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Maundrell R. Brain Death: Still A Puzzle After All These Years. NEUROETHICS-NETH 2023. [DOI: 10.1007/s12152-022-09513-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Lalgudi Ganesan S, Hornby L, Weiss M, Dawe K, Lanos C, Wollny K, Dhanani S, Gofton T. Brain-based arterial pulse pressure threshold for death determination: a systematic review. Can J Anaesth 2023; 70:685-698. [PMID: 37138154 PMCID: PMC10202984 DOI: 10.1007/s12630-023-02425-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 05/05/2023] Open
Abstract
PURPOSE There is lack of consensus regarding the minimum arterial pulse pressure required for confirming permanent cessation of circulation for death determination by circulatory criteria in organ donors. We assessed direct and indirect evidence supporting whether one should use an arterial pulse pressure of 0 mm Hg vs more than 0 (5, 10, 20, 40) mm Hg to confirm permanent cessation of circulation. SOURCE We conducted this systematic review as part of a larger project to develop a clinical practice guideline for death determination by circulatory or neurologic criteria. We systematically searched Ovid MEDLINE, Ovid Embase, Cochrane Central Register of Controlled Trials (CENTRAL) via the Cochrane Library, and Web of Science for articles published from inception until August 2021. We included all types of peer-reviewed original research publications related to arterial pulse pressure as monitored by an indwelling arterial pressure transducer around circulatory arrest or determination of death with either direct context-specific (organ donation) or indirect (outside of organ donation context) data. PRINCIPAL FINDINGS A total of 3,289 abstracts were identified and screened for eligibility. Fourteen studies were included; three from personal libraries. Five studies were of sufficient quality for inclusion in the evidence profile for the clinical practice guideline. One study measured cessation of cortical scalp electroencephalogram (EEG) activity after withdrawal of life-sustaining measures and showed that EEG activity fell below 2 μV when the pulse pressure reached 8 mm Hg. This indirect evidence suggests there is a possibility of persistent cerebral activity at arterial pulse pressures > 5 mm Hg. CONCLUSION Indirect evidence suggests that clinicians may incorrectly diagnose death by circulatory criteria if they apply any arterial pulse pressure threshold of greater than 5 mm Hg. Moreover, there is insufficient evidence to determine that any pulse pressure threshold greater than 0 and less than 5 can safely determine circulatory death. STUDY REGISTRATION PROSPERO (CRD42021275763); first submitted 28 August 2021.
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Affiliation(s)
- Saptharishi Lalgudi Ganesan
- Department of Paediatrics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.
- Paediatric Critical Care Medicine, Children's Hospital - London Health Sciences Center, London, ON, Canada.
| | | | - Matthew Weiss
- Transplant Québec, Montreal, QC, Canada
- CHU de Québec, Université Laval Research Centre, Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Université Laval, Quebec City, QC, Canada
| | - Kirk Dawe
- Discipline of Medicine, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
- Critical Care Program, Eastern Health, St. John's, NL, Canada
| | - Chelsea Lanos
- County of Renfrew Paramedic Service, Pembroke, ON, Canada
| | - Krista Wollny
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | - Sonny Dhanani
- Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Teneille Gofton
- Department of Clinical Neurological Sciences, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
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Proteomics Reveals Long-Term Alterations in Signaling and Metabolic Pathways Following Both Myocardial Infarction and Chemically Induced Denervation. Neurochem Res 2022; 47:2416-2430. [PMID: 35716295 DOI: 10.1007/s11064-022-03636-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 05/11/2022] [Accepted: 05/12/2022] [Indexed: 10/18/2022]
Abstract
Myocardial infraction (MI) is the principal risk factor for the onset of heart failure (HF). Investigations regarding the physiopathology of MI progression to HF have revealed the concerted engagement of other tissues, such as the autonomic nervous system and the medulla oblongata (MO), giving rise to systemic effects, important in the regulation of heart function. Cardiac sympathetic afferent denervation following application of resiniferatoxin (RTX) attenuates cardiac remodelling and restores cardiac function following MI. While the physiological responses are well documented in numerous species, the underlying molecular responses during the initiation and progression from MI to HF remains unclear. We obtained multi-tissue time course proteomics with a murine model of HF induced by MI in conjunction with RTX application. We isolated tissue sections from the left ventricle (LV), MO, cervical spinal cord and cervical vagal nerves at four time points over a 12-week study. Bioinformatic analyses consistently revealed a high statistical enrichment for metabolic pathways in all tissues and treatments, implicating a central role of mitochondria in the tissue-cellular response to both MI and RTX. In fact, the additional functional pathways found to be enriched in these tissues, involving the cytoskeleton, vesicles and signal transduction, could be downstream of responses initiated by mitochondria due to changes in neuronal pulse frequency after a shock such as MI or the modification of such frequency communication from the heart to the brain after RTX application. Development of future experiments, based on our proteomic results, should enable the dissection of more precise mechanisms whereby metabolic changes in neuronal and cardiac tissues can effectively ameliorate the negative physiological effects of MI via RTX application.
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Affiliation(s)
- George A. Mashour
- From the Departments of Anesthesiology and Pharmacology, Center for Consciousness Science, Michigan Neuroscience Institute, Neuroscience Graduate Program, University of Michigan, Ann Arbor, Michigan
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Vicente R, Rizzuto M, Sarica C, Yamamoto K, Sadr M, Khajuria T, Fatehi M, Moien-Afshari F, Haw CS, Llinas RR, Lozano AM, Neimat JS, Zemmar A. Enhanced Interplay of Neuronal Coherence and Coupling in the Dying Human Brain. Front Aging Neurosci 2022; 14:813531. [PMID: 35273490 PMCID: PMC8902637 DOI: 10.3389/fnagi.2022.813531] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/19/2022] [Indexed: 11/13/2022] Open
Abstract
The neurophysiological footprint of brain activity after cardiac arrest and during near-death experience (NDE) is not well understood. Although a hypoactive state of brain activity has been assumed, experimental animal studies have shown increased activity after cardiac arrest, particularly in the gamma-band, resulting from hypercapnia prior to and cessation of cerebral blood flow after cardiac arrest. No study has yet investigated this matter in humans. Here, we present continuous electroencephalography (EEG) recording from a dying human brain, obtained from an 87-year-old patient undergoing cardiac arrest after traumatic subdural hematoma. An increase of absolute power in gamma activity in the narrow and broad bands and a decrease in theta power is seen after suppression of bilateral hemispheric responses. After cardiac arrest, delta, beta, alpha and gamma power were decreased but a higher percentage of relative gamma power was observed when compared to the interictal interval. Cross-frequency coupling revealed modulation of left-hemispheric gamma activity by alpha and theta rhythms across all windows, even after cessation of cerebral blood flow. The strongest coupling is observed for narrow- and broad-band gamma activity by the alpha waves during left-sided suppression and after cardiac arrest. Albeit the influence of neuronal injury and swelling, our data provide the first evidence from the dying human brain in a non-experimental, real-life acute care clinical setting and advocate that the human brain may possess the capability to generate coordinated activity during the near-death period.
