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Cheng Y, Han X, Xie W, Xu G, Bai X, Qi L, Zhang L, Liu R, Dong W, Feng W, Pang C, Zhang W, Liu F, Cao X, Xu Y, Luo G. Safety and efficacy of magnesium-rich artificial cerebrospinal fluid for subarachnoid hemorrhage. Front Neurol 2024; 15:1376216. [PMID: 38606277 PMCID: PMC11007082 DOI: 10.3389/fneur.2024.1376216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 03/19/2024] [Indexed: 04/13/2024] Open
Abstract
Objectives This study aimed to investigate the efficacy of using a newly formulated magnesium-rich artificial cerebrospinal fluid (MACSF) as an alternative to normal saline (NS) for intraoperative irrigation during aneurysm clipping in improving the prognosis of patients with Aneurysmal subarachnoid hemorrhage (aSAH). Methods Patients with aSAH who underwent intraoperative irrigation with MACSF or NS during the clipping in the First Affiliated Hospital of Xi 'an Jiaotong University from March 2019 to March 2022 were selected as MACSF group and NS group, respectively. The primary prognostic indicators were the incidence of favorable outcomes (mRS 0-2). The secondary outcome measures included cerebral vasospasm (CVS), mortality, total hospital stay, and intensive care unit (ICU) stay. Safety was evaluated based on the occurrence rates of hypermagnesemia, meningitis, and hydrocephalus. Results Overall, 34 and 37 patients were enrolled in the MACSF and NS groups, respectively. At 90 days after aSAH onset, the proportion of favorable prognosis in the MACSF group was significantly higher than that in the NS group (p = 0.035). The incidence of CVS within 14 days after surgery was significantly lower in the MACSF group than that in the NS group (p = 0.026). The mortality rate in the MACSF group was significantly lower than in the NS group (p = 0.048). The median lengths of hospital stay (p = 0.008) and ICU stay (p = 0.018) were significantly shorter in the MACSF group than in the NS group. No significant differences were observed in safety measures. Conclusion Using MACSF as an irrigation fluid for aneurysm clipping can significantly improve the 90-day prognosis of patients with aSAH, which may be related to the reduced incidence of CVS. Clinical trial registration https://www.clinicaltrials.gov, identifier NCT04358445.
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Affiliation(s)
- Yawen Cheng
- Department of Neurology and Stroke Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xiangning Han
- Department of Neurology and Stroke Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Wanfu Xie
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Gaofeng Xu
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xiaobin Bai
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Lei Qi
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Linjuan Zhang
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Rui Liu
- Department of Neurology and Stroke Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Weihua Dong
- Department of Pharmacy Intravenous Admixture Services, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Weiyi Feng
- Department of Pharmacy Intravenous Admixture Services, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Chengsen Pang
- Department of Pharmacy Intravenous Admixture Services, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Wei Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Fude Liu
- Department of Neurology and Stroke Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xiangqi Cao
- Department of Neurology and Stroke Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yue Xu
- Department of Neurology and Stroke Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Guogang Luo
- Department of Neurology and Stroke Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Mathew AA, Panonnummal R. A Mini Review on the Various Facets Effecting Brain Delivery of Magnesium and Its Role in Neurological Disorders. Biol Trace Elem Res 2022:10.1007/s12011-022-03517-8. [PMID: 36534337 DOI: 10.1007/s12011-022-03517-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022]
Abstract
Magnesium is an essential cation present in the body that participates in the regulation of various vital body functions. Maintaining normal level of magnesium is essential for proper brain functions by regulating the activities of numerous neurotransmitters and their receptors. Various studies have been reported that magnesium level is found to be declined in both neurological and psychiatric diseases. Declined magnesium level in the brain initiates various cumbersome effects like excitotoxicity, altered blood-brain permeability, oxidative stress, and inflammation, which may further worsen the disease condition. Shreds of evidence from the experimental and clinical studies proved that exogenous administration of magnesium is useful for correcting disease-induced alterations in the brain. But one of the major limiting factors in the use of magnesium for treatment purposes is its poor blood-brain barrier permeability. Various approaches like the administration of its organic salts as pidolate and threonate forms, and the combination with polyethylene glycol or mannitol have been tried to improve its permeability to make magnesium as a suitable drug for different neurological disorders. These results have shown their experimental efficacy in diseased animal models, but studies regarding the safety and efficacy in human subjects are currently underway. We present a comprehensive review on the role of magnesium in the maintenance of normal functioning of the brain and various approaches for improving its BBB permeability.
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Affiliation(s)
- Aparna Ann Mathew
- Amrita School of Pharmacy, Amrita Institute of Medical Science & Research Centre, Amrita Vishwa Vidyapeetham, Kochi, 682041, India
| | - Rajitha Panonnummal
- Amrita School of Pharmacy, Amrita Institute of Medical Science & Research Centre, Amrita Vishwa Vidyapeetham, Kochi, 682041, India.
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3
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Inhibition of Delayed Cerebral Ischemia by Magnesium Is Insufficient for Subarachnoid Hemorrhage Patients: A Network Meta-Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:9357726. [PMID: 36065271 PMCID: PMC9440634 DOI: 10.1155/2022/9357726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 07/22/2022] [Indexed: 11/18/2022]
Abstract
Objective After subarachnoid hemorrhage, magnesium could reduce the incidence of delayed cerebral ischemia; however, it is still controversial. This study updated the results of recently published magnesium-related studies and conducted an exploratory analysis of the impact of application strategies and intervention factors on the results. Methods Public databases were searched from the date of their inception to May 10, 2021. Randomized controlled trials on magnesium agent-related regimens for subarachnoid hemorrhage patients were included. Results In total, 28 articles were included in the meta-analysis. For delayed cerebral ischemia, magnesium-related interventions significantly reduced the risk of delayed cerebral ischemia compared with nonmagnesium interventions (odds ratios: 0.40; 95% confidence interval: 0.28–0.56; p < 0.01). For cerebral vasospasm, a random effects model showed that magnesium significantly reduced the risk of cerebral vasospasm (odds ratios: 0.46; 95% confidence interval: 0.33–0.63; p < 0.01). In the subgroup analysis, intracranial magnesium (odds ratios: 6.67; 95% confidence interval: 1.14–38.83; p=0.03) and magnesium plus hydrogen (odds ratios: 10; 95% confidence interval: 1.59–62.73; p=0.01) produced significant results in improving the good recovery rate compared to the control. In the network meta-analysis, magnesium plus nimodipine and simvastatin even showed an effective trend in death/persistent vegetative status improvement. Conclusion This study supports the beneficial effect of magnesium in reducing the risk of delayed cerebral ischemia. Based on a single randomized controlled trial, immediate intracranial magnesium therapy with intravenous hydrogen after subarachnoid hemorrhage can increase the good recovery rate. Therefore, more high-quality studies are needed to confirm this finding.
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4
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Magnesium Sulfate and Cerebral Oxygen Saturation in Mild Traumatic Brain Injury: A Randomized, Double-Blind, Controlled Trial. J Clin Med 2022; 11:jcm11123388. [PMID: 35743456 PMCID: PMC9225065 DOI: 10.3390/jcm11123388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 02/01/2023] Open
Abstract
Perioperative cerebral hypoperfusion/ischemia is considered to play a pivotal role in the development of secondary traumatic brain injury (TBI). This prospective randomized, double-blind, controlled study investigated whether magnesium sulfate (MgSO4) infusion was associated with neuroprotection in maintaining regional cerebral oxygen saturation (rSO2) values in patients with mild TBI undergoing general anesthesia. Immediately after intubation, we randomly assigned patients with TBI to receive either intravenous MgSO4 (30 mg/kg for 10 min, followed by a continuous infusion of 15 mg/kg/h) or a placebo (saline) during surgery. We also implemented an intervention protocol for a sudden desaturation exceeding 20% of the initial baseline rSO2. The intraoperative rSO2 values were similar with respect to the median (left. 67% vs. 66%, respectively; p = 0.654), lowest, and highest rSO2 in both groups. The incidence (left 31.2% vs. 24.3%; p = 0.521) and duration (left 2.6% vs. 3.5%; p = 0.638) of cerebral desaturations (the relative decline in rSO2 < 80% of the baseline value) were also similar for both groups. Although the patients suffered serious traumatic injuries, all critical desaturation events were restored (100%) following stringent adherence to the intervention protocol. Intraoperative remifentanil consumption, postoperative pain intensity, and fentanyl consumption at 6 h were lower in the MgSO4 group (p = 0.024, 0.017, and 0.041, respectively) compared to the control group, whereas the satisfaction score was higher in the MgSO4 group (p = 0.007). The rSO2 did not respond to intraoperative MgSO4 in mild TBI. Nevertheless, MgSO4 helped the postoperative pain intensity, reduce the amount of intraoperative and postoperative analgesics administered, and heighten the satisfaction score.
