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Almubayyidh M, Alghamdi I, Parry-Jones AR, Jenkins D. Prehospital identification of intracerebral haemorrhage: a scoping review of early clinical features and portable devices. BMJ Open 2024; 14:e079316. [PMID: 38643005 PMCID: PMC11033659 DOI: 10.1136/bmjopen-2023-079316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 03/26/2024] [Indexed: 04/22/2024] Open
Abstract
INTRODUCTION Prehospital identification of intracerebral haemorrhage (ICH) in suspected stroke cases may enable the initiation of appropriate treatments and facilitate better-informed transport decisions. This scoping review aims to examine the literature to identify early clinical features and portable devices for the detection of ICH in the prehospital setting. METHODS Three databases were searched via Ovid (MEDLINE, EMBASE and CENTRAL) from inception to August 2022 using prespecified search strategies. One reviewer screened all titles, abstracts and full-text articles for eligibility, while a second reviewer independently screened 20% of the literature during each screening stage. Data extracted were tabulated to summarise the key findings. RESULTS A total of 6803 articles were screened for eligibility, of which 22 studies were included for analysis. Among them, 15 studies reported on early clinical features, while 7 considered portable devices. Associations between age, sex and comorbidities with the presence of ICH varied across studies. However, most studies reported that patients with ICH exhibited more severe neurological deficits (n=6) and higher blood pressure levels (n=11) at onset compared with other stroke and non-stroke diagnoses. Four technologies were identified for ICH detection: microwave imaging technology, volumetric impedance phase shift spectroscopy, transcranial ultrasound and electroencephalography. Microwave and ultrasound imaging techniques showed promise in distinguishing ICH from other diagnoses. CONCLUSION This scoping review has identified potential clinical features for the identification of ICH in suspected stroke patients. However, the considerable heterogeneity among the included studies precludes meta-analysis of available data. Moreover, we have explored portable devices to enhance ICH identification. While these devices have shown promise in detecting ICH, further technological development is required to distinguish between stroke subtypes (ICH vs ischaemic stroke) and non-stroke diagnoses.
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Affiliation(s)
- Mohammed Almubayyidh
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
- Department of Aviation and Marine, Prince Sultan Bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh, Saudi Arabia
| | - Ibrahim Alghamdi
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
- Department of Emergency Medical Services, College of Applied Medical Sciences, Khamis Mushait Campus, King Khalid University, Abha, Saudi Arabia
| | - Adrian Robert Parry-Jones
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
- Manchester Centre for Clinical Neurosciences, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - David Jenkins
- Division of Informatics, Imaging and Data Science, The University of Manchester, Manchester, UK
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Valaikiene J, Schlachetzki F, Azevedo E, Kaps M, Lochner P, Katsanos AH, Walter U, Baracchini C, Bartels E, Školoudík D. Point-of-Care Ultrasound in Neurology - Report of the EAN SPN/ESNCH/ERcNsono Neuro-POCUS Working Group. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2022; 43:354-366. [PMID: 35512836 DOI: 10.1055/a-1816-8548] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
In the last decade, ultrasound examination in neurology has been undergoing a significant expansion of its modalities. In parallel, there is an increasing demand for rapid and high-quality diagnostics in various acute diseases in the prehospital setting, the emergency room, intensive care unit, and during surgical or interventional procedures. Due to the growing need for rapid answers to clinical questions, there is particular demand for diagnostic ultrasound imaging. The Neuro-POCUS working group, a joint project by the European Academy of Neurology Scientific Panel Neurosonology, the European Society of Neurosonology and Cerebral Hemodynamics, and the European Reference Centers in Neurosonology (EAN SPN/ESNCH/ERcNsono Neuro-POCUS working group), was given the task of creating a concept for point-of-care ultrasound in neurology called "Neuro-POCUS". We introduce here a new ultrasound examination concept called point-of-care ultrasound in neurology (Neuro-POCUS) designed to streamline conclusive imaging outside of the ultrasound center, directly at the bedside. The aim of this study is to encourage neurologists to add quick and disease-oriented Neuro-POCUS to accompany the patient in the critical phase as an adjunct not a substitution for computed tomography, magnetic resonance imaging, or standard comprehensive neurosonology examination. Another goal is to avoid unwanted complications during imaging-free periods, ultimately resulting in advantages for the patient.