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Affiliation(s)
- Raul Vicente
- Department of Neurosurgery, Henan Provincial People’s Hospital, Henan University People’s Hospital, Henan University School of Medicine, Zhengzhou, China
- Institute of Computer Science, University of Tartu, Tartu, Estonia
| | - Michael Rizzuto
- Division of Neurosurgery, Department of Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Can Sarica
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Kazuaki Yamamoto
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Mohammed Sadr
- Division of Neurosurgery, Department of Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Tarun Khajuria
- Institute of Computer Science, University of Tartu, Tartu, Estonia
| | - Mostafa Fatehi
- Division of Neurosurgery, Department of Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Farzad Moien-Afshari
- Epilepsy Program, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Charles S. Haw
- Division of Neurosurgery, Department of Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Rodolfo R. Llinas
- Department of Neuroscience and Physiology, New York University Grossman School of Medicine, New York, NY, United States
| | - Andres M. Lozano
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Joseph S. Neimat
- Department of Neurosurgery, School of Medicine, University of Louisville, Louisville, KY, United States
| | - Ajmal Zemmar
- Department of Neurosurgery, Henan Provincial People’s Hospital, Henan University People’s Hospital, Henan University School of Medicine, Zhengzhou, China
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
- Department of Neurosurgery, School of Medicine, University of Louisville, Louisville, KY, United States
- *Correspondence: Ajmal Zemmar,
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Administration of N,N-dimethyltryptamine (DMT) in psychedelic therapeutics and research and the study of endogenous DMT. Psychopharmacology (Berl) 2022; 239:1749-1763. [PMID: 35064294 PMCID: PMC8782705 DOI: 10.1007/s00213-022-06065-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 01/11/2022] [Indexed: 12/20/2022]
Abstract
As with all drugs, the route, form, and/or dose of a substance administered or applied can play a defining role in its overall pharmacology and use as a therapeutic. This review will focus on these factors as they relate to the psychedelic N,N-dimethyltryptamine (DMT). It will examine the positive and negative aspects of different formulations and routes of administration of DMT and the observed effects from such administrations in the form of ayahuasca teas; oral "pharmahuasca"; injections by intravenous (IV) and intramuscular (IM) routes; inhalation, insufflation; and other routes; and high-dose, low-dose, and "micro-dose" effects. The review will consider possible oral route of administration alternatives that would not require concomitant use of a monoamine oxidase inhibitor. The review will then address the current research findings for DMT from in vivo and in vitro studies as well as the possibility that these findings may be revealing the role of endogenous DMT in normal brain function.
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Kermorgant M, Ben Salem J, Iacovoni JS, Calise D, Dahan L, Guiard BP, Lopez S, Lairez O, Lasbories A, Nasr N, Pavy Le‐Traon A, Beaudry F, Senard J, Arvanitis DN. Cardiac sensory afferents modulate susceptibility to anxio-depressive behaviour in a mouse model of chronic heart failure. Acta Physiol (Oxf) 2021; 231:e13601. [PMID: 33316126 DOI: 10.1111/apha.13601] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 11/23/2020] [Accepted: 12/09/2020] [Indexed: 12/20/2022]
Abstract
AIM Impairments in cerebral structure and cognitive performance in chronic heart failure (CHF) are critical components of its comorbidity spectrum. Autonomic afferents that arise from cardiac sensory fibres show enhanced activity with CHF. Desensitization of these fibres by local application of resiniferatoxin (RTX) during myocardial infarction (MI) is known to prevent cardiac hypertrophy, sympathetic hyperactivity and CHF. Whether these afferents mediate cerebral allostasis is unknown. METHODS CHF was induced by myocardial infarction. To evaluate if cardiac afferents contribute to cerebral allostasis, RTX was acutely applied to the pericardial space in controls (RTX) and in MI treated animals (MI/RTX). Subjects were then evaluated in a series of behavioural tests recapitulating different symptoms of depressive disorders. Proteomics of the frontal cortices (FC) was performed to identify contributing proteins and pathways responsible for behavioural allostasis. RESULTS Desensitization of cardiac afferents relieves hallmarks of an anxio/depressive-like state in mice. Unique protein signatures and regulatory pathways in FCs isolated from each treatment reveal the degree of complexity inherent in the FC response to stresses originating in the heart. While cortices from the combined treatment (MI/RTX) did not retain protein signatures from the individual treatment groups, all three groups suffer dysregulation in circadian entrainment. CONCLUSION CHF is comorbid with an anxio/depressive-like state and ablation of cardiac afferents relieves the despair phenotype. The strikingly different proteomic profiles observed in FCs suggest that MI and RTX lead to unique brain-signalling patterns and that the combined treatment, potentially through destructive interference mechanisms, most closely resembles controls.
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Affiliation(s)
- Marc Kermorgant
- INSERM DR Midi‐Pyrénées LimousinInstitut des Maladies Métaboliques et Cardiovasculaires (I2MC) UMR1048Université de Toulouse III Toulouse France
| | - Jennifer Ben Salem
- INSERM DR Midi‐Pyrénées LimousinInstitut des Maladies Métaboliques et Cardiovasculaires (I2MC) UMR1048Université de Toulouse III Toulouse France
- Groupe de Recherche en Pharmacologie Animale du Québec (GREPAQ) Département de Biomédecine Vétérinaire Faculté de Médecine Vétérinaire Université de Montréal Saint Hyacinthe QC Canada
- Centre de recherche sur le cerveau et l’apprentissage (CIRCA) Université de Montréal Montréal QC Canada
| | - Jason S. Iacovoni
- INSERM DR Midi‐Pyrénées LimousinInstitut des Maladies Métaboliques et Cardiovasculaires (I2MC) UMR1048Université de Toulouse III Toulouse France
| | - Denis Calise
- INSERM DR Midi‐Pyrénées LimousinCentre Régional d’Exploration Fonctionnelle et Ressources Expérimentales Service Microchirurgie, (CREFRE‐US06, Rangueil) Toulouse France
| | - Lionel Dahan
- Centre de Recherches sur la Cognition Animale Centre de Biologie Intégrative Université de Toulouse Toulouse France
- CNRSUniversité de Toulouse III Toulouse France
| | - Bruno P. Guiard
- Centre de Recherches sur la Cognition Animale Centre de Biologie Intégrative Université de Toulouse Toulouse France
- CNRSUniversité de Toulouse III Toulouse France
| | - Sébastien Lopez
- Centre de Recherches sur la Cognition Animale Centre de Biologie Intégrative Université de Toulouse Toulouse France
- CNRSUniversité de Toulouse III Toulouse France
| | - Olivier Lairez
- INSERM DR Midi‐Pyrénées LimousinInstitut des Maladies Métaboliques et Cardiovasculaires (I2MC) UMR1048Université de Toulouse III Toulouse France
- Fédération des services de cardiologie Hôpital RangueilUniversité de Toulouse III Toulouse France
| | - Antoine Lasbories
- INSERM DR Midi‐Pyrénées LimousinInstitut des Maladies Métaboliques et Cardiovasculaires (I2MC) UMR1048Université de Toulouse III Toulouse France
| | - Nathalie Nasr
- INSERM DR Midi‐Pyrénées LimousinInstitut des Maladies Métaboliques et Cardiovasculaires (I2MC) UMR1048Université de Toulouse III Toulouse France
- Département de Neurologie et Institut des Neurosciences CHU de ToulouseUniversité de Toulouse III Toulouse France
