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Laviv Y, Schwartz N, Yassin S, Harnof S. Deep, spontaneous intracerebral hemorrhages: Clinical differences and risk factors associated with anterior versus posterior circulation. Clin Neurol Neurosurg 2023; 226:107594. [PMID: 36731163 DOI: 10.1016/j.clineuro.2023.107594] [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: 11/25/2022] [Revised: 12/26/2022] [Accepted: 01/11/2023] [Indexed: 01/21/2023]
Abstract
BACKGROUND spontaneous intracerebral hemorrhages (ICH) in different anatomical locations are considered different clinical entities, associated with different vascular etiologies. However, such a distinction between deep ICH in the posterior vs. the anterior circulation is not well documented. OBJECTIVE to look for different demographic, clinical, laboratory and radiological variables in order to clarify any distinction between deep ICH of the posterior versus the anterior circulations. MATERIAL AND METHODS Retrospective study on patients diagnosed with deep, spontaneous ICH at a single tertiary center. Patients were divided into two groups: posterior circulation (group 1) and anterior circulation (group 2). Computerized medical records were extracted for multiple variables. RESULTS A total of 142 patients with deep ICH were included in the study; 54.9 % (n = 78) with posterior (group 1) and 45.1 % (n = 64) with anterior circulation hemorrhages (group 2). In group 1, 67.9 % (n = 53) of hemorrhages were in the cerebellum and 28.2 % (n = 22) in the thalamus. Patients in group 1 were older at time of hemorrhage (68.69 ± 11.66 vs. 64.95 ± 13.34, p = 0.073) and had nearly threefold increased rate of BMI≥ 35 (22.0 % vs. 8.6 %, p = 0.071). In multivariate analysis, use of anti-aggregates (OR=2.391; 95 % CI 1.082-5.285, p = 0.031) and past medical history of HTN (OR=2.904; 95 % CI 1.102-7.654, p = 0.031) were significantly associated with ICH of the posterior circulation. When excluding patients with thalamic hemorrhages, BMI ≥ 35 was also associated with significant risk of having a deep hemorrhage in the posterior circulation vs. the anterior circulation (OR=3.420; 95 % CI 1.011-11.574, p = 0.048). No significant differences were found between the two groups in terms of functional and survival outcomes. CONCLUSION HTN, use of anti-aggregates and morbid obesity are associated with deep ICHs of the posterior circulation and should be considered significant risk factors for this major clinical event. The growing data on pathophysiology of distinct subgroups of ICH will provide useful tools that will aid in preventing and treating these neurological emergencies. Future epidemiological and clinical studies should use the distinction between ICH subgroups based on their anatomical location and vascular territories as accurately as possible in order to reach solid conclusions.
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Affiliation(s)
- Yosef Laviv
- Neurosurgery Department, Beilinson Hospital, Rabin Medical Center, Tel-Aviv University, Petah Tikva, Israel.
| | - Noa Schwartz
- Neurosurgery Department, Beilinson Hospital, Rabin Medical Center, Tel-Aviv University, Petah Tikva, Israel
| | - Saeed Yassin
- Neurosurgery Department, Beilinson Hospital, Rabin Medical Center, Tel-Aviv University, Petah Tikva, Israel
| | - Sagi Harnof
- Neurosurgery Department, Beilinson Hospital, Rabin Medical Center, Tel-Aviv University, Petah Tikva, Israel
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2
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Ng MA. Posterior Circulation Ischaemic Stroke. Am J Med Sci 2022; 363:388-398. [PMID: 35104439 DOI: 10.1016/j.amjms.2021.10.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 06/09/2021] [Accepted: 10/21/2021] [Indexed: 11/16/2022]
Abstract
Posterior circulation ischaemic stroke (PCIS) is a disease of high burden. They account for 20-25% of all ischaemic strokes. However, it is relatively under-researched and requires more clinical attention, since it carries worse functional outcomes. Vertigo, visual disturbances and sensory/motor disturbances are found in PCIS. Large artery atherosclerosis and embolism are main causes of PCIS, while there is growing evidence that vertebrobasilar dolichoectasia is a key association. Hypertension is the commonest risk factor, while diabetes mellitus is more specific to PCIS. PCIS is diagnosed through neuroimaging techniques, which examine structural brain abnormalities, vascular patency and perfusion. PCIS, in line with ischaemic stroke in general, requires medical treatment and lifestyle modifications. This includes smoking cessation, weight control, and dietary alterations. Aspirin use also significantly improves survival outcomes. While intravascular and intra-arterial thrombolysis improve clinical outcomes, this is not proven conclusively for stenting and angioplasty. Future research on PCIS can focus on multi-centre epidemiological studies, clinically significant anatomical variants, and collateralisation.
