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Li C, Jiang M, Chen Z, Hu Q, Liu Z, Wang J, Yin X, Wang J, Wu M. The neuroprotective effects of normobaric oxygen therapy after stroke. CNS Neurosci Ther 2024; 30:e14858. [PMID: 39009510 PMCID: PMC11250159 DOI: 10.1111/cns.14858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Revised: 06/29/2024] [Accepted: 07/03/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND Stroke, including ischemic and hemorrhagic stroke, is a severe and prevalent acute cerebrovascular disease. The development of hypoxia following stroke can trigger a cascade of pathological events, including mitochondrial dysfunction, energy deficiency, oxidative stress, neuroinflammation, and excitotoxicity, all of which are often associated with unfavorable prognosis. Nonetheless, a noninvasive intervention, referred to as normobaric hyperoxia (NBO), is known to have neuroprotective effects against stroke. RESULTS NBO can exert neuroprotective effects through various mechanisms, such as the rescue of hypoxic tissues, preservation of the blood-brain barrier, reduction of brain edema, alleviation of neuroinflammation, improvement of mitochondrial function, mitigation of oxidative stress, reduction of excitotoxicity, and inhibition of apoptosis. These mechanisms may help improve the prognosis of stroke patients. CONCLUSIONS This review summarizes the mechanism by which hypoxia causes brain injury and how NBO can act as a neuroprotective therapy to treat stroke. We conclude that NBO has significant potential for treating stroke and may represent a novel therapeutic strategy.
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Affiliation(s)
- Chuan Li
- Department of Medical LaboratoryAffiliated Hospital of Jiujiang UniversityJiujiangJiangxiChina
| | - Min Jiang
- Jiujiang Clinical Precision Medicine Research CenterJiujiangJiangxiChina
| | - Zhiying Chen
- Department of NeurologyAffiliated Hospital of Jiujiang UniversityJiujiangJiangxiChina
| | - Qiongqiong Hu
- Department of NeurologyZhengzhou Central Hospital, Zhengzhou UniversityZhengzhouHenanChina
| | - Ziying Liu
- Department of Medical LaboratoryAffiliated Hospital of Jiujiang UniversityJiujiangJiangxiChina
| | - Junmin Wang
- Department of Human AnatomySchool of Basic Medical Sciences, Zhengzhou UniversityZhengzhouHenanChina
| | - Xiaoping Yin
- Department of NeurologyAffiliated Hospital of Jiujiang UniversityJiujiangJiangxiChina
| | - Jian Wang
- Department of Human AnatomySchool of Basic Medical Sciences, Zhengzhou UniversityZhengzhouHenanChina
| | - Moxin Wu
- Department of Medical LaboratoryAffiliated Hospital of Jiujiang UniversityJiujiangJiangxiChina
- Jiujiang Clinical Precision Medicine Research CenterJiujiangJiangxiChina
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Li W, Qi Z, Ma Q, Ding J, Wu C, Song H, Yang Q, Duan J, Liu L, Kang H, Wu L, Ji K, Zhao W, Li C, Sun C, Li N, Fisher M, Ji X, Liu KJ. Normobaric Hyperoxia Combined With Endovascular Treatment for Patients With Acute Ischemic Stroke: A Randomized Controlled Clinical Trial. Neurology 2022; 99:e824-e834. [PMID: 35715198 DOI: 10.1212/wnl.0000000000200775] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 04/08/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVES To investigate the safety and efficacy of normobaric hyperoxia (NBO) combined with endovascular treatment (EVT) in patients with acute ischemic stroke (AIS). METHODS In this single-center, proof-of-concept, assessor-blinded, randomized, controlled pilot study, patients with AIS in the acute anterior circulation with large vessel occlusion who had an indication for EVT were randomly assigned to the EVT group or the NBO + EVT group. The NBO + EVT group was given 100% oxygen through a face mask initiated before vascular recanalization (10L/min for 4 hours), while the EVT group was given room air. The primary endpoint was infarct volume measured by MRI within 24-48 hours after randomization. RESULTS A total of 231 patients were screened, and 86 patients were randomized into a ratio of 1:1 (EVT group, n = 43; NBO + EVT group, n = 43). The median infarction volume of the NBO + EVT group at 24-48 hours after randomization was significantly smaller than that of the EVT group (median 20.1 vs 37.7 mL, p < 0.01). The median mRS score at 90 days was 2 for the NBO + EVT group when compared with 3 for the EVT group (adjusted value 1.8, 95% CI 1.3-4.2; p = 0.038). Compared with the EVT group, the NBO + EVT group had a lower incidence of symptomatic intracranial hemorrhagic (7% vs 12%), mortality (9% vs 16%), and adverse events (33% vs 42%); however, such a difference was not statistically significant. DISCUSSION NBO in combination with EVT seems to be a safe and feasible treatment strategy that could significantly reduce infarct volume, improve short-term neurobehavioral test score, and enhance clinical outcomes at 90 days when compared with EVT alone in patients with AIS. These observations need to be further confirmed by a large, multicenter, randomized clinical trial. CLINICAL TRIALS REGISTRATION NCT03620370. CLASSIFICATION OF EVIDENCE This pilot study provides Class I evidence that NBO combined with standard EVT decreases infarction volume in patients with acute anterior circulation stroke.
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Affiliation(s)
- Weili Li
- From the Cerebrovascular Diseases Research Institute (W.L., Z.Q., X.J.) and the Departments of Neurology (Q.M., Jiayue Ding, C.W., H.S., L.W., K.J., W.Z., C.S., N.L.), Radiology (Q.Y.), Emergency (Jiangang Duan, C.L.), and Neurosurgery (X.J.), Xuanwu Hospital of Capital Medical University, Beijing; Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology (W.L., X.J.), Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China; School of Statistics (L.L.), University of Minnesota at Twin Cities, Minneapolis; Department of Internal Medicine (H.K.), University of New Mexico, Albuquerque; Department of Neurology (M.F.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Department of Pharmaceutical Sciences (K.J.L.), University of New Mexico Health Sciences Center, Albuquerque
| | - Zhifeng Qi
- From the Cerebrovascular Diseases Research Institute (W.L., Z.Q., X.J.) and the Departments of Neurology (Q.M., Jiayue Ding, C.W., H.S., L.W., K.J., W.Z., C.S., N.L.), Radiology (Q.Y.), Emergency (Jiangang Duan, C.L.), and Neurosurgery (X.J.), Xuanwu Hospital of Capital Medical University, Beijing; Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology (W.L., X.J.), Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China; School of Statistics (L.L.), University of Minnesota at Twin Cities, Minneapolis; Department of Internal Medicine (H.K.), University of New Mexico, Albuquerque; Department of Neurology (M.F.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Department of Pharmaceutical Sciences (K.J.L.), University of New Mexico Health Sciences Center, Albuquerque
| | - Qingfeng Ma
- From the Cerebrovascular Diseases Research Institute (W.L., Z.Q., X.J.) and the Departments of Neurology (Q.M., Jiayue Ding, C.W., H.S., L.W., K.J., W.Z., C.S., N.L.), Radiology (Q.Y.), Emergency (Jiangang Duan, C.L.), and Neurosurgery (X.J.), Xuanwu Hospital of Capital Medical University, Beijing; Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology (W.L., X.J.), Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China; School of Statistics (L.L.), University of Minnesota at Twin Cities, Minneapolis; Department of Internal Medicine (H.K.), University of New Mexico, Albuquerque; Department of Neurology (M.F.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Department of Pharmaceutical Sciences (K.J.L.), University of New Mexico Health Sciences Center, Albuquerque
| | - Jiayue Ding
- From the Cerebrovascular Diseases Research Institute (W.L., Z.Q., X.J.) and the Departments of Neurology (Q.M., Jiayue Ding, C.W., H.S., L.W., K.J., W.Z., C.S., N.L.), Radiology (Q.Y.), Emergency (Jiangang Duan, C.L.), and Neurosurgery (X.J.), Xuanwu Hospital of Capital Medical University, Beijing; Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology (W.L., X.J.), Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China; School of Statistics (L.L.), University of Minnesota at Twin Cities, Minneapolis; Department of Internal Medicine (H.K.), University of New Mexico, Albuquerque; Department of Neurology (M.F.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Department of Pharmaceutical Sciences (K.J.L.), University of New Mexico Health Sciences Center, Albuquerque
| | - Chuanjie Wu
- From the Cerebrovascular Diseases Research Institute (W.L., Z.Q., X.J.) and the Departments of Neurology (Q.M., Jiayue Ding, C.W., H.S., L.W., K.J., W.Z., C.S., N.L.), Radiology (Q.Y.), Emergency (Jiangang Duan, C.L.), and Neurosurgery (X.J.), Xuanwu Hospital of Capital Medical University, Beijing; Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology (W.L., X.J.), Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China; School of Statistics (L.L.), University of Minnesota at Twin Cities, Minneapolis; Department of Internal Medicine (H.K.), University of New Mexico, Albuquerque; Department of Neurology (M.F.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Department of Pharmaceutical Sciences (K.J.L.), University of New Mexico Health Sciences Center, Albuquerque
| | - Haiqing Song
- From the Cerebrovascular Diseases Research Institute (W.L., Z.Q., X.J.) and the Departments of Neurology (Q.M., Jiayue Ding, C.W., H.S., L.W., K.J., W.Z., C.S., N.L.), Radiology (Q.Y.), Emergency (Jiangang Duan, C.L.), and Neurosurgery (X.J.), Xuanwu Hospital of Capital Medical University, Beijing; Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology (W.L., X.J.), Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China; School of Statistics (L.L.), University of Minnesota at Twin Cities, Minneapolis; Department of Internal Medicine (H.K.), University of New Mexico, Albuquerque; Department of Neurology (M.F.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Department of Pharmaceutical Sciences (K.J.L.), University of New Mexico Health Sciences Center, Albuquerque
| | - Qi Yang
- From the Cerebrovascular Diseases Research Institute (W.L., Z.Q., X.J.) and the Departments of Neurology (Q.M., Jiayue Ding, C.W., H.S., L.W., K.J., W.Z., C.S., N.L.), Radiology (Q.Y.), Emergency (Jiangang Duan, C.L.), and Neurosurgery (X.J.), Xuanwu Hospital of Capital Medical University, Beijing; Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology (W.L., X.J.), Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China; School of Statistics (L.L.), University of Minnesota at Twin Cities, Minneapolis; Department of Internal Medicine (H.K.), University of New Mexico, Albuquerque; Department of Neurology (M.F.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Department of Pharmaceutical Sciences (K.J.L.), University of New Mexico Health Sciences Center, Albuquerque
| | - Jiangang Duan
- From the Cerebrovascular Diseases Research Institute (W.L., Z.Q., X.J.) and the Departments of Neurology (Q.M., Jiayue Ding, C.W., H.S., L.W., K.J., W.Z., C.S., N.L.), Radiology (Q.Y.), Emergency (Jiangang Duan, C.L.), and Neurosurgery (X.J.), Xuanwu Hospital of Capital Medical University, Beijing; Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology (W.L., X.J.), Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China; School of Statistics (L.L.), University of Minnesota at Twin Cities, Minneapolis; Department of Internal Medicine (H.K.), University of New Mexico, Albuquerque; Department of Neurology (M.F.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Department of Pharmaceutical Sciences (K.J.L.), University of New Mexico Health Sciences Center, Albuquerque
| | - Lan Liu
- From the Cerebrovascular Diseases Research Institute (W.L., Z.Q., X.J.) and the Departments of Neurology (Q.M., Jiayue Ding, C.W., H.S., L.W., K.J., W.Z., C.S., N.L.), Radiology (Q.Y.), Emergency (Jiangang Duan, C.L.), and Neurosurgery (X.J.), Xuanwu Hospital of Capital Medical University, Beijing; Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology (W.L., X.J.), Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China; School of Statistics (L.L.), University of Minnesota at Twin Cities, Minneapolis; Department of Internal Medicine (H.K.), University of New Mexico, Albuquerque; Department of Neurology (M.F.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Department of Pharmaceutical Sciences (K.J.L.), University of New Mexico Health Sciences Center, Albuquerque
| | - Huining Kang
- From the Cerebrovascular Diseases Research Institute (W.L., Z.Q., X.J.) and the Departments of Neurology (Q.M., Jiayue Ding, C.W., H.S., L.W., K.J., W.Z., C.S., N.L.), Radiology (Q.Y.), Emergency (Jiangang Duan, C.L.), and Neurosurgery (X.J.), Xuanwu Hospital of Capital Medical University, Beijing; Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology (W.L., X.J.), Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China; School of Statistics (L.L.), University of Minnesota at Twin Cities, Minneapolis; Department of Internal Medicine (H.K.), University of New Mexico, Albuquerque; Department of Neurology (M.F.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Department of Pharmaceutical Sciences (K.J.L.), University of New Mexico Health Sciences Center, Albuquerque
| | - Longfei Wu
- From the Cerebrovascular Diseases Research Institute (W.L., Z.Q., X.J.) and the Departments of Neurology (Q.M., Jiayue Ding, C.W., H.S., L.W., K.J., W.Z., C.S., N.L.), Radiology (Q.Y.), Emergency (Jiangang Duan, C.L.), and Neurosurgery (X.J.), Xuanwu Hospital of Capital Medical University, Beijing; Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology (W.L., X.J.), Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China; School of Statistics (L.L.), University of Minnesota at Twin Cities, Minneapolis; Department of Internal Medicine (H.K.), University of New Mexico, Albuquerque; Department of Neurology (M.F.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Department of Pharmaceutical Sciences (K.J.L.), University of New Mexico Health Sciences Center, Albuquerque
| | - Kangxiang Ji
- From the Cerebrovascular Diseases Research Institute (W.L., Z.Q., X.J.) and the Departments of Neurology (Q.M., Jiayue Ding, C.W., H.S., L.W., K.J., W.Z., C.S., N.L.), Radiology (Q.Y.), Emergency (Jiangang Duan, C.L.), and Neurosurgery (X.J.), Xuanwu Hospital of Capital Medical University, Beijing; Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology (W.L., X.J.), Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China; School of Statistics (L.L.), University of Minnesota at Twin Cities, Minneapolis; Department of Internal Medicine (H.K.), University of New Mexico, Albuquerque; Department of Neurology (M.F.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Department of Pharmaceutical Sciences (K.J.L.), University of New Mexico Health Sciences Center, Albuquerque.