| | - Anne Pavy Le‐Traon
- INSERM DR Midi‐Pyrénées LimousinInstitut des Maladies Métaboliques et Cardiovasculaires (I2MC) UMR1048Université de Toulouse III Toulouse France
- Département de Neurologie et Institut des Neurosciences CHU de ToulouseUniversité de Toulouse III Toulouse France
| | - Francis Beaudry
- Groupe de Recherche en Pharmacologie Animale du Québec (GREPAQ) Département de Biomédecine Vétérinaire Faculté de Médecine Vétérinaire Université de Montréal Saint Hyacinthe QC Canada
- Centre de recherche sur le cerveau et l’apprentissage (CIRCA) Université de Montréal Montréal QC Canada
| | - Jean‐Michel Senard
- INSERM DR Midi‐Pyrénées LimousinInstitut des Maladies Métaboliques et Cardiovasculaires (I2MC) UMR1048Université de Toulouse III Toulouse France
- Département de Neurologie et Institut des Neurosciences CHU de ToulouseUniversité de Toulouse III Toulouse France
- Service de Pharmacologie Clinique CHU de ToulouseUniversité de Toulouse III Toulouse France
| | - Dina N Arvanitis
- INSERM DR Midi‐Pyrénées LimousinInstitut des Maladies Métaboliques et Cardiovasculaires (I2MC) UMR1048Université de Toulouse III Toulouse France
- CNRSUniversité de Toulouse III Toulouse France
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Abstract
This paper introduces a new construct, the 'pivotal mental state', which is defined as a hyper-plastic state aiding rapid and deep learning that can mediate psychological transformation. We believe this new construct bears relevance to a broad range of psychological and psychiatric phenomena. We argue that pivotal mental states serve an important evolutionary function, that is, to aid psychological transformation when actual or perceived environmental pressures demand this. We cite evidence that chronic stress and neurotic traits are primers for a pivotal mental state, whereas acute stress can be a trigger. Inspired by research with serotonin 2A receptor agonist psychedelics, we highlight how activity at this particular receptor can robustly and reliably induce pivotal mental states, but we argue that the capacity for pivotal mental states is an inherent property of the human brain itself. Moreover, we hypothesize that serotonergic psychedelics hijack a system that has evolved to mediate rapid and deep learning when its need is sensed. We cite a breadth of evidences linking stress via a variety of inducers, with an upregulated serotonin 2A receptor system (e.g. upregulated availability of and/or binding to the receptor) and acute stress with 5-HT release, which we argue can activate this primed system to induce a pivotal mental state. The pivotal mental state model is multi-level, linking a specific molecular gateway (increased serotonin 2A receptor signaling) with the inception of a hyper-plastic brain and mind state, enhanced rate of associative learning and the potential mediation of a psychological transformation.
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Affiliation(s)
- Ari Brouwer
- Centre for Psychedelic Research, Imperial College London, London, United Kingdom
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Ahn JH, Lee TK, Tae HJ, Kim B, Sim H, Lee JC, Kim DW, Kim YS, Shin MC, Park Y, Cho JH, Park JH, Lee CH, Choi SY, Won MH. Neuronal Death in the CNS Autonomic Control Center Comes Very Early after Cardiac Arrest and Is Not Significantly Attenuated by Prompt Hypothermic Treatment in Rats. Cells 2021; 10:E60. [PMID: 33401719 PMCID: PMC7824613 DOI: 10.3390/cells10010060] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/28/2020] [Accepted: 12/29/2020] [Indexed: 12/19/2022] Open
Abstract
Autonomic dysfunction in the central nervous system (CNS) can cause death after recovery from a cardiac arrest (CA). However, few studies on histopathological changes in animal models of CA have been reported. In this study, we investigated the prevalence of neuronal death and damage in various brain regions and the spinal cord at early times after asphyxial CA and we studied the relationship between the mortality rate and neuronal damage following hypothermic treatment after CA. Rats were subjected to 7-8 min of asphyxial CA, followed by resuscitation and prompt hypothermic treatment. Eight regions related to autonomic control (the cingulate cortex, hippocampus, thalamus, hypothalamus, myelencephalon, and spinal cord) were examined using cresyl violet (a marker for Nissl substance) and Fluoro-Jade B (a marker for neuronal death). The survival rate was 44.5% 1 day post-CA, 18.2% 2 days post-CA and 0% 5 days post-CA. Neuronal death started 12 h post-CA in the gigantocellular reticular nucleus and caudoventrolateral reticular nucleus in the myelencephalon and lamina VII in the cervical, thoracic, lumbar, and sacral spinal cord, of which neurons are related to autonomic lower motor neurons. In these regions, Iba-1 immunoreactivity indicating microglial activation (microgliosis) was gradually increased with time after CA. Prompt hypothermic treatment increased the survival rate at 5 days after CA with an attenuation of neuronal damages and death in the damaged regions. However, the survival rate was 0% at 12 days after CA. Taken together, our study suggests that the early damage and death of neurons related to autonomic lower motor neurons was significantly related to the high mortality rate after CA and that prompt hypothermic therapy could increase the survival rate temporarily after CA, but could not ultimately save the animal.
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Affiliation(s)
- Ji Hyeon Ahn
- Department of Physical Therapy, College of Health Science, Youngsan University, Yangsan 50510, Korea;
- Department of Neurobiology, School of Medicine, Kangwon National University, Chuncheon 24341, Korea; (B.K.); (H.S.); (J.-C.L.)
| | - Tae-Kyeong Lee
- Department of Biomedical Science and Research Institute for Bioscience and Biotechnology, Hallym University, Chuncheon 24252, Korea;
| | - Hyun-Jin Tae
- Bio-Safety Research Institute, College of Veterinary Medicine, Chonbuk National University, Iksan 54596, Korea;
| | - Bora Kim
- Department of Neurobiology, School of Medicine, Kangwon National University, Chuncheon 24341, Korea; (B.K.); (H.S.); (J.-C.L.)
| | - Hyejin Sim
- Department of Neurobiology, School of Medicine, Kangwon National University, Chuncheon 24341, Korea; (B.K.); (H.S.); (J.-C.L.)
| | - Jae-Chul Lee
- Department of Neurobiology, School of Medicine, Kangwon National University, Chuncheon 24341, Korea; (B.K.); (H.S.); (J.-C.L.)
| | - Dae Won Kim
- Department of Biochemistry and Molecular Biology, and Research Institute of Oral Sciences, College of Dentistry, Gangnung-Wonju National University, Gangneung 25457, Korea;
| | - Yoon Sung Kim
- Department of Emergency Medicine, Samcheok Medical Center, Samcheok 25920, Korea;
| | - Myoung Cheol Shin
- Department of Emergency Medicine, School of Medicine, Kangwon National University, Chuncheon 24341, Korea; (M.C.S.); (Y.P.); (J.H.C.)
| | - Yoonsoo Park
- Department of Emergency Medicine, School of Medicine, Kangwon National University, Chuncheon 24341, Korea; (M.C.S.); (Y.P.); (J.H.C.)
| | - Jun Hwi Cho
- Department of Emergency Medicine, School of Medicine, Kangwon National University, Chuncheon 24341, Korea; (M.C.S.); (Y.P.); (J.H.C.)
| | - Joon Ha Park
- Department of Anatomy, College of Korean Medicine, Dongguk University, Gyeongju 38066, Korea;
| | - Choong-Hyun Lee
- Department of Pharmacy, College of Pharmacy, Dankook University, Cheonan 31116, Korea;
| | - Soo Young Choi
- Department of Biomedical Science and Research Institute for Bioscience and Biotechnology, Hallym University, Chuncheon 24252, Korea;
| | - Moo-Ho Won
- Department of Neurobiology, School of Medicine, Kangwon National University, Chuncheon 24341, Korea; (B.K.); (H.S.); (J.-C.L.)