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Affiliation(s)
- Mr Alexander Ng
- Department of Diagnostic Radiology, Li Ka Shing Faculty of Medicine, University of Hong Kong, Full Address: Block K, Queen Mary Hospital, Pokfulam Road, Hong Kong.
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3
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de Andrade JBC, Mohr JP, Timbó FB, Nepomuceno CR, Moreira JVDS, Timbó IDCG, Lima FO, Silva GS, Bamford J. Oxfordshire Community Stroke Project Classification: A proposed automated algorithm. Eur Stroke J 2021; 6:160-167. [PMID: 34414291 DOI: 10.1177/23969873211012136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/31/2021] [Indexed: 12/19/2022] Open
Abstract
Introduction The Oxfordshire Community Stroke Project (OCSP) proposed a clinical classification for Stroke patients. This classification has proved helpful to predict the risk of neurological complications. However, the OCSP was initially based on findings on the neurological assesment, which can pose difficulties for classifying patients. We aimed to describe the development and the validation step of a computer-based algorithm based on the OCSP classification. Materials and methods A flow-chart was created which was reviewed by five board-certified vascular neurologists from which a computer-based algorithm (COMPACT) was developed. Neurology residents from 12 centers were invited to participate in a randomized trial to assess the effect of using COMPACT. They answered a 20-item questionnaire for classifying the vignettes according to the OCSP classification. Each correct answer has been attributed to 1-point for calculating the final score. Results Six-two participants agreed to participate and answered the questionnaire. Thirty-two were randomly allocated to use our algorithm, and thirty were allocated to adopt a list of symptoms alone. The group who adopted our algorithm had a median score of correct answers of 16.5[14.5, 17]/20 versus 15[13, 16]/20 points, p = 0.014. The use of our algorithm was associated with the overall rate of correct scores (p = 0.03). Discussion Our algorithm seemed a useful tool for any postgraduate year Neurology resident. A computer-based algorithm may save time and improve the accuracy to classify these patients. Conclusion An easy-to-use computer-based algorithm improved the accuracy of the OCSP classification, with the possible benefit of further improvement of the prediction of neurological complications and prognostication.
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Affiliation(s)
- Joao Brainer Clares de Andrade
- Department of Neurology, Universidade Federal de Sao Paulo, Sao Paulo, Brazil.,Columbia University, Doris and Stanley Tananbaum Stroke Center, New York, NY, USA
| | - Jay P Mohr
- Columbia University, Doris and Stanley Tananbaum Stroke Center, New York, NY, USA
| | - Felipe Brito Timbó
- Department of Computational Science, Universidade Federal do Ceara, Fortaleza, Brazil
| | | | | | | | | | | | - John Bamford
- Department of Neurology, University of Leeds, Leeds, UK
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4
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Focal brainstem infarction in the adult rat. Lab Anim (NY) 2021; 50:97-107. [PMID: 33564191 DOI: 10.1038/s41684-021-00722-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 01/12/2021] [Indexed: 11/08/2022]
Abstract
Animal models are required to study the pathogenesis of brainstem ischemia and to develop new therapeutic approaches to promote functional recovery after ischemia in humans. Few models of brainstem ischemia are available, and they show great variability or cause early lethality. New, reliable animal models are therefore needed. By selectively ligating four points of the lower basilar artery, we developed a new focal basilar artery occlusion model that causes a localized brainstem ischemic lesion in female Sprague-Dawley rats. Analysis of ischemic lesion volume and neurological deficits over a period of 28 d showed that the rats present symptoms specific to this type of stroke while the ischemic lesion remains relatively unchanged over time. This procedure allows higher survival rates and extended observation periods compared with other models of brainstem ischemia. The procedure takes ~40 min, can be performed by researchers with basic surgical skills and does not require specialized surgical equipment. This protocol is highly reliable and will be useful to evaluate new therapeutic approaches to promote functional recovery in patients with brainstem ischemia.