| | - Wenbo Zhao
- From the Cerebrovascular Diseases Research Institute (W.L., Z.Q., X.J.) and the Departments of Neurology (Q.M., Jiayue Ding, C.W., H.S., L.W., K.J., W.Z., C.S., N.L.), Radiology (Q.Y.), Emergency (Jiangang Duan, C.L.), and Neurosurgery (X.J.), Xuanwu Hospital of Capital Medical University, Beijing; Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology (W.L., X.J.), Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China; School of Statistics (L.L.), University of Minnesota at Twin Cities, Minneapolis; Department of Internal Medicine (H.K.), University of New Mexico, Albuquerque; Department of Neurology (M.F.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Department of Pharmaceutical Sciences (K.J.L.), University of New Mexico Health Sciences Center, Albuquerque
| | - Chuanhui Li
- From the Cerebrovascular Diseases Research Institute (W.L., Z.Q., X.J.) and the Departments of Neurology (Q.M., Jiayue Ding, C.W., H.S., L.W., K.J., W.Z., C.S., N.L.), Radiology (Q.Y.), Emergency (Jiangang Duan, C.L.), and Neurosurgery (X.J.), Xuanwu Hospital of Capital Medical University, Beijing; Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology (W.L., X.J.), Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China; School of Statistics (L.L.), University of Minnesota at Twin Cities, Minneapolis; Department of Internal Medicine (H.K.), University of New Mexico, Albuquerque; Department of Neurology (M.F.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Department of Pharmaceutical Sciences (K.J.L.), University of New Mexico Health Sciences Center, Albuquerque
| | - Chenghe Sun
- From the Cerebrovascular Diseases Research Institute (W.L., Z.Q., X.J.) and the Departments of Neurology (Q.M., Jiayue Ding, C.W., H.S., L.W., K.J., W.Z., C.S., N.L.), Radiology (Q.Y.), Emergency (Jiangang Duan, C.L.), and Neurosurgery (X.J.), Xuanwu Hospital of Capital Medical University, Beijing; Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology (W.L., X.J.), Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China; School of Statistics (L.L.), University of Minnesota at Twin Cities, Minneapolis; Department of Internal Medicine (H.K.), University of New Mexico, Albuquerque; Department of Neurology (M.F.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Department of Pharmaceutical Sciences (K.J.L.), University of New Mexico Health Sciences Center, Albuquerque
| | - Na Li
- From the Cerebrovascular Diseases Research Institute (W.L., Z.Q., X.J.) and the Departments of Neurology (Q.M., Jiayue Ding, C.W., H.S., L.W., K.J., W.Z., C.S., N.L.), Radiology (Q.Y.), Emergency (Jiangang Duan, C.L.), and Neurosurgery (X.J.), Xuanwu Hospital of Capital Medical University, Beijing; Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology (W.L., X.J.), Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China; School of Statistics (L.L.), University of Minnesota at Twin Cities, Minneapolis; Department of Internal Medicine (H.K.), University of New Mexico, Albuquerque; Department of Neurology (M.F.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Department of Pharmaceutical Sciences (K.J.L.), University of New Mexico Health Sciences Center, Albuquerque
| | - Marc Fisher
- From the Cerebrovascular Diseases Research Institute (W.L., Z.Q., X.J.) and the Departments of Neurology (Q.M., Jiayue Ding, C.W., H.S., L.W., K.J., W.Z., C.S., N.L.), Radiology (Q.Y.), Emergency (Jiangang Duan, C.L.), and Neurosurgery (X.J.), Xuanwu Hospital of Capital Medical University, Beijing; Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology (W.L., X.J.), Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China; School of Statistics (L.L.), University of Minnesota at Twin Cities, Minneapolis; Department of Internal Medicine (H.K.), University of New Mexico, Albuquerque; Department of Neurology (M.F.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Department of Pharmaceutical Sciences (K.J.L.), University of New Mexico Health Sciences Center, Albuquerque
| | - Xunming Ji
- From the Cerebrovascular Diseases Research Institute (W.L., Z.Q., X.J.) and the Departments of Neurology (Q.M., Jiayue Ding, C.W., H.S., L.W., K.J., W.Z., C.S., N.L.), Radiology (Q.Y.), Emergency (Jiangang Duan, C.L.), and Neurosurgery (X.J.), Xuanwu Hospital of Capital Medical University, Beijing; Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology (W.L., X.J.), Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China; School of Statistics (L.L.), University of Minnesota at Twin Cities, Minneapolis; Department of Internal Medicine (H.K.), University of New Mexico, Albuquerque; Department of Neurology (M.F.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Department of Pharmaceutical Sciences (K.J.L.), University of New Mexico Health Sciences Center, Albuquerque.
| | - Ke Jian Liu
- From the Cerebrovascular Diseases Research Institute (W.L., Z.Q., X.J.) and the Departments of Neurology (Q.M., Jiayue Ding, C.W., H.S., L.W., K.J., W.Z., C.S., N.L.), Radiology (Q.Y.), Emergency (Jiangang Duan, C.L.), and Neurosurgery (X.J.), Xuanwu Hospital of Capital Medical University, Beijing; Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology (W.L., X.J.), Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China; School of Statistics (L.L.), University of Minnesota at Twin Cities, Minneapolis; Department of Internal Medicine (H.K.), University of New Mexico, Albuquerque; Department of Neurology (M.F.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Department of Pharmaceutical Sciences (K.J.L.), University of New Mexico Health Sciences Center, Albuquerque
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Lansberg MG, Wintermark M, Kidwell CS, Albers GW. Magnetic Resonance Imaging of Cerebrovascular Diseases. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00048-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Barnett HM, Davis AP, Khot SP. Stroke and breathing. HANDBOOK OF CLINICAL NEUROLOGY 2022; 189:201-222. [PMID: 36031305 DOI: 10.1016/b978-0-323-91532-8.00016-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Stroke remains a leading cause of neurologic disability with wide ranging effects, including a variety of respiratory abnormalities. Stroke may influence the central control of the respiratory drive and breathing pattern, airway protection and maintenance, and the respiratory mechanics of inspiration and expiration. In the acute phase of stroke, the central control of breathing is affected by changes in consciousness, cerebral edema, and direct damage to brainstem respiratory centers, resulting in abnormalities in respiratory pattern and loss of airway protection. Common acute complications related to respiratory dysfunction include dysphagia, aspiration, and pneumonia. Respiratory control centers are located in the brainstem, and brainstem stroke causes specific patterns of respiratory dysfunction. Depending on the exact location and extent of stroke, respiratory failure may occur. While major respiratory abnormalities often improve over time, sleep-disordered breathing remains common in the subacute and chronic phases and worsens outcomes. Respiratory mechanics are impaired in hemiplegic or hemiparetic stroke, contributing to worse cardiopulmonary health in stroke survivors. Interventions to address the respiratory complications are under researched, and further investigation in this area is critical to improving outcomes among stroke survivors.
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Affiliation(s)
- Heather M Barnett
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | - Arielle P Davis
- Department of Neurology, University of Washington, Seattle, WA, United States
| | - Sandeep P Khot
- Department of Neurology, University of Washington, Seattle, WA, United States.
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Eslami M, Oryan SH, Rahnema M, Bigdeli MR. Neuroprotective Effects of Normobaric Hyperoxia and Transplantation of Encapsulated Choroid Plexus Epithelial Cells on The Focal Brain Ischemia. CELL JOURNAL 2021; 23:303-312. [PMID: 34308573 PMCID: PMC8286464 DOI: 10.22074/cellj.2021.7204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 12/21/2020] [Indexed: 01/01/2023]
Abstract
Objective Choroid plexus epithelial cells (CPECs) have the epithelial characteristic, produce cerebrospinal fluid,
contribute to the detoxification process in the central nervous system (CNS), and are responsible for the synthesis and
release of many nerve growth factors. On the other hand, studies suggest that normobaric hyperoxia (HO) by induction
of ischemic tolerance (IT) can protect against brain damage and neurological diseases. We examined the effect of
combination therapy of encapsulated CPECs and HO to protect against ischemic brain injury.
Materials and Methods In this experimental study, six groups of adult male Wistar rats were randomly organized:
sham, room air (RA)+middle cerebral artery occlusion (MCAO), HO+MCAO, RA+MCAO+encapsulated CPECs,
HO+MCAO+encapsulated CPECs, RA+MCAO+empty capsules. RA/HO were pretreatment. The CPECs were isolated
from the brain of neonatal Wistar rats, cultured, and encapsulated. Then microencapsulated CPECs were transplanted
in the neck of the animal immediately after the onset of reperfusion in adult rats that had been exposed to 60 minutes
MCAO. After 23 hours of reperfusion, the neurologic deficit score (NDS) was assessed. Next, rats were killed, and
brains were isolated for measuring brain infarction volume, blood-brain barrier (BBB) permeability, edema, the activity
of superoxide dismutase (SOD), and catalase (CAT) and also, the level of malondialdehyde (MDA). Results Our results showed that NDS decreased equally in HO+MCAO, RA+MCAO+encapsulated CPECs, and
HO+MCAO+encapsulated CPECs groups. Brain infarction volume decreased up 79%, BBB stability increased, edema
decreased, SOD and CAT activities increased, and MDA decreased in the combination group of HO and transplantation
of encapsulated CPECs in the ischemic brain as compared with when HO or transplantation of encapsulated CPECs was
applied alone.
Conclusion The combination of HO and transplantation of encapsulated CPECs for stroke in rats was more effective
than the other treatments, and it can be taken into account as a promising treatment for ischemic stroke.
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Affiliation(s)
- Maesumeh Eslami
- Department of Animal Physiology, Faculty of Biological Sciences, Kharazmi University, Tehran, Iran.
| | - S Hahrbanoo Oryan
- Department of Animal Physiology, Faculty of Biological Sciences, Kharazmi University, Tehran, Iran
| | - Mehdi Rahnema
- Biology Research Center, Zanjan Branch, Islamic Azad University, Zanjan, Iran
| | - Mohammad Reza Bigdeli
- Department of Animal Sciences and Biotechnology, Faculty of Life Sciences and Biotechnology, Shahid Beheshti University, Tehran, Iran. .,Inistitute for Cognitive and Brain Science, Shahid Beheshti University, Tehran, Iran
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Ding JY, Liu Y, Rajah GB, Chen ZY, Zhang SY, Ding YC, Ji XM, Meng R. Normobaric oxygen may correct chronic cerebral ischemia-mediated EEG anomalies. CNS Neurosci Ther 2021; 27:1214-1223. [PMID: 34242498 PMCID: PMC8446210 DOI: 10.1111/cns.13703] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 06/09/2021] [Accepted: 06/25/2021] [Indexed: 01/03/2023] Open
Abstract
AIMS To explore the safety and efficacy of normobaric oxygen (NBO) on correcting chronic cerebral ischemia (CCI) and related EEG anomalies. METHODS This prospective randomized trial (NCT03745092) enrolled 50 cases of CCI patients, which were divided into NBO (8 L/min of oxygen supplement) group and control group (room air) randomly, and also enrolled 21 healthy volunteers. Two times of 30-min EEG recordings with the interval of 45min of NBO or room air were analyzed quantitatively. RESULTS The CCI-mediated EEG presented with two patterns of electrical activities: high-power oscillations (high-power EEG, n = 26) and paroxysmal slow activities under the normal-power background (normal-power EEG, n = 24). The fronto-central absolute power (AP) of the beta, alpha, theta, and delta in the high-power EEG was higher than that in healthy EEG (p < 0.05). The fronto-central theta/alpha, delta/alpha and (delta + theta)/(alpha + beta) ratios in the normal-power EEG were higher than those in healthy EEG (p < 0.05). The high-power EEG in NBO group had higher fronto-central AP reduction rates than those in control group (p < 0.05). NBO remarkably reduced the fronto-central theta/alpha, delta/alpha, and (delta + theta)/(alpha + beta) ratios in the normal-power EEG (p < 0.05). CONCLUSIONS NBO rapidly ameliorates CCI-mediated EEG anomalies, including attenuation of the abnormal high-power oscillations and the paroxysmal slow activities associated with CCI.
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Affiliation(s)
- Jia-Yue Ding
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
| | - Yu Liu
- Epilepsy Center, Beijing Fengtai You'anmen Hospital, Beijing, China
| | - Gary-B Rajah
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Zhi-Ying Chen
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Shi-Yong Zhang
- Department of Interventional Neurology, Beijing Fengtai You'anmen Hospital, Beijing, China
| | - Yu-Chuan Ding
- Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China.,Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Xun-Ming Ji
- Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China.,Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ran Meng
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
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7
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Li N, Wu L, Zhao W, Dornbos D, Wu C, Li W, Wu D, Ding J, Ding Y, Xie Y, Ji X. Efficacy and safety of normobaric hyperoxia combined with intravenous thrombolysis on acute ischemic stroke patients. Neurol Res 2021; 43:809-814. [PMID: 34126868 DOI: 10.1080/01616412.2021.1939234] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Intravenous thrombolysis elevates the prognostic level of acute ischemic stroke (AIS) patients. Normobaric hyperoxia (NBO) delays the progression of the infarct core and promotes neurological recovery. However, it is uncertain whether NBO can further raise the prognostic level of AIS patients based on intravenous thrombolysis. To explore the efficacy and safety of NBO combined with intravenous thrombolysis on AIS patients. This observational study included anterior circulation stroke patients who received intravenous thrombolysis within 4.5 h after stroke onset. These patients were divided into two groups based on whether or not they received NBO therapy. The baseline data and the prognosis of the two groups were compared. The primary outcome was the proportion of functional independence (modified Rankin Scale 0-2) at 90 days post discharge. A total of 227 patients were included in this study. 125 patients received NBO therapy combined with intravenous thrombolysis, while 102 patients received intravenous thrombolysis only. Overall, the rate of recanalization was 83.3%. Consequently, 101 patients (80.8%) who received NBO combined with intravenous thrombolysis and 63 patients (61.8%) in the control group achieved functional independence (P = 0.002). Multivariable logistic regression analysis showed that NBO combined with intravenous thrombolysis over intravenous thrombolysis alone was associated with 90-day functional independence (OR: 2.318; 95% CI: 1.226-4.381; P = 0.01). This study verified the efficacy and safety of NBO combined with intravenous thrombolysis in AIS patients. Prospective study is needed to further substantiate these findings.