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Serotonin depletion impairs both Pavlovian and instrumental reversal learning in healthy humans. Mol Psychiatry 2021; 26:7200-7210. [PMID: 34429517 PMCID: PMC8873011 DOI: 10.1038/s41380-021-01240-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/03/2021] [Accepted: 07/09/2021] [Indexed: 02/07/2023]
Abstract
Serotonin is involved in updating responses to changing environmental circumstances. Optimising behaviour to maximise reward and minimise punishment may require shifting strategies upon encountering new situations. Likewise, autonomic responses to threats are critical for survival yet must be modified as danger shifts from one source to another. Whilst numerous psychiatric disorders are characterised by behavioural and autonomic inflexibility, few studies have examined the contribution of serotonin in humans. We modelled both processes, respectively, in two independent experiments (N = 97). Experiment 1 assessed instrumental (stimulus-response-outcome) reversal learning whereby individuals learned through trial and error which action was most optimal for obtaining reward or avoiding punishment initially, and the contingencies subsequently reversed serially. Experiment 2 examined Pavlovian (stimulus-outcome) reversal learning assessed by the skin conductance response: one innately threatening stimulus predicted receipt of an uncomfortable electric shock and another did not; these contingencies swapped in a reversal phase. Upon depleting the serotonin precursor tryptophan-in a double-blind randomised placebo-controlled design-healthy volunteers showed impairments in updating both actions and autonomic responses to reflect changing contingencies. Reversal deficits in each domain, furthermore, were correlated with the extent of tryptophan depletion. Initial Pavlovian conditioning, moreover, which involved innately threatening stimuli, was potentiated by depletion. These results translate findings in experimental animals to humans and have implications for the neurochemical basis of cognitive inflexibility.
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Heartbeat-evoked cortical responses: Underlying mechanisms, functional roles, and methodological considerations. Neuroimage 2019; 197:502-511. [DOI: 10.1016/j.neuroimage.2019.04.081] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 04/29/2019] [Accepted: 04/30/2019] [Indexed: 11/24/2022] Open
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Dean JG, Liu T, Huff S, Sheler B, Barker SA, Strassman RJ, Wang MM, Borjigin J. Biosynthesis and Extracellular Concentrations of N,N-dimethyltryptamine (DMT) in Mammalian Brain. Sci Rep 2019; 9:9333. [PMID: 31249368 PMCID: PMC6597727 DOI: 10.1038/s41598-019-45812-w] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 06/10/2019] [Indexed: 02/07/2023] Open
Abstract
N,N-dimethyltryptamine (DMT), a psychedelic compound identified endogenously in mammals, is biosynthesized by aromatic-L-amino acid decarboxylase (AADC) and indolethylamine-N-methyltransferase (INMT). Whether DMT is biosynthesized in the mammalian brain is unknown. We investigated brain expression of INMT transcript in rats and humans, co-expression of INMT and AADC mRNA in rat brain and periphery, and brain concentrations of DMT in rats. INMT transcripts were identified in the cerebral cortex, pineal gland, and choroid plexus of both rats and humans via in situ hybridization. Notably, INMT mRNA was colocalized with AADC transcript in rat brain tissues, in contrast to rat peripheral tissues where there existed little overlapping expression of INMT with AADC transcripts. Additionally, extracellular concentrations of DMT in the cerebral cortex of normal behaving rats, with or without the pineal gland, were similar to those of canonical monoamine neurotransmitters including serotonin. A significant increase of DMT levels in the rat visual cortex was observed following induction of experimental cardiac arrest, a finding independent of an intact pineal gland. These results show for the first time that the rat brain is capable of synthesizing and releasing DMT at concentrations comparable to known monoamine neurotransmitters and raise the possibility that this phenomenon may occur similarly in human brains.
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Affiliation(s)
- Jon G Dean
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, USA.,Center for Consciousness Science, University of Michigan, Ann Arbor, MI, USA
| | - Tiecheng Liu
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, USA
| | - Sean Huff
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, USA
| | - Ben Sheler
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, USA
| | - Steven A Barker
- Department of Comparative Biomedical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, USA
| | - Rick J Strassman
- Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Michael M Wang
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, USA.,Department of Neurology, University of Michigan, Ann Arbor, MI, USA.,Neuroscience Graduate Program, University of Michigan, Ann Arbor, MI, USA.,VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Jimo Borjigin
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, USA. .,Department of Neurology, University of Michigan, Ann Arbor, MI, USA. .,Neuroscience Graduate Program, University of Michigan, Ann Arbor, MI, USA. .,Center for Consciousness Science, University of Michigan, Ann Arbor, MI, USA.
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13
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Paradoxical lucidity: A potential paradigm shift for the neurobiology and treatment of severe dementias. Alzheimers Dement 2019; 15:1107-1114. [DOI: 10.1016/j.jalz.2019.04.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 03/26/2019] [Accepted: 04/03/2019] [Indexed: 01/17/2023]
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14
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Brown DL, Xu G, Belinky Krzyske AM, Buhay NC, Blaha M, Wang MM, Farrehi P, Borjigin J. Electrocardiomatrix Facilitates Accurate Detection of Atrial Fibrillation in Stroke Patients. Stroke 2019; 50:1676-1681. [PMID: 31177972 DOI: 10.1161/strokeaha.119.025361] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background and Purpose- Cardiac telemetry is a routine part of inpatient ischemic stroke/transient ischemic attack evaluation to assess for atrial fibrillation (AF). Yet, tools to assist stroke clinicians in the evaluation of the large quantities of telemetry data are limited. The investigators developed a new method to evaluate electrocardiographic signals, electrocardiomatrix, that was applied to stroke unit telemetry data to determine its feasibility, validity, and usefulness. Electrocardiomatrix displays telemetry data in a 3-dimensional matrix that allows for more accurate and less time consuming P-wave analysis. Methods- In this single-center, prospective, observational study conducted in a stroke unit, all telemetry data from ischemic stroke and transient ischemic attack patients were collected (April 2017-January 2018) for examination facilitated by electrocardiomatrix. AF>30 seconds was identified through review of electrocardiomatrix-generated matrices by a nonphysician researcher. Electrocardiomatrix results were compared with the clinical team's medical record documentation of AF identified through telemetry. A study cardiologist reviewed the standard telemetry associated with all AF episodes identified by electrocardiomatrix and each case of disagreement. Results- Telemetry data (median 46 hours [interquartile range: 22-90]) were analyzed among 265 unique subjects (88% ischemic stroke). Electrocardiomatrix was successfully applied in 260 (98%) of cases. The positive predictive value of electrocardiomatrix compared with the clinical documentation was 86% overall and 100% among the subset with no prior history of AF. For the 5 false-positive and 5 false-negative cases, expert overview disagreed with the clinical documentation and confirmed the electrocardiomatrix-based diagnosis. Conclusions- The application of electrocardiomatrix to stroke unit-acquired telemetry data is feasible and appears to have superior accuracy compared with traditional monitor analysis by noncardiologists.