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5
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Kim YY, Chao JR, Kim C, Kang TC, Park HS, Chang J, Suh JG, Lee JH. Applicability of vital staining and tissue clearing to vascular anatomy and melanocytes' evaluation of temporal bone in six laboratory species. Anat Histol Embryol 2019; 48:296-305. [PMID: 30916435 DOI: 10.1111/ahe.12440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 02/11/2019] [Accepted: 02/26/2019] [Indexed: 12/14/2022]
Abstract
The purpose of the present study was to define the applicability of tissue clearing to the field of otology. We combined tissue clearing with vital staining perfusion via a pumping system to examine the vascular anatomy of temporal bones in laboratory animals. We used six different types of species including Korean wild mouse, mouse, Mongolian gerbil, hamsters and Guinea pigs. A mixture of Alcian blue reagent and 4% paraformaldehyde was circulated throughout the entire circulatory system of the animal via a perfusion pump system. Transparency images were obtained from the temporal bones according to the protocol of the SunHyun 3D Imaging Kit. In examining the inner surface of the tympanic membrane, flaccid part (pars flaccida) was positioned along the entire marginal area in Guinea pig. In the Guinea pig, unlike the other species, the cortical bone of the mastoid (bullae) was easily removed using cold instruments, allowing a direct approach to the enclosed structures. The distribution and pattern of cochlea melanocytes were compared among the species. "Mobius strip"-like accumulated melanocytes in vestibules were shown in both the Korean wild mouse and mouse. The collateral blood supply to the cochlea in six different species was checked in various pattern. Combining dye infusion with tissue-clearing techniques, we documented the middle ear and transparent inner ear structures in six different species. The information and associated images will help other researchers to develop hypotheses and design experimental investigations.
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Affiliation(s)
- Yoo Yeon Kim
- Department of Medical Genetics, College of Medicine, Hallym University, Chuncheon, Korea
| | - Janet Ren Chao
- Division of Otolaryngology, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Chulho Kim
- Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University, Chuncheon, Korea
| | - Tae-Cheon Kang
- Department of Anatomy and Neurobiology, College of Medicine, Hallym University, Chuncheon, Korea
| | - Hae Sang Park
- Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon, Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Hallym University, Chuncheon, Korea
| | - Jiwon Chang
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Hallym University, Chuncheon, Korea
| | - Jun-Gyo Suh
- Department of Medical Genetics, College of Medicine, Hallym University, Chuncheon, Korea
| | - Jun Ho Lee
- Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon, Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Hallym University, Chuncheon, Korea
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6
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Namioka A, Namioka T, Sasaki M, Kataoka-Sasaki Y, Oka S, Nakazaki M, Onodera R, Suzuki J, Sasaki Y, Nagahama H, Kocsis JD, Honmou O. Intravenous infusion of mesenchymal stem cells for protection against brainstem infarction in a persistent basilar artery occlusion model in the adult rat. J Neurosurg 2018; 131:1308-1316. [PMID: 30485204 DOI: 10.3171/2018.4.jns173121] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 04/05/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Morbidity and mortality in patients with posterior circulation stroke remains an issue despite advances in acute stroke therapies. The intravenous infusion of mesenchymal stem cells (MSCs) elicits therapeutic efficacy in experimental supratentorial stroke models. However, since there are few reliable animal models of ischemia in the posterior circulation, the therapeutic approach with intravenous MSC infusion has not been tested. The objective of this study was to test the hypothesis that intravenously infused MSCs provide functional recovery in a newly developed model of brainstem infarction in rats. METHODS Basilar artery (BA) occlusion (BAO) was established in rats by selectively ligating 4 points of the proximal BA with 10-0 nylon monofilament suture. The intravenous infusion of MSCs was performed 1 day after BAO induction. MRI and histological examinations were performed to assess ischemic lesion volume, while multiple behavioral tests were performed to evaluate functional recovery. RESULTS The MSC-treated group exhibited a greater reduction in ischemic lesion volume, while behavioral testing indicated that the MSC-infused group had greater improvement than the vehicle group 28 days after the MSC infusion. Accumulated infused MSCs were observed in the ischemic brainstem lesion. CONCLUSIONS Infused MSCs may provide neuroprotection to facilitate functional outcomes and reduce ischemic lesion volume as evaluated in a newly developed rat model of persistent BAO.