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Affiliation(s)
- Na Li
- Department of Neurology and China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China.,Department of Neurology, Beijing Renhe Hospital, Beijing, China
| | - Longfei Wu
- Department of Neurology and China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wenbo Zhao
- Department of Neurology and China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - David Dornbos
- Department of Neurological Surgery, Semmes-Murphey Clinic and University of Tennessee Health Science Center, Memphis, TN, USA
| | - Chuanjie Wu
- Department of Neurology and China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Weili Li
- Department of Neurology and China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Di Wu
- Department of Neurology and China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jianping Ding
- Department of Neurology and China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yuchuan Ding
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Yunyan Xie
- Department of Neurology and China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xunming Ji
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
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8
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Shiga Y, Nezu T, Nakamori M, Hosomi N, Akiyama Y, Tachiyama K, Kamimura T, Kinoshita N, Hayashi Y, Matsushima H, Imamura E, Aoki S, Ueno H, Ohshita T, Wakabayashi S, Yamasaki F, Awai K, Maruyama H. Utility of Magnetic Resonance Spectroscopy for the Progression of Neurological Symptoms in Lenticulostriate Artery Territory Infarction. J Stroke Cerebrovasc Dis 2021; 30:105747. [PMID: 33784520 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105747] [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: 01/04/2021] [Revised: 02/24/2021] [Accepted: 03/08/2021] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVES The present study aimed to examine the effectiveness of proton magnetic resonance spectroscopy (1HMRS) in determining the progression of neurological symptoms resulting in acute ischemic stroke in patients with lenticulostriate artery (LSA) infarction. MATERIALS AND METHODS 1HMRS was performed within 72 h after neurological symptom onset. Voxel of interest was placed in tissue that included the pyramidal tract and identified diffusion weighted echo planar spin-echo sequence (DWI) coronal images. Infarct volume in DWI was calculated using the ABC/2 method. 1HMRS data (tNAA, tCr, Glx, tCho, and Ins) were analyzed using LCModel. Progressive neurological symptoms were defined as an increase of 1 or more in the NIHSS score. Patients who underwent 1HMRS after progressive neurological symptoms were excluded. RESULTS In total, 77 patients were enrolled. Of these, 19 patients had progressive neurological symptoms. The patients with progressive neurological symptoms were significantly more likely to be female and had higher tCho/tCr values, higher rates of axial slices ≥ 3 slices on DWI, higher infarct volume on DWI, higher maximum diameter of infarction of axial slice on DWI, and higher SBP on admission compared to those without. Multivariable logistic analysis revealed that higher tCho/tCr values were independently associated with progressive neurological symptoms after adjusting for age, sex, and initial DWI infarct volume (tCho/tCr per 0.01 increase, OR 1.26, 95% CI 1.03-1.52, P = 0.022). CONCLUSIONS Increased tCho/tCr score were associated with progressive neurological symptoms in patients with LSA ischemic stroke. Quantitative evaluation of 1HMRS parameters may be useful for predicting the progression of neurological symptoms.
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Affiliation(s)
- Yuji Shiga
- Department of Clinical Neuroscience and Therapeutics, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
| | - Tomohisa Nezu
- Department of Clinical Neuroscience and Therapeutics, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
| | - Masahiro Nakamori
- Department of Clinical Neuroscience and Therapeutics, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan; Department of Neurology, Suiseikai Kajikawa Hospital, Hiroshima, Japan.
| | - Naohisa Hosomi
- Department of Neurology, Chikamori Hospital, Kochi, Japan; Department of Disease Model, Research Institute of Radiation Biology and Medicine, Hiroshima University, Japan.
| | - Yuji Akiyama
- Department of Clinical Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
| | - Keisuke Tachiyama
- Department of Clinical Neuroscience and Therapeutics, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
| | - Teppei Kamimura
- Department of Clinical Neuroscience and Therapeutics, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan; Department of Neurology, Suiseikai Kajikawa Hospital, Hiroshima, Japan.
| | - Naoto Kinoshita
- Department of Clinical Neuroscience and Therapeutics, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
| | - Yuki Hayashi
- Department of Clinical Neuroscience and Therapeutics, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan; Department of Neurology, Suiseikai Kajikawa Hospital, Hiroshima, Japan.
| | - Hayato Matsushima
- Department of Neurology, Suiseikai Kajikawa Hospital, Hiroshima, Japan.
| | - Eiji Imamura
- Department of Neurology, Suiseikai Kajikawa Hospital, Hiroshima, Japan.
| | - Shiro Aoki
- Department of Clinical Neuroscience and Therapeutics, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
| | - Hiroki Ueno
- Department of Clinical Neuroscience and Therapeutics, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
| | - Tomohiko Ohshita
- Department of Clinical Neuroscience and Therapeutics, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
| | | | - Fumiyuki Yamasaki
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
| | - Kazuo Awai
- Department of Diagnostic Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
| | - Hirofumi Maruyama
- Department of Clinical Neuroscience and Therapeutics, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
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9
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Humaloja J, Skrifvars MB, Raj R, Wilkman E, Pekkarinen PT, Bendel S, Reinikainen M, Litonius E. The Association Between Arterial Oxygen Level and Outcome in Neurocritically Ill Patients is not Affected by Blood Pressure. Neurocrit Care 2021; 34:413-422. [PMID: 33403587 PMCID: PMC8128839 DOI: 10.1007/s12028-020-01178-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 12/04/2020] [Indexed: 11/27/2022]
Abstract
Background In neurocritically ill patients, one early mechanism behind secondary brain injury is low systemic blood pressure resulting in inadequate cerebral perfusion and consequent hypoxia. Intuitively, higher partial pressures of arterial oxygen (PaO2) could be protective in case of inadequate cerebral circulation related to hemodynamic instability. Study purpose We examined whether the association between PaO2 and mortality is different in patients with low compared to normal and high mean arterial pressure (MAP) in patients after various types of brain injury. Methods We screened the Finnish Intensive Care Consortium database for mechanically ventilated adult (≥ 18) brain injury patients treated in several tertiary intensive care units (ICUs) between 2003 and 2013. Admission diagnoses included traumatic brain injury, cardiac arrest, subarachnoid and intracranial hemorrhage, and acute ischemic stroke. The primary exposures of interest were PaO2 (recorded in connection with the lowest measured PaO2/fraction of inspired oxygen ratio) and the lowest MAP, recorded during the first 24 h in the ICU. PaO2 was grouped as follows: hypoxemia (< 8.2 kPa, the lowest 10th percentile), normoxemia (8.2–18.3 kPa), and hyperoxemia (> 18.3 kPa, the highest 10th percentile), and MAP was divided into equally sized tertiles (< 60, 60–68, and > 68 mmHg). The primary outcome was 1-year mortality. We tested the association between hyperoxemia, MAP, and mortality with a multivariable logistic regression model, including the PaO2, MAP, and interaction of PaO2*MAP, adjusting for age, admission diagnosis, premorbid physical performance, vasoactive use, intracranial pressure monitoring use, and disease severity. The relationship between predicted 1-year mortality and PaO2 was visualized with locally weighted scatterplot smoothing curves (Loess) for different MAP levels. Results From a total of 8290 patients, 3912 (47%) were dead at 1 year. PaO2 was not an independent predictor of mortality: the odds ratio (OR) for hyperoxemia was 1.16 (95% CI 0.85–1.59) and for hypoxemia 1.24 (95% CI 0.96–1.61) compared to normoxemia. Higher MAP predicted lower mortality: OR for MAP 60–68 mmHg was 0.73 (95% CI 0.64–0.84) and for MAP > 68 mmHg 0.80 (95% CI 0.69–0.92) compared to MAP < 60 mmHg. The interaction term PaO2*MAP was nonsignificant. In Loess visualization, the relationship between PaO2 and predicted mortality appeared similar in all MAP tertiles. Conclusions During the first 24 h of ICU treatment in mechanically ventilated brain injured patients, the association between PaO2 and mortality was not different in patients with low compared to normal MAP. Supplementary Information The online version of this article (10.1007/s12028-020-01178-w) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jaana Humaloja
- Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Markus B Skrifvars
- Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Rahul Raj
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Erika Wilkman
- Division of Intensive Care Medicine, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Pirkka T Pekkarinen
- Division of Intensive Care Medicine, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Stepani Bendel
- Department of Anesthesiology and Intensive Care, Kuopio University Hospital & University of Eastern Finland, Kuopio, Finland
| | - Matti Reinikainen
- Department of Anesthesiology and Intensive Care, Kuopio University Hospital & University of Eastern Finland, Kuopio, Finland
| | - Erik Litonius
- Division of Anesthesiology, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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10
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Dylla L, Cushman JT, Abar B, Benesch C, Jones CMC, O'Banion MK, Adler DH. Retrospective analysis of the hemodynamic consequences of prehospital supplemental oxygen in acute stroke. Am J Emerg Med 2020; 38:2125-2129. [PMID: 33069547 DOI: 10.1016/j.ajem.2020.07.021] [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: 03/18/2020] [Revised: 06/19/2020] [Accepted: 07/05/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE Hyperoxia, the delivery of high levels of supplemental oxygen (sO2) despite normoxia, may increase cerebral oxygenation to penumbral tissue and improve stroke outcomes. However, it may also alter peripheral hemodynamic profiles with potential negative effects on cerebral blood flow (CBF). This study examines the hemodynamic consequences of prehospital sO2 in stroke. METHODS A retrospective analysis of adult acute stroke patients (aged ≥18 years) presenting via EMS to an academic Comprehensive Stroke Center between January 1, 2013 and December 31, 2017 was conducted using demographic and clinical characteristics obtained from Get with the Guidelines-Stroke registry and subjects' medical records. Outcomes were compared across three groups based on prehospital oxygen saturation and sO2 administration. Chi-square, ANOVA, and multivariable linear regression were used to determine if sO2 was associated with differences in peripheral hemodynamic profiles. RESULTS All subjects had similar initial EMS vitals except for oxygen saturation. However, both univariate and multivariable analysis revealed that hyperoxia subjects had slightly lower average ED mean arterial pressures (MAP) compared to normoxia (Cohen's d = 0.313). CONCLUSIONS Prehospital-initiated hyperoxia for acute stroke is associated with a small, but significant decrease in average ED MAP, without changes in heart rate, compared to normoxia. While limited by the inability to link changes in peripheral hemodynamical profiles directly to changes in CBF, this study suggests that hyperoxia may result in a relative hypotension. Further studies are needed to determine if this small change in peripheral vascular resistance translates into a clinically significant reduced CBF.
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Affiliation(s)
- Layne Dylla
- Department of Emergency Medicine, University of Rochester Medical Center, 601 Elmwood Ave., Box 655C, Rochester, NY 14642, USA.
| | - Jeremy T Cushman
- Department of Emergency Medicine, University of Rochester Medical Center, 601 Elmwood Ave., Box 655C, Rochester, NY 14642, USA
| | - Beau Abar
- Department of Emergency Medicine, University of Rochester Medical Center, 601 Elmwood Ave., Box 655C, Rochester, NY 14642, USA
| | - Curtis Benesch
- Comprehensive Stroke Center, Department of Neurology, University of Rochester Medical Center, 601 Elmwood Ave., Rochester, NY 14642, USA
| | - Courtney M C Jones
- Department of Emergency Medicine, University of Rochester Medical Center, 601 Elmwood Ave., Box 655C, Rochester, NY 14642, USA
| | - M Kerry O'Banion
- Department of Neuroscience, University of Rochester Medical Center, 601 Elmwood Ave., Box 603, Rochester, NY 14642, USA
| | - David H Adler
- Department of Emergency Medicine, University of Rochester Medical Center, 601 Elmwood Ave., Box 655C, Rochester, NY 14642, USA
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11
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Hyperbaric oxygen therapy in acute stroke: is it time for Justitia to open her eyes? Neurol Sci 2020; 41:1381-1390. [PMID: 31925614 DOI: 10.1007/s10072-020-04241-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 01/06/2020] [Indexed: 01/27/2023]
Abstract
Hypoxia is a critical component of neuronal death in patients with stroke. Therefore increasing oxygenation of brain tissue seems to be a logical therapy against cerebral ischemia. Oxygen therapy exists in two modalities: normobaric hyperoxia therapy and hyperbaric oxygen therapy (HBO). HBO is a therapeutic procedure in which pure (100%) oxygen is administered at greater than atmospheric pressure in HBO therapy chambers. In this review article, we aimed to summarize the current knowledge regarding the therapeutic use of HBO in acute stroke patients. Literature review and electronic search were performed using PubMed, Medscape, and UpToDate with the keywords stroke, acute stroke, hyperbaric oxygen therapy, and hyperoxia. According to the reviewed literature, the use of HBO as routine stroke therapy cannot be justified in acute stage of stroke. More randomized, controlled studies are needed regarding safety and especially effectives of HBO in stroke patients. Also, standardized definitionof HBO should be proposed and used in all future studies.
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12
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Robba C, Bonatti G, Battaglini D, Rocco PRM, Pelosi P. Mechanical ventilation in patients with acute ischaemic stroke: from pathophysiology to clinical practice. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2019; 23:388. [PMID: 31791375 PMCID: PMC6889568 DOI: 10.1186/s13054-019-2662-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 10/25/2019] [Indexed: 12/17/2022]
Abstract
Most patients with ischaemic stroke are managed on the ward or in specialty stroke units, but a significant number requires higher-acuity care and, consequently, admission to the intensive care unit. Mechanical ventilation is frequently performed in these patients due to swallowing dysfunction and airway or respiratory system compromise. Experimental studies have focused on stroke-induced immunosuppression and brain-lung crosstalk, leading to increased pulmonary damage and inflammation, as well as reduced alveolar macrophage phagocytic capability, which may increase the risk of infection. Pulmonary complications, such as respiratory failure, pneumonia, pleural effusions, acute respiratory distress syndrome, lung oedema, and pulmonary embolism from venous thromboembolism, are common and found to be among the major causes of death in this group of patients. Furthermore, over the past two decades, tracheostomy use has increased among stroke patients, who can have unique indications for this procedure—depending on the location and type of stroke—when compared to the general population. However, the optimal mechanical ventilator strategy remains unclear in this population. Although a high tidal volume (VT) strategy has been used for many years, the latest evidence suggests that a protective ventilatory strategy (VT = 6–8 mL/kg predicted body weight, positive end-expiratory pressure and rescue recruitment manoeuvres) may also have a role in brain-damaged patients, including those with stroke. The aim of this narrative review is to explore the pathophysiology of brain-lung interactions after acute ischaemic stroke and the management of mechanical ventilation in these patients.
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Affiliation(s)
- Chiara Robba
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, University of Genoa, Largo Rosanna Benzi, 15, 16100, Genoa, Italy.
| | - Giulia Bonatti
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, University of Genoa, Largo Rosanna Benzi, 15, 16100, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Denise Battaglini
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, University of Genoa, Largo Rosanna Benzi, 15, 16100, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Patricia R M Rocco
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Paolo Pelosi
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, University of Genoa, Largo Rosanna Benzi, 15, 16100, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
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13
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Dylla L, Adler DH, Abar B, Benesch C, Jones CMC, Kerry O'Banion M, Cushman JT. Prehospital supplemental oxygen for acute stroke - A retrospective analysis. Am J Emerg Med 2019; 38:2324-2328. [PMID: 31787444 DOI: 10.1016/j.ajem.2019.11.002] [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: 08/19/2019] [Revised: 10/02/2019] [Accepted: 11/01/2019] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Brief early administration of supplemental oxygen (sO2) to create hyperoxia may increase oxygenation to penumbral tissue and improve stroke outcomes. Hyperoxia may also result in respiratory compromise and vasoconstriction leading to worse outcomes. This study examines the effects of prehospital sO2 in stroke. METHODS This is a retrospective analysis of adult acute stroke patients (aged ≥18 years) presenting via EMS to an academic Comprehensive Stroke Center between January 1, 2013 and December 31, 2017. Demographic and clinical characteristics obtained from Get with the Guidelines-Stroke registry and subjects' medical records were compared across three groups based on prehospital oxygen saturation and sO2 administration. Chi-square, ANOVA, and multivariate logistic regression were used to determine if sO2 status was associated with neurological outcomes or respiratory complications. RESULTS 1352 eligible patients were identified. 62.7% (n = 848) did not receive sO2 ("controls"), 10.7% (n = 144) received sO2 due to hypoxia ("hypoxia"), and 26.6% (n = 360) received sO2 despite normoxia ("hyperoxia"). The groups represented a continuum from more severe deficits (hypoxia) to less severe deficits (controls): mean prehospital GCS (hypoxia -12, hyperoxia - 2, controls - 14 p ≤ 0.001), mean initial NIHSS (hypoxia - 15, hyperoxia - 13, controls - 8 p < 0.001). After controlling for potential confounders, all groups had similar rates of respiratory complications and favorable neurological outcomes. CONCLUSIONS Hyperoxic subjects had no significant increase in respiratory complications, nor did they differ in neurologic outcomes at discharge when controlling for confounders. While limited by the retrospective nature, this suggests brief, early sO2 for stroke may be safe to evaluate prospectively.
