas sequências T1, DP e T2 foram complementares para o estudo dos aspectos anatômicos da cabeça de cães demonstrando-os com riqueza de detalhes. O tempo requerido para o exame completo da cabeça é compátivel para uso em animais vivos desde que devidamente anestesiados e controlados. Os resultados obtidos por esse trabalho abrem caminho em nosso meio, para o estudo de animais vivos e para o início da investigação de doenças, principalmente as de origem neurológica, visto ser esta técnica excelente para a visibilização do encéfalo.
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Reddy CC, Moroz A, Edgley SR, Lew HL, Chae J, Lombard LA. Stroke and Neurodegenerative Disorders: 1. Stroke Management in the Acute Care Setting. PM R 2009; 1:S4-12. [DOI: 10.1016/j.pmrj.2009.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Chan T, Huang HK. Effect of a computer-aided diagnosis system on clinicians' performance in detection of small acute intracranial hemorrhage on computed tomography. Acad Radiol 2008; 15:290-9. [PMID: 18280927 DOI: 10.1016/j.acra.2007.09.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2007] [Revised: 09/21/2007] [Accepted: 09/21/2007] [Indexed: 11/19/2022]
Abstract
RATIONALE AND OBJECTIVES To analyze the effect of a computer-aided diagnosis (CAD) system on clinicians' performance in detection of small acute intracranial hemorrhage (AIH) on computed tomography (CT). MATERIALS AND METHODS The authors have developed a CAD scheme that used both image processing techniques and anatomic knowledge based classification system to improve diagnosis of small AIH on CT. A multiple-reader, multiple-case receiver operating characteristic (ROC) study was performed. Twenty clinicians, including seven emergency physicians, seven radiology residents, and six radiology specialists were recruited as readers of 60 sets of brain CT, including 30 cases that show AIH smaller than 1 cm, and 30 controls. Each reader read the same 60 cases twice, first without, then with the prompts produced by the CAD system. The clinicians ranked their confidence in diagnosing a case of showing AIH, which produced the ROC curves. RESULTS Significantly improved performance is observed in emergency physicians, average area under the ROC curve (Az) increased from 0.8422 to 0.9294 (P = .0107) when they make the diagnosis without and with the support of CAD. Az for radiology residents increased from 0.9371 to 0.9762 (P = .0088). Az for radiology specialists increased from 0.9742 to 0.9868, but was statistically insignificant (P = .1755). CONCLUSIONS CAD can improve the clinicians' performance in detecting AIH on CT. In particular, emergency physicians can benefit most from the CAD and improve their performance to a level approaching that of the average radiology residents.
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Affiliation(s)
- Tao Chan
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
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Bussières AE, Taylor JA, Peterson C. Diagnostic Imaging Practice Guidelines for Musculoskeletal Complaints in Adults—An Evidence-Based Approach—Part 3: Spinal Disorders. J Manipulative Physiol Ther 2008; 31:33-88. [DOI: 10.1016/j.jmpt.2007.11.003] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2007] [Revised: 09/28/2007] [Accepted: 10/14/2007] [Indexed: 01/29/2023]
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Abstract
Due to its widespread availability, computer tomography (CT) scanning continues to be the primary initial imaging modality for assessment of patients with suspected acute stroke. It serves as a screening tool for other structural lesions which can mimic stroke and evaluates for possible hemorrhage prior to potential thrombolytic therapy. Findings seen on the initial CT may also serve as prognostic indicators of patient outcome helping with management decisions. As well, follow-up imaging in the subacute stages of infarct is also valuable for assessment of potential complications such as infarct extension, hemorrhagic transformation (and/or intracranial hemorrhage), and cerebral edema.
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Affiliation(s)
- Bao-Tram Nguyen
- Department of Radiology, Division of Neuroradiology, Massachusetts General Hospital, Boston, MA 02139, USA.
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Affiliation(s)
- Nicole M Orzechowski
- Mayo School of Graduate Medical Education, Mayo Clinic College of Medicine, Rochester, Minn 55905, USA
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13
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Black K, Dillon H. How OTs and PTs can help stroke patients recover. Nursing 2006; 36 Suppl P T:10-6; quiz 17. [PMID: 17038853 DOI: 10.1097/00152193-200610002-00004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Affiliation(s)
- Karen Black
- Occupational Therapy, University of Pennsylvania Health System, Philadelphia, PA, USA
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Abstract
The hyperdense artery sign on noncontrast head CT is thought to be one of the earliest and most useful signs of intra-arterial clot and probable (clinical) stroke. It should be evaluated in the context of the clinical scenario. Rigorous criteria should be applied in order to reduce potential false positives. The hyperdense middle cerebral artery sign is the most studied version and correlates with patient outcome. Our data suggest that the density on noncontrast head CT is not likely to universally represent in situ clot.
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Affiliation(s)
- Mark E Mullins
- Division of Neuroradiology, Massachusetts General Hospital, Boston 02114, USA.
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