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Krstic B, Selakovic D, Jovicic N, Krstic M, Katanic Stankovic JS, Rosic S, Milovanovic D, Rosic G. Complex Hippocampal Response to Thermal Skin Injury and Protocols with Hyperbaric Oxygen Therapy and Filipendula ulmaria Extract in Rats. Int J Mol Sci 2024; 25:3033. [PMID: 38474277 DOI: 10.3390/ijms25053033] [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: 01/30/2024] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 03/14/2024] Open
Abstract
The aim of this study was to evaluate the alterations of the hippocampal function that may be related to anxiogenic response to thermal skin injury, including the morpho-functional alterations, and the effects of hyperbaric oxygen (HBO) and Filipendula ulmaria (FU) extract in the treatment of anxiety-like behavior that coincides with thermal skin injury. A rat thermal skin injury experimental model was performed on 2-month-old male Wistar albino rats. The evaluated therapeutic protocols included HBO and/or antioxidant supplementation. HBO was applied for 7 days in the hyperbaric chamber (100% O2, 2.5 ATA, 60 min). Oral administration of FU extract (final concentration of 100 mg/kg b.w.) to achieve antioxidant supplementation was also applied for 7 days. Anxiety level was estimated in the open field and elevated plus-maze test, which was followed by anesthesia, sacrifice, and collection of hippocampal tissue samples. HBO treatment and FU supplementation significantly abolished anxiogenic response to thermal skin injury. This beneficial effect was accompanied by the reduction in hippocampal pro-inflammatory and pro-apoptotic indicators, and enhanced BDNF and GABA-ARα2S gene expression, previously observed in untreated burns. The hippocampal relative gene expression of melatonin receptors and NPY positively responded to the applied protocols, in the same manner as µ and δ opioid receptors, while the opposite response was observed for κ receptors. The results of this study provide some confirmations that adjuvant strategies, such as HBO and antioxidant supplementation, may be simultaneously applied in the treatment of the anxiety-like behavior that coincides with thermal skin injury.
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Affiliation(s)
- Bojana Krstic
- Department of Physiology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Dragica Selakovic
- Department of Physiology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Nemanja Jovicic
- Department of Histology and Embryology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Milos Krstic
- Department of Physiology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Jelena S Katanic Stankovic
- Department of Science, Institute for Information Technologies Kragujevac, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Sara Rosic
- Department of Physiology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Dragan Milovanovic
- Clinical Pharmacology Department, Clinical Centre Kragujevac, 34000 Kragujevac, Serbia
- Department of Pharmacology and Toxicology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Gvozden Rosic
- Department of Physiology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
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Allahham A, Rowe G, Stevenson A, Fear MW, Vallence AM, Wood FM. The impact of burn injury on the central nervous system. BURNS & TRAUMA 2024; 12:tkad037. [PMID: 38312739 PMCID: PMC10835674 DOI: 10.1093/burnst/tkad037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/31/2023] [Accepted: 06/21/2023] [Indexed: 02/06/2024]
Abstract
Burn injuries can be devastating, with life-long impacts including an increased risk of hospitalization for a wide range of secondary morbidities. One area that remains not fully understood is the impact of burn trauma on the central nervous system (CNS). This review will outline the current findings on the physiological impact that burns have on the CNS and how this may contribute to the development of neural comorbidities including mental health conditions. This review highlights the damaging effects caused by burn injuries on the CNS, characterized by changes to metabolism, molecular damage to cells and their organelles, and disturbance to sensory, motor and cognitive functions in the CNS. This damage is likely initiated by the inflammatory response that accompanies burn injury, and it is often long-lasting. Treatments used to relieve the symptoms of damage to the CNS due to burn injury often target inflammatory pathways. However, there are non-invasive treatments for burn patients that target the functional and cognitive damage caused by the burn, including transcranial magnetic stimulation and virtual reality. Future research should focus on understanding the mechanisms that underpin the impact of a burn injury on the CNS, burn severity thresholds required to inflict damage to the CNS, and acute and long-term therapies to ameliorate deleterious CNS changes after a burn.