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Affiliation(s)
- Jurgita Valaikiene
- Center of Neurology, Clinic of Neurology and Neurosurgery, Vilnius University Faculty of Medicine, Vilnius, Lithuania
| | - Felix Schlachetzki
- Department of Neurology, Center for Vascular Neurology and Intensive Care, medbo Bezirksklinikum Regensburg, University of Regensburg, Germany
| | - Elsa Azevedo
- Department of Neurology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Manfred Kaps
- Neurology, Justus Liebig University Giessen Faculty of Medicine, Giessen, Germany
| | - Piergiorgio Lochner
- Department of Neurology, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg, Germany
| | - Aristeidis H Katsanos
- Division of Neurology, Population Health Research Institute, McMaster University, Hamilton, Canada
| | - Uwe Walter
- Department of Neurology, Rostock University Medical Center, Rostock, Germany
| | - Claudio Baracchini
- Stroke Unit and Neurosonology Laboratory, Padua University Hospital, Padova, Italy
| | - Eva Bartels
- Neurology, Center for Neurological Vascular Diagnostics, Munich, Germany
| | - David Školoudík
- Center for Health Research, University of Ostrava Faculty of Medicine, Ostrava, Czech Republic
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Administration of 4-Hydroxy-3,5-Di-Tertbutyl Cinnamic Acid Restores Mitochondrial Function in Rabbits with Cerebral Ischemia. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2021. [DOI: 10.2478/sjecr-2019-0075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
The aim of the study is to evaluate the effect of 4-hydroxy-3,5- di-tertbutyl cinnamic acid on the change in mitochondrial function under conditions of experimental cerebral ischemia in rabbits. The study was performed on 48 male rabbits, which were used for modeling permanent cerebral ischemia by occlusion of the common carotid arteries. The test compound was administered before modeling ischemia for 14 days and after the occurrence of reproducing ischemia, in a similar time interval. After that, neurological deficit and the parameters of mitochondrial respiration, the intensity of anaerobic processes, the latent opening time of the mitochondrial permeability transition pore, the value of the mitochondrial membrane potential and the concentration of caspase – 3 were determined. The administration of 100 mg/kg of 4-hydroxy-3,5-di-tertbutyl cinnamic acid into the animals reduced neurological deficit and restored the mitochondrial membrane potential. Prophylactic administration of 4-hydroxy- 3,5-di-tertbutyl cinnamic acid, contributed to an increase in ATPgenerating ability, the maximum level of respiration and respiratory capacity by 4.1 times (p<0.01), 4.8 times (p<0.01) and 4.3 times (p<0.01), respectively. With therapeutic administration, these indicators increased by 11 times (p<0.01), 12.2 times (p<0.01) and 8.6 times (p<0.01), respectively. Also, both the prophylactic and therapeutic use of 4-hydroxy-3,5-di-tret-butyl cinnamic acid normalized aerobic/anaerobic metabolism, as well as reduced the concentration of caspase-3. Based on the obtained data, significant cerebroprotective properties of 4-hydroxy-3,5- di-tertbutyl cinnamic acid can be assumed. Moreover, the potential mechanism of action of this compound may be mediated by the normalization of mitochondrial function.
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Zeleňák K, Krajina A, Meyer L, Fiehler J, Behme D, Bulja D, Caroff J, Chotai AA, Da Ros V, Gentric JC, Hofmeister J, Kass-Hout O, Kocatürk Ö, Lynch J, Pearson E, Vukasinovic I. How to Improve the Management of Acute Ischemic Stroke by Modern Technologies, Artificial Intelligence, and New Treatment Methods. Life (Basel) 2021; 11:life11060488. [PMID: 34072071 PMCID: PMC8229281 DOI: 10.3390/life11060488] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/25/2021] [Accepted: 05/25/2021] [Indexed: 12/22/2022] Open
Abstract
Stroke remains one of the leading causes of death and disability in Europe. The European Stroke Action Plan (ESAP) defines four main targets for the years 2018 to 2030. The COVID-19 pandemic forced the use of innovative technologies and created pressure to improve internet networks. Moreover, 5G internet network will be helpful for the transfer and collecting of extremely big databases. Nowadays, the speed of internet connection is a limiting factor for robotic systems, which can be controlled and commanded potentially from various places in the world. Innovative technologies can be implemented for acute stroke patient management soon. Artificial intelligence (AI) and robotics are used increasingly often without the exception of medicine. Their implementation can be achieved in every level of stroke care. In this article, all steps of stroke health care processes are discussed in terms of how to improve them (including prehospital diagnosis, consultation, transfer of the patient, diagnosis, techniques of the treatment as well as rehabilitation and usage of AI). New ethical problems have also been discovered. Everything must be aligned to the concept of “time is brain”.