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Affiliation(s)
- Ai Namioka
- 1Department of Neural Regenerative Medicine, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Takahiro Namioka
- 1Department of Neural Regenerative Medicine, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Masanori Sasaki
- 1Department of Neural Regenerative Medicine, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
- 3Center for Neuroscience and Regeneration Research, VA Connecticut Healthcare System, West Haven, Connecticut
| | - Yuko Kataoka-Sasaki
- 1Department of Neural Regenerative Medicine, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Shinichi Oka
- 1Department of Neural Regenerative Medicine, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Masahito Nakazaki
- 1Department of Neural Regenerative Medicine, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Rie Onodera
- 1Department of Neural Regenerative Medicine, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Junpei Suzuki
- 1Department of Neural Regenerative Medicine, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Yuichi Sasaki
- 1Department of Neural Regenerative Medicine, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Hiroshi Nagahama
- 1Department of Neural Regenerative Medicine, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Jeffery D Kocsis
- 2Department of Neurology, Yale University School of Medicine, New Haven; and
- 3Center for Neuroscience and Regeneration Research, VA Connecticut Healthcare System, West Haven, Connecticut
| | - Osamu Honmou
- 1Department of Neural Regenerative Medicine, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
- 3Center for Neuroscience and Regeneration Research, VA Connecticut Healthcare System, West Haven, Connecticut
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7
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Lubomirov LT, Papadopoulos S, Pütz S, Welter J, Klöckener T, Weckmüller K, Ardestani MA, Filipova D, Metzler D, Metzner H, Staszewski J, Zittrich S, Gagov H, Schroeter MM, Pfitzer G. Aging-related alterations in eNOS and nNOS responsiveness and smooth muscle reactivity of murine basilar arteries are modulated by apocynin and phosphorylation of myosin phosphatase targeting subunit-1. J Cereb Blood Flow Metab 2017; 37:1014-1029. [PMID: 27193035 PMCID: PMC5363478 DOI: 10.1177/0271678x16649402] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 04/07/2016] [Accepted: 04/08/2016] [Indexed: 12/20/2022]
Abstract
Aging causes major alterations of all components of the neurovascular unit and compromises brain blood supply. Here, we tested how aging affects vascular reactivity in basilar arteries from young (<10 weeks; y-BA), old (>22 months; o-BA) and old (>22 months) heterozygous MYPT1-T-696A/+ knock-in mice. In isometrically mounted o-BA, media thickness was increased by ∼10% while the passive length tension relations were not altered. Endothelial denudation or pan-NOS inhibition (100 µmol/L L-NAME) increased the basal tone by 11% in y-BA and 23% in o-BA, while inhibition of nNOS (1 µmol/L L-NPA) induced ∼10% increase in both ages. eNOS expression was ∼2-fold higher in o-BA. In o-BA, U46619-induced force was augmented (pEC50 ∼6.9 vs. pEC50 ∼6.5) while responsiveness to DEA-NONOate, electrical field stimulation or nicotine was decreased. Basal phosphorylation of MLC20-S19 and MYPT1-T-853 was higher in o-BA and was reversed by apocynin. Furthermore, permeabilized o-BA showed enhanced Ca2+-sensitivity. Old T-696A/+ BA displayed a reduced phosphorylation of MYPT1-T696 and MLC20, a lower basal tone in response to L-NAME and a reduced eNOS expression. The results indicate that the vascular hypercontractility found in o-BA is mediated by inhibition of MLCP and is partially compensated by an upregulation of endothelial NO release.