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Affiliation(s)
- Amira Allahham
- Burn injury research unit, School of Biomedical Sciences, University of Western Australia, 35 Stirling Highway, Crawley, Perth, WA 6009, Australia
- Fiona Wood Foundation, 11 Robin Warren Dr, Murdoch WA 6150, Australia
| | - Grant Rowe
- Centre for Molecular Medicine and Innovative Therapeutics, Murdoch University, 90 South Street, Murdoch, Perth 6150, Australia
| | - Andrew Stevenson
- Burn injury research unit, School of Biomedical Sciences, University of Western Australia, 35 Stirling Highway, Crawley, Perth, WA 6009, Australia
- Fiona Wood Foundation, 11 Robin Warren Dr, Murdoch WA 6150, Australia
| | - Mark W Fear
- Burn injury research unit, School of Biomedical Sciences, University of Western Australia, 35 Stirling Highway, Crawley, Perth, WA 6009, Australia
- Fiona Wood Foundation, 11 Robin Warren Dr, Murdoch WA 6150, Australia
| | - Ann-Maree Vallence
- Centre for Molecular Medicine and Innovative Therapeutics, Murdoch University, 90 South Street, Murdoch, Perth 6150, Australia
- Centre for Healthy Ageing, Health Futures Institute, Murdoch University, 90 South Street, Murdoch Perth 6150, Australia
- Burn Service of Western Australia, Fiona Stanley Hospital, MNH (B), Level 4, 102-118 Murdoch Drive, Murdoch, Perth, WA 6150, Australia
| | - Fiona M Wood
- Burn injury research unit, School of Biomedical Sciences, University of Western Australia, 35 Stirling Highway, Crawley, Perth, WA 6009, Australia
- Fiona Wood Foundation, 11 Robin Warren Dr, Murdoch WA 6150, Australia
- School of Psychology, College of Health and Education, Murdoch University, 90 South Street, Murdoch, Perth 6150, Australia
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Chen J, Zhang D, Zhang J, Wang Y. Pathological changes in the brain after peripheral burns. BURNS & TRAUMA 2023; 11:tkac061. [PMID: 36865685 PMCID: PMC9972189 DOI: 10.1093/burnst/tkac061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 12/22/2022] [Indexed: 02/09/2023]
Abstract
Brain injuries are common complications in patients with thermal burns and are associated with unpleasant outcomes. In clinical settings, it was once believed that brain injuries were not major pathological processes after burn, at least in part due to the unavailability of specific clinical manifestations. Burn-related brain injuries have been studied for more than a century, but the underlying pathophysiology has not been completely clarified. This article reviews the pathological changes in the brain following peripheral burns at the anatomical, histological, cytological, molecular and cognitive levels. Therapeutic indications based on brain injury as well as future directions for research have been summarized and proposed.
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Affiliation(s)
- Jigang Chen
- Department of Burn and Plastic Surgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Danfeng Zhang
- Department of Neurosurgery, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai 200003, China
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Xie C, Hu J, Cheng Y, Yao Z. Researches on cognitive sequelae of burn injury: Current status and advances. Front Neurosci 2022; 16:1026152. [PMID: 36408414 PMCID: PMC9672468 DOI: 10.3389/fnins.2022.1026152] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/20/2022] [Indexed: 09/29/2023] Open
Abstract
Burn injury is a devastating disease with high incidence of disability and mortality. The cognitive dysfunctions, such as memory defect, are the main neurological sequelae influencing the life quality of burn-injured patients. The post-burn cognitive dysfunctions are related to the primary peripheral factors and the secondary cerebral inflammation, resulting in the destruction of blood-brain barrier (BBB), as is shown on Computed Tomography (CT) and magnetic resonance imaging examinations. As part of the neurovascular unit, BBB is vital to the nutrition and homeostasis of the central nervous system (CNS) and undergoes myriad alterations after burn injury, causing post-burn cognitive defects. The diagnosis and treatment of cognitive dysfunctions as burn injury sequelae are of great importance. In this review, we address the major manifestations and interventions of post-burn cognitive defects, as well as the mechanisms involved in memory defect, including neuroinflammation, destruction of BBB, and hormone imbalance.