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Affiliation(s)
- Layne Dylla
- Department of Emergency Medicine, University of Rochester Medical Center, 601 Elmwood Ave. Box 655C, Rochester, NY 14642, USA.
| | - David H Adler
- Department of Emergency Medicine, University of Rochester Medical Center, 601 Elmwood Ave. Box 655C, Rochester, NY 14642, USA
| | - Beau Abar
- Department of Emergency Medicine, University of Rochester Medical Center, 601 Elmwood Ave. Box 655C, Rochester, NY 14642, USA
| | - Curtis Benesch
- Comprehensive Stroke Center, Department of Neurology, University of Rochester Medical Center, 601 Elmwood Ave., Rochester, NY 14642, USA
| | - Courtney M C Jones
- Department of Emergency Medicine, University of Rochester Medical Center, 601 Elmwood Ave. Box 655C, Rochester, NY 14642, USA
| | - M Kerry O'Banion
- Department of Neuroscience, University of Rochester Medical Center, Rochester, NY, 601 Elmwood Ave. Box 603, Rochester, NY 14642, USA
| | - Jeremy T Cushman
- Department of Emergency Medicine, University of Rochester Medical Center, 601 Elmwood Ave. Box 655C, Rochester, NY 14642, USA
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14
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Baron JC. Protecting the ischaemic penumbra as an adjunct to thrombectomy for acute stroke. Nat Rev Neurol 2019; 14:325-337. [PMID: 29674752 DOI: 10.1038/s41582-018-0002-2] [Citation(s) in RCA: 106] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
After ischaemic stroke, brain damage can be curtailed by rescuing the 'ischaemic penumbra' - that is, the severely hypoperfused, at-risk but not yet infarcted tissue. Current evidence-based treatments involve restoration of blood flow so as to salvage the penumbra before it evolves into irreversibly damaged tissue, termed the 'core'. Intravenous thrombolysis (IVT) can salvage the penumbra if given within 4.5 h after stroke onset; however, the early recanalization rate is only ~30%. Direct removal of the occluding clot by mechanical thrombectomy considerably improves outcomes over IVT alone, but despite early recanalization in > 80% of cases, ~50% of patients who receive this treatment do not enjoy functional independence, usually because the core is already too large at the time of recanalization. Novel therapies aiming to 'freeze' the penumbra - that is, prevent core growth until recanalization is complete - hold potential as adjuncts to mechanical thrombectomy. This Review focuses on nonpharmacological approaches that aim to restore the physiological balance between oxygen delivery to and oxygen demand of the penumbra. Particular emphasis is placed on normobaric oxygen therapy, hypothermia and sensory stimulation. Preclinical evidence and early pilot clinical trials are critically reviewed, and future directions, including clinical translation and trial design issues, are discussed.
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Affiliation(s)
- Jean-Claude Baron
- Department of Neurology, Hôpital Sainte-Anne, Université Paris 5, INSERM U894, Paris, France.
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15
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Ding J, Zhou D, Liu C, Pan L, Ya J, Ding Y, Ji X, Meng R. Normobaric oxygen: a novel approach for treating chronic cerebral circulation insufficiency. Clin Interv Aging 2019; 14:565-570. [PMID: 30936686 PMCID: PMC6421875 DOI: 10.2147/cia.s190984] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Chronic cerebral circulation insufficiency (CCCI) is viewed as an alarming state induced by long-term reduction in cerebral perfusion, which is associated with neurological deficits and high risk of stroke occurrence or recurrence. CCCI accounts for a large proportion of both outpatients and inpatients with cerebrovascular diseases, while management of CCCI remains a formidable challenge to clinicians. Normobaric oxygen (NBO) is an adjuvant hyperoxygenation intervention supplied with one atmosphere pressure (1 ATA =101.325 kPa). A plethora of studies have demonstrated the efficacy of NBO on the penumbra in acute stroke. NBO has been shown to increase the oxygen pressure, raise the intracranial blood flow, protect blood–brain barrier and enhance neuroprotective effects. As similar underlying mechanisms are shared by the penumbra in stroke and the ischemic–hypoxic brain tissues in CCCI, we speculate that NBO may serve as a promising therapeutic strategy for attenuating short-term symptoms or improving long-term clinical outcomes among patients with CCCI. Due to the scant research exploring the efficacy and safety of NBO for treating CCCI so far, both experimental and clinical studies are warranted to verify our hypothesis in the future.
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Affiliation(s)
- Jiayue Ding
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China, .,Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing 100053, China, .,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing 100053, China,
| | - Da Zhou
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China, .,Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing 100053, China, .,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing 100053, China,
| | - Cheng Liu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China, .,Department of Neurology, Yongxin People's Hospital, Ji'an 343400, China
| | - Liqun Pan
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China, .,Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing 100053, China, .,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing 100053, China,
| | - Jingyuan Ya
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China, .,Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing 100053, China, .,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing 100053, China,
| | - Yuchuan Ding
- Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing 100053, China, .,Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI 48201, USA
| | - Xunming Ji
- Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing 100053, China, .,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing 100053, China, .,Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Ran Meng
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China, .,Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing 100053, China, .,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing 100053, China,
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16
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Zhang Z, Zhang L, Ding Y, Han Z, Ji X. Effects of Therapeutic Hypothermia Combined with Other Neuroprotective Strategies on Ischemic Stroke: Review of Evidence. Aging Dis 2018; 9:507-522. [PMID: 29896438 PMCID: PMC5988605 DOI: 10.14336/ad.2017.0628] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 06/28/2017] [Indexed: 12/19/2022] Open
Abstract
Ischemic stroke is a major cause of death and disability globally, and its incidence is increasing. The only treatment approved by the US Food and Drug Administration for acute ischemic stroke is thrombolytic treatment with recombinant tissue plasminogen activator. As an alternative, therapeutic hypothermia has shown excellent potential in preclinical and small clinical studies, but it has largely failed in large clinical studies. This has led clinicians to explore the combination of therapeutic hypothermia with other neuroprotective strategies. This review examines preclinical and clinical progress towards developing highly effective combination therapy involving hypothermia for stroke patients.
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Affiliation(s)
- Zheng Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Department of Neurology, the First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Linlei Zhang
- Department of Neurology, the Second Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Yuchuan Ding
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Zhao Han
- Department of Neurology, the Second Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Xunming Ji
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
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17
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Ding J, Zhou D, Sui M, Meng R, Chandra A, Han J, Ding Y, Ji X. The effect of normobaric oxygen in patients with acute stroke: a systematic review and meta-analysis. Neurol Res 2018; 40:433-444. [PMID: 29600891 DOI: 10.1080/01616412.2018.1454091] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Normobaric oxygen (NBO) has received considerable attention due to controversial data in brain protection in patients with acute stroke. This study aims to analyze current data of NBO on brain protection as used in the clinic. Methods We searched for and reviewed relevant articles and references from Pubmed, Medline, Embase, Cochrane, and Clincialtrials.gov that were published prior to October 2017. Data from prospective studies were processed using RevMan5.0 software, provided by Cochrane collaboration and transformed using relevant formulas. Results A total of 11 prospective RCT studies including 6366 patients with acute stroke (NBO group, 3207; control group, 3159) were enrolled in this analysis. △NIHSS represented the values of NIHSS at 4, 24 h, or 7 days post-stroke minus baseline NIHSS. Compared to controls, there was a minor trend toward NBO benefits in short-term prognostic indices, as indicated by decreased ΔNIHSS at our defined time points. By contrast, NBO decreased Barthel Index scores between 3 and 7 months, and increased death rates at 3, 6 months, and 1 year, whereas, modified Rankin Scale scores between 3 and 6 months were unchanged. Conclusions The existing trends toward benefits revealed in this meta-analysis help us appreciate the promising value of NBO, although current evidence of NBO on improving clinical outcomes of stroke is insufficient. Well-designed multi-center clinical trials are encouraged and urgently needed to further explore the efficacy of NBO on brain protection.
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Affiliation(s)
- Jiayue Ding
- a Department of Neurology , Xuanwu Hospital, Capital Medical University , Beijing , China.,b Beijing Institute for Brain Disorders , Beijing , China
| | - Da Zhou
- a Department of Neurology , Xuanwu Hospital, Capital Medical University , Beijing , China.,b Beijing Institute for Brain Disorders , Beijing , China
| | - Meng Sui
- c Department of Economics , Fordham University , Bronx , NY , USA
| | - Ran Meng
- a Department of Neurology , Xuanwu Hospital, Capital Medical University , Beijing , China.,b Beijing Institute for Brain Disorders , Beijing , China
| | - Ankush Chandra
- d Department of Neurosurgery , Wayne State University School of Medicine , Detroit , MI , USA.,e Department of Neurosurgery , University of California San Francisco , San Francisco, CA , USA
| | - Jie Han
- f Department of Neurology , The First Affiliated Hospital of Dalian Medical University , Dalian , China
| | - Yuchuan Ding
- d Department of Neurosurgery , Wayne State University School of Medicine , Detroit , MI , USA
| | - Xunming Ji
- b Beijing Institute for Brain Disorders , Beijing , China.,g Department of Neurosurgery , Xuanwu Hospital, Capital Medical University , Beijing , China
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18
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Seok J, Lee JS, Jeong KY, Lee CM. Association between Systolic Blood Pressure after Thrombolysis and Early Neurological Improvement in Ischaemic Stroke Patients. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791702400304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction This study aimed to evaluate the relationship between systolic blood pressures (SBPs) within 12 hours after intravenous recombinant tissue plasminogen activator (rtPA) treatment and early neurological outcomes. Methods This was a retrospective observational study of acute ischaemic stroke (AIS) patients who received intravenous rtPA administration. SBPs at the time of rtPA bolus and thereafter every hour were collected. The mean, standard deviation, and coefficient of variation values of SBP during the periods of 0-2 h, 2-6 h, and 6-12 h were calculated. The primary outcome was major neurologic improvement (MNI) at 24 hours after thrombolysis. Results Serial measures of SBPs revealed different 12-hour courses between the patients with and without MNI. The difference of SBP tendency was statistically significant (p=0.013). In univariate analysis, patients with MNI showed lower levels of mean SBPs during the periods of 2-6 h and 6-12 h (p=0.030 and p=0.005, respectively), and higher frequency of very early neurologic improvement (VENI) at the end of rtPA infusion (p<0.001). In logistic regression analysis, VENI at 1 h, mean SBP value during 6-12 h, and atrial fibrillation were independently related to MNI at 24 h. Conclusions SBP level during the first 12 hours after intravenous rtPA treatment may be an important clinical factor that is associated with early neurological improvement of AIS patients.
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Affiliation(s)
- J Seok
- Kyung Hee University Medical Center, Department of Emergency Medicine, Seoul, Korea
| | - JS Lee
- Kyung Hee University Medical Center, Department of Emergency Medicine, Seoul, Korea
| | - KY Jeong
- Kyung Hee University Medical Center, Department of Emergency Medicine, Seoul, Korea
| | - CM Lee
- Kyung Hee University, Department of Medicine, Graduate School, Seoul, Korea
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19
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Sheng M, Liu P, Mao D, Ge Y, Lu H. The impact of hyperoxia on brain activity: A resting-state and task-evoked electroencephalography (EEG) study. PLoS One 2017; 12:e0176610. [PMID: 28464001 PMCID: PMC5412995 DOI: 10.1371/journal.pone.0176610] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 04/13/2017] [Indexed: 12/17/2022] Open
Abstract
A better understanding of the effect of oxygen on brain electrophysiological activity may provide a more mechanistic insight into clinical studies that use oxygen treatment in pathological conditions, as well as in studies that use oxygen to calibrate functional magnetic resonance imaging (fMRI) signals. This study applied electroencephalography (EEG) in healthy subjects and investigated how high a concentration of oxygen in inhaled air (i.e., normobaric hyperoxia) alters brain activity under resting-state and task-evoked conditions. Study 1 investigated its impact on resting EEG and revealed that hyperoxia suppressed α (8-13Hz) and β (14-35Hz) band power (by 15.6±2.3% and 14.1±3.1%, respectively), but did not change the δ (1-3Hz), θ (4-7Hz), and γ (36-75Hz) bands. Sham control experiments did not result in such changes. Study 2 reproduced these findings, and, furthermore, examined the effect of hyperoxia on visual stimulation event-related potentials (ERP). It was found that the main peaks of visual ERP, specifically N1 and P2, were both delayed during hyperoxia compared to normoxia (P = 0.04 and 0.02, respectively). In contrast, the amplitude of the peaks did not show a change. Our results suggest that hyperoxia has a pronounced effect on brain neural activity, for both resting-state and task-evoked potentials.
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Affiliation(s)
- Min Sheng
- Advanced Imaging Research Center, The University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Peiying Liu
- Advanced Imaging Research Center, The University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Deng Mao
- Advanced Imaging Research Center, The University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Yulin Ge
- Department of Radiology, New York University Langone Medical Center, New York, New York, United States of America
| | - Hanzhang Lu
- Advanced Imaging Research Center, The University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- * E-mail:
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20
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Dani KA, Moreton FC, Santosh C, Lopez R, Brennan D, Schwarzbauer C, Goutcher C, O'Hare K, Macrae IM, Muir KW. Oxygen challenge magnetic resonance imaging in healthy human volunteers. J Cereb Blood Flow Metab 2017; 37:366-376. [PMID: 26787107 PMCID: PMC5363753 DOI: 10.1177/0271678x15627827] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 11/12/2015] [Accepted: 11/16/2015] [Indexed: 11/15/2022]
Abstract
Oxygen challenge imaging involves transient hyperoxia applied during deoxyhaemoglobin sensitive (T2*-weighted) magnetic resonance imaging and has the potential to detect changes in brain oxygen extraction. In order to develop optimal practical protocols for oxygen challenge imaging, we investigated the influence of oxygen concentration, cerebral blood flow change, pattern of oxygen administration and field strength on T2*-weighted signal. Eight healthy volunteers underwent multi-parametric magnetic resonance imaging including oxygen challenge imaging and arterial spin labelling using two oxygen concentrations (target FiO2 of 100 and 60%) administered consecutively (two-stage challenge) at both 1.5T and 3T. There was a greater signal increase in grey matter compared to white matter during oxygen challenge (p < 0.002 at 3T, P < 0.0001 at 1.5T) and at FiO2 = 100% compared to FiO2 = 60% in grey matter at both field strengths (p < 0.02) and in white matter at 3T only (p = 0.0314). Differences in the magnitude of signal change between 1.5T and 3T did not reach statistical significance. Reduction of T2*-weighted signal to below baseline, after hyperoxia withdrawal, confounded interpretation of two-stage oxygen challenge imaging. Reductions in cerebral blood flow did not obscure the T2*-weighted signal increases. In conclusion, the optimal protocol for further study should utilise target FiO2 = 100% during a single oxygen challenge. Imaging at both 1.5T and 3T is clinically feasible.