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Picetti E, Barbanera A, Bernucci C, Bertuccio A, Bilotta F, Boccardi EP, Cafiero T, Caricato A, Castioni CA, Cenzato M, Chieregato A, Citerio G, Gritti P, Lanterna L, Menozzi R, Munari M, Panni P, Rossi S, Stocchetti N, Sturiale C, Zoerle T, Zona G, Rasulo F, Robba C. Early management of patients with aneurysmal subarachnoid hemorrhage in a hospital with neurosurgical/neuroendovascular facilities: a consensus and clinical recommendations of the Italian Society of Anesthesia and Intensive Care (SIAARTI)-part 2. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE (ONLINE) 2022; 2:21. [PMID: 37386571 DOI: 10.1186/s44158-022-00049-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 04/27/2022] [Indexed: 07/01/2023]
Abstract
BACKGROUND Questions remain on the optimal management of subarachnoid hemorrhage (SAH) patients once they are admitted to the referring center, before and after the aneurysm treatment. To address these issues, we created a consensus of experts endorsed by the Italian Society of Anesthesia and Intensive Care (SIAARTI) to provide clinical guidance regarding this topic. Specifically, in this manuscript (part 2), we aim to provide a list of experts' recommendations regarding the management of SAH patients in a center with neurosurgical/neuroendovascular facilities after aneurysm treatment. METHODS A multidisciplinary consensus panel composed by 24 physicians selected for their established clinical and scientific expertise in the acute management of SAH patients with different specializations (anesthesia/intensive care, neurosurgery, and interventional neuroradiology) was created. A modified Delphi approach was adopted. RESULTS A total of 33 statements were discussed, voted, and approved. Consensus was reached on 30 recommendations (28 strong and 2 weak). In 3 cases, where consensus could not be agreed upon, no recommendation was provided. CONCLUSIONS This consensus provides practical recommendations (and not mandatory standard of practice) to support clinician's decision-making in the management of SAH patients in centers with neurosurgical/neuroendovascular facilities after aneurysm securing.
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Affiliation(s)
- Edoardo Picetti
- Department of Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
| | - Andrea Barbanera
- Department of Neurosurgery, "SS Antonio e Biagio e Cesare Arrigo" Hospital, Alessandria, Italy
| | - Claudio Bernucci
- Department of Neuroscience and Surgery of the Nervous System, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Alessandro Bertuccio
- Department of Neurosurgery, "SS Antonio e Biagio e Cesare Arrigo" Hospital, Alessandria, Italy
| | - Federico Bilotta
- Department of Anesthesiology and Critical Care, Policlinico Umberto I Hospital, La Sapienza University of Rome, Rome, Italy
| | - Edoardo Pietro Boccardi
- Department of Interventional Neuroradiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Tullio Cafiero
- Department of Anesthesia and Intensive Care Unit, AORN Cardarelli, Naples, Italy
| | - Anselmo Caricato
- Department of Anesthesia and Critical Care, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Carlo Alberto Castioni
- Department of Anesthesia and Intensive Care, IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - Marco Cenzato
- Department of Neurosurgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Arturo Chieregato
- Neurointensive Care Unit, Department of Neuroscience and Department of Anesthesiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giuseppe Citerio
- School of Medicine and Surgery, University Milano - Bicocca, Milan, Italy
| | - Paolo Gritti
- Department of Anesthesia and Critical Care Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Luigi Lanterna
- Department of Neuroscience and Surgery of the Nervous System, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Roberto Menozzi
- Interventional Neuroradiology Unit, University Hospital of Parma, Parma, Italy
| | - Marina Munari
- Anesthesia and Intensive Care, Padua University Hospital, Padua, Italy
| | - Pietro Panni
- Department of Neuroradiology, San Raffaele Hospital, Milan, Italy
| | - Sandra Rossi
- Department of Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Nino Stocchetti
- Neuroscience Intensive Care Unit, Department of Anesthesia and Critical Care, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Carmelo Sturiale
- Neurosurgery Unit, IRCCS Istituto delle Scienze Neurologiche Ospedale Bellaria di Bologna, Bologna, Italy
| | - Tommaso Zoerle
- Neuroscience Intensive Care Unit, Department of Anesthesia and Critical Care, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Gianluigi Zona
- Department of Neurosurgery, Policlinico San Martino Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
| | - Frank Rasulo
- Department of Anesthesia, Intensive Care and Emergency Medicine, Spedali Civili University Hospital, Brescia, Italy
| | - Chiara Robba
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
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6
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Kumar M, Perucki W, Hiendlmayr B, Mazigh S, O'Sullivan DM, Fernandez AB. The Association of Serum Magnesium Levels and QT Interval with Neurological Outcomes After Targeted Temperature Management. Ther Hypothermia Temp Manag 2022; 12:210-214. [PMID: 35467975 DOI: 10.1089/ther.2021.0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Targeted temperature management (TTM) is associated with corrected QT (QTc) prolongation and decrease in serum magnesium (Mg) levels that may lead to recurrent ventricular arrhythmia and poor neurological outcomes. We aimed to evaluate the association between QTc interval and Mg levels during TTM with neurological outcomes. We reviewed the electrocardiograms of 366 patients who underwent TTM during the induction, maintenance, and rewarming phase after cardiac arrest. We reviewed the association of change in QTc interval, and Mg levels with neurological outcomes. In total, 71.3% of the patients had a significant increase in QTc interval defined as >60 ms or any QTc >500 ms during TTM. Poor neurological outcome was associated with persistent prolongation of QTc after rewarming (507 vs. 483 ms, p = 0.046) and higher Mg levels at presentation (2.08 ± 0.41 mg/dL, p = 0.014). Supplemental Mg did not have any significant change in their QTc. Patients with prolonged QTc during TTM should be promptly evaluated for QTc-prolonging factors given its association with worse neurological outcomes. The inverse correlation between Mg levels and poor neurological outcomes deserves further investigation.
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Affiliation(s)
- Manish Kumar
- Department of Medicine, Pat and Jim Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - William Perucki
- Department of Medicine, Pat and Jim Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington, Connecticut, USA.,Division of Cardiology, Hartford Hospital, Hartford, Connecticut, USA
| | - Brett Hiendlmayr
- Division of Cardiology, Hartford Hospital, Hartford, Connecticut, USA
| | - Silya Mazigh
- Department of Medicine, Pat and Jim Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - David M O'Sullivan
- Department of Research, Research Administration, Hartford HealthCare, Hartford, Connecticut, USA
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Valencia E, García M, Fernández-Vega B, Pereiro R, Lobo L, González-Iglesias H. Targeted Analysis of Tears Revealed Specific Altered Metal Homeostasis in Age-Related Macular Degeneration. Invest Ophthalmol Vis Sci 2022; 63:10. [PMID: 35426907 PMCID: PMC9034717 DOI: 10.1167/iovs.63.4.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Purpose Specific altered metal homeostasis has been investigated in the tear film of age-related macular degeneration (AMD) patients considering that metal dyshomeostasis contributes to the production of free radicals, inflammation, and apoptosis and results in conformational changes of proteins. Methods A multitargeted approach based on spectrophotometry and mass spectrometry techniques has been implemented to the multiplexed quantitation of lactoferrin (LF), S100 calcium binding protein A6 (S100A6), metallothionein 1A (MT1A), complement factor H (CFH), clusterin (CLU), amyloid precursor protein (APP), Mg, P, Na, Fe, Cu, Zn, and Ca, in the tear film from 60 subjects, 31 patients diagnosed with the dry form of AMD, and 29 healthy individuals Results Significant up-regulations of MT1A (1.9-fold) and S100A6 (1.4-fold) and down-regulations of LF (0.7-fold), Fe (0.6-fold), Mg (0.7-fold), and Cu (0.7-fold) were observed in AMD patients, when compared to control subjects. Of all the studied variables, only APP showed negative correlation with age in the AMD group. Also, positive correlations were observed for the variables Mg and Na, Cu and Mg, and P and Mg in both the AMD and control groups, whereas positive correlations were exclusively determined in the AMD group for Cu and LF, Na and Ca, and Mg and Ca. The panel constituted of MT1A, Na, and Mg predicts AMD disease in 73% of cases. Conclusions The different levels of target metals and (metallo-)proteins in the tear film suggest altered metal homeostasis in AMD patients. These observed pathophysiological changes may be related with the anomalous protein aggregation in the macula.