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Affiliation(s)
- Chenchen Xie
- Department of Neurology, Affiliated Hospital and Clinical Medical College of Chengdu University, Chengdu, China
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jun Hu
- Department of Neurology, First Affiliated Hospital of Army Medical University, Chongqing, China
| | - Yong Cheng
- Department of Neurology, General Hospital of Central Theater Command of PLA, Wuhan, China
| | - Zhongxiang Yao
- Department of Physiology, Army Medical University, Chongqing, China
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Weremijewicz A, Matuszczak E, Sankiewicz A, Tylicka M, Komarowska M, Tokarzewicz A, Debek W, Gorodkiewicz E, Hermanowicz A. Matrix metalloproteinase-2 and its correlation with basal membrane components laminin-5 and collagen type IV in paediatric burn patients measured with Surface Plasmon Resonance Imaging (SPRI) biosensors. Burns 2018; 44:931-940. [PMID: 29395405 DOI: 10.1016/j.burns.2017.12.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 11/16/2017] [Accepted: 12/07/2017] [Indexed: 01/28/2023]
Abstract
The purpose of this study was the determination of matrix metalloproteinase-2 and its correlation with basal membrane components laminin-5 and collagen type IV in the blood plasma of burn patients measured with Surface Plasmon Resonance Imaging (SPRI) biosensors. MATERIAL AND METHODS 31 children scalded by hot water who were managed at the Department of Paediatric Surgery between 2014-2015, after primarily presenting with burns in 4-20% TBSA were included into the study (age 9 months up to 14 years, mean age 2,5+1 years). There were 10 girls and 21 boys. Venous blood samples were drawn 2-6h, and 12-16h after the thermal injury, and on the subsequent days 3, 5 and 7. The matrix metalloproteinase-2, collagen type IV and laminin-5 concentrations were assessed using Surface Plasmon Resonance Imaging by the investigators blinded to the other data. RESULTS The MMP-2, laminin-5 and collagen type IV concentrations in the blood plasma of patients with burns, were highest 12-16h after thermal injury, the difference was statistically significant. The MMP-2, laminin-5 and collagen type IV concentrations measured 3 days, 5 days and 7 days after the thermal injury, slowly decreased over time, and on the 7th day reached the normal range, when compared with the concentration measured in controls. CONCLUSION Current work is the first follow-up study regarding MMP-2 in burns. MMP-2, laminin-5 and collagen type IV levels were elevated early after burn injury in the plasma of studied patients, and were highest 12-16h after the injury. MMP-2, laminin-5 and collagen type IV levels were not proportional to the severity of the burn. We believe in the possibility that the gradual decrease of MMP-2, collagen type IV and laminin-5 concentrations could be connected with the process of healing, but to prove it, more investigation is needed in this area. The SPR imaging biosensor is a good diagnostic tool for determination of MMP-2, laminin-5 and collagen type IV in blood plasma of patients with burns.
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Affiliation(s)
| | - Ewa Matuszczak
- Paediatric Surgery Department, Medical University of Bialystok, Poland.