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Affiliation(s)
- Kamil Zeleňák
- Clinic of Radiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 03659 Martin, Slovakia
- ESMINT Artificial Intelligence and Robotics Ad hoc Committee, ESMINT, 8008 Zurich, Switzerland; (E.A.I.R.A.h.C.); (D.B.); (D.B.); (J.C.); (A.A.C.); (V.D.R.); (J.-C.G.); (J.H.); (O.K.-H.); (Ö.K.); (J.L.); (E.P.); (I.V.)
- Correspondence: ; Tel.: +421-43-4203-990
| | - Antonín Krajina
- Department of Radiology, Charles University Faculty of Medicine and University Hospital, CZ-500 05 Hradec Králové, Czech Republic;
| | - Lukas Meyer
- Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (L.M.); (J.F.)
| | - Jens Fiehler
- Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (L.M.); (J.F.)
| | | | - Daniel Behme
- ESMINT Artificial Intelligence and Robotics Ad hoc Committee, ESMINT, 8008 Zurich, Switzerland; (E.A.I.R.A.h.C.); (D.B.); (D.B.); (J.C.); (A.A.C.); (V.D.R.); (J.-C.G.); (J.H.); (O.K.-H.); (Ö.K.); (J.L.); (E.P.); (I.V.)
- University Clinic for Neuroradiology, Medical Faculty, Otto-von-Guericke University Magdeburg, 39120 Magdeburg, Germany
| | - Deniz Bulja
- ESMINT Artificial Intelligence and Robotics Ad hoc Committee, ESMINT, 8008 Zurich, Switzerland; (E.A.I.R.A.h.C.); (D.B.); (D.B.); (J.C.); (A.A.C.); (V.D.R.); (J.-C.G.); (J.H.); (O.K.-H.); (Ö.K.); (J.L.); (E.P.); (I.V.)
- Diagnostic-Interventional Radiology Department, Clinic of Radiology, Clinical Center of University of Sarajevo, 71000 Sarajevo, Bosnia and Herzegovina
| | - Jildaz Caroff
- ESMINT Artificial Intelligence and Robotics Ad hoc Committee, ESMINT, 8008 Zurich, Switzerland; (E.A.I.R.A.h.C.); (D.B.); (D.B.); (J.C.); (A.A.C.); (V.D.R.); (J.-C.G.); (J.H.); (O.K.-H.); (Ö.K.); (J.L.); (E.P.); (I.V.)
- Department of Interventional Neuroradiology–NEURI Brain Vascular Center, Bicêtre Hospital, APHP, 94270 Paris, France
| | - Amar Ajay Chotai
- ESMINT Artificial Intelligence and Robotics Ad hoc Committee, ESMINT, 8008 Zurich, Switzerland; (E.A.I.R.A.h.C.); (D.B.); (D.B.); (J.C.); (A.A.C.); (V.D.R.); (J.-C.G.); (J.H.); (O.K.-H.); (Ö.K.); (J.L.); (E.P.); (I.V.)
- Department of Neuroradiology, Royal Victoria Infirmary, Newcastle upon Tyne NE14LP, UK
| | - Valerio Da Ros
- ESMINT Artificial Intelligence and Robotics Ad hoc Committee, ESMINT, 8008 Zurich, Switzerland; (E.A.I.R.A.h.C.); (D.B.); (D.B.); (J.C.); (A.A.C.); (V.D.R.); (J.-C.G.); (J.H.); (O.K.-H.); (Ö.K.); (J.L.); (E.P.); (I.V.)
- Department of Biomedicine and Prevention, University Hospital of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Jean-Christophe Gentric
- ESMINT Artificial Intelligence and Robotics Ad hoc Committee, ESMINT, 8008 Zurich, Switzerland; (E.A.I.R.A.h.C.); (D.B.); (D.B.); (J.C.); (A.A.C.); (V.D.R.); (J.-C.G.); (J.H.); (O.K.-H.); (Ö.K.); (J.L.); (E.P.); (I.V.)