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Affiliation(s)
- Krishna A Dani
- Institute of Neuroscience and Psychology, College of Medical Veterinary and Life Sciences, University of Glasgow, Queen Elizabeth University Hospital Glasgow, Glasgow
| | - Fiona C Moreton
- Institute of Neuroscience and Psychology, College of Medical Veterinary and Life Sciences, University of Glasgow, Queen Elizabeth University Hospital Glasgow, Glasgow
| | - Celestine Santosh
- Department of Neuroradiology, Institute of Neurological Sciences, Queen Elizabeth University Hospital Glasgow, Glasgow
| | - Rosario Lopez
- Department of Clinical Physics, Institute of Neurological Sciences, Queen Elizabeth University Hospital Glasgow, Glasgow
| | - David Brennan
- Department of Clinical Physics, Institute of Neurological Sciences, Queen Elizabeth University Hospital Glasgow, Glasgow
| | - Christian Schwarzbauer
- University of Applied Sciences Munich, School of Applied Sciences and Mechatronics, München
| | - Colin Goutcher
- Department of Anaesthetics, Institute of Neurological Sciences, Queen Elizabeth University Hospital Glasgow, Glasgow
| | - Kevin O'Hare
- Department of Anaesthetics, Institute of Neurological Sciences, Queen Elizabeth University Hospital Glasgow, Glasgow
| | - I Mhairi Macrae
- Institute of Neuroscience and Psychology, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow
| | - Keith W Muir
- Institute of Neuroscience and Psychology, College of Medical Veterinary and Life Sciences, University of Glasgow, Queen Elizabeth University Hospital Glasgow, Glasgow
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21
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Seok J, Lee JS, Jeong KY, Choi HS, Hong HP, Ko YG. Association Between Blood Pressure After Thrombolysis and Neurological Outcome in the Elderly Patients With Ischemic Stroke. Ann Geriatr Med Res 2016. [DOI: 10.4235/agmr.2016.20.4.195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Junsoo Seok
- Department of Emergency Medicine, Kyung Hee University College of Medicine, Seoul, Korea
| | - Jong-Seok Lee
- Department of Emergency Medicine, Kyung Hee University College of Medicine, Seoul, Korea
| | - Ki Young Jeong
- Department of Emergency Medicine, Kyung Hee University College of Medicine, Seoul, Korea
| | - Han Sung Choi
- Department of Emergency Medicine, Kyung Hee University College of Medicine, Seoul, Korea
| | - Hoon Pyo Hong
- Department of Emergency Medicine, Kyung Hee University College of Medicine, Seoul, Korea
| | - Young Gwan Ko
- Department of Emergency Medicine, Kyung Hee University College of Medicine, Seoul, Korea
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22
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Shi SH, Qi ZF, Luo YM, Ji XM, Liu KJ. Normobaric oxygen treatment in acute ischemic stroke: a clinical perspective. Med Gas Res 2016; 6:147-153. [PMID: 27867482 PMCID: PMC5110139 DOI: 10.4103/2045-9912.191360] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Acute ischemic stroke is a common and serious neurological disease. Oxygen therapy has been shown to increase oxygen supply to ischemic tissues and improve outcomes after cerebral ischemia/reperfusion. Normobaric hyperoxia (NBO), an easily applicable and non-invasive method, shows protective effects on acute ischemic stroke animals and patients in pilot studies. However, many critical scientific questions are still unclear, such as the therapeutic time window of NBO, the long-term effects and the benefits of NBO in large clinic trials. In this article, we review the current literatures on NBO treatment of acute ischemic stroke in preclinical and clinical studies and try to analyze and identify the key gaps or unknowns in our understanding about NBO. Based on these analyses, we provide suggestions for future studies.
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Affiliation(s)
- Shu-Hai Shi
- Cerebrovascular Diseases Research Institute, Xuanwu Hospital of Capital Medical University, Beijing, China; Pediatric Intensive Care, First Affiliated Hospital of Baotou Medical College, Baotou, Inner Mongolia Autonomous Region, China
| | - Zhi-Feng Qi
- Cerebrovascular Diseases Research Institute, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Yu-Min Luo
- Cerebrovascular Diseases Research Institute, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Xun-Ming Ji
- Cerebrovascular Diseases Research Institute, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Ke Jian Liu
- Cerebrovascular Diseases Research Institute, Xuanwu Hospital of Capital Medical University, Beijing, China; Department of Pharmaceutical Sciences, College of Pharmacy, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
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23
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Rodriguez P, Zhao J, Milman B, Tiwari YV, Duong TQ. Methylene blue and normobaric hyperoxia combination therapy in experimental ischemic stroke. Brain Behav 2016; 6:e00478. [PMID: 27458543 PMCID: PMC4951618 DOI: 10.1002/brb3.478] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 03/11/2016] [Accepted: 03/18/2016] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Ischemic stroke is a global burden that contributes to the disability and mortality of millions of patients. This study aimed to evaluate the efficacy of combined MB (methylene blue) and NBO (normobaric hyperoxia) therapy in experimental ischemic stroke. METHODS Rats with transient (60 min) MCAO (middle cerebral artery occlusion) were treated with: (1) air + vehicle (N = 8), (2) air + MB (N = 8), (3) NBO + vehicle (N = 7), and (4) NBO + MB (N = 9). MB (1 mg/kg) was administered at 30 min, again on days 2, 7, and 14 after stroke. NBO was given during MRI (30-150 min) on day 0, and again 1 h each during MRI on subsequent days. Serial diffusion, perfusion and T2 MRI were performed to evaluate lesion volumes. Foot-fault and cylinder tests were performed to evaluate sensorimotor function. RESULTS The major findings were: (1) NBO + MB therapy showed a greater decrease in infarct volume compared to NBO alone, but similar infarct volume compared to MB alone, (2) NBO + MB therapy accelerated sensorimotor functional recovery compared to NBO or MB alone, (3) Infarct volumes on day 2 did not change significantly from those on day 28 for all four groups, but behavioral function continued to show improved recovery in the NBO + MB group. CONCLUSIONS These findings support the hypothesis that combined NBO + MB further improves functional outcome and reduces infarct volume compared to either treatment alone and these improvements extended up to 28 days.
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Affiliation(s)
- Pavel Rodriguez
- Research Imaging InstituteUniversity of Texas Health Science CenterSan AntonioTexas
- Department of RadiologyUniversity of Texas Health Science CenterSan AntonioTexas
| | - Jiang Zhao
- Research Imaging InstituteUniversity of Texas Health Science CenterSan AntonioTexas
- Department of Anatomy and EmbryologyPeking University Health Science CenterBeijingChina
| | - Brian Milman
- Research Imaging InstituteUniversity of Texas Health Science CenterSan AntonioTexas
| | - Yash Vardhan Tiwari
- Research Imaging InstituteUniversity of Texas Health Science CenterSan AntonioTexas
- Department of Biomedical EngineeringUniversity of TexasSan AntonioTexas
| | - Timothy Q. Duong
- Research Imaging InstituteUniversity of Texas Health Science CenterSan AntonioTexas
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24
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Tiwari YV, Jiang Z, Sun Y, Du F, Rodriguez P, Shen Q, Duong TQ. Effects of stroke severity and treatment duration in normobaric hyperoxia treatment of ischemic stroke. Brain Res 2016; 1635:121-9. [PMID: 26826010 PMCID: PMC4779399 DOI: 10.1016/j.brainres.2016.01.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Revised: 01/15/2016] [Accepted: 01/19/2016] [Indexed: 11/26/2022]
Abstract
In order to improve clinical trial design and translation of normobaric oxygen (NBO) treatment of ischemic stroke, NBO treatment parameters need to be better understood. This study investigated NBO treatment efficacy at two different stroke severities and two NBO treatment durations in rats. For the 60-min middle cerebral artery occlusion (MCAO), NBO treatment for 25 min and 150 min were studied. For the 90-min MCAO, NBO treatment for 55 min and 150 min were studied. Cerebral blood flow (CBF), apparent diffusion coefficients (ADC) and T2 MRI were acquired during occlusion prior to treatment, after reperfusion, and 48h after MCAO. The effects of NBO treatment on lesion volumes, and CBF, ADC and T2 of ischemic core, perfusion-diffusion mismatch and normal tissue were analyzed longitudinally. The major findings were: i) NBO treatment was effective in both groups of stroke severities, salvaging similar percentage of initial abnormal ADC tissue, and ii) NBO treatments continued after reperfusion were more beneficial than NBO treatment during occlusion alone for both MCAO groups. These findings underscore the importance of the effects of NBO duration and stroke severity on treatment outcomes.
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Affiliation(s)
- Yash Vardhan Tiwari
- Research Imaging Institute, University of Texas Health Science Center, 8403 Floyd Curl Dr, San Antonio, TX 78229, USA; Department of Biomedical Engineering, University of Texas, San Antonio, TX, USA
| | - Zhao Jiang
- Research Imaging Institute, University of Texas Health Science Center, 8403 Floyd Curl Dr, San Antonio, TX 78229, USA
| | - Yuhao Sun
- Research Imaging Institute, University of Texas Health Science Center, 8403 Floyd Curl Dr, San Antonio, TX 78229, USA
| | - Fang Du
- Research Imaging Institute, University of Texas Health Science Center, 8403 Floyd Curl Dr, San Antonio, TX 78229, USA
| | - Pavel Rodriguez
- Research Imaging Institute, University of Texas Health Science Center, 8403 Floyd Curl Dr, San Antonio, TX 78229, USA
| | - Qiang Shen
- Research Imaging Institute, University of Texas Health Science Center, 8403 Floyd Curl Dr, San Antonio, TX 78229, USA
| | - Timothy Q Duong
- Research Imaging Institute, University of Texas Health Science Center, 8403 Floyd Curl Dr, San Antonio, TX 78229, USA.
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25
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Shen Q, Huang S, Duong TQ. T2*-weighted fMRI time-to-peak of oxygen challenge in ischemic stroke. J Cereb Blood Flow Metab 2016; 36:283-91. [PMID: 26661164 PMCID: PMC4759668 DOI: 10.1177/0271678x15606461] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 07/11/2015] [Indexed: 11/16/2022]
Abstract
T2 (*)-weighted MRI of transient oxygen challenge (OC) showed exaggerated OC percent changes in the ischemic tissue at risk compared to normal tissue. One ambiguity is that regions with high vascular density also showed exaggerated OC percent changes. This study explored time-to-peak (TTP) of the OC percent changes to improve the utility of T2 (*)-weighted OC MRI. Experiments were performed longitudinally at 30 min, 150 min and 24 h after transient (60-min) stroke in rats. Ischemic core, normal, and mismatch tissue were classified pixel-by-pixel based on apparent diffusion coefficient and cerebral blood flow. Major findings were: (i) Delayed OC TTP was localized to and corresponded well with the perfusion-diffusion mismatch. (ii) By contrast, the exaggerated OC percent changes were less localized, with changes not only in the at-risk tissue but also in some areas of the contralesional hemisphere with venous vessel origins. (iii) The OC time-course of the mismatch tissue was biphasic, with a faster initial increase followed by a slower increase. (iv) At-risk tissue with delayed TTP and exaggerated OC was normal after reperfusion and the at-risk tissue was mostly (83 ± 18%) rescued by reperfusion as indicated by normal 24-h T2. OC TTP offers unique information toward better characterization of at-risk tissue in ischemic stroke.
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Affiliation(s)
- Qiang Shen
- Research Imaging Institute, University of Texas Health Science Center, San Antonio, TX, USA Department of Ophthalmology, University of Texas Health Science Center, San Antonio, TX, USA Department of Radiology, University of Texas Health Science Center, San Antonio, TX, USA
| | - Shiliang Huang
- Research Imaging Institute, University of Texas Health Science Center, San Antonio, TX, USA
| | - Timothy Q Duong
- Research Imaging Institute, University of Texas Health Science Center, San Antonio, TX, USA Department of Ophthalmology, University of Texas Health Science Center, San Antonio, TX, USA Department of Radiology, University of Texas Health Science Center, San Antonio, TX, USA South Texas Veterans Health Care System, Department of Veterans Affairs, San Antonio, TX, USA
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26
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Ejaz S, Emmrich JV, Sitnikov SL, Hong YT, Sawiak SJ, Fryer TD, Aigbirhio FI, Williamson DJ, Baron JC. Normobaric hyperoxia markedly reduces brain damage and sensorimotor deficits following brief focal ischaemia. Brain 2016; 139:751-64. [PMID: 26767570 DOI: 10.1093/brain/awv391] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 11/16/2015] [Indexed: 01/02/2023] Open
Abstract
'True' transient ischaemic attacks are characterized not only clinically, but also radiologically by a lack of corresponding changes on magnetic resonance imaging. During a transient ischaemic attack it is assumed that the affected tissue is penumbral but rescued by early spontaneous reperfusion. There is, however, evidence from rodent studies that even brief focal ischaemia not resulting in tissue infarction can cause extensive selective neuronal loss associated with long-lasting sensorimotor impairment but normal magnetic resonance imaging. Selective neuronal loss might therefore contribute to the increasingly recognized cognitive impairment occurring in patients with transient ischaemic attacks. It is therefore relevant to consider treatments to reduce brain damage occurring with transient ischaemic attacks. As penumbral neurons are threatened by markedly constrained oxygen delivery, improving the latter by increasing arterial O2 content would seem logical. Despite only small increases in arterial O2 content, normobaric oxygen therapy experimentally induces significant increases in penumbral O2 pressure and by such may maintain the penumbra alive until reperfusion. Nevertheless, the effects of normobaric oxygen therapy on infarct volume in rodent models have been conflicting, although duration of occlusion appeared an important factor. Likewise, in the single randomized trial published to date, early-administered normobaric oxygen therapy had no significant effect on clinical outcome despite reduced diffusion-weighted imaging lesion growth during therapy. Here we tested the hypothesis that normobaric oxygen therapy prevents both selective neuronal loss and sensorimotor deficits in a rodent model mimicking true transient ischaemic attack. Normobaric oxygen therapy was applied from the onset and until completion of 15 min distal middle cerebral artery occlusion in spontaneously hypertensive rats, a strain representative of the transient ischaemic attack-prone population. Whereas normoxic controls showed normal magnetic resonance imaging but extensive cortical selective neuronal loss associated with microglial activation (present both at Day 14 in vivo and at Day 28 post-mortem) and marked and long-lasting sensorimotor deficits, normobaric oxygen therapy completely prevented sensorimotor deficit (P < 0.02) and near-completely Day 28 selective neuronal loss (P < 0.005). Microglial activation was substantially reduced at Day 14 and completely prevented at Day 28 (P = 0.002). Our findings document that normobaric oxygen therapy administered during ischaemia nearly completely prevents the neuronal death, microglial inflammation and sensorimotor impairment that characterize this rodent true transient ischaemic attack model. Taken together with the available literature, normobaric oxygen therapy appears a promising therapy for short-lasting ischaemia, and is attractive clinically as it could be started at home in at-risk patients or in the ambulance in subjects suspected of transient ischaemic attack/early stroke. It may also be a straightforward adjunct to reperfusion therapies, and help prevent subtle brain damage potentially contributing to long-term cognitive and sensorimotor impairment in at-risk populations.