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Affiliation(s)
- Devin L Brown
- From the Departments of Neurology (D.L.B., N.B., M.M.W., J.B.), University of Michigan Medical School, Ann Arbor.,Cardiovascular Center (D.L.B., M.M.W., J.B.), University of Michigan Medical School, Ann Arbor
| | - Gang Xu
- Molecular and Integrative Physiology (G.X., A.M.B.K., M.B., M.M.W., J.B.), University of Michigan Medical School, Ann Arbor
| | - Alexandra Mary Belinky Krzyske
- Molecular and Integrative Physiology (G.X., A.M.B.K., M.B., M.M.W., J.B.), University of Michigan Medical School, Ann Arbor
| | - Nicholas C Buhay
- From the Departments of Neurology (D.L.B., N.B., M.M.W., J.B.), University of Michigan Medical School, Ann Arbor
| | - Madeline Blaha
- Molecular and Integrative Physiology (G.X., A.M.B.K., M.B., M.M.W., J.B.), University of Michigan Medical School, Ann Arbor
| | - Michael M Wang
- From the Departments of Neurology (D.L.B., N.B., M.M.W., J.B.), University of Michigan Medical School, Ann Arbor.,Molecular and Integrative Physiology (G.X., A.M.B.K., M.B., M.M.W., J.B.), University of Michigan Medical School, Ann Arbor.,Cardiovascular Center (D.L.B., M.M.W., J.B.), University of Michigan Medical School, Ann Arbor.,the VA Ann Arbor Healthcare System, MI (M.M.W.)
| | - Peter Farrehi
- Internal Medicine-Cardiology (P.F.), University of Michigan Medical School, Ann Arbor
| | - Jimo Borjigin
- From the Departments of Neurology (D.L.B., N.B., M.M.W., J.B.), University of Michigan Medical School, Ann Arbor.,Molecular and Integrative Physiology (G.X., A.M.B.K., M.B., M.M.W., J.B.), University of Michigan Medical School, Ann Arbor.,Cardiovascular Center (D.L.B., M.M.W., J.B.), University of Michigan Medical School, Ann Arbor
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15
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Lake J. The near-death experience (NDE) as an inherited predisposition: Possible genetic, epigenetic, neural and symbolic mechanisms. Med Hypotheses 2019; 126:135-148. [PMID: 31010490 DOI: 10.1016/j.mehy.2019.03.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 02/24/2019] [Accepted: 03/21/2019] [Indexed: 12/21/2022]
Affiliation(s)
- James Lake
- Center for Integrative Medicine, University of Arizona College of Medicine, Tucson, AZ, United States.
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16
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Martínez-Aguilar GM, Gutiérrez D. Using cortico-muscular and cortico-cardiac coherence to study the role of the brain in the development of muscular fatigue. Biomed Signal Process Control 2019. [DOI: 10.1016/j.bspc.2018.10.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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17
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Tian F, Liu T, Xu G, Ghazi T, Sajjad A, Farrehi P, Wang MM, Borjigin J. Surge of corticocardiac coupling in SHRSP rats exposed to forebrain cerebral ischemia. J Neurophysiol 2019; 121:842-852. [PMID: 30625009 DOI: 10.1152/jn.00533.2018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Sudden death is an important but underrecognized consequence of stroke. Acute stroke can disturb central control of autonomic function and result in cardiac dysfunction and sudden death. Previous study showed that bilateral common carotid artery ligation (BCCAL) in the spontaneously hypertensive stroke-prone rat strain (SHRSP) is a well-established model for forebrain ischemic sudden death. This study aims to investigate the temporal dynamic changes in electrical activities of the brain and heart and functional interactions between the two vital organs following forebrain ischemia. EEG and ECG signals were simultaneously collected from nine SHRSP and eight Wistar-Kyoto (WKY) rats. RR interval was analyzed to investigate the cardiac response to brain ischemia. EEG power and coherence (CCoh) analysis were conducted to study the cortical response. Corticocardiac coherence (CCCoh) and directional connectivity (CCCon) were analyzed to determine brain-heart connection. Heart rate variability (HRV) was analyzed to evaluate autonomic functionality. BCCAL resulted in 100% mortality in SHRSP within 14 h, whereas no mortality was observed in WKY rats. The functionality of both the brain and the heart were significantly altered in SHRSP compared with WKY rats after BCCAL. SHRSP, but not WKY rats, exhibited intermittent surge of CCCoh, which paralleled the elevated CCCon and reduced HRV, following the onset of ischemia until sudden death. Elevated brain-heart coupling invariably associated with the disruption of the autonomic nervous system and the risk of sudden death. This study may improve our understanding of the mechanism of forebrain ischemia-induced sudden death. NEW & NOTEWORTHY This study demonstrates a marked surge of corticocardiac coupling in rats dying from focal cerebral ischemia, consistent with our earlier data in rats exposed to fatal asphyxia. Since the bidirectional electrical signal coupling (corticocardiac coherence) and communication (corticocardiac connectivity) between the brain and the heart are only identified in dying animals, they could be used as potential biomarkers to predict the risk of sudden death.
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Affiliation(s)
- Fangyun Tian
- Department of Molecular and Integrative Physiology, University of Michigan , Ann Arbor, Michigan
| | - Tiecheng Liu
- Department of Molecular and Integrative Physiology, University of Michigan , Ann Arbor, Michigan
| | - Gang Xu
- Department of Molecular and Integrative Physiology, University of Michigan , Ann Arbor, Michigan
| | - Talha Ghazi
- Department of Molecular and Integrative Physiology, University of Michigan , Ann Arbor, Michigan
| | - Azeem Sajjad
- Department of Molecular and Integrative Physiology, University of Michigan , Ann Arbor, Michigan
| | - Peter Farrehi
- Cardiovascular Center, University of Michigan , Ann Arbor, Michigan.,Department of Internal Medicine-Cardiology, University of Michigan , Ann Arbor, Michigan
| | - Michael M Wang
- Department of Molecular and Integrative Physiology, University of Michigan , Ann Arbor, Michigan.,Department of Neurology, University of Michigan , Ann Arbor, Michigan.,Neuroscience Graduate Program, University of Michigan , Ann Arbor, Michigan.,Cardiovascular Center, University of Michigan , Ann Arbor, Michigan.,Veterans Administration Ann Arbor Healthcare System , Ann Arbor, Michigan
| | - Jimo Borjigin
- Department of Molecular and Integrative Physiology, University of Michigan , Ann Arbor, Michigan.,Department of Neurology, University of Michigan , Ann Arbor, Michigan.,Neuroscience Graduate Program, University of Michigan , Ann Arbor, Michigan.,Cardiovascular Center, University of Michigan , Ann Arbor, Michigan.,Michigan Center for Integrative Research in Critical Care, University of Michigan , Ann Arbor, Michigan
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18
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Tian F, Liu T, Xu G, Li D, Ghazi T, Shick T, Sajjad A, Wang MM, Farrehi P, Borjigin J. Adrenergic Blockade Bi-directionally and Asymmetrically Alters Functional Brain-Heart Communication and Prolongs Electrical Activities of the Brain and Heart during Asphyxic Cardiac Arrest. Front Physiol 2018; 9:99. [PMID: 29487541 PMCID: PMC5816970 DOI: 10.3389/fphys.2018.00099] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 01/29/2018] [Indexed: 01/12/2023] Open
Abstract
Sudden cardiac arrest is a leading cause of death in the United States. The neurophysiological mechanism underlying sudden death is not well understood. Previously we have shown that the brain is highly stimulated in dying animals and that asphyxia-induced death could be delayed by blocking the intact brain-heart neuronal connection. These studies suggest that the autonomic nervous system plays an important role in mediating sudden cardiac arrest. In this study, we tested the effectiveness of phentolamine and atenolol, individually or combined, in prolonging functionality of the vital organs in CO2-mediated asphyxic cardiac arrest model. Rats received either saline, phentolamine, atenolol, or phentolamine plus atenolol, 30 min before the onset of asphyxia. Electrocardiogram (ECG) and electroencephalogram (EEG) signals were simultaneously collected from each rat during the entire process and investigated for cardiac and brain functions using a battery of analytic tools. We found that adrenergic blockade significantly suppressed the initial decline of cardiac output, prolonged electrical activities of both brain and heart, asymmetrically altered functional connectivity within the brain, and altered, bi-directionally and asymmetrically, functional, and effective connectivity between the brain and heart. The protective effects of adrenergic blockers paralleled the suppression of brain and heart connectivity, especially in the right hemisphere associated with central regulation of sympathetic function. Collectively, our results demonstrate that blockade of brain-heart connection via alpha- and beta-adrenergic blockers significantly prolonged the detectable activities of both the heart and the brain in asphyxic rat. The beneficial effects of combined alpha and beta blockers may help extend the survival of cardiac arrest patients.