- Interventional Neuroradiology Unit, Hôpital de la Cavale Blanche, 29200 Brest, France
| | - Jeremy Hofmeister
- ESMINT Artificial Intelligence and Robotics Ad hoc Committee, ESMINT, 8008 Zurich, Switzerland; (E.A.I.R.A.h.C.); (D.B.); (D.B.); (J.C.); (A.A.C.); (V.D.R.); (J.-C.G.); (J.H.); (O.K.-H.); (Ö.K.); (J.L.); (E.P.); (I.V.)
- Unité de Neuroradiologie Interventionnelle, Service de Neuroradiologie Diagnostique et Interventionnelle, 1205 Genève, Switzerland
| | - Omar Kass-Hout
- ESMINT Artificial Intelligence and Robotics Ad hoc Committee, ESMINT, 8008 Zurich, Switzerland; (E.A.I.R.A.h.C.); (D.B.); (D.B.); (J.C.); (A.A.C.); (V.D.R.); (J.-C.G.); (J.H.); (O.K.-H.); (Ö.K.); (J.L.); (E.P.); (I.V.)
- Stroke and Neuroendovascular Surgery, Rex Hospital, University of North Carolina, 4207 Lake Boone Trail, Suite 220, Raleigh, NC 27607, USA
| | - Özcan Kocatürk
- ESMINT Artificial Intelligence and Robotics Ad hoc Committee, ESMINT, 8008 Zurich, Switzerland; (E.A.I.R.A.h.C.); (D.B.); (D.B.); (J.C.); (A.A.C.); (V.D.R.); (J.-C.G.); (J.H.); (O.K.-H.); (Ö.K.); (J.L.); (E.P.); (I.V.)
- Balikesir Atatürk City Hospital, Gaziosmanpaşa Mahallesi 209., Sok. No: 26, 10100 Altıeylül/Balıkesir, Turkey
| | - Jeremy Lynch
- ESMINT Artificial Intelligence and Robotics Ad hoc Committee, ESMINT, 8008 Zurich, Switzerland; (E.A.I.R.A.h.C.); (D.B.); (D.B.); (J.C.); (A.A.C.); (V.D.R.); (J.-C.G.); (J.H.); (O.K.-H.); (Ö.K.); (J.L.); (E.P.); (I.V.)
- Department of Neuroradiology, Toronto Western Hospital, Toronto, ON M5T 2S8, Canada
| | - Ernesto Pearson
- ESMINT Artificial Intelligence and Robotics Ad hoc Committee, ESMINT, 8008 Zurich, Switzerland; (E.A.I.R.A.h.C.); (D.B.); (D.B.); (J.C.); (A.A.C.); (V.D.R.); (J.-C.G.); (J.H.); (O.K.-H.); (Ö.K.); (J.L.); (E.P.); (I.V.)
- CH Bergerac-Centre Hospitalier, Samuel Pozzi 9 Boulevard du Professeur Albert Calmette, 24100 Bergerac, France
| | - Ivan Vukasinovic
- ESMINT Artificial Intelligence and Robotics Ad hoc Committee, ESMINT, 8008 Zurich, Switzerland; (E.A.I.R.A.h.C.); (D.B.); (D.B.); (J.C.); (A.A.C.); (V.D.R.); (J.-C.G.); (J.H.); (O.K.-H.); (Ö.K.); (J.L.); (E.P.); (I.V.)
