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Liang Z, Chen D, Jiang Y, Su Z, Pi Y, Luo T, Jiang Q, Yang L, Guo L. Multifunctional Lithium-Doped Mesoporous Nanoparticles for Effective Dentin Regeneration in vivo. Int J Nanomedicine 2023; 18:5309-5325. [PMID: 37746049 PMCID: PMC10516199 DOI: 10.2147/ijn.s424930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/07/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction Effective infection control without irritating the pulp tissue is the key to successful vital pulp therapy. Developing a novel antibacterial biomaterial that promotes dentin regeneration for pulp capping is thus a promising strategy for enhancing vital pulp therapy. Methods Lithium-doped mesoporous nanoparticles (Li-MNPs) were synthesized using an alkali-catalyzed sol-gel method. The particle size, elemental distribution, surface morphology, pore structure, and ion release from Li-MNPs were measured. Human dental pulp stem cells (hDPSCs) and Streptococcus mutans (S. mutans) were used to evaluate the biological effects of Li-MNPs. In addition, a dental pulp exposure mouse model was used to evaluate the regenerative effects of Li-MNPs. Results Li-MNPs had a larger surface area (221.18 m2/g), a larger pore volume (0.25 cm3/g), and a smaller particle size (520.92 ± 35.21 nm) than MNPs. The in vitro investigation demonstrated that Li-MNPs greatly enhanced the biomineralization and odontogenic differentiation of hDPSCs through the Wnt/β-catenin signaling pathway. Li-MNPs showed a strong antibacterial effect on S. mutans. As expected, Li-MNPs significantly promoted dentin regeneration in situ and in vivo. Conclusion Li-MNPs promoted dentin regeneration and inhibited S. mutans growth, implying a possible application as a pulp capping agent in vital pulp therapy.
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Affiliation(s)
- Zitian Liang
- Department of Endodontics, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangdong Engineering Research Center of Oral Restoration and Reconstruction, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangzhou, Guangdong, 510182, People’s Republic of China
| | - Ding Chen
- Department of Prosthodontics, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangdong Engineering Research Center of Oral Restoration and Reconstruction, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangzhou, Guangdong, 510182, People’s Republic of China
| | - Ye Jiang
- Department of Endodontics, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangdong Engineering Research Center of Oral Restoration and Reconstruction, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangzhou, Guangdong, 510182, People’s Republic of China
| | - Zhikang Su
- Department of Prosthodontics, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangdong Engineering Research Center of Oral Restoration and Reconstruction, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangzhou, Guangdong, 510182, People’s Republic of China
| | - Yixing Pi
- Department of Prosthodontics, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangdong Engineering Research Center of Oral Restoration and Reconstruction, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangzhou, Guangdong, 510182, People’s Republic of China
| | - Tao Luo
- Department of Prosthodontics, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangdong Engineering Research Center of Oral Restoration and Reconstruction, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangzhou, Guangdong, 510182, People’s Republic of China
| | - Qianzhou Jiang
- Department of Endodontics, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangdong Engineering Research Center of Oral Restoration and Reconstruction, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangzhou, Guangdong, 510182, People’s Republic of China
| | - Li Yang
- Department of Endodontics, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangdong Engineering Research Center of Oral Restoration and Reconstruction, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangzhou, Guangdong, 510182, People’s Republic of China
| | - Lvhua Guo
- Department of Prosthodontics, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangdong Engineering Research Center of Oral Restoration and Reconstruction, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangzhou, Guangdong, 510182, People’s Republic of China
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Yan H, Chen H, Liu Y, Zhang Q, Guo Y, Fu Y, Ren H, Wang H, Wang C, Ge Y. Assessment of cognitive impairment after acute cerebral infarction with T1 relaxation time measured by MP2RAGE sequence and cerebral hemodynamic by transcranial Doppler. Front Neurol 2022; 13:1056423. [PMID: 36561306 PMCID: PMC9763460 DOI: 10.3389/fneur.2022.1056423] [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: 09/28/2022] [Accepted: 11/23/2022] [Indexed: 12/12/2022] Open
Abstract
Objective This study aimed to investigate early brain microstructural changes discovered using magnetization-prepared two rapid acquisition gradient echo (MP2RAGE) sequence and cerebral hemodynamic using TCD for cognitive impairment after acute cerebral infarction. Methods We enrolled 43 patients with acute cerebral infarction and 21 healthy people in the study, who were subjected to cognitive assessments, the MP2RAGE sequence, and a cerebral hemodynamic examination. A total of 26 brain regions of interest were investigated. Furthermore, we used cerebral hemodynamics to explain brain microstructural changes, which helped us better understand the pathophysiology of cognitive impairment after acute cerebral infarction and guide treatment. Results T1 relaxation times in the left frontal lobe, right frontal lobe, right temporal lobe, left precuneus, left thalamus, right hippocampus, right head of caudate nucleus, and splenium of corpus callosum were substantially different across the three groups, which were significantly correlated with neuropsychological test scores. CI group patients had significantly lower cerebral blood flow velocity than those in the N-CI and Normal groups. The receiver operating curve analysis revealed that most T1 relaxation times had high sensitivity and specificity, especially on the right temporal lobe and right frontal lobe. There was a potential correlation between T1 relaxation times and MMSE scores through TCD parameters. Conclusion The MP2RAGE sequence can detect alterations in whole brain microstructure in patients with cognitive impairment after acute cerebral infarction. Brain microstructural changes could influence cognitive function through cerebral hemodynamics. T1 relaxation times on the right temporal lobe and the right frontal lobe are expected to be a prospective biomarker of cognitive impairment after acute cerebral infarction.