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Affiliation(s)
| | | | - Sandra Pütz
- Institute of Vegetative Physiology, University of Cologne, Germany
| | - Johannes Welter
- Institute of Vegetative Physiology, University of Cologne, Germany
| | - Tim Klöckener
- Institute for Genetics, University of Cologne, Germany
| | | | | | - Dilyana Filipova
- Institute of Vegetative Physiology, University of Cologne, Germany
| | - Doris Metzler
- Institute of Vegetative Physiology, University of Cologne, Germany
| | - Harald Metzner
- Institute of Vegetative Physiology, University of Cologne, Germany
| | | | - Stefan Zittrich
- Institute of Vegetative Physiology, University of Cologne, Germany
| | - Hristo Gagov
- Faculty of Biology, Sofia University St. Kliment Ohridski, Sofia, Bulgaria
| | | | - Gabriele Pfitzer
- Institute of Vegetative Physiology, University of Cologne, Germany
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8
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Tao C, Zhang R, Hu X, Song L, Wang C, Gao F, You C. A Novel Brainstem Hemorrhage Model by Autologous Blood Infusion in Rat: White Matter Injury, Magnetic Resonance Imaging, and Neurobehavioral Features. J Stroke Cerebrovasc Dis 2016; 25:1102-1109. [DOI: 10.1016/j.jstrokecerebrovasdis.2016.01.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 01/20/2016] [Indexed: 12/16/2022] Open
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9
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Toklu HZ, Muller-Delp J, Sakaraya Y, Oktay S, Kirichenko N, Matheny M, Carter CS, Morgan D, Strehler KYE, Tumer N, Scarpace PJ. High dietary fructose does not exacerbate the detrimental consequences of high fat diet on basilar artery function. JOURNAL OF PHYSIOLOGY AND PHARMACOLOGY : AN OFFICIAL JOURNAL OF THE POLISH PHYSIOLOGICAL SOCIETY 2016; 67:205-216. [PMID: 27226180 PMCID: PMC5572808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 03/29/2016] [Indexed: 06/05/2023]
Abstract
The objective of the study was to determine the effects of a high fat (HF) diet alone or with high fructose (HF/F) on functional and structural changes in the basilar arteries and cardiovascular health parameters in rats. Male Sprague Dawley rats were fed either a HF (30%) or HF/F (30/40%) diet for 12 weeks. The basilar artery was cannulated in a pressurized system (90 cm H2O) and vascular responses to KCl (30 - 120 mM), endothelin (10(-11) - 10(-7) M), acetylcholine (ACh) (10(-10) - 10(-4) M), diethylamine (DEA)-NONO-ate (10(-10) - 10(-4) M), and papaverine (10(-10) - 10(-4) M) were evaluated. Rats were also monitored for food intake, body weight, blood lipids, blood pressure, and heart rate. At death, asymmetrical dimethyl arginine level (ADMA) and leptin were assayed in serum. Although there was no significant difference in weight gain and food intake, HF and HF/F diets increased body fat composition and decreased the lean mass. HF/F diet accelerated the development of dyslipidemia. Although resting blood pressure remained unchanged, stress caused a significant elevation in blood pressure and a modest increase in heart rate in HF fed rats. Both HF and HF/F diet resulted in decreased response to endothelium-dependent and -independent relaxation, whereas increased basilar artery wall thickness was observed only in HF group. Serum leptin levels positively correlated with wall thickness. Moreover serum ADMA was increased and eNOS immunofluorescence was significantly decreased with both diets. These data suggest that the presence of high fructose in a HF diet does not exacerbate the detrimental consequences of a HF diet on basilar artery function.
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Affiliation(s)
- H Z Toklu
- Department of Pharmacology and Therapeutics, University of Florida, Gainesville, FL, USA
- North Florida/South Georgia Veterans Health System, Geriatric Research, Education, and Clinical Center, Gainesville, FL, USA
| | - J Muller-Delp
- Department of Biomedical Sciences, Florida State University, Tallahassee, FL, USA
| | - Y Sakaraya
- Department of Pharmacology and Therapeutics, University of Florida, Gainesville, FL, USA
- North Florida/South Georgia Veterans Health System, Geriatric Research, Education, and Clinical Center, Gainesville, FL, USA
| | - S Oktay
- North Florida/South Georgia Veterans Health System, Geriatric Research, Education, and Clinical Center, Gainesville, FL, USA
- School of Dentistry, Marmara University, Istanbul, Turkey
| | - N Kirichenko
- Department of Pharmacology and Therapeutics, University of Florida, Gainesville, FL, USA
- North Florida/South Georgia Veterans Health System, Geriatric Research, Education, and Clinical Center, Gainesville, FL, USA
| | - M Matheny
- Department of Pharmacology and Therapeutics, University of Florida, Gainesville, FL, USA
| | - C S Carter
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, USA
| | - D Morgan
- Department of Psychiatry, University of Florida, Gainesville, FL, USA
| | - K Y E Strehler
- Department of Pharmacology and Therapeutics, University of Florida, Gainesville, FL, USA
| | - N Tumer
- Department of Pharmacology and Therapeutics, University of Florida, Gainesville, FL, USA
- North Florida/South Georgia Veterans Health System, Geriatric Research, Education, and Clinical Center, Gainesville, FL, USA
| | - P J Scarpace
- Department of Pharmacology and Therapeutics, University of Florida, Gainesville, FL, USA.