- Department of Neuroradiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
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Lumley HA, Flynn D, Shaw L, McClelland G, Ford GA, White PM, Price CI. A scoping review of pre-hospital technology to assist ambulance personnel with patient diagnosis or stratification during the emergency assessment of suspected stroke. BMC Emerg Med 2020; 20:30. [PMID: 32336270 PMCID: PMC7183583 DOI: 10.1186/s12873-020-00323-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 04/08/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Pre-hospital identification of key subgroups within the suspected stroke population could reduce delays to emergency treatment. We aimed to identify and describe technology with existing proof of concept for diagnosis or stratification of patients in the pre-hospital setting. METHODS A systematic electronic search of published literature (from 01/01/2000 to 06/06/2019) was conducted in five bibliographic databases. Two reviewers independently assessed eligibility of studies or study protocols describing diagnostic/stratification tests (portable imaging/biomarkers) or technology facilitating diagnosis/stratification (telemedicine) used by ambulance personnel during the assessment of suspected stroke. Eligible descriptions required use of tests or technology during the actual assessment of suspected stroke to provide information directly to ambulance personnel in the pre-hospital setting. Due to study, intervention and setting heterogeneity there was no attempt at meta-analysis. RESULTS 2887 articles were screened for eligibility, 19 of which were retained. Blood biomarker studies (n = 2) were protocols of prospective diagnostic accuracy studies, one examining purines and the other a panel of known and novel biomarkers for identifying stroke sub-types (versus mimic). No data were yet available on diagnostic accuracy or patient health outcomes. Portable imaging studies (n = 2) reported that an infrared screening device for detecting haemorrhages yielded moderate sensitivity and poor specificity in a small study, whilst a dry-EEG study to detect large vessel occlusion in ischaemic stroke has not yet reported results. Fifteen evaluations of pre-hospital telemedicine were identified (12 observational and 3 controlled comparisons) which all involved transmission of stroke assessment data from the pre-hospital setting to the hospital. Diagnosis was generally comparable with hospital diagnosis and most telemedicine systems reduced time-to-treatment; however, it is unknown whether this time saving translated into more favourable clinical outcomes. Telemedicine systems were deemed acceptable by clinicians. CONCLUSIONS Pre-hospital technologies to identify clinically important subgroups amongst the suspected stroke population are in development but insufficient evidence precludes recommendations about routine use in the pre-hospital setting. Multi-centre diagnostic accuracy studies and clinical utility trials combining promising technologies are warranted.
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Affiliation(s)
- Hannah A Lumley
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Darren Flynn
- School of Health and Social Care, Teesside University, Tees Valley, UK
| | - Lisa Shaw
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Graham McClelland
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- North East Ambulance Service NHS Foundation Trust, Newcastle upon Tyne, England
| | - Gary A Ford
- Medical Sciences Division, Oxford Academic Health Science Network, University of Oxford, and Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Phil M White
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, England
| | - Christopher I Price
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, England
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Wang Y, Gu J, Hu L, Kong L, Wang T, Di M, Li C, Gui S. miR-130a alleviates neuronal apoptosis and changes in expression of Bcl-2/Bax and caspase-3 in cerebral infarction rats through PTEN/PI3K/Akt signaling pathway. Exp Ther Med 2020; 19:2119-2126. [PMID: 32104274 PMCID: PMC7027342 DOI: 10.3892/etm.2020.8415] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 12/04/2019] [Indexed: 12/26/2022] Open
Abstract
Effect of micro ribonucleic acid (miR)-130a on neuronal apoptosis in rats with cerebral infarction (CI) was studied to explore whether phosphatase and tensin homolog deleted on chromosome ten (PTEN)/phosphatidylinositol 3-hydroxy kinase (PI3K)/protein kinase B (Akt) is involved in the regulation of neuronal apoptosis. Thirty-six Sprague-Dawley (SD) rats were randomly divided into blank control group, model group and miR-130a low-expression group. miR-130a was determined by quantitative polymerase chain reaction (qPCR), the content of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and IL-10 was detected using the enzyme-linked immunosorbent assay (ELISA) kits, and the neuronal apoptosis level in each group was determined through terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) staining. The neurobehavioral score was significantly lower in model group than that in blank control group (P<0.01), while it was significantly higher in miR-130a low-expression group than that in model group (P<0.01). Compared with blank control group, the model group had obviously increased content of TNF-α and IL-6 (P<0.01), decreased content of IL-10 (P<0.01), more apoptotic neurons (P<0.01), higher expression of caspase-3 (P<0.01), and obviously lower Bcl-2/Bax (P<0.01). Moreover, expression of phosphorylated (p)-PTEN, PI3K and p-Akt in brain tissues was remarkably lower in the model group than those in the blank control group (P<0.01). The expression level of miR-130a in brain tissues of CI rats is significantly increased. miR-130a promotes the release of inflammatory factors and facilitates neuronal apoptosis through suppressing the PTEN/PI3K/Akt signaling pathway.