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Affiliation(s)
- Fangyun Tian
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, United States
| | - Tiecheng Liu
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, United States
| | - Gang Xu
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, United States
| | - Duan Li
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, United States
| | - Talha Ghazi
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, United States
| | - Trevor Shick
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, United States
| | - Azeem Sajjad
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, United States
| | - Michael M Wang
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, United States.,Department of Neurology, University of Michigan, Ann Arbor, MI, United States.,Neuroscience Graduate Program, University of Michigan, Ann Arbor, MI, United States.,Cardiovascular Center, University of Michigan, Ann Arbor, MI, United States.,Veterans Administration Ann Arbor Healthcare System, Ann Arbor, MI, United States
| | - Peter Farrehi
- Cardiovascular Center, University of Michigan, Ann Arbor, MI, United States.,Department of Internal Medicine-Cardiology, University of Michigan, Ann Arbor, MI, United States
| | - Jimo Borjigin
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, United States.,Department of Neurology, University of Michigan, Ann Arbor, MI, United States.,Neuroscience Graduate Program, University of Michigan, Ann Arbor, MI, United States.,Cardiovascular Center, University of Michigan, Ann Arbor, MI, United States.,Michigan Center for Integrative Research in Critical Care, University of Michigan, Ann Arbor, MI, United States
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19
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Lacuey N, Zonjy B, Hampson JP, Rani MRS, Zaremba A, Sainju RK, Gehlbach BK, Schuele S, Friedman D, Devinsky O, Nei M, Harper RM, Allen L, Diehl B, Millichap JJ, Bateman L, Granner MA, Dragon DN, Richerson GB, Lhatoo SD. The incidence and significance of periictal apnea in epileptic seizures. Epilepsia 2018; 59:573-582. [PMID: 29336036 DOI: 10.1111/epi.14006] [Citation(s) in RCA: 103] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study was to investigate periictal central apnea as a seizure semiological feature, its localizing value, and possible relationship with sudden unexpected death in epilepsy (SUDEP) pathomechanisms. METHODS We prospectively studied polygraphic physiological responses, including inductance plethysmography, peripheral capillary oxygen saturation (SpO2 ), electrocardiography, and video electroencephalography (VEEG) in 473 patients in a multicenter study of SUDEP. Seizures were classified according to the International League Against Epilepsy (ILAE) 2017 seizure classification based on the most prominent clinical signs during VEEG. The putative epileptogenic zone was defined based on clinical history, seizure semiology, neuroimaging, and EEG. RESULTS Complete datasets were available in 126 patients in 312 seizures. Ictal central apnea (ICA) occurred exclusively in focal epilepsy (51/109 patients [47%] and 103/312 seizures [36.5%]) (P < .001). ICA was the only clinical manifestation in 16/103 (16.5%) seizures, and preceded EEG seizure onset by 8 ± 4.9 s, in 56/103 (54.3%) seizures. ICA ≥60 s was associated with severe hypoxemia (SpO2 <75%). Focal onset impaired awareness (FOIA) motor onset with automatisms and FOA nonmotor onset semiologies were associated with ICA presence (P < .001), ICA duration (P = .002), and moderate/severe hypoxemia (P = .04). Temporal lobe epilepsy was highly associated with ICA in comparison to extratemporal epilepsy (P = .001) and frontal lobe epilepsy (P = .001). Isolated postictal central apnea was not seen; in 3/103 seizures (3%), ICA persisted into the postictal period. SIGNIFICANCE ICA is a frequent, self-limiting semiological feature of focal epilepsy, often starting before surface EEG onset, and may be the only clinical manifestation of focal seizures. However, prolonged ICA (≥60 s) is associated with severe hypoxemia and may be a potential SUDEP biomarker. ICA is more frequently seen in temporal than extratemporal seizures, and in typical temporal seizure semiologies. ICA rarely persists after seizure end. ICA agnosia is typical, and thus it may remain unrecognized without polygraphic measurements that include breathing parameters.
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Affiliation(s)
- Nuria Lacuey
- Epilepsy Center, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Bilal Zonjy
- NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA
| | - Johnson P Hampson
- Epilepsy Center, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | | | - Anita Zaremba
- NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA
| | - Rup K Sainju
- NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA.,University of Iowa School of Medicine, Iowa City, IA, USA
| | - Brian K Gehlbach
- NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA.,University of Iowa School of Medicine, Iowa City, IA, USA
| | - Stephan Schuele
- NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA.,Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Daniel Friedman
- NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA.,NYU Langone School of Medicine, New York, NY, USA
| | - Orrin Devinsky
- NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA.,NYU Langone School of Medicine, New York, NY, USA
| | - Maromi Nei
- NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA.,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ronald M Harper
- NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA.,Department of Neurobiology and the Brain Research Institute, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Luke Allen
- NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA.,Institute of Neurology, University College London, London, UK
| | - Beate Diehl
- NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA.,Institute of Neurology, University College London, London, UK
| | - John J Millichap
- NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA.,Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Lisa Bateman
- NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA.,Department of Neurology, Columbia University, New York, NY, USA
| | - Mark A Granner
- NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA
| | | | - George B Richerson
- NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA.,University of Iowa School of Medicine, Iowa City, IA, USA
| | - Samden D Lhatoo
- Epilepsy Center, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA
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20
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Abstract
The pineal gland has a romantic history, from pharaonic Egypt, where it was equated with the eye of Horus, through various religious traditions, where it was considered the seat of the soul, the third eye, etc. Recent incarnations of these notions have suggested that N,N-dimethyltryptamine is secreted by the pineal gland at birth, during dreaming, and at near death to produce out of body experiences. Scientific evidence, however, is not consistent with these ideas. The adult pineal gland weighs less than 0.2 g, and its principal function is to produce about 30 µg per day of melatonin, a hormone that regulates circadian rhythm through very high affinity interactions with melatonin receptors. It is clear that very minute concentrations of N,N-dimethyltryptamine have been detected in the brain, but they are not sufficient to produce psychoactive effects. Alternative explanations are presented to explain how stress and near death can produce altered states of consciousness without invoking the intermediacy of N,N-dimethyltryptamine.