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Affiliation(s)
- Sohail Ejaz
- 1 Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, UK
| | - Julius V Emmrich
- 1 Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, UK 2 Department of Neurology, Charité - Universitätsmedizin Berlin, Germany
| | - Sergey L Sitnikov
- 1 Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, UK
| | - Young T Hong
- 3 Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, UK
| | - Stephen J Sawiak
- 3 Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, UK
| | - Tim D Fryer
- 3 Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, UK
| | - Franklin I Aigbirhio
- 3 Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, UK
| | - David J Williamson
- 3 Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, UK
| | - Jean-Claude Baron
- 1 Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, UK 4 INSERM U894, Hôpital Sainte-Anne, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
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Cai L, Stevenson J, Peng C, Xin R, Rastogi R, Liu K, Geng X, Gao Z, Ji X, Rafols JA, Ji Z, Ding Y. Adjuvant therapies using normobaric oxygen with hypothermia or ethanol for reducing hyperglycolysis in thromboembolic cerebral ischemia. Neuroscience 2016; 318:45-57. [PMID: 26794589 DOI: 10.1016/j.neuroscience.2016.01.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 11/25/2015] [Accepted: 01/06/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND PURPOSE Normobaric oxygen (NBO), ethanol (EtOH), and therapeutic hypothermia (TH) delivered alone or in combination have neuroprotective properties after acute stroke. We used an autologous thromboembolic rat stroke model to assess the additive effects of these treatments for reducing the deleterious effects of hyperglycolysis post-stroke in which reperfusion is induced with recombinant tissue plasminogen activator (rt-PA). METHODS Sprague-Dawley rats were subjected to middle cerebral artery (MCA) occlusion with an autologous embolus. One hour after occlusion, rt-PA was administered alone or with NBO (60%), EtOH (1.0 g/kg), TH (33 °C), either singly or in combination. Infarct volume and neurological deficit were assessed at 24h after rt-PA-induced reperfusion with or without other treatments. The extent of hyperglycolysis, as determined by cerebral glucose and lactate levels was evaluated at 3 and 24h after rt-PA administration. At the same time points, expressions of glucose transporter 1 (Glut1), glucose transporter 3 (Glut3), phosphofructokinase1 (PFK-1), and lactate dehydrogenase were (LDH) measured by Western blotting. RESULTS Following rt-PA in rats with thromboembolic stroke, NBO combined with TH or EtOH most effectively decreased infarct volume and neurological deficit. As compared to rt-PA alone, EtOH or TH but not NBO monotherapies significantly reduced post-stroke hyperglycolysis. The increased utilization of glucose and production of lactate post-stroke was prevented most effectively when NBO was combined with either EtOH or TH after reperfusion with rt-PA, as shown by the significantly decreased Glut1, Glut3, PFK-1, and LDH levels. CONCLUSIONS In a rat thromboembolic stroke model, both EtOH and TH used individually offer neuroprotection after the administration of rt-PA. While NBO monotherapy does not appear to be effective, it significantly potentiates the efficacy of EtOH and TH. The similar neuroprotection and underlying mechanisms pertaining to the attenuation of hyperglycolysis provided by EtOH or TH in combination with NBO suggest a possibility of substituting EtOH for TH. Thus a combination of NBO and EtOH, which are widely available and easily used, could become a novel and effective neuroprotective strategy in the clinical setting.
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Affiliation(s)
- L Cai
- China-America Institute of Neuroscience, Department of Neurology, Luhe Hospital, Capital Medical University, Beijing, China; Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - J Stevenson
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - C Peng
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - R Xin
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA; Department of Radiology, Luhe Hospital, Capital Medical University, Beijing, China
| | - R Rastogi
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - K Liu
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - X Geng
- China-America Institute of Neuroscience, Department of Neurology, Luhe Hospital, Capital Medical University, Beijing, China; Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Z Gao
- Cerebral Vascular Diseases Research Institute, Capital Medical University, Beijing, China
| | - X Ji
- Cerebral Vascular Diseases Research Institute, Capital Medical University, Beijing, China
| | - J A Rafols
- Department of Anatomy and Cell Biology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Z Ji
- China-America Institute of Neuroscience, Department of Neurology, Luhe Hospital, Capital Medical University, Beijing, China.
| | - Y Ding
- China-America Institute of Neuroscience, Department of Neurology, Luhe Hospital, Capital Medical University, Beijing, China; Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA.
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Magnetic Resonance Imaging of Cerebrovascular Diseases. Stroke 2016. [DOI: 10.1016/b978-0-323-29544-4.00048-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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González-Muniesa P, Garcia-Gerique L, Quintero P, Arriaza S, Lopez-Pascual A, Martinez JA. Effects of Hyperoxia on Oxygen-Related Inflammation with a Focus on Obesity. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2015; 2015:8957827. [PMID: 26697142 PMCID: PMC4678090 DOI: 10.1155/2016/8957827] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 07/29/2015] [Accepted: 08/19/2015] [Indexed: 12/22/2022]
Abstract
Several studies have shown a pathological oxygenation (hypoxia/hyperoxia) on the adipose tissue in obese subjects. Additionally, the excess of body weight is often accompanied by a state of chronic low-degree inflammation. The inflammation phenomenon is a complex biological response mounted by tissues to combat injurious stimuli in order to maintain cell homeostasis. Furthermore, it is believed that the abnormal oxygen partial pressure occurring in adipose tissue is involved in triggering inflammatory processes. In this context, oxygen is used in modern medicine as a treatment for several diseases with inflammatory components. Thus, hyperbaric oxygenation has demonstrated beneficial effects, apart from improving local tissue oxygenation, on promoting angiogenesis, wound healing, providing neuroprotection, facilitating glucose uptake, appetite, and others. Nevertheless, an excessive hyperoxia exposure can lead to deleterious effects such as oxidative stress, pulmonary edema, and maybe inflammation. Interestingly, some of these favorable outcomes occur under high and low oxygen concentrations. Hereby, we review a potential therapeutic approach to the management of obesity as well as the oxygen-related inflammation accompanying expanded adipose tissue, based on elevated oxygen concentrations. To conclude, we highlight at the end of this review some areas that need further clarification.
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Affiliation(s)
- Pedro González-Muniesa
- Centre for Nutrition Research, Department of Nutrition, Food Sciences and Physiology, University of Navarra, Irunlarrea 1, 31008 Pamplona, Spain
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
- Navarra's Health Research Institute (IDISNA), 31008 Pamplona, Spain
| | - Laura Garcia-Gerique
- Centre for Nutrition Research, Department of Nutrition, Food Sciences and Physiology, University of Navarra, Irunlarrea 1, 31008 Pamplona, Spain
| | - Pablo Quintero
- Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Libertador Bernardo O'Higgins 340, Santiago, Chile
| | - Suyen Arriaza
- Centre for Nutrition Research, Department of Nutrition, Food Sciences and Physiology, University of Navarra, Irunlarrea 1, 31008 Pamplona, Spain
| | - Amaya Lopez-Pascual
- Centre for Nutrition Research, Department of Nutrition, Food Sciences and Physiology, University of Navarra, Irunlarrea 1, 31008 Pamplona, Spain
| | - J. Alfredo Martinez
- Centre for Nutrition Research, Department of Nutrition, Food Sciences and Physiology, University of Navarra, Irunlarrea 1, 31008 Pamplona, Spain
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
- Navarra's Health Research Institute (IDISNA), 31008 Pamplona, Spain
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Hafner S, Beloncle F, Koch A, Radermacher P, Asfar P. Hyperoxia in intensive care, emergency, and peri-operative medicine: Dr. Jekyll or Mr. Hyde? A 2015 update. Ann Intensive Care 2015; 5:42. [PMID: 26585328 PMCID: PMC4653126 DOI: 10.1186/s13613-015-0084-6] [Citation(s) in RCA: 123] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 11/02/2015] [Indexed: 12/22/2022] Open
Abstract
This review summarizes the (patho)-physiological effects of ventilation with high FiO2 (0.8–1.0), with a special focus on the most recent clinical evidence on its use for the management of circulatory shock and during medical emergencies. Hyperoxia is a cornerstone of the acute management of circulatory shock, a concept which is based on compelling experimental evidence that compensating the imbalance between O2 supply and requirements (i.e., the oxygen dept) is crucial for survival, at least after trauma. On the other hand, “oxygen toxicity” due to the increased formation of reactive oxygen species limits its use, because it may cause serious deleterious side effects, especially in conditions of ischemia/reperfusion. While these effects are particularly pronounced during long-term administration, i.e., beyond 12–24 h, several retrospective studies suggest that even hyperoxemia of shorter duration is also associated with increased mortality and morbidity. In fact, albeit the clinical evidence from prospective studies is surprisingly scarce, a recent meta-analysis suggests that hyperoxia is associated with increased mortality at least in patients after cardiac arrest, stroke, and traumatic brain injury. Most of these data, however, originate from heterogenous, observational studies with inconsistent results, and therefore, there is a need for the results from the large scale, randomized, controlled clinical trials on the use of hyperoxia, which can be anticipated within the next 2–3 years. Consequently, until then, “conservative” O2 therapy, i.e., targeting an arterial hemoglobin O2 saturation of 88–95 % as suggested by the guidelines of the ARDS Network and the Surviving Sepsis Campaign, represents the treatment of choice to avoid exposure to both hypoxemia and excess hyperoxemia.
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Affiliation(s)
- Sebastian Hafner
- Institut für Anästhesiologische Pathophysiologie und Verfahrensentwicklung, Universitätsklinikum Ulm, Helmholtzstrasse 8-1, 89081, Ulm, Germany. .,Klinik für Anästhesiologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
| | - François Beloncle
- Département de Réanimation Médicale et de Médecine Hyperbare, Centre Hospitalier Universitaire, 4 rue Larrey, Cedex 9, 49933, Angers, France. .,Laboratoire de Biologie Neurovasculaire et Mitochondriale Intégrée, CNRS UMR 6214-INSERM U1083, Université Angers, PRES L'UNAM, Nantes, France.
| | - Andreas Koch
- Sektion Maritime Medizin, Institut für Experimentelle Medizin, Christian-Albrechts-Universität, 24118, Kiel, Germany. .,Schifffahrtmedizinisches Institut der Marine, 24119, Kronshagen, Germany.
| | - Peter Radermacher
- Institut für Anästhesiologische Pathophysiologie und Verfahrensentwicklung, Universitätsklinikum Ulm, Helmholtzstrasse 8-1, 89081, Ulm, Germany.
| | - Pierre Asfar
- Département de Réanimation Médicale et de Médecine Hyperbare, Centre Hospitalier Universitaire, 4 rue Larrey, Cedex 9, 49933, Angers, France. .,Laboratoire de Biologie Neurovasculaire et Mitochondriale Intégrée, CNRS UMR 6214-INSERM U1083, Université Angers, PRES L'UNAM, Nantes, France.
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Weaver J, Liu KJ. Does normobaric hyperoxia increase oxidative stress in acute ischemic stroke? A critical review of the literature. Med Gas Res 2015; 5:11. [PMID: 26306184 PMCID: PMC4547432 DOI: 10.1186/s13618-015-0032-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 08/02/2015] [Indexed: 12/22/2022] Open
Abstract
Stroke, one of the most debilitating cerebrovascular and nuerological diseases, is a serious life-threatening condition and a leading cause of long-term adult disability and brain damage, either directly or by secondary complications. Most effective treatments for stroke are time dependent such as the only FDA-approved therapy, reperfusion with tissue-type plasminogen activator; thus, improving tissue oxygenation with normobaric hyperoxia (NBO) has been considered a logical and potential important therapy. NBO is considered a good approach because of its potential clinical advantages, and many studies suggest that NBO is neuroprotective, reducing ischemic brain injury and infarct volume in addition to improving pathologic and neurobehavorial outcomes. However, increased reactive oxygen species (ROS) generation may occur when tissue oxygen level is too high or too low. Therefore, a major concern with NBO therapy in acute ischemic stroke is the potential increase of ROS, which could exacerbate brain injury. The purpose of this review is to critically review the current literature reports on the effect of NBO treatment on ROS and oxidative stress with respect to acute ischemic stroke. Considering the available data from relevant animal models, NBO does not increase ROS or oxidative stress if applied for a short duration; therefore, the potential that NBO is a viable neuroprotective strategy for acute ischemic stroke is compelling. The benefits of NBO may significantly outweigh the risks of potential increase in ROS generation for the treatment of acute ischemic stroke.
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Affiliation(s)
- John Weaver
- Department of Pharmaceutical Sciences, College of Pharmacy, BRaIN Imaging Center, MSC10 5620, 1 University of New Mexico Health Sciences Center, Albuquerque, NM 87131 USA ; Center of Biomedical Research Excellence, College of Pharmacy, University of New Mexico Health Sciences Center, Albuquerque, NM 87131 USA
| | - Ke Jian Liu
- Department of Pharmaceutical Sciences, College of Pharmacy, BRaIN Imaging Center, MSC10 5620, 1 University of New Mexico Health Sciences Center, Albuquerque, NM 87131 USA ; Center of Biomedical Research Excellence, College of Pharmacy, University of New Mexico Health Sciences Center, Albuquerque, NM 87131 USA ; Department of Neurology, University of New Mexico Health Sciences Center, Albuquerque, NM 87131 USA
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Abstract
Hyperoxia has been uniformly efficacious in experimental focal cerebral ischemia. However, pilot clinical trials have showed mixed results slowing its translation in patient care. To explain the discordance between experimental and clinical outcomes, we tested the impact of endothelial dysfunction, exceedingly common in stroke patients but under-represented in experimental studies, on the neuroprotective efficacy of normobaric hyperoxia. We used hyperlipidemic apolipoprotein E knock-out and endothelial nitric oxide synthase knock-out mice as models of endothelial dysfunction, and examined the effects of normobaric hyperoxia on tissue perfusion and oxygenation using high-resolution combined laser speckle and multispectral reflectance imaging during distal middle cerebral artery occlusion. In normal wild-type mice, normobaric hyperoxia rapidly and significantly improved tissue perfusion and oxygenation, suppressed peri-infarct depolarizations, reduced infarct volumes, and improved neurological function. In contrast, normobaric hyperoxia worsened perfusion in ischemic brain and failed to reduce infarct volumes or improve neurological function in mice with endothelial dysfunction. These data suggest that the beneficial effects of hyperoxia on ischemic tissue oxygenation, perfusion, and outcome are critically dependent on endothelial nitric oxide synthase function. Therefore, vascular risk factors associated with endothelial dysfunction may predict normobaric hyperoxia nonresponders in ischemic stroke. These data may have implications for myocardial and systemic circulation as well.