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Affiliation(s)
- Eva Valencia
- Ophtalmological Research Foundation, University Institute Fernández-Vega, University of Oviedo, Oviedo, Spain.,Department of Physical and Analytical Chemistry, Faculty of Chemistry, University of Oviedo, Oviedo, Spain
| | - Montserrat García
- Ophtalmological Research Foundation, University Institute Fernández-Vega, University of Oviedo, Oviedo, Spain.,Ophthalmological Institute Fernández-Vega, Oviedo, Spain
| | - Beatriz Fernández-Vega
- Ophtalmological Research Foundation, University Institute Fernández-Vega, University of Oviedo, Oviedo, Spain.,Ophthalmological Institute Fernández-Vega, Oviedo, Spain
| | - Rosario Pereiro
- Ophtalmological Research Foundation, University Institute Fernández-Vega, University of Oviedo, Oviedo, Spain.,Department of Physical and Analytical Chemistry, Faculty of Chemistry, University of Oviedo, Oviedo, Spain
| | - Lara Lobo
- Department of Physical and Analytical Chemistry, Faculty of Chemistry, University of Oviedo, Oviedo, Spain
| | - Héctor González-Iglesias
- Ophtalmological Research Foundation, University Institute Fernández-Vega, University of Oviedo, Oviedo, Spain.,Ophthalmological Institute Fernández-Vega, Oviedo, Spain
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8
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Current status and outlook of biodegradable metals in neuroscience and their potential applications as cerebral vascular stent materials. Bioact Mater 2021; 11:140-153. [PMID: 34938919 PMCID: PMC8665265 DOI: 10.1016/j.bioactmat.2021.09.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 09/01/2021] [Accepted: 09/18/2021] [Indexed: 12/12/2022] Open
Abstract
Over the past two decades, biodegradable metals (BMs) have emerged as promising materials to fabricate temporary biomedical devices, with the purpose of avoiding potential side effects of permanent implants. In this review, we first surveyed the current status of BMs in neuroscience, and briefly summarized the representative stents for treating vascular stenosis. Then, inspired by the convincing clinical evidence on the in vivo safety of Mg alloys as cardiovascular stents, we analyzed the possibility of producing biodegradable cerebrovascular Mg alloy stents for treating ischemic stroke. For these novel applications, some key factors should also be considered in designing BM brain stents, including the anatomic features of the cerebral vasculature, hemodynamic influences, neuro-cytocompatibility and selection of alloying elements. This work may provide insights into the future design and fabrication of BM neurological devices, especially for brain stents. The current status of the application of biodegradable metals (BM) in neuroscience was presented. We analyzed the possibility of producing biodegradable cerebrovascular Mg alloy stents for ischemic stroke treatment. Key factors in designing BM brain stents were discussed. This work may provide insights into the future design and fabrication of BM neurological devices, especially for brain stents.
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Maruhashi T, Higashi Y. An overview of pharmacotherapy for cerebral vasospasm and delayed cerebral ischemia after subarachnoid hemorrhage. Expert Opin Pharmacother 2021; 22:1601-1614. [PMID: 33823726 DOI: 10.1080/14656566.2021.1912013] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Introduction: Survival from aneurysmal subarachnoid hemorrhage has increased in the past few decades. However, functional outcome after subarachnoid hemorrhage is still suboptimal. Delayed cerebral ischemia (DCI) is one of the major causes of morbidity.Areas covered: Mechanisms underlying vasospasm and DCI after aneurysmal subarachnoid hemorrhage and pharmacological treatment are summarized in this review.Expert opinion: Oral nimodine, an L-type dihydropyridine calcium channel blocker, is the only FDA-approved drug for the prevention and treatment of neurological deficits after aneurysmal subarachnoid hemorrhage. Fasudil, a potent Rho-kinase inhibitor, has also been shown to improve the clinical outcome and has been approved in some countries for use in patients with aneurysmal subarachnoid hemorrhage. Although other drugs, including nicardipine, cilostazol, statins, clazosentan, magnesium and heparin, have been expected to have beneficial effects on DCI, there has been no convincing evidence supporting the routine use of those drugs in patients with aneurysmal subarachnoid hemorrhage in clinical practice. Further elucidation of the mechanisms underlying DCI and the development of effective therapeutic strategies for DCI, including combination therapy, are necessary to further improve the functional outcome and mortality after subarachnoid hemorrhage.
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Affiliation(s)
- Tatsuya Maruhashi
- Department of Cardiovascular Regeneration and Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Yukihito Higashi
- Department of Cardiovascular Regeneration and Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan.,Division of Regeneration and Medicine, Medical Center for Translational and Clinical Research, Hiroshima University Hospital, Hiroshima, Japan
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10
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Takeuchi S, Kumagai K, Toyooka T, Otani N, Wada K, Mori K. Intravenous Hydrogen Therapy With Intracisternal Magnesium Sulfate Infusion in Severe Aneurysmal Subarachnoid Hemorrhage. Stroke 2020; 52:20-27. [PMID: 33349011 DOI: 10.1161/strokeaha.120.031260] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND PURPOSE Poor-grade subarachnoid hemorrhage still has a poor prognosis. This randomized controlled clinical trial evaluated intracisternal magnesium sulfate infusion combined with intravenous hydrogen therapy in patients with poor-grade subarachnoid hemorrhage. METHODS Thirty-seven patients with poor-grade subarachnoid hemorrhage were randomized to Mg+H2, Mg, and control groups. Mg and Mg+H2 groups received intracisternal magnesium sulfate infusion (2.5 mmol/L) at 20 mL/h for 14 days. Mg+H2 group also received intravenous hydrogen-rich solution infusion for 14 days. Primary outcome measures were occurrence of delayed cerebral ischemia and cerebral vasospasm. Secondary outcome measures were modified Rankin Scale and Karnofsky performance status at 3 and 12 months, Barthel index at 12 months, and serum and cerebrospinal fluid malondialdehyde and neuron-specific enolase. RESULTS Serum neuron-specific enolase levels were significantly lower in the Mg+H2 group from days 3 to 14 than in the control group. Cerebrospinal fluid neuron-specific enolase levels were also significantly lower in the Mg+H2 group from days 3 to 7 than in the control group. Incidences of cerebral vasospasm and delayed cerebral ischemia were significantly higher in the control group than in other groups. Modified Rankin Scale and Karnofsky performance status did not significantly differ between the three groups at 3 months. Modified Rankin Scale scores 0 to 2 were more common in the Mg and Mg+H2 groups at 1 year. Barthel index was higher in the Mg+H2 group than in the control group. CONCLUSIONS Intracisternal magnesium sulfate infusion started immediately after surgery reduces the incidence of cerebral vasospasm and delayed cerebral ischemia and improves clinical outcomes without complications in patients with poor-grade subarachnoid hemorrhage. Intracisternal magnesium sulfate infusion combined with intravenous hydrogen therapy decreases serum malondialdehyde and neuron-specific enolase and improves Barthel index, indicating hydrogen has additional effects. Registration: URL: https://www.umin.ac.jp/ctr/index.htm. Unique identifier: UMIN000014696.
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Affiliation(s)
- Satoru Takeuchi
- Department of Neurosurgery, National Defense Medical College, Saitama, Japan (S.T., K.K., T.T., N.O., K.W., K.M.)
| | - Kosuke Kumagai
- Department of Neurosurgery, National Defense Medical College, Saitama, Japan (S.T., K.K., T.T., N.O., K.W., K.M.)
| | - Terushige Toyooka
- Department of Neurosurgery, National Defense Medical College, Saitama, Japan (S.T., K.K., T.T., N.O., K.W., K.M.)
| | - Naoki Otani
- Department of Neurosurgery, National Defense Medical College, Saitama, Japan (S.T., K.K., T.T., N.O., K.W., K.M.)
| | - Kojiro Wada
- Department of Neurosurgery, National Defense Medical College, Saitama, Japan (S.T., K.K., T.T., N.O., K.W., K.M.)
| | - Kentaro Mori
- Department of Neurosurgery, National Defense Medical College, Saitama, Japan (S.T., K.K., T.T., N.O., K.W., K.M.).,Department of Neurosurgery, Tokyo General Hospital, Japan (K.M.)