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21
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Abstract
Previous attempts to identify a unified theory of brain serotonin function have largely failed to achieve consensus. In this present synthesis, we integrate previous perspectives with new and older data to create a novel bipartite model centred on the view that serotonin neurotransmission enhances two distinct adaptive responses to adversity, mediated in large part by its two most prevalent and researched brain receptors: the 5-HT1A and 5-HT2A receptors. We propose that passive coping (i.e. tolerating a source of stress) is mediated by postsynaptic 5-HT1AR signalling and characterised by stress moderation. Conversely, we argue that active coping (i.e. actively addressing a source of stress) is mediated by 5-HT2AR signalling and characterised by enhanced plasticity (defined as capacity for change). We propose that 5-HT1AR-mediated stress moderation may be the brain's default response to adversity but that an improved ability to change one's situation and/or relationship to it via 5-HT2AR-mediated plasticity may also be important - and increasingly so as the level of adversity reaches a critical point. We propose that the 5-HT1AR pathway is enhanced by conventional 5-HT reuptake blocking antidepressants such as the selective serotonin reuptake inhibitors (SSRIs), whereas the 5-HT2AR pathway is enhanced by 5-HT2AR-agonist psychedelics. This bipartite model purports to explain how different drugs (SSRIs and psychedelics) that modulate the serotonergic system in different ways, can achieve complementary adaptive and potentially therapeutic outcomes.
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Affiliation(s)
- RL Carhart-Harris
- Psychedelic Research Group, Neuropsychopharmacology Unit, Centre for Psychiatry, Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK
| | - DJ Nutt
- Psychedelic Research Group, Neuropsychopharmacology Unit, Centre for Psychiatry, Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK
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22
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Chawla LS, Terek M, Junker C, Akst S, Yoon B, Brasha-Mitchell E, Seneff MG. Characterization of end-of-life electroencephalographic surges in critically ill patients. DEATH STUDIES 2017; 41:385-392. [PMID: 28145850 DOI: 10.1080/07481187.2017.1287138] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Neuromonitoring devices to assess level of sedation are now used commonly in many hospital settings. The authors previously reported that electroencephalicgraphic (EEG) spikes frequently occurred after the time of death in patients being neuromonitored at the time of cessation of circulation. In addition to the initial report, end-of-life electrical surges (ELES) have been subsequently documented in animal and human studies by other investigators. The frequency, character, intensity, and significance of ELES are unknown. Some have proposed that patients should not be declared dead for purposes of organ donation prior to the occurrence of an ELES. If clinical practice were altered to await the presence of an ELES, there could be detrimental consequences to donated organs and their recipients. To better characterize ELES, the authors retrospectively assessed the frequency and nature of ELES in serial patients. To better document ELES, they collected neuromonitoring, demographic, and clinical data on consecutive patients who expired while being actively monitored as part of their standard palliative care. These data were retrospectively collected when available as a convenience sample. The authors assessed 35 patients of which 7 were clinically confirmed as brain dead. None of the brain-dead patients displayed an ELES. Thirteen of the 28 remaining patients (46.4%) exhibited an ELES. The ELES observed were demonstrated to have high frequency EEG signal. The mean peak amplitude of ELES as measured by Patient State IndexTM (PSI) was 58.5 ± 25.7. In this preliminary assessment, the authors found that ELES are common in critically ill patients who succumb. The exact cause and significance of ELES remain unknown; further study is warranted.
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Affiliation(s)
- Lakhmir S Chawla
- a Department of Medicine, Division of Intensive Care Medicine , Veterans Affairs Medical Center , Washington , DC , USA
- b Department of Medicine, Division of Nephrology , Veterans Affairs Medical Center , Washington , DC , USA
- c Department of Anesthesiology and Critical Care Medicine , George Washington University Medical Center , Washington , DC , USA
| | - Megan Terek
- c Department of Anesthesiology and Critical Care Medicine , George Washington University Medical Center , Washington , DC , USA
| | - Christopher Junker
- c Department of Anesthesiology and Critical Care Medicine , George Washington University Medical Center , Washington , DC , USA
| | - Seth Akst
- c Department of Anesthesiology and Critical Care Medicine , George Washington University Medical Center , Washington , DC , USA
| | - Bona Yoon
- a Department of Medicine, Division of Intensive Care Medicine , Veterans Affairs Medical Center , Washington , DC , USA
| | - Ermira Brasha-Mitchell
- c Department of Anesthesiology and Critical Care Medicine , George Washington University Medical Center , Washington , DC , USA
| | - Michael G Seneff
- c Department of Anesthesiology and Critical Care Medicine , George Washington University Medical Center , Washington , DC , USA
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23
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Lee DE, Lee LG, Siu D, Bazrafkan AK, Farahabadi MH, Dinh TJ, Orellana J, Xiong W, Lopour BA, Akbari Y. Neural Correlates of Consciousness at Near-Electrocerebral Silence in an Asphyxial Cardiac Arrest Model. Brain Connect 2017; 7:172-181. [PMID: 28398813 PMCID: PMC5399737 DOI: 10.1089/brain.2016.0471] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Recent electrophysiological studies have suggested surges in electrical correlates of consciousness (i.e., elevated gamma power and connectivity) after cardiac arrest (CA). This study examines electrocorticogram (ECoG) activity and coherence of the dying brain during asphyxial CA. Male Wistar rats (n = 16) were induced with isoflurane anesthesia, which was washed out before asphyxial CA. Mean phase coherence and ECoG power were compared during different stages of the asphyxial period to assess potential neural correlates of consciousness. After asphyxia, the ECoG progressed through four distinct stages (asphyxial stages 1-4 [AS1-4]), including a transient period of near-electrocerebral silence lasting several seconds (AS3). Electrocerebral silence (AS4) occurred within 1 min of the start of asphyxia, and pulseless electrical activity followed the start of AS4 by 1-2 min. AS3 was linked to a significant increase in frontal coherence between the left and right motor cortices (p < 0.05), with no corresponding increase in ECoG power. AS3 was also associated with a significant posterior shift of ECoG power, favoring the visual cortices (p < 0.05). Although the ECoG during AS3 appears visually flat or silent when viewed with standard clinical settings, our study suggests that this period of transient near-electrocerebral silence contains distinctive neural activity. Specifically, the burst in frontal coherence and posterior shift of ECoG power that we find during this period immediately preceding CA may be a neural correlate of conscious processing.
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Affiliation(s)
- Donald E. Lee
- Department of Neurology, University of California, Irvine, California
| | - Lauren G. Lee
- Department of Neurology, University of California, Irvine, California
| | - Danny Siu
- Department of Neurology, University of California, Irvine, California
| | | | | | - Tin J. Dinh
- Department of Neurology, University of California, Irvine, California
| | - Josue Orellana
- Center for the Neural Basis of Cognition, Carnegie Mellon University, Pittsburgh, Pennsylvania
| | - Wei Xiong
- Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Beth A. Lopour
- Department of Biomedical Engineering, University of California, Irvine, California
| | - Yama Akbari
- Department of Neurology, University of California, Irvine, California
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24
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Lacuey N, Zonjy B, Londono L, Lhatoo SD. Amygdala and hippocampus are symptomatogenic zones for central apneic seizures. Neurology 2017; 88:701-705. [PMID: 28087822 DOI: 10.1212/wnl.0000000000003613] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 11/15/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To identify limbic sites of respiratory control in the human brain, and by extension, the symptomatogenic zone for central apnea. METHODS We used direct stimulation of anatomically, precisely placed stereotactic EEG electrodes to analyze breathing responses. We prospectively studied 3 patients who were explored with stereotactically implanted depth electrodes. The amygdala and hippocampus, as well as extralimbic sites (orbitofrontal, temporal tip, and temporal neocortex), were investigated. RESULTS Individual stimulation of the amygdala and hippocampal head consistently elicited central apnea in the expiratory phase, as did exquisitely focal hippocampal seizures. CONCLUSIONS These findings confirm that hippocampus and amygdala are limbic breathing control sites in humans, as well as the symptomatogenic zone for central apneic seizures.