| | - Anna Sankiewicz
- Electrochemistry Department, University of Bialystok, Poland
| | - Marzena Tylicka
- Biophysics Department, Medical University of Bialystok, Poland
| | - Marta Komarowska
- Paediatric Surgery Department, Medical University of Bialystok, Poland
| | | | - Wojciech Debek
- Paediatric Surgery Department, Medical University of Bialystok, Poland
| | | | - Adam Hermanowicz
- Paediatric Surgery Department, Medical University of Bialystok, Poland
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Hamasaki MY, Machado MCC, Pinheiro da Silva F. Animal models of neuroinflammation secondary to acute insults originated outside the brain. J Neurosci Res 2017; 96:371-378. [DOI: 10.1002/jnr.24184] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 09/11/2017] [Accepted: 09/12/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Mike Yoshio Hamasaki
- Laboratório de Emergências Clínicas, Faculdade de Medicina FMUSP; Universidade de São Paulo; São Paulo SP Brazil
| | | | - Fabiano Pinheiro da Silva
- Laboratório de Emergências Clínicas, Faculdade de Medicina FMUSP; Universidade de São Paulo; São Paulo SP Brazil
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Vetrichevvel TP, Randall SM, Fear MW, Wood FM, Boyd JH, Duke JM. Burn injury and long-term nervous system morbidity: a population-based cohort study. BMJ Open 2016; 6:e012668. [PMID: 27609857 PMCID: PMC5020894 DOI: 10.1136/bmjopen-2016-012668] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To investigate if children and adults who are hospitalised for a burn injury have increased long-term hospital use for nervous system diseases. DESIGN A population-based retrospective cohort study using linked administrative health data from the Western Australian Data Linkage System. PARTICIPANTS Records of 30 997 persons hospitalised for a first burn injury in Western Australia during the period 1980-2012, and 123 399 persons who were age and gender frequency matched with no injury admissions randomly selected from Western Australia's birth registrations and electoral roll. MAIN OUTCOME MEASURES Admission rates and summed length of stay for nervous system diseases. Negative binomial and Cox proportional hazards regression modelling were used to generate incidence rate ratios (IRRs) and HRs with 95% CIs, respectively. RESULTS After adjustment for demographic factors and pre-existing health status, the burn injury cohort had 2.20 times (95% CI 1.86 to 2.61) as many nervous system admissions and 3.25 times the number of days in hospital (95% CI: 2.28 to 4.64) than the uninjured cohort. This increase was found for those who had sustained burns during childhood (<15 years: IRR, 95% CI: 1.97, 1.49 to 2.61) and early to mid-adulthood (15-45 years: IRR, 95% CI: 2.70, 2.06 to 3.55) and older adults (≥45 years: IRR, 95% CI: 1.62, 1.33 to 1.97). Significantly elevated first-time postburn admissions were observed for children for 15 years postburn discharge (0-5 years: HR, 95% CI: 1.97, 1.75 to 2.22; 5-15 years: HR, 95% CI: 1.44, 1.28 to 1.63) and for adults 45 years and older at index burn for 5 years postburn only (HR, 95% CI: 1.72, 1.42 to 2.09). CONCLUSIONS Burn injury appears to be associated with increased nervous system-related morbidity for many years after burn injury. Further work into the mechanisms and possible treatments to reduce this morbidity are warranted in light of these findings.
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Affiliation(s)
- Thirthar P Vetrichevvel
- Burn Injury Research Unit, School of Surgery, University of Western Australia, Perth, Western Australia, Australia
| | - Sean M Randall
- Centre for Data Linkage, Curtin University, Perth, Western Australia, Australia
| | - Mark W Fear
- Burn Injury Research Unit, School of Surgery, University of Western Australia, Perth, Western Australia, Australia
| | - Fiona M Wood
- Burn Injury Research Unit, School of Surgery, University of Western Australia, Perth, Western Australia, Australia
- Burns Service of Western Australia, Fiona Stanley Hospital and Princess Margaret Hospital, Perth, Western Australia, Australia
| | - James H Boyd
- Centre for Data Linkage, Curtin University, Perth, Western Australia, Australia
| | - Janine M Duke
- Burn Injury Research Unit, School of Surgery, University of Western Australia, Perth, Western Australia, Australia
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Li H, Jia JP, Xu M, Zhang L. Changes in the blood-nerve barrier after sciatic nerve cold injury: indications supporting early treatment. Neural Regen Res 2015; 10:419-24. [PMID: 25878590 PMCID: PMC4396104 DOI: 10.4103/1673-5374.153690] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2014] [Indexed: 11/04/2022] Open
Abstract
Severe edema in the endoneurium can occur after non-freezing cold injury to the peripheral nerve, which suggests damage to the blood-nerve barrier. To determine the effects of cold injury on the blood-nerve barrier, the sciatic nerve on one side of Wistar rats was treated with low temperatures (3-5°C) for 2 hours. The contralateral sciatic nerve was used as a control. We assessed changes in the nerves using Evans blue as a fluid tracer and morphological methods. Excess fluid was found in the endoneurium 1 day after cold injury, though the tight junctions between cells remained closed. From 3 to 5 days after the cold injury, the fluid was still present, but the tight junctions were open. Less tracer leakage was found from 3 to 5 days after the cold injury compared with 1 day after injury. The cold injury resulted in a breakdown of the blood-nerve barrier function, which caused endoneurial edema. However, during the early period, the breakdown of the blood-nerve barrier did not include the opening of tight junctions, but was due to other factors. Excessive fluid volume produced a large increase in the endoneurial fluid pressure, prevented liquid penetration into the endoneurium from the microvasculature. These results suggest that drug treatment to patients with cold injuries should be administered during the early period after injury because it may be more difficult for the drug to reach the injury site through the microcirculation after the tissue fluid pressure becomes elevated.