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Ugurlu A, Yılmaz H. Influences of Hypomagnesemia on Optic Nerve and Retinal Vascular Structure Determined Using Optical Coherence Tomography (OCT) Angiography. Curr Eye Res 2020; 46:579-584. [PMID: 33259256 DOI: 10.1080/02713683.2020.1857779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Purpose: To evaluate the effects of low blood magnesium levels on the optic nerve, retina, and retinal vascular structure.Methods: This observational and cross-sectional study was conducted between June 2019 and May 2020 with participants aged 20-39 years, who had a visual acuity of ≥20/20, the axial length of 22-24.5 mm, refractive defect spherical equivalent of ≤±3D, and intraocular pressure of ≤21 mm Hg. All participants had a complaint of twitching in their eyes. The participants with normal serum magnesium levels constituted the control group, and patients with hypomagnesemia constituted the patient group. Updated AngioScan software (Navis ver. 1.8.0.) of Nidek's RS-3000 Advance system was used to analyze the spectral domain-optical coherence tomography (SD-OCT) and optical coherence tomography-angiography (OCT-A) images.Results: A total of 100 right eyes of 100 individuals was included in the study. The mean retinal nerve fiber layer (RNFL) thickness was 108.52 ± 12.46 μm in the control group, and 97.3 ± 9.7 μm in the hypomagnesemia group (P < .001). In the control group, the global superficial capillary plexus (SCP) and deep capillary plexus (DCP) vessel densities (VDs) were 41.92 ± 2.29, and 37.54 ± 3.83, respectively. In the patient group, the global SCP and DCP VDs were 37.66 ± 3.14, and 32.95 ± 5.57, respectively. The SCP and DCP VD percentages were significantly lower in the patient group. The mean foveal avascular zone (FAZ) area, perimeter and circularity index (CI) were 0.32 ± 0.13 mm2, 2.89 ± 0.59 mm, and 0.52 ± 0.09, respectively, for the control group and 0.38 ± 0.11 mm2, 2.99 ± 0.64 mm, and 0.38 ± 0.1, respectively, for the patient group. The FAZ area and perimeter were significantly higher (P = .013 and P = .001) and FAZ CI was significantly lower (P < .001) in the patients with hypomagnesemia.Conclusion: Our study revealed that OCT and OCT-A measurements may be used in the determination of the optic nerve and retinal vascular structure changes in hypomagnesemia.
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Affiliation(s)
- Adem Ugurlu
- Department of Ophthalmology, Faculty of Medicine, Erzincan Binali Yildirim University, Erzincan, Turkey
| | - Hayati Yılmaz
- Department of Ophthalmology, Health Science University Umraniye Training and Research Hospital, İstanbul, Turkey
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12
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Johnstone JM, Hughes A, Goldenberg JZ, Romijn AR, Rucklidge JJ. Multinutrients for the Treatment of Psychiatric Symptoms in Clinical Samples: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrients 2020; 12:E3394. [PMID: 33158241 PMCID: PMC7694278 DOI: 10.3390/nu12113394] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 10/28/2020] [Indexed: 12/16/2022] Open
Abstract
This systematic review and meta-analysis focused on randomized controlled trials (RCT) of multinutrients consisting of at least four vitamins and/or minerals as interventions for participants with psychiatric symptoms. A systematic search identified 16 RCTs that fit the inclusion criteria (n = 1719 participants) in six psychiatric categories: depression, post-disaster stress, antisocial behavior, behavioral deficits in dementia, attention-deficit/hyperactivity disorder, and autism. Grading of Recommendations, Assessment, Development and Evaluations (GRADE) was used to rate the evidence base. Significant clinical benefit was assessed using minimal clinically important differences (MIDs). Due to heterogeneity in participants, multinutrient formulas, outcome measures, and absence of complete data, only the Attention-Deficit/Hyperactivity Disorder (ADHD) category was eligible for meta-analyses. In ADHD populations, statistically and clinically significant improvements were found in global functioning, Mean Difference (MD) -3.3, p = 0.001, MID -3.26; Standardized Mean Difference (SMD) -0.49 p = 0.001 MD -0.5), clinician ratings of global improvement (MD -0.58, p = 0.001, MID -0.5) and ADHD improvement (MD -0.54, p = 0.002, MID -0.5), and clinician (but not observer) measures of ADHD inattentive symptoms (MD -1.53, p = 0.05, MID -0.5). Narrative synthesis also revealed a pattern of benefit for global measures of improvement, for example: in autism, and in participants with behavioral deficits in dementia. Post-natural disaster anxiety and the number of violent incidents in prison populations also improved. Broad-spectrum formulas (vitamins + minerals) demonstrated more robust effects than formulas with fewer ingredients. This review highlights the need for robust methodology-RCTs that report full data, including means and standard deviations for all outcomes-in order to further elucidate the effects of multinutrients for psychiatric symptoms.
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Affiliation(s)
- Jeanette M. Johnstone
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR 97201, USA;
- Child and Adolescent Psychiatry, Oregon Health & Science University, Portland, OR 97239, USA
| | - Andrew Hughes
- Adult Psychiatry, Oregon Health & Science University, Portland, OR 97239, USA;
| | - Joshua Z. Goldenberg
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR 97201, USA;
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Sydney 2007, Australia
| | - Amy R. Romijn
- Department of Psychology, Swansea University, Swansea SA2 8PP, UK;
| | - Julia J. Rucklidge
- School of Psychology, Speech and Hearing, University of Canterbury, 8140 Christchurch, New Zealand
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13
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The Effect of Magnesium Deficiency on Neurological Disorders: A Narrative Review Article. IRANIAN JOURNAL OF PUBLIC HEALTH 2019; 48:379-387. [PMID: 31223564 PMCID: PMC6570791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Magnesium (Mg) is an essential element for the body. It is a cofactor for ATP, DNA, and RNA and more than 600 enzymes. As it is similar to Ca2+, this element can also act as a cell signaling molecule and play multiple important roles in the nervous, muscle, and immune systems. Recent studies have associated Mg-deficiency with many neurological disorders, such as cerebral vasospasm, Alzheimer's disease, stroke, and migraine. As it plays such a crucial role in human body, therefore, we summarized the role of Mg in neurological disorders to illustrate the symptoms caused by Mg-deficiency and the possible underlying mechanisms. METHODS We critically discuss the role of it that we review the recent literature of magnesium. We also review the available data which are concerning the role of magnesium in neurological disorders. RESULTS Magnesium is related to neurological disorders on the basis of the study of animals and humans experiments. Furthermore, these nervous systems related diseases include cerebral vasospasm, Alzheimer's disease, Parkinson's disease, stroke and migraine. CONCLUSION Magnesium has effects on neurological disorders, such as its utility in cerebral vasospasm, Alzheimer's disease, Parkinson's disease, stroke and migraine. So here we make a brief review to conclude it.
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14
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Jafari M, Di Napoli M, Lattanzi S, Mayer SA, Bachour S, Bershad EM, Damani R, Datta YH, Divani AA. Serum magnesium level and hematoma expansion in patients with intracerebral hemorrhage. J Neurol Sci 2019; 398:39-44. [PMID: 30682519 DOI: 10.1016/j.jns.2019.01.027] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 12/25/2018] [Accepted: 01/15/2019] [Indexed: 12/28/2022]
Abstract
Spontaneous intracerebral hemorrhage (ICH) is a devastating subtype of stroke that results in significant rates of mortality and morbidities. The initial hematoma volume, hematoma expansion (HE), blood pressure (BP), and coagulopathy are considered strong predictors of clinical outcomes and mortality. Low serum magnesium (Mg++) levels have been shown to be associated with larger initial hematoma and greater HE. Coagulopathy, platelet dysfunction, high BP, and increased inflammatory response might form the mechanistic link between low serum Mg++ levels, larger hematoma size and greater HE. However, randomized clinical trials administering intravenous Mg++ have shown no benefit over placebo in ICH patients. The confounding effect of hypocalcemia and a delay in Mg++ trafficking across the blood-brain barrier might explain the futile results for intravenous Mg++ therapy. In the current review, we will discuss the evidence regarding the possible role of low serum Mg++ level on HE in acute ICH.