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Jeon SB, Choi HA, Badjatia N, Schmidt JM, Lantigua H, Claassen J, Connolly ES, Mayer SA, Lee K. Hyperoxia may be related to delayed cerebral ischemia and poor outcome after subarachnoid haemorrhage. J Neurol Neurosurg Psychiatry 2014; 85:1301-7. [PMID: 24860138 DOI: 10.1136/jnnp-2013-307314] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To determine the association between exposure to hyperoxia and the risk of delayed cerebral ischaemia (DCI) after subarachnoid haemorrhage (SAH). METHODS We analysed data from a single centre, prospective, observational cohort database. Patient inclusion criteria were age ≥18 years, aneurysmal SAH, endotracheal intubation with mechanical ventilation, and arterial partial pressure of oxygen (PaO2) measurements. Hyperoxia was defined as the highest quartile of an area under the curve of PaO2, until the development of DCI (PaO2≥173 mm Hg). Poor outcome was defined as modified Rankin Scale 4-6 at 3 months after SAH. RESULTS Of 252 patients, there were no differences in baseline characteristics between the hyperoxia and control group. Ninety-seven (38.5%) patients developed DCI. The hyperoxia group had a higher incidence of DCI (p<0.001) and poor outcome (p=0.087). After adjusting for modified Fisher scale, rebleeding, global cerebral oedema, intracranial pressure crisis, pneumonia and sepsis, hyperoxia was independently associated with DCI (OR, 3.16; 95% CI 1.69 to 5.92; p<0.001). After adjusting for age, Hunt-Hess grade, aneurysm size, Acute Physiology and Chronic Health Evaluation II score, rebleeding, pneumonia and sepsis, hyperoxia was independently associated with poor outcome (OR, 2.30; 95% CI 1.03 to 5.12; p=0.042). CONCLUSIONS In SAH patients, exposure to hyperoxia was associated with DCI. Our findings suggest that exposure to excess oxygen after SAH may represent a modifiable factor for morbidity and mortality in this population.
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Affiliation(s)
- Sang-Beom Jeon
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea Departments of Neurology and Neurosurgery, The University of Texas Medical School at Houston, Houston, Texas, USA Department of Neurology, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - H Alex Choi
- Departments of Neurology and Neurosurgery, The University of Texas Medical School at Houston, Houston, Texas, USA Department of Neurology, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Neeraj Badjatia
- Department of Neurology, Columbia University College of Physicians and Surgeons, New York, New York, USA Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - J Michael Schmidt
- Department of Neurology, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Hector Lantigua
- Department of Neurology, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Jan Claassen
- Department of Neurology, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - E Sander Connolly
- Departments of Neurosurgery, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Stephan A Mayer
- Department of Neurology, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Kiwon Lee
- Departments of Neurology and Neurosurgery, The University of Texas Medical School at Houston, Houston, Texas, USA Department of Neurology, Columbia University College of Physicians and Surgeons, New York, New York, USA
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Moon KC, Han SK, Lee YN, Jeong SH, Dhong ES, Kim WK. Effect of normobaric hyperoxic therapy on tissue oxygenation in diabetic feet: A pilot study. J Plast Reconstr Aesthet Surg 2014; 67:1580-6. [DOI: 10.1016/j.bjps.2014.07.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 05/20/2014] [Accepted: 07/06/2014] [Indexed: 11/16/2022]
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Chan YFY, Katz M, Moskowitz A, Levine SR, Richardson LD, Tuhrim S, Chason K, Barsan- Silverman K, Singhal A. Supplemental oxygen delivery to suspected stroke patients in pre hospital and emergency department settings. Med Gas Res 2014; 4:16. [PMID: 26413266 PMCID: PMC4582959 DOI: 10.1186/2045-9912-4-16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 10/01/2014] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Recent data suggests that high-flow oxygen started promptly after stroke symptom onset salvages ischemic brain tissue. We investigated the consistency of oxygen delivery to suspected stroke patients in the pre-hospital (PH) and Emergency Department (ED) settings, and associated adverse events (AEs). METHODS We retrospectively reviewed pre-hospital call reports of suspected stroke patients transported by our institution's paramedics. We extracted data on oxygen delivery in the PH and ED settings, demographics, Glasgow Coma Scale score (GCS), final diagnosis, and selected AEs (mortality, seizures, worsening neurological status, new infarction, and post-ischemic hemorrhage). Patients were grouped according to ED oxygen delivery: none, low-flow (2-4 L/min), and high-flow (10-15 L/min). RESULTS Oxygen delivery was documented in 84% of 366 stroke transports, with 98% receiving 10-15 L/min. Our hospital received 164 patients. Oxygen delivery in the ED was documented in 150 patients, with 38% receiving none, 47% low-flow, and 15% high-flow oxygen. There were no instances of oxygen refusal, premature termination, or technical difficulties. Advanced age and low GCS predicted the use of higher flow rates. High-flow oxygen was more frequently administered to patients with symptom onset < 3 hours, and those with intracerebral hemorrhage (ICH), hypoxic-ischemic encephalopathy (HIE) or seizures (p < 0.001). More patients receiving high-flow oxygen were documented to have an AE (p = 0.02), however the low- and no-oxygen groups more frequently had multiple AEs (p = 0.01). The occurrence of AEs was predicted by the diagnosis of ICH/HIE/seizures (p = 0.013) and acute ischemic stroke (AIS)/transient ischemic attack (TIA) (p = 0.009), but not by the amount of oxygen. CONCLUSIONS Suspected stroke patients routinely receive 10-15 L/min oxygen in the ambulance however in the ED there is wide variability due to factors such as clinical severity. Oxygen delivery appears safe in the PH and ED settings.
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Affiliation(s)
- Yu-Feng Yvonne Chan
- Department of Emergency Medicine, Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, 19 East 98th Street, 3rd Floor, New York, NY 10029, USA
- Genetics and Genomic Sciences, Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, 19 East 98th Street, 3rd Floor, New York, NY 10029, USA
| | - Maya Katz
- Department of Neurology, University of California, San Francisco (UCSF) Medical Center, 1635 Divisadero Street, Suite 520, San Francisco, CA 94115, USA
| | - Ari Moskowitz
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Steven R Levine
- Department of Neurology, State University of New York (SUNY) Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY 11203, USA
| | - Lynne D Richardson
- Department of Emergency Medicine, Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, 19 East 98th Street, 3rd Floor, New York, NY 10029, USA
| | - Stanley Tuhrim
- Department of Neurology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Kevin Chason
- Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Kelly Barsan- Silverman
- Personalized Medicine and Digital Health, Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, 19 East 98th Street, 3rd Floor, New York, NY 10029, USA
| | - Aneesh Singhal
- Genetics and Genomic Sciences, Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, 19 East 98th Street, 3rd Floor, New York, NY 10029, USA
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Yuan Z, Pan R, Liu W, Liu KJ. Extended normobaric hyperoxia therapy yields greater neuroprotection for focal transient ischemia-reperfusion in rats. Med Gas Res 2014; 4:14. [PMID: 25177481 PMCID: PMC4149308 DOI: 10.1186/2045-9912-4-14] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 08/04/2014] [Indexed: 12/18/2022] Open
Abstract
Background Normobaric hyperoxia (NBO) therapy is neuroprotective in acute ischemic stroke. However, how long the NBO should last to obtain optimal outcome is still unclear. Reports show that ischemic penumbra blood supply may remain compromised for a long period after ischemia-reperfusion, which would impair tissue oxygenation in ischemic penumbra. Therefore, we hypothesized that longer-lasting NBO may yield greater neuroprotection. Methods The relationship between treatment outcome and NBO duration was examined in this study. Rats were subjected to 90 min middle cerebral artery occlusion followed by reperfusion for 22.5 hours. NBO started at 30 min post ischemia and lasted for 2, 4 or 8 h. Treatment efficacy was evaluated by measuring infarction volume, oxidative stress and apoptosis. Results Among 2 h, 4 h and 8 h NBO, 8 h NBO offered the greatest efficacy in reducing 24-hour infarction volume, attenuating oxidative stress that was indicated by decreased production of 8-hydroxydeoxyguanosine and NADPH oxidase catalytic subunit gp91phox, and alleviating apoptosis that was associated with reduced production of DNA fragment and caspase-3 activity in cortex penumbra. Conclusions Under our experimental conditions, longer duration of NBO treatment produced greater benefits in focal transient cerebral ischemia-reperfusion rats.
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Affiliation(s)
- Zhongrui Yuan
- College of Pharmacy, University of New Mexico Health Sciences Center, MSC09 5360, Albuquerque, NM 87131-0001, USA ; College of Medicine, Shandong University, Jinan 250012, China
| | - Rong Pan
- College of Pharmacy, University of New Mexico Health Sciences Center, MSC09 5360, Albuquerque, NM 87131-0001, USA
| | - Wenlan Liu
- College of Pharmacy, University of New Mexico Health Sciences Center, MSC09 5360, Albuquerque, NM 87131-0001, USA
| | - Ke Jian Liu
- College of Pharmacy, University of New Mexico Health Sciences Center, MSC09 5360, Albuquerque, NM 87131-0001, USA
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Ridler N, Plumb J, Grocott M. Oxygen Therapy in Critical Illness: Friend or Foe? A Review of Oxygen Therapy in Selected Acute Illnesses. J Intensive Care Soc 2014. [DOI: 10.1177/175114371401500303] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
In recent years there has been a gradual shift away from using uncontrolled high concentrations of inspired oxygen in some acute illnesses. Oxygen is perhaps the most frequently used drug in medicine, and understanding the balance of benefits and harms is essential knowledge for all anaesthetists and intensivists. While current teaching and practice emphasise avoiding hypoxaemia over concerns about hyperoxaemia, it may transpire that oxygen excess is more harmful than previously thought. As with many interventions in intensive care medicine, striving to achieve physiological normality may sometimes do more harm than good, and tolerance of abnormal values may on occasion be in patients' best interests. Incorporating Single Best Answers (see page 197: answers on page 237).
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Dani KA, Warach S. Metabolic imaging of ischemic stroke: the present and future. AJNR Am J Neuroradiol 2014; 35:S37-43. [PMID: 24722308 DOI: 10.3174/ajnr.a3789] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Measures of cerebral metabolism may be useful in the selection of patients for reperfusion therapies and as end points in clinical trials. However, there are currently no clinically routine techniques that provide such data directly. We review how imaging modalities in current clinical use may provide surrogate markers of metabolic activity. Promising techniques for metabolic imaging that are currently in the pipeline are reviewed.
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Affiliation(s)
- K A Dani
- From the Institute of Neurosciences and Psychology (K.A.D.), University of Glasgow, Institute of Neurological Sciences, Glasgow, United Kingdom
| | - S Warach
- Department of Neurology and Neurotherapeutics (S.W.), UT Southwestern, Dallas, Texas.
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Deng J, Lei C, Chen Y, Fang Z, Yang Q, Zhang H, Cai M, Shi L, Dong H, Xiong L. Neuroprotective gases – Fantasy or reality for clinical use? Prog Neurobiol 2014; 115:210-45. [DOI: 10.1016/j.pneurobio.2014.01.001] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 01/03/2014] [Accepted: 01/03/2014] [Indexed: 12/17/2022]
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Chen F, Qi Z, Luo Y, Hinchliffe T, Ding G, Xia Y, Ji X. Non-pharmaceutical therapies for stroke: mechanisms and clinical implications. Prog Neurobiol 2014; 115:246-69. [PMID: 24407111 PMCID: PMC3969942 DOI: 10.1016/j.pneurobio.2013.12.007] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 12/19/2013] [Accepted: 12/27/2013] [Indexed: 12/14/2022]
Abstract
Stroke is deemed a worldwide leading cause of neurological disability and death, however, there is currently no promising pharmacotherapy for acute ischemic stroke aside from intravenous or intra-arterial thrombolysis. Yet because of the narrow therapeutic time window involved, thrombolytic application is very restricted in clinical settings. Accumulating data suggest that non-pharmaceutical therapies for stroke might provide new opportunities for stroke treatment. Here we review recent research progress in the mechanisms and clinical implications of non-pharmaceutical therapies, mainly including neuroprotective approaches such as hypothermia, ischemic/hypoxic conditioning, acupuncture, medical gases and transcranial laser therapy. In addition, we briefly summarize mechanical endovascular recanalization devices and recovery devices for the treatment of the chronic phase of stroke and discuss the relative merits of these devices.
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Affiliation(s)
- Fan Chen
- Cerebrovascular Diseases Research Institute, Xuanwu Hospital of Capital Medical University, Beijing, Beijing 100053, China
| | - Zhifeng Qi
- Cerebrovascular Diseases Research Institute, Xuanwu Hospital of Capital Medical University, Beijing, Beijing 100053, China
| | - Yuming Luo
- Cerebrovascular Diseases Research Institute, Xuanwu Hospital of Capital Medical University, Beijing, Beijing 100053, China
| | - Taylor Hinchliffe
- The Vivian L. Smith Department of Neurosurgery, The University of Texas Medical School at Houston, Houston, TX 77030, USA
| | - Guanghong Ding
- Shanghai Research Center for Acupuncture and Meridian, Shanghai 201203, China
| | - Ying Xia
- The Vivian L. Smith Department of Neurosurgery, The University of Texas Medical School at Houston, Houston, TX 77030, USA.
| | - Xunming Ji
- Cerebrovascular Diseases Research Institute, Xuanwu Hospital of Capital Medical University, Beijing, Beijing 100053, China.