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Affiliation(s)
- Hao Li
- Department of Neurology, the First People's Hospital of Yibin, Yibin, Sichuan Province, China
| | - Jian-ping Jia
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Min Xu
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Lei Zhang
- Department of Pharmacy, the First People's Hospital of Yibin, Yibin, Sichuan Province, China
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Blyth BJ, Farahvar A, He H, Nayak A, Yang C, Shaw G, Bazarian JJ. Elevated serum ubiquitin carboxy-terminal hydrolase L1 is associated with abnormal blood-brain barrier function after traumatic brain injury. J Neurotrauma 2011; 28:2453-62. [PMID: 21428722 DOI: 10.1089/neu.2010.1653] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Serum S100B elevations accurately reflect blood-brain barrier (BBB) damage. Because S100B is also present in peripheral tissues, release of this protein may not be specific to central nervous system (CNS) injury. Ubiquitin C-terminal hydrolase 1 (UCHL1), and phosphorylated neurofilament heavy chain (pNF-H) are found exclusively in neurons, but their relationship to BBB dysfunction has not been determined. The objective of this study was to determine the accuracy of serum UCHL1 and pNF-H as measures of BBB integrity after traumatic brain injury (TBI), to and compare them to S100B. We performed a prospective study of 16 patients with moderate to severe TBI (Glasgow Coma Scale [GCS] score ≤12) and 6 patients with non-traumatic headache who had cerebrospinal fluid (CSF) collected by ventriculostomy or lumbar puncture (LP). Serum and CSF were collected at the time of LP for headache patients and at 12, 24, and 48 h after injury for TBI patients. BBB function was determined by calculating albumin quotients (Q(A)), where Q(A)=[albumin(CSF)]/[albumin(serum)]. S100B, UCHL1, and pNF-H were measured by enzyme-linked immunosorbent assay (ELISA). Pearson's correlation coefficient and area under the receiver operator characteristic (ROC) curve were used to determine relationships between serum markers and Q(A). At 12 hours after TBI, a significant relationship was found between Q(A) and serum UCHL1 concentrations (AUC=0.76; 95% CI 0.55,1.00), and between Q(A) and serum S100B concentrations (AUC=0.794; 95% CI 0.57,1.02). There was no significant relationship found between these markers and Q(A) at other time points, or between pNF-H and Q(A) at any time point. We conclude that serum concentrations of UCHL1 are associated with abnormal BBB status 12 h after moderate to severe TBI. This relationship is similar to that observed between serum S100B and Q(A,) despite the fact that S100B may be released from peripheral tissues after multi-trauma. We conclude that peripheral release of S100B after multi-trauma is probably negligible and that UCHL1 may have some utility to monitor BBB disruption following TBI.
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Affiliation(s)
- Brian J Blyth
- Department of Emergency Medicine and Center for Neural Development and Disease, University of Rochester Medical Center, Rochester, New York 14642, USA.