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Affiliation(s)
- Mostafa Jafari
- Department of Neurology, University of Minnesota, Minneapolis, MN, United States
| | - Mario Di Napoli
- Department of Neurology, San Camillo de' Lellis District General Hospital, Rieti, Italy
| | - Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Stephan A Mayer
- Department of Neurology, Henry Ford Health System, Detroit, MI, United States
| | - Salam Bachour
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, United States
| | - Eric M Bershad
- Department of Neurology, Baylor College of Medicine, Houston, TX, United States
| | - Rahul Damani
- Department of Neurology, Baylor College of Medicine, Houston, TX, United States
| | - Yvonne H Datta
- Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Afshin A Divani
- Department of Neurology, University of Minnesota, Minneapolis, MN, United States; Department of Neurosurgery, University of Minnesota, Minneapolis, MN, United States.
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15
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Bromley L, Horvath PJ, Bennett SE, Weinstock-Guttman B, Ray AD. Impact of Nutritional Intake on Function in People with Mild-to-Moderate Multiple Sclerosis. Int J MS Care 2019; 21:1-9. [PMID: 30833865 DOI: 10.7224/1537-2073.2017-039] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background We sought to assess the associations between nutrition and ambulation, daily activity, quality of life (QOL), and fatigue in individuals with mild-to-moderate disability with multiple sclerosis (MS). Methods This cross-sectional pilot study included 20 ambulatory adult volunteers with MS (14 women and 6 men; mean ± SD age, 57.9 ± 10.2 years; mean ± SD Expanded Disability Status Scale score = 4.1 ± 1.8). Primary outcome variables included dietary assessment and the 6-Minute Walk Test (6MWT). Secondary measures included the Timed 25-Foot Walk test, Timed Up and Go test, daily activity, and three self-report questionnaires: the 12-item Multiple Sclerosis Walking Scale, the 36-item Short Form Health Survey (SF-36), and the Modified Fatigue Impact Scale. Results Significant correlations were seen between the percentage of diet comprising fats and the 6MWT (r = 0.51, P = .02) and the physical functioning component of the SF-36 (r = 0.47, P = .03). The percentage of carbohydrates was significantly correlated with the 6MWT (r = -0.43, P = .05), daily activity (r = -0.59, P = .005), and the physical functioning component of the SF-36 (r = -0.47, P = .03). Cholesterol, folate, iron, and magnesium were significantly positively correlated with the physical functioning component of the SF-36 and the 6MWT. Conclusions These findings indicate better ambulation, daily function, and QOL with increased fat intake, decreased carbohydrate intake, and increased intake of the micronutrients cholesterol, folate, iron, and magnesium in people with mild-to-moderate MS. This pilot study highlights the potential impact of diet on function and QOL in MS.
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16
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Chang JJ, Armonda R, Goyal N, Arthur AS. Magnesium: Pathophysiological mechanisms and potential therapeutic roles in intracerebral hemorrhage. Neural Regen Res 2019; 14:1116-1121. [PMID: 30804233 PMCID: PMC6425828 DOI: 10.4103/1673-5374.251189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Intracerebral hemorrhage (ICH) remains the second-most common form of stroke with high morbidity and mortality. ICH can be divided into two pathophysiological stages: an acute primary phase, including hematoma volume expansion, and a subacute secondary phase consisting of blood-brain barrier disruption and perihematomal edema expansion. To date, all major trials for ICH have targeted the primary phase with therapies designed to reduce hematoma expansion through blood pressure control, surgical evacuation, and hemostasis. However, none of these trials has resulted in improved clinical outcomes. Magnesium is a ubiquitous element that also plays roles in vasodilation, hemostasis, and blood-brain barrier preservation. Animal models have highlighted potential therapeutic roles for magnesium in neurological diseases specifically targeting these pathophysiological mechanisms. Retrospective studies have also demonstrated inverse associations between admission magnesium levels and hematoma volume, hematoma expansion, and clinical outcome in patients with ICH. These associations, coupled with the multifactorial role of magnesium that targets both primary and secondary phases of ICH, suggest that magnesium may be a viable target of study in future ICH studies.
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Affiliation(s)
- Jason J Chang
- Department of Critical Care Medicine, MedStar Washington Hospital Center; Department of Neurology, Georgetown University School of Medicine, Washington, DC, USA
| | - Rocco Armonda
- Department of Neurosurgery, Georgetown University School of Medicine, Washington, DC, USA
| | - Nitin Goyal
- Department of Neurology, University of Tennessee Health Science Center; Semmes Murphey Clinic, Memphis, TN, USA
| | - Adam S Arthur
- Semmes Murphey Clinic; Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, USA
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17
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Zhang C, Zhao S, Zang Y, Zhao W, Song Q, Feng S, Hu L, Gu F. Magnesium sulfate in combination with nimodipine for the treatment of subarachnoid hemorrhage: a randomized controlled clinical study. Neurol Res 2018. [PMID: 29540123 DOI: 10.1080/01616412.2018.1426207] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Objective Cerebral vasospasm(CVS) after Subarachnoid hemorrhage (SAH) can cause delayed cerebral ischemia,secondary cerebral infarction, and rehemorrhage, which are the leading causes of mutilation and death. Nimodipine has been shown to prevent CVS. Magnesium ion (Mg2+) can competitively inhibit the influx of calcium (Ca2+) and prevent vasospasm. There is evidence that magnesium sulfate can prevent CVS and reduce infarct volume after SAH. In this study, we evaluated the efficacy and safety of intravenous magnesium sulfate combined with oral nimodipine on CVS, delayed cerebral ischemia, secondary cerebral infarction, and rehemorrhage after SAH. Methods This is a prospective randomized, double-blind trial of 120 patients with SAH who were recruited between January 2003 and January 2009. These patients were assigned to two groups and received the same basic treatment and symptomatic treatment. In group A, patients received 14 days of intravenous administration of 1400 mL 0.9% normal saline + 40 mL 25% magnesium sulfate, 1 mL/min, once per day, followed 7 days of intravenous administration of 500 mL 0.9% normal saline + 15 mL 25% magnesium sulfate, 1 mL/min, once per day and oral nimodipine, 20 mg once, four times a day, for 21 days. Patients in group B received identical treatment to that in group A, except that 25% magnesium sulfate was replaced by placebo. On day 22 of treatment, incidences of intracranial CVS, delayed cerebral ischemia, secondary cerebral infarction, rehemorrhage, neurologic deficits, and death were assessed and adverse events were monitored. Results CVS occurred in 4, 12 patients, lasting for 11.09 ± 5.38, 13.73 ± 6.24 hours, mean velocity (Vm) of 143.2 ± 12.7, 149.6 ± 18.9 cm/s in group A, B; Delayed cerebral ischemia occurred in 3, 10 patients, lasting for 13.16 ± 4.82, 15.57 ± 5.35 hours in group A, B; Secondary cerebral infarction occurred in 2 and 8 patients in groups A and B; Neurologic deficits occurred in3 and 11 patients in groups A and B, All P < 0.05; Rehemorrhage occurred in 4 and 5 patients; Death occurred in 5 and 8 patients in groups A and B, respectively, P >0.05. No obvious adverse events were found in both groups. Conclusion Intravenous magnesium sulfate in combination with oral nimodipine for the treatment of SAH can help reduce the incidences of CVS, delayed cerebral ischemia, secondary cerebral infarction, and neurologic deficits with good safety, but it does not reduce the incidences of rehemorrhage and death.