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Affiliation(s)
- Yinming Wang
- Department of Neurology, The Third People's Hospital of Wuxi, Wuxi, Jiangsu 214041, P.R. China
| | - Junquan Gu
- Department of Neurology, The Third People's Hospital of Wuxi, Wuxi, Jiangsu 214041, P.R. China
| | - Linlin Hu
- Department of Neurology, The Third People's Hospital of Wuxi, Wuxi, Jiangsu 214041, P.R. China
| | - Liang Kong
- Department of Neurology, The Third People's Hospital of Wuxi, Wuxi, Jiangsu 214041, P.R. China
| | - Tinggang Wang
- Department of Neurology, The Third People's Hospital of Wuxi, Wuxi, Jiangsu 214041, P.R. China
| | - Meiqi Di
- Department of Neurology, The Third People's Hospital of Wuxi, Wuxi, Jiangsu 214041, P.R. China
| | - Chaosheng Li
- Department of Neurology, The Third People's Hospital of Wuxi, Wuxi, Jiangsu 214041, P.R. China
| | - Shuhua Gui
- Department of Neurology, The Third People's Hospital of Wuxi, Wuxi, Jiangsu 214041, P.R. China
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Ludewig P, Gdaniec N, Sedlacik J, Forkert ND, Szwargulski P, Graeser M, Adam G, Kaul MG, Krishnan KM, Ferguson RM, Khandhar AP, Walczak P, Fiehler J, Thomalla G, Gerloff C, Knopp T, Magnus T. Magnetic Particle Imaging for Real-Time Perfusion Imaging in Acute Stroke. ACS NANO 2017; 11:10480-10488. [PMID: 28976180 DOI: 10.1021/acsnano.7b05784] [Citation(s) in RCA: 113] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
The fast and accurate assessment of cerebral perfusion is fundamental for the diagnosis and successful treatment of stroke patients. Magnetic particle imaging (MPI) is a new radiation-free tomographic imaging method with a superior temporal resolution, compared to other conventional imaging methods. In addition, MPI scanners can be built as prehospital mobile devices, which require less complex infrastructure than computed tomography (CT) and magnetic resonance imaging (MRI). With these advantages, MPI could accelerate the stroke diagnosis and treatment, thereby improving outcomes. Our objective was to investigate the capabilities of MPI to detect perfusion deficits in a murine model of ischemic stroke. Cerebral ischemia was induced by inserting of a microfilament in the internal carotid artery in C57BL/6 mice, thereby blocking the blood flow into the medial cerebral artery. After the injection of a contrast agent (superparamagnetic iron oxide nanoparticles) specifically tailored for MPI, cerebral perfusion and vascular anatomy were assessed by the MPI scanner within seconds. To validate and compare our MPI data, we performed perfusion imaging with a small animal MRI scanner. MPI detected the perfusion deficits in the ischemic brain, which were comparable to those with MRI but in real-time. For the first time, we showed that MPI could be used as a diagnostic tool for relevant diseases in vivo, such as an ischemic stroke. Due to its shorter image acquisition times and increased temporal resolution compared to that of MRI or CT, we expect that MPI offers the potential to improve stroke imaging and treatment.
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Affiliation(s)
| | - Nadine Gdaniec
- Institute for Biomedical Imaging, Hamburg University of Technology , 21071 Hamburg, Germany
| | | | - Nils D Forkert
- Department of Radiology and Hotchkiss Brain Institute, University of Calgary , Calgary, AB T2N 1N4, Canada
| | - Patryk Szwargulski
- Institute for Biomedical Imaging, Hamburg University of Technology , 21071 Hamburg, Germany
| | - Matthias Graeser
- Institute for Biomedical Imaging, Hamburg University of Technology , 21071 Hamburg, Germany
| | | | | | - Kannan M Krishnan
- LodeSpin Laboratories LLC , Seattle, Washington 98103, United States
- Materials Science and Engineering Department, University of Washington , Seattle, Washington 98195, United States
| | | | - Amit P Khandhar
- LodeSpin Laboratories LLC , Seattle, Washington 98103, United States
| | - Piotr Walczak
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine , Baltimore, Maryland 21205, United States
- Department of Neurology and Neurosurgery, University of Warmia and Mazury , Olsztyn, Poland
| | | | | | | | - Tobias Knopp
- Institute for Biomedical Imaging, Hamburg University of Technology , 21071 Hamburg, Germany
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