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Abstract
Oxygen treatment has been a cornerstone of acute medical care for numerous pathological states. Initially, this was supported by the assumed need to avoid hypoxaemia and tissue hypoxia. Most acute treatment algorithms, therefore, recommended the liberal use of a high fraction of inspired oxygen, often without first confirming the presence of a hypoxic insult. However, recent physiological research has underlined the vasoconstrictor effects of hyperoxia on normal vasculature and, consequently, the risk of significant blood flow reduction to the at-risk tissue. Positive effects may be claimed simply by relief of an assumed local tissue hypoxia, such as in acute cardiovascular disease, brain ischaemia due to, for example, stroke or shock or carbon monoxide intoxication. However, in most situations, a generalized hypoxia is not the problem and a risk of negative hyperoxaemia-induced local vasoconstriction effects may instead be the reality. In preclinical studies, many important positive anti-inflammatory effects of both normobaric and hyperbaric oxygen have been repeatedly shown, often as surrogate end-points such as increases in gluthatione levels, reduced lipid peroxidation and neutrophil activation thus modifying ischaemia-reperfusion injury and also causing anti-apoptotic effects. However, in parallel, toxic effects of oxygen are also well known, including induced mucosal inflammation, pneumonitis and retrolental fibroplasia. Examining the available 'strong' clinical evidence, such as usually claimed for randomized controlled trials, few positive studies stand up to scrutiny and a number of trials have shown no effect or even been terminated early due to worse outcomes in the oxygen treatment arm. Recently, this has led to less aggressive approaches, even to not providing any supplemental oxygen, in several acute care settings, such as resuscitation of asphyxiated newborns, during acute myocardial infarction or after stroke or cardiac arrest. The safety of more advanced attempts to deliver increased oxygen levels to hypoxic or ischaemic tissues, such as with hyperbaric oxygen therapy, is therefore also being questioned. Here, we provide an overview of the present knowledge of the physiological effects of oxygen in relation to its therapeutic potential for different medical conditions, as well as considering the potential for harm. We conclude that the medical use of oxygen needs to be further examined in search of solid evidence of benefit in many of the current clinical settings in which it is routinely used.
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Affiliation(s)
- F Sjöberg
- Departments of Hand and Plastic Surgery and Intensive Care, Burn Center, Linköping County Council, Linköping, Sweden; Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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Esposito E, Mandeville ET, Hayakawa K, Singhal AB, Lo EH. Effects of normobaric oxygen on the progression of focal cerebral ischemia in rats. Exp Neurol 2013; 249:33-8. [PMID: 23958492 DOI: 10.1016/j.expneurol.2013.08.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 07/20/2013] [Accepted: 08/06/2013] [Indexed: 12/26/2022]
Abstract
Normobaric oxygen (NBO) reduces infarction at 24-48 h in experimental models of focal cerebral ischemia. However, to be clinically relevant, longer term safety and efficacy must be explored. Here, we assessed the effects of NBO on glial activation, neurovascular recovery, and behavioral outcomes at 2 weeks after transient focal ischemia in rats. 100 min transient focal ischemia was induced by intraluminal occlusion of the middle cerebral artery in adult male Sprague-Dawley rats. Animals were randomized into sham, controls or 85'NBO started 15 min after ischemic onset. Infarct volumes and behavioral outcomes were blindly quantified. Immunohistochemistry was used to examine the effects of NBO on glial activation and neurovascular responses. After 2 weeks of reperfusion the infarct volume was marked reduced in animals subjected to NBO. They also had better outcomes in forelimb placement test and in body-swing test and weight loss reduction. After 14 days, NBO decreased expression of Iba1, a marker of activated microglia, and GFAP, a marker of activated astrocytes. NBO treatment had no detectable effect on angiogenesis. These results suggest that protective effects of NBO may persist for up to 2 weeks post-stroke.
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Affiliation(s)
- Elga Esposito
- Departments of Neurology and Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
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Jauch EC, Saver JL, Adams HP, Bruno A, Connors JJB, Demaerschalk BM, Khatri P, McMullan PW, Qureshi AI, Rosenfield K, Scott PA, Summers DR, Wang DZ, Wintermark M, Yonas H. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2013; 44:870-947. [PMID: 23370205 DOI: 10.1161/str.0b013e318284056a] [Citation(s) in RCA: 3203] [Impact Index Per Article: 291.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND PURPOSE The authors present an overview of the current evidence and management recommendations for evaluation and treatment of adults with acute ischemic stroke. The intended audiences are prehospital care providers, physicians, allied health professionals, and hospital administrators responsible for the care of acute ischemic stroke patients within the first 48 hours from stroke onset. These guidelines supersede the prior 2007 guidelines and 2009 updates. METHODS Members of the writing committee were appointed by the American Stroke Association Stroke Council's Scientific Statement Oversight Committee, representing various areas of medical expertise. Strict adherence to the American Heart Association conflict of interest policy was maintained throughout the consensus process. Panel members were assigned topics relevant to their areas of expertise, reviewed the stroke literature with emphasis on publications since the prior guidelines, and drafted recommendations in accordance with the American Heart Association Stroke Council's Level of Evidence grading algorithm. RESULTS The goal of these guidelines is to limit the morbidity and mortality associated with stroke. The guidelines support the overarching concept of stroke systems of care and detail aspects of stroke care from patient recognition; emergency medical services activation, transport, and triage; through the initial hours in the emergency department and stroke unit. The guideline discusses early stroke evaluation and general medical care, as well as ischemic stroke, specific interventions such as reperfusion strategies, and general physiological optimization for cerebral resuscitation. CONCLUSIONS Because many of the recommendations are based on limited data, additional research on treatment of acute ischemic stroke remains urgently needed.
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Qi Z, Liu W, Luo Y, Ji X, Liu KJ. Normobaric hyperoxia-based neuroprotective therapies in ischemic stroke. Med Gas Res 2013; 3:2. [PMID: 23298701 PMCID: PMC3552719 DOI: 10.1186/2045-9912-3-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Accepted: 01/07/2013] [Indexed: 01/11/2023] Open
Abstract
Stroke is a leading cause of death and disability due to disturbance of blood supply to the brain. As brain is highly sensitive to hypoxia, insufficient oxygen supply is a critical event contributing to ischemic brain injury. Normobaric hyperoxia (NBO) that aims to enhance oxygen delivery to hypoxic tissues has long been considered as a logical neuroprotective therapy for ischemic stroke. To date, many possible mechanisms have been reported to elucidate NBO’s neuroprotection, such as improving tissue oxygenation, increasing cerebral blood flow, reducing oxidative stress and protecting the blood brain barrier. As ischemic stroke triggers a battery of damaging events, combining NBO with other agents or treatments that target multiple mechanisms of injury may achieve better outcome than individual treatment alone. More importantly, time loss is brain loss in acute cerebral ischemia. NBO can be a rapid therapy to attenuate or slow down the evolution of ischemic tissues towards necrosis and therefore “buy time” for reperfusion therapies. This article summarizes the current literatures on NBO as a simple, widely accessible, and potentially cost-effective therapeutic strategy for treatment of acute ischemic stroke.
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Affiliation(s)
- Zhifeng Qi
- Cerebrovascular Diseases Research Institute, Xuanwu Hospital of Capital Medical University, No,45 Changchun Street, Beijing, 100053, China.
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Dani KA, An L, Henning EC, Shen J, Warach S. Multivoxel MR spectroscopy in acute ischemic stroke: comparison to the stroke protocol MRI. Stroke 2013; 43:2962-7. [PMID: 23091121 DOI: 10.1161/strokeaha.112.656058] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND PURPOSE Few patients with stroke have been imaged with MR spectroscopy (MRS) within the first few hours after onset. We compared data from current MRI protocols to MRS in subjects with ischemic stroke. METHODS MRS was incorporated into the standard clinical MRI stroke protocol for subjects <24 hours after onset. MRI and clinical correlates for the metabolic data from MRS were sought. RESULTS One hundred thirty-six MRS voxels from 32 subjects were analyzed. Lactate preceded the appearance of the lesion on diffusion-weighted imaging in some voxels but in others lagged behind it. Current protocols may predict up to 41% of the variance of MRS metabolites. Serum glucose concentration and time to maximum partially predicted the concentration of all major metabolites. CONCLUSIONS MRS may be helpful in acute stroke, especially for lactate detection when perfusion-weighted imaging is unavailable. Current MRI protocols do provide surrogate markers for some indices of metabolic activity.
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Affiliation(s)
- Krishna A Dani
- Section on Stroke Diagnostics and Therapeutics, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
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Graham GD. The Spectroscopist’s Lament. Stroke 2012; 43:2843-4. [DOI: 10.1161/strokeaha.112.672014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Glenn D. Graham
- From Specialty Care Services (10P4E), Department of Veterans Affairs, Washington, DC, and the University of New Mexico School of Medicine, Albuquerque, NM
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47
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Dynamic functional cerebral blood volume responses to normobaric hyperoxia in acute ischemic stroke. J Cereb Blood Flow Metab 2012; 32:1800-9. [PMID: 22739619 PMCID: PMC3434635 DOI: 10.1038/jcbfm.2012.87] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Studies suggest that neuroprotective effects of normobaric oxygen (NBO) therapy in acute stroke are partly mediated by hemodynamic alterations. We investigated cerebral hemodynamic effects of repeated NBO exposures. Serial magnetic resonance imaging (MRI) was performed in Wistar rats subjected to focal ischemic stroke. Normobaric oxygen-induced functional cerebral blood volume (fCBV) responses were analyzed. All rats had diffusion-weighted MRI (DWI) lesions within larger perfusion deficits, with DWI lesion expansion after 3 hours. Functional cerebral blood volume responses to NBO were spatially and temporally heterogeneous. Contralateral healthy tissue responded consistently with vasoconstriction that increased with time. No significant responses were evident in the acute DWI lesion. In hypoperfused regions surrounding the acute DWI lesion, tissue that remained viable until the end of the experiment showed relative preservation of mean fCBV at early time points, with some rats showing increased fCBV (vasodilation); however, these regions later exhibited significantly decreased fCBV (vasoconstriction). Tissue that became DWI abnormal by study-end initially showed marginal fCBV changes that later became moderate fCBV reductions. Our results suggest that a reverse-steal hemodynamic effect may occur in peripheral ischemic zones during NBO treatment of focal stroke. In addition, CBV responses to NBO challenge may have potential as an imaging marker to distinguish ischemic core from salvageable tissues.
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48
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Continuous brain tissue oxygenation monitoring in the management of pediatric stroke. Neurocrit Care 2012; 15:529-36. [PMID: 21416310 DOI: 10.1007/s12028-011-9531-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Direct invasive monitoring of brain tissue oxygenation (PbtO(2)) has been routinely utilized to predict cerebral ischemia and to prevent secondary injury in patients with traumatic brain injury (TBI) and vasospasm secondary to subarachnoid hemorrhage (SAH). The safety and utility of these devices in the pediatric population have been examined in a few small studies. No studies, however, have examined the use of PbtO(2) monitoring in stroke patients. METHODS Retrospective chart review of the first two consecutive, critically ill pediatric patients in the pediatric intensive care unit requiring brain tissue oxygen monitoring for newly diagnosed cerebral ischemia. ICP, CPP, PbtO(2), SaO(2), BP, and RR were all continually monitored during their care and were retrospectively collected and reviewed. RESULTS We present two pediatric stroke patients managed in a critical care setting with PbtO(2) monitoring in addition to ICP, MAP, CPP, and SaO(2). Both patients had multiple events of low brain tissue oxygen (PbtO(2) <20 torr), independent of abnormal values in other monitoring parameters, which required physician intervention. No new ischemic damage occurred after PbtO(2) monitoring began in either patient. CONCLUSIONS There is currently inadequate data to support the application of PbtO(2) monitoring in children with stroke to prevent progressive ischemia and to improve outcome. However, the positive results for these two patients support the need for further study in this area.
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Wu O, Benner T, Roccatagliata L, Zhu M, Schaefer PW, Sorensen AG, Singhal AB. Evaluating effects of normobaric oxygen therapy in acute stroke with MRI-based predictive models. Med Gas Res 2012; 2:5. [PMID: 22404875 PMCID: PMC3388462 DOI: 10.1186/2045-9912-2-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Accepted: 03/09/2012] [Indexed: 12/04/2022] Open
Abstract
Background Voxel-based algorithms using acute multiparametric-MRI data have been shown to accurately predict tissue outcome after stroke. We explored the potential of MRI-based predictive algorithms to objectively assess the effects of normobaric oxygen therapy (NBO), an investigational stroke treatment, using data from a pilot study of NBO in acute stroke. Methods The pilot study of NBO enrolled 11 patients randomized to NBO administered for 8 hours, and 8 Control patients who received room-air. Serial MRIs were obtained at admission, during gas therapy, post-therapy, and pre-discharge. Diffusion/perfusion MRI data acquired at admission (pre-therapy) was used in generalized linear models to predict the risk of lesion growth at subsequent time points for both treatment scenarios: NBO or Control. Results Lesion volume sizes 'during NBO therapy' predicted by Control-models were significantly larger (P = 0.007) than those predicted by NBO models, suggesting that ischemic lesion growth is attenuated during NBO treatment. No significant difference was found between the predicted lesion volumes at later time-points. NBO-treated patients, despite showing larger lesion volumes on Control-models than NBO-models, tended to have reduced lesion growth. Conclusions This study shows that NBO has therapeutic potential in acute ischemic stroke, and demonstrates the feasibility of using MRI-based algorithms to evaluate novel treatments in early-phase clinical trials.
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Affiliation(s)
- Ona Wu
- Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Boston MA 02114, USA.
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Holmes WM, Lopez-Gonzalez MR, Gallagher L, Deuchar GA, Macrae IM, Santosh C. Novel MRI detection of the ischemic penumbra: direct assessment of metabolic integrity. NMR IN BIOMEDICINE 2012; 25:295-304. [PMID: 21751274 DOI: 10.1002/nbm.1748] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Revised: 04/12/2011] [Accepted: 04/17/2011] [Indexed: 05/31/2023]
Abstract
We describe a novel magnetic resonance imaging technique to directly assess the metabolic integrity of penumbral tissue following stroke. For ischemically stressed tissue to be salvageable, it has to be capable of recovering aerobic metabolism (in place of anaerobic metabolism) on reperfusion. We probed ischemic brain tissue by altering the rate of oxygen delivery using a challenge of 100% oxygen ventilation. Any change from anaerobic to aerobic metabolism should alter the rate of lactate production and hence, levels of tissue lactate. Stroke was induced by permanent middle cerebral artery occlusion in rats. In Series 1 (n = 6), changes in tissue lactate during and following 100% oxygen challenge were monitored using (1)H magnetic resonance spectroscopy (MRS). Diffusion weighted imaging (DWI) and perfusion weighted imaging (PWI) were used to locate MRS voxels within the ischemic core, the homotopic contralateral striatum and within PWI/DWI mismatch (i.e. presumed penumbra). After 20 min of oxygen, lactate signal change was -16.1 ± 8.8% (mean ± SD) in PWI/DWI mismatch, +2.8 ± 5.1% in the ischemic core, and -0.6 ± 7.6% in the contralateral striatum. Return to air ventilation for 20 min resulted in a reversal, with lactate increasing by 46 ± 25.3% in the PWI/DWI mismatch, 6.6 ± 6.2% in the ischemic core, and -5 ± 11.4% in the contralateral striatum. In Series 2 (n = 6), a novel form of spectroscopic imaging was used to acquire lactate change maps to spatially identify regions of lactate change within the ischemic brain. This technique has potential clinical utility by identifying tissue that displays anaerobic metabolism capable of recovering aerobic metabolism when oxygen delivery is increased, which could provide a more precise assessment of penumbra.
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Affiliation(s)
- William M Holmes
- Glasgow Experimental MRI Centre, Division of Clinical Neuroscience, Faculty of Medicine, University of Glasgow, G61 1QH, Scotland, UK.
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