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Affiliation(s)
- Chenhao Zhang
- a Department of Neurology , The Second Hospital of Baoding City , Baoding , China
| | - Shuqin Zhao
- b Department of Internal Medicine , Hospital Affiliated to Hebei University , Baoding , China
| | - Yanjing Zang
- c Department of Geriatric , The Second Hospital of Baoding City , Baoding , China
| | - Weidong Zhao
- d Second Department of Neurology , The Second Hospital of Baoding City , Baoding , China
| | - Qin Song
- d Second Department of Neurology , The Second Hospital of Baoding City , Baoding , China
| | - Shanshan Feng
- a Department of Neurology , The Second Hospital of Baoding City , Baoding , China
| | - Lei Hu
- a Department of Neurology , The Second Hospital of Baoding City , Baoding , China
| | - Fang Gu
- e Fifth Department of Internal Medicine , Baoding Children's Hospital , Baoding , China
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18
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Manetta F, Mullan CW, Catalano MA. Neuroprotective Strategies in Repair and Replacement of the Aortic Arch. Int J Angiol 2018; 27:98-109. [PMID: 29896042 PMCID: PMC5995688 DOI: 10.1055/s-0038-1649512] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Aortic arch surgery is a technical challenge, and cerebral protection during distal anastomosis is a continued topic of controversy and discussion. The physiologic effects of hypothermic arrest and adjunctive cerebral perfusion have yet to be fully defined, and the optimal strategies are still undetermined. This review highlights the historical context, physiological rationale, and clinical efficacy of various neuroprotective strategies during arch operations.
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Affiliation(s)
- Frank Manetta
- Department of Cardiovascular and Thoracic Surgery, Barbara and Donald Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - Clancy W. Mullan
- Department of Cardiovascular and Thoracic Surgery, Barbara and Donald Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - Michael A. Catalano
- Department of Cardiovascular and Thoracic Surgery, Barbara and Donald Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
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19
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Goyal N, Tsivgoulis G, Malhotra K, Houck AL, Khorchid YM, Pandhi A, Inoa V, Alsherbini K, Alexandrov AV, Arthur AS, Elijovich L, Chang JJ. Serum Magnesium Levels and Outcomes in Patients With Acute Spontaneous Intracerebral Hemorrhage. J Am Heart Assoc 2018; 7:JAHA.118.008698. [PMID: 29654197 PMCID: PMC6015418 DOI: 10.1161/jaha.118.008698] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Magnesium (Mg) has potential hemostatic properties. We sought to investigate the potential association of serum Mg levels (at baseline and at 48 hours) with outcomes in patients with acute spontaneous intracerebral hemorrhage (ICH). METHODS AND RESULTS We reviewed data on all patients with spontaneous ICH with available Mg levels at baseline, over a 5-year period. Clinical and radiological outcome measures included initial hematoma volume, admission National Institutes of Health Stroke Scale and ICH scores, in-hospital mortality, favorable functional outcome (modified Rankin Scale scores, 0-1), and functional independence (modified Rankin Scale scores, 0-2) at discharge. Our study population consisted of 299 patients with ICH (mean age, 61±13 years; mean admission serum Mg, 1.8±0.3 mg/dL). Increasing admission Mg levels strongly correlated with lower admission National Institutes of Health Stroke Scale score (Spearman's r, -0.141; P=0.015), lower ICH score (Spearman's r, -0.153; P=0.009), and lower initial hematoma volume (Spearman's r, -0.153; P=0.012). Higher admission Mg levels were documented in patients with favorable functional outcome (1.9±0.3 versus 1.8±0.3 mg/dL; P=0.025) and functional independence (1.9±0.3 versus 1.8±0.3 mg/dL; P=0.022) at discharge. No association between serum Mg levels at 48 hours and any of the outcome variables was detected. In multiple linear regression analyses, a 0.1-mg/dL increase in admission serum Mg was independently and negatively associated with the cubed root of hematoma volume at admission (regression coefficient, -0.020; 95% confidence interval, -0.040 to -0.000; P=0.049) and admission ICH score (regression coefficient, -0.053; 95% confidence interval, -0.102 to -0.005; P=0.032). CONCLUSIONS Higher admission Mg levels were independently related to lower admission hematoma volume and lower admission ICH score in patients with acute spontaneous ICH.
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Affiliation(s)
- Nitin Goyal
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN
| | - Georgios Tsivgoulis
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN.,Second Department of Neurology, "Attikon University Hospital,", School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Konark Malhotra
- Department of Neurology, West Virginia University Charleston Division, Charleston, WV
| | - Alexander L Houck
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN
| | - Yasser M Khorchid
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN
| | - Abhi Pandhi
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN
| | - Violiza Inoa
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN.,Department of Neurosurgery, University of Tennessee Health Science Center, Semmes-Murphey Neurologic and Spine Clinic, Memphis, TN
| | - Khalid Alsherbini
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN
| | - Andrei V Alexandrov
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN
| | - Adam S Arthur
- Department of Neurosurgery, University of Tennessee Health Science Center, Semmes-Murphey Neurologic and Spine Clinic, Memphis, TN
| | - Lucas Elijovich
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN.,Department of Neurosurgery, University of Tennessee Health Science Center, Semmes-Murphey Neurologic and Spine Clinic, Memphis, TN
| | - Jason J Chang
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN.,Medstar Washington Hospital Medical Center, Washington, DC
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20
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Perucki WH, Hiendlmayr B, O'Sullivan DM, Gunaseelan AC, Fayas F, Fernandez AB. Magnesium Levels and Neurologic Outcomes in Patients Undergoing Therapeutic Hypothermia After Cardiac Arrest. Ther Hypothermia Temp Manag 2018; 8:14-17. [DOI: 10.1089/ther.2017.0016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- William H. Perucki
- Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Brett Hiendlmayr
- Division of Cardiology, Hartford Hospital, Hartford, Connecticut
| | | | | | - Farruk Fayas
- Aureus University School of Medicine, Noord, Aruba
| | - Antonio B. Fernandez
- Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut
- Division of Cardiology, Hartford Hospital, Hartford, Connecticut
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21
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Sommer B, Weidinger CS, Wolf D, Buchfelder M, Schmitt H. Intraoperative continuous cerebral microcirculation measurement in patients with aneurysmal subarachnoid hemorrhage: preliminary data on the early administration of magnesium sulfate. BMC Anesthesiol 2017; 17:143. [PMID: 29041920 PMCID: PMC5645977 DOI: 10.1186/s12871-017-0435-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 10/11/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In patients with subarachnoid hemorrhage (SAH), vasospasm remains one of the major complications. The application of intravenous magnesium sulfate (MgSO4) has been under discussion to prevent cerebral ischemia. Our aim was to examine the impact of early MgSO4 administration on local cerebral microcirculation during microsurgical clipping of SAH-related aneurysms. METHODS The non-invasive laser-Doppler spectrophotometry system "Oxygen-to-See (O2C)" was used in 14 consecutive patients (11 female, 3 male, median age 56.5±9.7 yrs) with aneurysmatic SAH. A subdural probe measured capillary venous oxygenation (SO2), relative hemoglobin content (rHb), blood cell velocity (velo) and blood flow (flow) in 7 mm tissue depth. Data samples were recorded as baseline immediately before intraoperative application of MgSO4 10% 50 mg/kg body weight and 10 min thereafter. The continuous MgSO4 infusion rate depended on blood pressure (mean arterial pressure > 60-65 mmHg) and lasted a maximum of 60 min. RESULTS MgSO4 was administered 2.8 (min. 1.6, max. 15.5) hours after onset of symptoms. Median flow increased significantly by 20.8% (5-68%, p = 0.001). Velo increased 4.9% (1-17%), rHb decreased 1.5% (3-34%) and SO2 decreased 9.4% (8-38%) by trend compared to the baseline values. FiO2 correlated positively with velo (rs = 0.712, p = 0.004), whereas arterial HCO3 correlated negatively with SO2 (rs = -0.599, p = 0.024). Of 14 patients, 2 had symptomatic vasospasm. CONCLUSIONS Our data suggest an increased cerebral blood flow after early intraoperative administration of MgSO4 in patients with SAH. Using a non-invasive laser-Doppler spectrophotometry system, this technique is feasible for continuous real-time monitoring of cerebral microcirculation. TRIAL REGISTRATION DRKS (German Clinical Trial Registry), DRKS00013047 , retrospectively registered on September 21st, 2017.