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Ji Q, Jia H, Dai H, Li W, Zhang L. Protective effects of pentoxifylline on the brain following remote burn injury. Burns 2010; 36:1300-8. [DOI: 10.1016/j.burns.2010.05.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Revised: 05/03/2010] [Accepted: 05/12/2010] [Indexed: 12/31/2022]
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Ackerman LL, Ryken TC, Kealey GP, Traynelis VC. Onset of symptomatic hydrocephalus requiring emergency cerebrospinal fluid diversion following high-voltage electrical burn injury. J Neurosurg 2009; 112:394-8. [PMID: 19681688 DOI: 10.3171/2009.7.jns09578] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
High-voltage electrical injuries have been reported to cause a plethora of neurological complications including cognitive, motor, and sensory deficits in an immediate or delayed fashion. In this setting, new-onset symptomatic hydrocephalus requiring CSF shunt placement has not been described. The authors present the case of an 18-year-old man who sustained a high-voltage electrical injury with a calvarial contact point that required emergency CSF diversion within hours of injury and subsequently required placement of a lumboperitoneal shunt. Management of the open calvarial wound, which required rotational flap reconstruction, and the need for ongoing CSF diversion required care and a team approach.
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Affiliation(s)
- Laurie L Ackerman
- Department of Neurological Surgery, Riley Children's Hospital/Indiana University, Indianapolis, Indiana 46202-5200, USA.
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Stereoscopic study on capillary density of early brain oedema in a dog postburn model. Injury 2009; 40:835-9. [PMID: 19232588 DOI: 10.1016/j.injury.2008.10.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2008] [Revised: 09/26/2008] [Accepted: 10/08/2008] [Indexed: 02/02/2023]
Abstract
BACKGROUND After severe burn, the effective circulating blood volume decreases drastically due to massive body fluid loss, and blood redistribution occurs to maintain sufficient blood supply to vital organs. Blood perfusion of brain tissue changes and the permeability of the blood brain barrier increases due to ischaemia and hypoxia, which results in brain oedema. The goal of this study was to explore the changes of cerebral blood flow during the brain oedema at the early stage of severe burn. METHODS Twenty-six dogs were randomly divided into control and 6, 12, 18, and 24 PBH groups. The manifestation of MRI and histopathology, changes of brain water content were investigated; the shapes and distribution of the cerebral capillaries were observed with the endogenous AKP histochemical staining method and image analysis technique. The volume, surface, and length fractions of cerebral capillaries were tested and analysed with a stereographic method in each group, respectively. RESULTS The earliest changes of cerebral oedema were found at 12 PBH with MRI, which showed the brain swelling as characteristic of cerebral morphological changes. The decrease of SIR on T(1)WI was not observed until it was above 10%. Signal of T(2)WI increased for 8.29% at 24 PBH. Histological changes were observed as early as 6h after burn, accompanied by swelling of endothelial cells and peri-vascular astrocytes, vacuolation took place in neurons at 12h after burn, necrosis of different degrees in capillary endothelium, neurons, and axons. Increase in cerebral water content was noted at 6h postburn, and it was the most marked in 24 postburn group.The distributional density of capillaries became thicker at 6h and 12h postburn, the shapes were normal. The capillaries became sparser at 18h, and almost disappeared from view, only a few ends of capillaries in the shape of vine were seen at 24h postburn. The percentages of capillary volume, surface, and length fractions were increased at 6h and 12h, but decreased at 18h and reached the lowest point at 24h postburn (P<0.05). CONCLUSION We suggest that the changes of cerebral blood flow might play an important role in the pathogenesis of brain oedema in the early stage of severe burn.