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10
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Adegoke SA, Figueiredo MS, Vicari P, Carrete H, Idagawa MH, Massaro AR, Silva GS. Posterior Circulation Evaluation in Patients with Sickle Cell Anemia. J Stroke Cerebrovasc Dis 2016; 25:717-21. [PMID: 26774870 DOI: 10.1016/j.jstrokecerebrovasdis.2015.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 09/08/2015] [Accepted: 11/05/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The role of transcranial Doppler (TCD) ultrasonography in identifying children with sickle cell anemia (SCA) at risk for stroke is well known; however, the major studies that evaluated TCD velocities in children with SCA did not report posterior circulation evaluation data. The objective of our study was to describe the pattern of blood flow velocities in the posterior circulation of patients with SCA and to examine their relationship with findings on magnetic resonance imaging (MRI)/magnetic resonance angiography (MRA). METHODS All adult patients with SCA followed in the outpatient clinic of our hospital were evaluated with TCD and MRI/MRA. The highest velocities of the middle cerebral arteries or internal carotid arteries were taken as the time-averaged maximum mean (TAMM) velocity for each patient and the maximum mean flow velocities in the posterior circulation (TAMMpost) were recorded. RESULTS Fifty-six patients with SCA and 56 healthy nonanemic volunteers were evaluated. The mean TAMMpost in the basilar, vertebral, and posterior cerebral arteries (PCAs) were significantly higher among cases than controls (P < .01). In patients with SCA, the TAMMpost in all posterior circulation arteries had a positive correlation with TAMM. Only 1 patient with stenosis in the posterior circulation (right PCA) was identified. CONCLUSION We found a low frequency of stenosis but high blood flow velocities in the posterior circulation in patients with SCA. The role of increased TCD velocities in the posterior circulation upon stroke risk in patients with SCA should be further examined.
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Affiliation(s)
- Samuel Ademola Adegoke
- Department of Pediatrics and Child Health, Obafemi Awolowo University, Ile-Ife, Nigeria; Department of Hematology, UNIFESP, São Paulo, SP, Brazil
| | | | - Perla Vicari
- Department of Hematology, UNIFESP, São Paulo, SP, Brazil
| | | | | | | | - Gisele Sampaio Silva
- Department of Neurology and Neurosurgery, UNIFESP, São Paulo, SP, Brazil; Programa Integrado de Neurologia, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
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11
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Pakkianathan C, Benggon M, Khatibi NH, Chen H, Marcantonio S, Applegate R, Tang J, Zhang J. Propofol Pretreatment Fails to Provide Neuroprotection Following a Surgically Induced Brain Injury Rat Model. ACTA NEUROCHIRURGICA. SUPPLEMENT 2016; 121:323-7. [PMID: 26463969 DOI: 10.1007/978-3-319-18497-5_56] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Neurosurgical procedures are associated with unintentional damage to the brain during surgery, known as surgically induced brain injuries (SBI), which have been implicated in orchestrating structural and neurobehavioral deterioration. Propofol, an established hypnotic anesthetic agent, has been shown to ameliorate neuronal injury when given after injury in a number of experimental brain studies. We tested the hypothesis that propofol pretreatment confers neuroprotection against SBI and will reduce cerebral edema formation and neurobehavioral deficits in our rat population. Sprague-Dawley rats were treated with low- and high-dose propofol 30 min before SBI. At 24 h post injury, brain water content and neurobehavioral assessment was conducted based on previously established models. In vehicle-treated rats, SBI resulted in significant cerebral edema and higher neurological deficit scores compared with sham-operated rats. Low- or high-dose propofol therapy neither reduced cerebral edema nor improved neurologic function. The results suggest that propofol pretreatment fails to provide neuroprotection in SBI rats. However, it is possible that a SBI model with less magnitude of injury or that propofol re-dosing, given the short-acting pharmacokinetic property of propofol, may be needed to provide definitive conclusions.