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Affiliation(s)
- Bjoern Sommer
- Department of Neurosurgery, University Hospital Erlangen, Schwabachanlage 6, 91054 Erlangen, Germany
- Department of Neurosurgery, Paracelsus-Klinik Osnabrück, Am Natruper Holz 69, 49076 Osnabrück, Germany
| | - Cornelia S. Weidinger
- Department of Anesthesiology, University Hospital Erlangen, Krankenhausstraße 12, 91054 Erlangen, Germany
| | - Dennis Wolf
- Department of Cardiology and Angiology I, University Heart Center Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany
| | - Michael Buchfelder
- Department of Neurosurgery, University Hospital Erlangen, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Hubert Schmitt
- Department of Anesthesiology, University Hospital Erlangen, Krankenhausstraße 12, 91054 Erlangen, Germany
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22
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Fernández Suárez FE, Fernández Del Valle D, González Alvarez A, Pérez-Lozano B. Intraoperative care for aortic surgery using circulatory arrest. J Thorac Dis 2017; 9:S508-S520. [PMID: 28616347 PMCID: PMC5462730 DOI: 10.21037/jtd.2017.04.67] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 04/06/2017] [Indexed: 11/06/2022]
Abstract
The total circulatory arrest (CA) is necessary to achieve optimal surgical conditions in certain aortic pathologies, especially in those affecting the ascending aorta and aortic arch. During this procedure it is necessary to protect all the organs of ischemia, especially those of the central nervous system and for this purpose several strategies have been developed. The first and most important protective method is systemic hypothermia. The degree of hypothermia and the route of application have been evolving and currently tend to use moderate hypothermia (MH) (20.1-28 °C) associated with unilateral or bilateral selective cerebral perfusion methods. In this way the neurological results are better, the interval of security is greater and the times of extracorporeal circulation are smaller. Even so, it is necessary to take into account that there is the possibility of ischemia in the lower part of the body, especially of the abdominal viscera and the spinal cord, therefore the time of circulatory stop should be limited and not to exceed 80 minutes. Evidence of possible neurological drug protection is very weak and only mannitol, magnesium, and statins can produce some benefit. Inhalational anesthetics and some intravenous seem to have advantages, but more studies would be needed to test their long-term benefit. Other important parameters to be monitored during these procedures are blood glucose, anemia and coagulation disorders and acid-base balance. The recommended monitoring is common in complex cardiovascular procedures and it is of special importance the neurological monitoring that can be performed with several techniques, although currently the most used are Bispectral Index (BIS) and Near-Infrared Spectroscopy (NIRS). It is also essential to monitor the temperature routinely at the nasopharyngeal and bladder level and it is important to control coagulation with rotational thromboelastometry (ROTEM).
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Affiliation(s)
| | | | - Adrián González Alvarez
- Department of Anesthesiology, Central University Hospital of Asturias, Oviedo, Asturias, Spain
| | - Blanca Pérez-Lozano
- Department of Anesthesiology, Central University Hospital of Asturias, Oviedo, Asturias, Spain
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Santos E, León F, Silos H, Sanchez-Porras R, Shuttleworth CW, Unterberg A, Sakowitz OW. Incidence, hemodynamic, and electrical characteristics of spreading depolarization in a swine model are affected by local but not by intravenous application of magnesium. J Cereb Blood Flow Metab 2016; 36:2051-2057. [PMID: 27683450 PMCID: PMC5363671 DOI: 10.1177/0271678x16671317] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 08/26/2016] [Accepted: 08/28/2016] [Indexed: 11/17/2022]
Abstract
The aim was to characterize the effects of magnesium sulfate, using i.v. bolus and local administration, using intrinsic signal imaging, and on electrocorticographic activity during the induction and propagation of spreading depolarizations in the gyrencephalic porcine brain. Local application of magnesium sulfate led to a complete inhibition of spreading depolarizations. One hour after washing out the topical magnesium sulfate, re-incidence of the spreading depolarizations was observed in 50% of the hemispheres. Those spreading depolarizations showed attenuation in hemodynamic characteristics and speed in intrinsic optical signal imaging. The electrical amplitude decreased through electrocorticographic activity. Intravenous magnesium therapy showed no significant effects on spreading depolarization incidence and characteristics.
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Affiliation(s)
- Edgar Santos
- Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Fiorella León
- Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Humberto Silos
- Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
| | | | | | - Andreas Unterberg
- Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Oliver W Sakowitz
- Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
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Magnesium in obstetric anesthesia and intensive care. J Anesth 2016; 31:127-139. [PMID: 27803982 DOI: 10.1007/s00540-016-2257-3] [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: 02/06/2016] [Accepted: 09/24/2016] [Indexed: 12/14/2022]
Abstract
Magnesium, one of the essential elements in the human body, has numerous favorable effects that offer a variety of possibilities for its use in obstetric anesthesia and intensive care. Administered as a single intravenous bolus dose or a bolus followed by continuous infusion during surgery, magnesium attenuates stress response to endotracheal intubation, and reduces intraoperative anesthetic and postoperative analgesic requirements, while at the same time preserving favorable hemodynamics. Applied as part of an intrathecal or epidural anesthetic mixture, magnesium prolongs the duration of anesthesia and diminishes total postoperative analgesic consumption with no adverse maternal or neonatal effects. In obstetric intensive care, magnesium represents a first-choice medication in the treatment and prevention of eclamptic seizures. If used in recommended doses with close monitoring, magnesium is a safe and effective medication.
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Sánchez-Larsen Á, Segura T, García-Muñozguren S, Peinado-Ródenas J, Zamarro J, Hernández-Fernández F. Cerebral vasospasm and wernicke encephalopathy secondary to adult cyclic vomiting syndrome: the role of magnesium. BMC Neurol 2016; 16:135. [PMID: 27515947 PMCID: PMC4982311 DOI: 10.1186/s12883-016-0660-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 08/02/2016] [Indexed: 12/03/2022] Open
Abstract
Background Magnesium has a regulatory role in the excitability of cell membranes, and is also a cofactor in the phosphorylation of thiamine. Hypomagnesemia has been associated with coronary vasospasm, but its role in cerebrovascular pathology is controversial, and cerebral vasospasm exclusively attributable to hypomagnesemia has not been reported in humans. Case presentation We report the case of a 51-year-old man in whom uncontrollable vomiting, treatment with omeprazole and thiazide, and renal impairment lead to a severe hypomagnesemia (magnesium below the level of detection in blood tests), which secondarily caused Wernicke’s encephalopathy and vasospasm in multiple cerebral arteries (seen with cerebral angiography and CT angiography) that presented with a complete right hemisphere neurological deficit. These disturbances completely resolved when magnesium levels were normalized and subsequent neuroimaging tests confirmed the resolution of angiographic changes. Conclusion Our case suggests that hypomagnesemia should be considered in the differential diagnosis of patients with neurological symptoms and predisposing causes. Electronic supplementary material The online version of this article (doi:10.1186/s12883-016-0660-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Álvaro Sánchez-Larsen
- Department of Neurology, Complejo Hospitalario Universitario de Albacete, Albacete, Spain.
| | - Tomás Segura
- Department of Neurology, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | | | - Javier Peinado-Ródenas
- Department of Radiology, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Joaquín Zamarro
- Unit of Interventional Neuroradiology, Department of Radiology, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Francisco Hernández-Fernández
- Department of Neurology, Complejo Hospitalario Universitario de Albacete, Albacete, Spain.,Unit of Interventional Neuroradiology, Department of Radiology, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
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Abstract
PURPOSE OF REVIEW Hypoxic-ischemic brain injury is a leading cause of mortality and morbidity in neonates. Treating such injury by interrupting the excitotoxic-oxidative cascade is of immense importance. This review will focus on novel techniques of neuroprotection and describe the latest advances in established therapeutic methods. KEY FINDINGS Although the primacy of therapeutic hypothermia in treating hypoxic-ischemic encephalopathy is well established, recent research establishes that the arbitrarily chosen regimen of cooling to 33°C for 72 h may indeed be the most appropriate method. The optimal duration of antenatal magnesium therapy for neuroprotection remains unsettled, though it is reassuring that even 12 h or less of magnesium therapy results in comparable neurological outcomes. Combining adjuvant therapies such as melatonin or erythropoietin with therapeutic hypothermia results in favorable neurological outcomes compared with hypothermia alone. Finally, stem cell-based therapies show considerable potential in preclinical studies. SUMMARY Significant advances have occurred in the management of neonatal brain injury. With establishment of the optimal temperature and duration of hypothermia, combinatory therapies using adjuncts hold the greatest promise. Promising preclinical approaches such as stem cell-based therapy and use of noble gases need to be confirmed with clinical trials.