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Reyes R, Guo M, Swann K, Shetgeri SU, Sprague SM, Jimenez DF, Barone CM, Ding Y. Role of tumor necrosis factor-alpha and matrix metalloproteinase-9 in blood-brain barrier disruption after peripheral thermal injury in rats. J Neurosurg 2009; 110:1218-26. [PMID: 19199470 DOI: 10.3171/2008.8.jns08382] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECT A relationship has been found between peripheral thermal injury and cerebral complications leading to injury and death. In the present study, the authors examined whether tumor necrosis factor-alpha (TNF-alpha) and matrix metalloproteinase-9 (MMP-9) play a causative role in blood-brain barrier (BBB) disruption after peripheral thermal injury. METHODS Thirty-two male Sprague-Dawley rats were subjected to thermal injury. One hour later, 8 rats were injected with TNF-alpha neutralizing antibody, and 8 were injected with doxycycline, an inhibitor of the MMP family proteins; 16 rats did not receive any treatment. Brain tissue samples obtained 7 hours after injury in the treated animals were examined for BBB function by using fluorescein isothiocyanate-dextran and by assessing parenchymal water content. Protein expression of basement membrane components (collagen IV, laminin, and fibronectin) was quantified on Western blot analysis, and MMP-9 protein expression and enzyme activity were determined using Western blot and gelatin zymography. Thermally injured rats that did not receive treatment were killed at 3, 7, or 24 hours after injury and tested for BBB functioning at each time point. Histological analysis for basement membrane proteins was also conducted in untreated rats killed at 7 hours after injury. Results of testing in injured rats were compared with those obtained in a control group of rats that did not undergo thermal injury. RESULTS At 7 hours after thermal injury, a significant increase in the fluorescein isothiocyanate-dextran and water content of the brain was found (p < 0.05), but BBB dysfunction was significantly decreased in the rats that received TNF-alpha antibody or doxycycline (p < 0.05). In addition, the components of the basal lamina were significantly decreased at 7 hours after thermal injury (p < 0.01), and there were significant increases in MMP-9 protein expression and enzyme activity (p < 0.05). The basal lamina damage was reversed by inhibition of TNF-alpha and MMP-9, and the increase in MMP-9 protein was reduced in the presence of doxycycline (p < 0.05). The authors found that MMP-9 enzyme activity was significantly increased after thermal injury (p < 0.01) but decreased in the presence of either TNF-alpha antibody or doxycycline (p < 0.01). CONCLUSIONS The dual, inhibitory activity of both TNF-alpha and MMP-9 in brain injury suggests that a TNF-alpha and MMP-9 cascade may play a key role in BBB disruption. These results offer a better understanding of the pathophysiology of burn injuries, which may open new avenues for burn treatment beyond the level of current therapies.
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Affiliation(s)
- Raul Reyes
- Department of Neurosurgery, The University of Texas Health Science Center at San Antonio, Texas, USA
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Flierl MA, Stahel PF, Touban BM, Beauchamp KM, Morgan SJ, Smith WR, Ipaktchi KR. Bench-to-bedside review: Burn-induced cerebral inflammation--a neglected entity? CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2009; 13:215. [PMID: 19638180 PMCID: PMC2717412 DOI: 10.1186/cc7794] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Severe burn injury remains a major burden on patients and healthcare systems. Following severe burns, the injured tissues mount a local inflammatory response aiming to restore homeostasis. With excessive burn load, the immune response becomes disproportionate and patients may develop an overshooting systemic inflammatory response, compromising multiple physiological barriers in the lung, kidney, liver, and brain. If the blood–brain barrier is breached, systemic inflammatory molecules and phagocytes readily enter the brain and activate sessile cells of the central nervous system. Copious amounts of reactive oxygen species, reactive nitrogen species, proteases, cytokines/chemokines, and complement proteins are being released by these inflammatory cells, resulting in additional neuronal damage and life-threatening cerebral edema. Despite the correlation between cerebral complications in severe burn victims with mortality, burn-induced neuroinflammation continues to fly under the radar as an underestimated entity in the critically ill burn patient. In this paper, we illustrate the molecular events leading to blood–brain barrier breakdown, with a focus on the subsequent neuroinflammatory changes leading to cerebral edema in patients with severe burns.
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Affiliation(s)
- Michael A Flierl
- Department of Orthopaedic Surgery, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO 80204, USA.
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Blood brain barrier (BBB) dysfunction associated with increased expression of tissue and urokinase plasminogen activators following peripheral thermal injury. Neurosci Lett 2008; 444:222-6. [DOI: 10.1016/j.neulet.2008.08.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2008] [Revised: 07/31/2008] [Accepted: 08/08/2008] [Indexed: 11/23/2022]
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