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Affiliation(s)
- Colleen Pakkianathan
- Department of Anesthesiology, Loma Linda School of Medicine, Room 2532 LLUMC, 11234 Anderson Street, Loma Linda, CA, 92354, USA
| | - Michael Benggon
- Department of Anesthesiology, Loma Linda School of Medicine, Room 2532 LLUMC, 11234 Anderson Street, Loma Linda, CA, 92354, USA
| | - Nikan H Khatibi
- Department of Anesthesiology, Loma Linda School of Medicine, Room 2532 LLUMC, 11234 Anderson Street, Loma Linda, CA, 92354, USA
| | - Hank Chen
- Division of Physiology, Department of Basic Science, Loma Linda School of Medicine, Loma Linda, CA, USA
| | - Suzzanne Marcantonio
- Department of Anesthesiology, Loma Linda School of Medicine, Room 2532 LLUMC, 11234 Anderson Street, Loma Linda, CA, 92354, USA.,Division of Physiology, Department of Basic Science, Loma Linda School of Medicine, Loma Linda, CA, USA
| | - Richard Applegate
- Department of Anesthesiology, Loma Linda School of Medicine, Room 2532 LLUMC, 11234 Anderson Street, Loma Linda, CA, 92354, USA.
| | - Jiping Tang
- Division of Physiology, Department of Basic Science, Loma Linda School of Medicine, Loma Linda, CA, USA
| | - John Zhang
- Department of Anesthesiology, Loma Linda School of Medicine, Room 2532 LLUMC, 11234 Anderson Street, Loma Linda, CA, 92354, USA.,Division of Physiology, Department of Basic Science, Loma Linda School of Medicine, Loma Linda, CA, USA
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Anwar MA, Eid AH. Determination of Vascular Reactivity of Middle Cerebral Arteries from Stroke and Spinal Cord Injury Animal Models Using Pressure Myography. Methods Mol Biol 2016; 1462:611-24. [PMID: 27604741 DOI: 10.1007/978-1-4939-3816-2_33] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Stroke and other neurovascular derangements are main causes of global death. They, along with spinal cord injuries, are responsible for being the principal cause of disability due to neurological and cognitive problems. These problems then lead to a burden on scarce financial resources and societal care facilities as well as have a profound effect on patients' families. The mechanism of action in these debilitating diseases is complex and unclear. An important component of these problems arises from derangement of blood vessels, such as blockage due to clotting/embolism, endothelial dysfunction, and overreactivity to contractile agents, as well as alteration in endothelial permeability. Moreover, the cerebro-vasculature (large vessels and arterioles) is involved in regulating blood flow by facilitating auto-regulatory processes. Moreover, the anterior (middle cerebral artery and the surrounding region) and posterior (basilar artery and its immediate locality) regions of the brain play a significant role in triggering the pathological progression of ischemic stroke particularly due to inflammatory activity and oxidative stress. Interestingly, modifiable and non-modifiable cardiovascular risk factors are responsible for driving ischemic and hemorrhagic stroke and spinal cord injury. There are different stroke animal models to examine the pathophysiology of middle cerebral and basilar arteries. In this context, arterial myography offers an opportunity to determine the etiology of vascular dysfunction in these diseases. Herein, we describe the technique of pressure myography to examine the reactivity of cerebral vessels to contractile and vasodilator agents and a prelude to stroke and spinal cord injury.
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Affiliation(s)
- Mohammad A Anwar
- Department of Biological & Environmental Sciences, College of Arts and Sciences, Qatar University, Doha, Qatar
| | - Ali H Eid
- Department of Biological & Environmental Sciences, College of Arts and Sciences, Qatar University, Doha, Qatar. .,Department of Pharmacology and Toxicology, Faculty of Medicine, American University of Beirut, 11-0236, Beirut, 1107-2020, Lebanon.
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The functional and structural changes in the basilar artery due to overpressure blast injury. J Cereb Blood Flow Metab 2015; 35:1950-6. [PMID: 26104291 PMCID: PMC4671114 DOI: 10.1038/jcbfm.2015.151] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 04/13/2015] [Accepted: 05/07/2015] [Indexed: 12/13/2022]
Abstract
Overpressure blast-wave induced brain injury (OBI) leads to progressive pathophysiologic changes resulting in a reduction in brain blood flow, blood brain barrier breakdown, edema, and cerebral ischemia. The aim of this study was to evaluate cerebral vascular function after single and repeated OBI. Male Sprague-Dawley rats were divided into three groups: Control (Naive), single OBI (30 psi peak pressure, 1 to 2 msec duration), and repeated (days 1, 4, and 7) OBI (r-OBI). Rats were killed 24 hours after injury and the basilar artery was isolated, cannulated, and pressurized (90 cm H2O). Vascular responses to potassium chloride (KCl) (30 to 100 mmol/L), endothelin-1 (10(-12) to 10(-7) mol/L), acetylcholine (ACh) (10(-10) to 10(-4) mol/L) and diethylamine-NONO-ate (DEA-NONO-ate) (10(-10) to 10(-4) mol/L) were evaluated. The OBI resulted in an increase in the contractile responses to endothelin and a decrease in the relaxant responses to ACh in both single and r-OBI groups. However, impaired DEA-NONO-ate-induced vasodilation and increased wall thickness to lumen ratio were observed only in the r-OBI group. The endothelin-1 type A (ET(A)) receptor and endothelial nitric oxide synthase (eNOS) immunoreactivity were significantly enhanced by OBI. These findings indicate that both single and r-OBI impairs cerebral vascular endothelium-dependent dilation, potentially a consequence of endothelial dysfunction and/or vascular remodelling in basilar arteries after OBI.