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Taccone FS, Crippa IA, Dell'Anna AM, Scolletta S. Neuroprotective strategies and neuroprognostication after cardiac arrest. Best Pract Res Clin Anaesthesiol 2015; 29:451-64. [PMID: 26670816 DOI: 10.1016/j.bpa.2015.08.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 08/20/2015] [Indexed: 12/23/2022]
Abstract
Neurocognitive disturbances are common among survivors of cardiac arrest (CA). Although initial management of CA, including bystander cardiopulmonary resuscitation, optimal chest compression, and early defibrillation, has been implemented continuously over the last years, few therapeutic interventions are available to minimize or attenuate the extent of brain injury occurring after the return of spontaneous circulation. In this review, we discuss several promising drugs that could provide some potential benefits for neurological recovery after CA. Most of these drugs have been investigated exclusively in experimental CA models and only limited clinical data are available. Further research, which also considers combined neuroprotective strategies that target multiple pathways involved in the pathophysiology of postanoxic brain injury, is certainly needed to demonstrate the effectiveness of these interventions in this setting. Moreover, the evaluation of neurological prognosis of comatose patients after CA remains an important challenge that requires the accurate use of several tools. As most patients with CA are currently treated with targeted temperature management (TTM), combined with sedative drug therapy, especially during the hypothermic phase, the reliability of neurological examination in evaluating these patients is delayed to 72-96 h after admission. Thus, additional tests, including electrophysiological examinations, brain imaging and biomarkers, have been largely implemented to evaluate earlier the extent of brain damage in these patients.
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Affiliation(s)
- Fabio Silvio Taccone
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB), Route de Lennik 808, 1070 Brussels, Belgium.
| | - Ilaria Alice Crippa
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB), Route de Lennik 808, 1070 Brussels, Belgium
| | - Antonio Maria Dell'Anna
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB), Route de Lennik 808, 1070 Brussels, Belgium
| | - Sabino Scolletta
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB), Route de Lennik 808, 1070 Brussels, Belgium
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Torres J, Ishida K. Neuroprotection After Major Cardiovascular Surgery. Curr Treat Options Neurol 2015; 17:357. [DOI: 10.1007/s11940-015-0357-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Vuckovic S, Srebro D, Savic Vujovic K, Prostran M. The antinociceptive effects of magnesium sulfate and MK-801 in visceral inflammatory pain model: The role of NO/cGMP/K(+)ATP pathway. PHARMACEUTICAL BIOLOGY 2015; 53:1621-1627. [PMID: 25856706 DOI: 10.3109/13880209.2014.996821] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
CONTEXT Magnesium and MK-801 (dizocilpine), antagonists of N-methyl-d-aspartate receptors, are involved in the processing of pain. OBJECTIVE This study determines whether magnesium sulfate (MS) and MK-801 affects visceral inflammatory pain and determines a possible mechanism of action. MATERIALS AND METHODS Analgesic activity was assessed using the acetic acid-induced writhing test in rats. MS (1-45 mg/kg) or MK-801 (0.005-0.03 mg/kg) was administrated subcutaneously (s.c.). To assess possible mechanisms of action, we examined the effects of l-NAME (10 mg/kg, intraperitoneal), methylene blue (0.5 mg/kg, s.c.), and glibenclamide (3 mg/kg, s.c.) on the effect of MS or MK-801. RESULTS MS and MK-801 showed biphasic and linear dose-response pattern, respectively. MS reduces the number of writhing on the dose of 1, 5, and 15 mg/kg by 60, 50, and 78%, respectively, while it has no effects on the doses of 30 and 45 mg/kg. MK-801 (0.005-0.03 mg/kg) showed decrease in the number of writhing by 33-79%. The mean effective doses of MS and MK-801 were 6.6 (first phase) and 0.009 mg/kg, respectively. Both drugs did not impair the rotarod performance. l-NAME, methylene blue, and glybenclamide reduced the effect of MK-801 by 100, 43, and 64%, respectively, but not the effect of MS. CONCLUSIONS The results suggest that MS and MK-801 may be useful analgesics in the management of visceral inflammatory pain, at doses that do not induce motor impairment. The modulation of NO/cGMP/K+ATP pathway plays an important role in the antinociceptive mechanism of MK-801, but does not contribute to the antinociceptive effect of MS.
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Affiliation(s)
- Sonja Vuckovic
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade , Belgrade , Serbia
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The Role of Magnesium in the Pathogenesis and Treatment of Glaucoma. INTERNATIONAL SCHOLARLY RESEARCH NOTICES 2014; 2014:745439. [PMID: 27433524 PMCID: PMC4897098 DOI: 10.1155/2014/745439] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Revised: 06/25/2014] [Accepted: 07/16/2014] [Indexed: 01/02/2023]
Abstract
Glaucoma is characterized by chronic optic neuropathy resulting in progressive vision loss. Not only is glaucoma considered as a condition of elevated intraocular pressure (IOP), but also other risk factors may play a role in the pathogenesis of glaucomatous optic nerve damage. Vascular dysregulation in ocular blood flow and oxidative stress are currently suggested as important risk factors for glaucomatous retinal ganglion cell loss. New treatment modalities that improve ocular blood flow and reduce oxidative stress have been investigated in many studies. Magnesium (Mg) is thought to be one of the molecules that has a treatment potential in glaucoma. Mg has been shown to improve blood flow by modifying endothelial function via endothelin-1 (ET-1) and endothelial nitric oxide (NO) pathways. Mg also exhibits neuroprotective role by blocking N-methyl-D-aspartate (NMDA) receptor-related calcium influx and by inhibiting the release of glutamate, and hence protects the cell against oxidative stress and apoptosis. Both improvement in ocular blood flow and prevention of ganglion cell loss would make magnesium a good candidate for glaucoma management. Further studies on the effect of Mg may open a new therapeutic era in glaucoma.
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Takeuchi S, Mori K, Arimoto H, Fujii K, Nagatani K, Tomura S, Otani N, Osada H, Wada K. Effects of intravenous infusion of hydrogen-rich fluid combined with intra-cisternal infusion of magnesium sulfate in severe aneurysmal subarachnoid hemorrhage: study protocol for a randomized controlled trial. BMC Neurol 2014; 14:176. [PMID: 25201463 PMCID: PMC4172868 DOI: 10.1186/s12883-014-0176-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 09/02/2014] [Indexed: 02/06/2023] Open
Abstract
Background The failures of recent studies intended to prevent cerebral vasospasm have moved the focus of research into delayed cerebral ischemia away from cerebral artery constriction towards other mechanisms. Recent accumulating evidence has suggested that early brain injury is also involved in the development of delayed cerebral ischemia, and that hydrogen can prevent early brain injury. Therefore, we have established a combination therapy of intravenous hydrogen infusion and intra-cisternal magnesium sulfate infusion for the treatment of both early brain injury and cerebral vasospasm. The present randomized controlled clinical trial is designed to investigate the effects of this novel therapeutic strategy on the occurrence of cerebral vasospasm, delayed cerebral ischemia, and clinical outcomes after high-grade subarachnoid hemorrhage. Methods This study is a randomized, double-blind, placebo-controlled design to be conducted in two hospitals. A total of 450 patients with high-grade subarachnoid hemorrhage will be randomized to one of three arms: (i) Mg + H2 group, (ii) Mg group, and (iii) control group. Patients who are assigned to the Mg + H2 group will receive intra-cisternal magnesium sulfate infusion (2.5 mmol/L) at 20 mL/h for 14 days and intravenous hydrogen-rich fluid infusion (200 mL) twice a day for 14 days. Patients who are assigned to the Mg group will receive intra-cisternal magnesium sulfate infusion (2.5 mmol/L) at 20 mL/h for 14 days and intravenous normal glucose-electrolyte solution (200 mL) without added hydrogen twice a day for 14 days. Patients who are assigned to the control group will receive intra-cisternal Ringer solution without magnesium sulfate at 20 mL/h for 14 days and intravenous normal glucose-electrolyte solution (200 mL) without added hydrogen twice a day for 14 days. Primary outcome measures will be occurrence of delayed cerebral ischemia and cerebral vasospasm. Secondary outcome measures will be modified Rankin scale score at 3, 6, and 12 months and biochemical markers. Discussion The present protocol for a randomized, placebo-controlled study of intravenous hydrogen therapy with intra-cisternal magnesium infusion is expected to establish the efficacy and safety of this therapeutic strategy. Trial registration UMIN-CTR: UMIN000014696
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