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Affiliation(s)
- Nuria Lacuey
- From the Epilepsy Center (N.L., B.Z., L.L., S.D.L.), UH Cleveland Medical Center, Cleveland, OH; Department of Neurology (N.L.), Vall d 'Hebron University Hospital; Department of Medicine (N.L.), Universitat Autonoma of Barcelona, Spain; and NINDS Center for SUDEP Research (CSR) (S.D.L.), Cleveland, OH.
| | - Bilal Zonjy
- From the Epilepsy Center (N.L., B.Z., L.L., S.D.L.), UH Cleveland Medical Center, Cleveland, OH; Department of Neurology (N.L.), Vall d 'Hebron University Hospital; Department of Medicine (N.L.), Universitat Autonoma of Barcelona, Spain; and NINDS Center for SUDEP Research (CSR) (S.D.L.), Cleveland, OH
| | - Luisa Londono
- From the Epilepsy Center (N.L., B.Z., L.L., S.D.L.), UH Cleveland Medical Center, Cleveland, OH; Department of Neurology (N.L.), Vall d 'Hebron University Hospital; Department of Medicine (N.L.), Universitat Autonoma of Barcelona, Spain; and NINDS Center for SUDEP Research (CSR) (S.D.L.), Cleveland, OH
| | - Samden D Lhatoo
- From the Epilepsy Center (N.L., B.Z., L.L., S.D.L.), UH Cleveland Medical Center, Cleveland, OH; Department of Neurology (N.L.), Vall d 'Hebron University Hospital; Department of Medicine (N.L.), Universitat Autonoma of Barcelona, Spain; and NINDS Center for SUDEP Research (CSR) (S.D.L.), Cleveland, OH
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Mash DC. Excited Delirium and Sudden Death: A Syndromal Disorder at the Extreme End of the Neuropsychiatric Continuum. Front Physiol 2016; 7:435. [PMID: 27790150 PMCID: PMC5061757 DOI: 10.3389/fphys.2016.00435] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 09/13/2016] [Indexed: 01/15/2023] Open
Abstract
Over the past decade, the excited delirium syndrome (ExDS) has raised continued controversy regarding the cause and manner of death of some highly agitated persons held in police custody, restrained or incapacitated by electrical devices. At autopsy, medical examiners have difficulty in identifying an anatomic cause of death, but frequently cite psychostimulant intoxication as a contributing factor. The characteristic symptoms of ExDS include bizarre and aggressive behavior, shouting, paranoia, panic, violence toward others, unexpected physical strength, and hyperthermia. Throughout the United States and Canada, these cases are most frequently associated with cocaine, methamphetamine, and designer cathinone abuse. Acute exhaustive mania and sudden death presents with behavioral symptoms that are identical to what is described for ExDS in psychostimulant abusers. Bell's mania or acute exhaustive mania was first described in the 1850's by American psychiatrist Luther Bell in institutionalized psychiatric patients. This rare disorder of violent mania, elevated body temperature and autonomic collapse continued to be described by others in the psychiatric literature, but with different names until the first cases of ExDS were seen at the beginning of the cocaine epidemic by medical examiners. The neurochemical pathology examination of brain tissues after death revealed a loss of dopamine transporter regulation together with increases in heat shock protein 70 (hsp70) expression as a biomarker of hyperthermia. The similarity in the behavioral symptoms between extremely agitated psychostimulant abusers and unmedicated psychiatric patients suggests that a genetic disorder that leads to dysregulated central dopamine transporter function could be a precipitating cause of the acute delirium and sudden death. While the precise cause and mechanism of lethality remains controversial, the likely whys and wherefores of sudden death of ExDS victims are seen to be "biological," since excessive dopamine in the brain triggers the manic excitement and delirium, which unabated, culminates in a loss of autonomic function that progresses to cardiorespiratory collapse.
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Affiliation(s)
- Deborah C Mash
- Department of Neurology and Molecular and Cellular Pharmacology, University of Miami Miller School of Medicine Miami, FL, USA
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McEwen BJ. Nondrowning Asphyxia in Veterinary Forensic Pathology: Suffocation, Strangulation, and Mechanical Asphyxia. Vet Pathol 2016; 53:1037-48. [PMID: 27084399 DOI: 10.1177/0300985816643370] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Asphyxia in a forensic context refers to death by rapid cerebral anoxia or hypoxia due to accidental or nonaccidental injury. Death due to nondrowning asphyxia can occur with strangulation, suffocation, and mechanical asphyxia, each of which is categorized based on the mechanism of injury. Individuals dying due to various types of asphyxia may or may not have lesions, and even those lesions that are present may be due to other causes. The interpretation or opinion that death was due to asphyxia requires definitive and compelling evidence from the postmortem examination, death scene, and/or history. Beyond the postmortem examination, pathologists may be faced with questions of forensic importance that revolve around the behavioral and physiological responses in animals subjected to strangulation, suffocation, or mechanical asphyxia to determine if the animal suffered. While there is no prescriptive answer to these questions, it is apparent that, because of physiological and anatomical differences between humans and animals, for some mechanisms of asphyxia, consciousness is maintained for longer periods and the onset of death is later in animals than that described for people. Veterinary pathologists must be cognizant that direct extrapolation from the medical forensic literature to animals may be incorrect. This article reviews the terminology, classification, mechanisms, and lesions associated with asphyxial deaths in companion animals and highlights significant comparative differences of the response to various types of asphyxia in animals and people.
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Affiliation(s)
- B J McEwen
- Animal Health Laboratory, University of Guelph, Guelph, Ontario, Canada
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Kellehear A. Unusual perceptions at the end of life: limitations to the diagnosis of hallucinations in palliative medicine. BMJ Support Palliat Care 2016; 7:238-246. [DOI: 10.1136/bmjspcare-2015-001083] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 01/12/2016] [Accepted: 01/13/2016] [Indexed: 01/10/2023]
Abstract
The diagnosis of hallucination for unusual perceptions such as deathbed visions, near-death experiences, or visions of the bereaved, is unhelpful in palliative medicine both academically and clinically. This paper reviews the broad prevalence data about unusual perceptions in the general population as background to identifying the more narrow epidemiological source from which the much smaller focus on hallucinations seem to emerge. Major debates and limitations of current hallucination research are reviewed to show that current academic and clinical certainties are largely confined to unusual perceptions that can be readily linked to psychopathology, quite specific organic disease states and psychoactive drug use. Current state-of-the-art in hallucination studies does not warrant broad or uncritical use of this type of diagnosis in end-of-life care. Conclusions from interdisciplinary (as opposed to single discipline) hallucination studies suggest that the way forward for clinical and research work in palliative medicine may lie in a more biographical and cultural approach to unusual perceptions at the end of life.
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Rady MY, Verheijde JL. The Safety of Terminal Withdrawal of Mechanical Ventilation in End-of-Life Care: Unanswered Questions. J Palliat Med 2015; 18:908-9. [PMID: 26393788 DOI: 10.1089/jpm.2015.0248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Mohamed Y Rady
- 1 Department of Critical Care Medicine, Mayo Clinic Hospital , Mayo Clinic, Phoenix, Arizona
| | - Joseph L Verheijde
- 2 Department of Physical Medicine and Rehabilitation, Mayo Clinic Hospital , Mayo Clinic, Phoenix, Arizona
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