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Tümer N, Toklu HZ, Muller-Delp JM, Oktay S, Ghosh P, Strang K, Delp MD, Scarpace PJ. The effects of aging on the functional and structural properties of the rat basilar artery. Physiol Rep 2014; 2:2/6/e12031. [PMID: 24907295 PMCID: PMC4208653 DOI: 10.14814/phy2.12031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Aging leads to progressive pathophysiological changes in blood vessels of the brain and periphery. The aim of this study was to evaluate the effects of aging on cerebral vascular function and structure. Basilar arteries were isolated from male Fischer 344 cross Brown Norway (F344xBN) rats at 3, 8, and 24 months of age. The basilar arteries were cannulated in the pressurized system (90 cm H2O). Contractile responses to KCl (30–120 mmol/L) and endothelin‐1 (10−11–10−7 mol/L) were evaluated. Responses to acetylcholine (ACh) (10−10–10−4 mol/L), diethylamine (DEA)‐NONO‐ate (10−10–10−4 mol/L), and papaverin (10−10–10−4 mol/L) were assessed to determine both endothelium‐dependent and endothelium‐independent responsiveness. Advanced aging (24 months) decreased responses of the basilar artery to both the contractile and relaxing agents; whereas, DEA‐induced dilation was significantly higher in the 8‐month‐old group compared with the younger and older groups. The arterial wall‐to‐lumen ratio was significantly increased in 24‐month‐old rats. Smooth muscle cell count was also decreased in old rats. These findings indicate that aging produces dysfunction of both the endothelium and the vascular smooth muscle in the basilar artery. Aging also alters wall structure of the basilar artery, possibly through decreases in smooth muscle cell number and concomitant hypertrophy. The purpose of this study was to determine the effects of advancing age on the structure and vasomotor responses of the basilar artery as well as the serum antioxidant capacity. Advanced aging (24 months) decreased responses of the basilar artery to both the contractile and relaxing agents, whereas, DEA‐induced dilation was significantly higher in the 8‐month‐old group compared with the younger and older rats. The arterial wall‐to‐lumen ratio was significantly increased in 24‐month‐old rats. Smooth muscle cell count was also decreased in old rats. Our findings demonstrate that aging is associated with functional impairment in endothelium‐dependent and ‐independent relaxation responses and contractility in the basilar arteries, and these diminished responses are accompanied by structural remodeling and decreased antioxidant capacity of the serum.
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Affiliation(s)
- Nihal Tümer
- Geriatric Research, Education, and Clinical Center, North Florida/South Georgia Veterans Health System, Gainesville, Florida, USA Department of Pharmacology and Therapeutics, University of Florida, Gainesville, Florida, USA
| | - Hale Z Toklu
- Geriatric Research, Education, and Clinical Center, North Florida/South Georgia Veterans Health System, Gainesville, Florida, USA Department of Pharmacology and Therapeutics, University of Florida, Gainesville, Florida, USA
| | - Judy M Muller-Delp
- Department of Physiology and Functional Genomics, University of Florida, Gainesville, Florida, USA
| | - Sehkar Oktay
- Department of Pharmacology and Therapeutics, University of Florida, Gainesville, Florida, USA School of Dentistry, Marmara University, Istanbul, Turkey
| | - Payal Ghosh
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida, USA
| | - Kevin Strang
- Department of Psychiatry, University of Florida, Gainesville, Florida, USA
| | - Michael D Delp
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida, USA
| | - Philip J Scarpace
- Department of Pharmacology and Therapeutics, University of Florida, Gainesville, Florida, USA
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