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Affiliation(s)
- Hongting Yan
- The Department of Neurology, The Second Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Honghai Chen
- The Department of Radiology, The Second Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Yanzhi Liu
- The Department of Neurology, The Second Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Qiannan Zhang
- The Department of Neurology, The Second Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Yunchu Guo
- The Department of Neurology, The Second Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Yu Fu
- The Department of Neurology, The Second Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Hongling Ren
- The Department of Neurology, The Second Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Hairong Wang
- The Department of Neurology, The Second Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Chun Wang
- The Department of Neurology, The Second Hospital of Dalian Medical University, Dalian, Liaoning, China,*Correspondence: Chun Wang
| | - Yusong Ge
- The Department of Neurology, The Second Hospital of Dalian Medical University, Dalian, Liaoning, China,Yusong Ge
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Wang Q, Wang G, Sun Q, Sun DH. Application of MAGnetic resonance imaging compilation in acute ischemic stroke. World J Clin Cases 2021; 9:10828-10837. [PMID: 35047594 PMCID: PMC8678888 DOI: 10.12998/wjcc.v9.i35.10828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 08/31/2021] [Accepted: 10/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Synthetic magnetic resonance imaging (MRI) MAGnetic resonance imaging compilation (MAGiC) is a new MRI technology. Conventional T1, T2, T2-fluid-attenuated inversion recovery (FLAIR) contrast images, quantitative images of T1 and T2 mapping, and MAGiC phase sensitive inversion recovery (PSIR) Vessel cerebrovascular images can be obtained simultaneously through post-processing at the same time after completing a scan. In recent years, studies have reported that MAGiC can be applied to patients with acute ischemic stroke. We hypothesized that the synthetic MRI vascular screening scheme can evaluate the degree of cerebral artery stenosis in patients with acute ischemic stroke.
AIM To explore the application value of vascular images obtained by synthetic MRI in diagnosing acute ischemic stroke.
METHODS A total of 64 patients with acute ischemic stroke were selected and examined by MRI in the current retrospective cohort study. The scanning sequences included traditional T1, T2, and T2-FLAIR, three-dimensional time-of-flight magnetic resonance angiography (3D TOF MRA), diffusion-weighted imaging (DWI), and synthetic MRI. Conventional contrast images (T1, T2, and T2-FLAIR) and intracranial vessel images (MAGiC PSIR Vessel] were automatically reconstructed using synthetic MRI raw data. The contrast-to-noise ratio (CNR) values of traditional T1, T2, and T2-FLAIR images and MAGiC reconstructed T1, T2, and T2-FLAIR images in DWI diffusion restriction areas were measured and compared. MAGiC PSIR Vessel and TOF MRA images were used to measure and calculate the stenosis degree of bilateral middle cerebral artery stenosis areas. The consistency of MAGiC PSIR Vessel and TOF MRA in displaying the degree of vascular stenosis with computed tomography angiography (CTA) was compared.
RESULTS Among the 64 patients with acute ischemic stroke, 79 vascular stenosis areas showed that the correlation between MAGiC PSIR Vessel and CTA (r = 0.90, P < 0.01) was higher than that between TOF MRA and CTA (r = 0.84, P < 0.01). With a degree of vascular stenosis > 50% assessed by CTA as a reference, the area under the receiver operating characteristic (ROC) curve of MAGiC PSIR Vessel [area under the curve (AUC) = 0.906, P < 0.01] was higher than that of TOF MRA (AUC = 0.790, P < 0.01). Among the 64 patients with acute ischemic stroke, 39 were scanned for traditional T1, T2, and T2-FLAIR images and MAGiC images simultaneously, and CNR values in DWI diffusion restriction areas were measured, which were: Traditional T2 = 21.2, traditional T1 = -6.7, and traditional T2-FLAIR = 11.9; and MAGiC T2 = 7.1, MAGiC T1 = -3.9, and MAGiC T2-FLAIR = 4.5.
CONCLUSION The synthetic MRI vascular screening scheme for patients with acute ischemic stroke can accurately evaluate the degree of bilateral middle cerebral artery stenosis, which is of great significance to early thrombolytic interventional therapy and improving patients’ quality of life.
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Affiliation(s)
- Qi Wang
- Department of Radiology, The Stroke Hospital of Liaoning Province, Shenyang 110101, Liaoning Province, China
| | - Gang Wang
- Department of Radiology, The Stroke Hospital of Liaoning Province, Shenyang 110101, Liaoning Province, China
| | - Qiang Sun
- Department of Radiology, The Stroke Hospital of Liaoning Province, Shenyang 110101, Liaoning Province, China
| | - Di-He Sun
- Department of Radiology, The Stroke Hospital of Liaoning Province, Shenyang 110101, Liaoning Province, China
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Cheung J, Doerr M, Hu R, Sun PZ. Refined Ischemic Penumbra Imaging with Tissue pH and Diffusion Kurtosis Magnetic Resonance Imaging. Transl Stroke Res 2021; 12:742-753. [PMID: 33159656 PMCID: PMC8102648 DOI: 10.1007/s12975-020-00868-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 10/14/2020] [Accepted: 10/18/2020] [Indexed: 12/19/2022]
Abstract
Imaging has played a vital role in our mechanistic understanding of acute ischemia and the management of acute stroke patients. The most recent DAWN and DEFUSE-3 trials showed that endovascular therapy could be extended to a selected group of late-presenting stroke patients with the aid of imaging. Although perfusion and diffusion MRI have been commonly used in stroke imaging, the approximation of their mismatch as the penumbra is oversimplified, particularly in the era of endovascular therapy. Briefly, the hypoperfusion lesion includes the benign oligemia that does not proceed to infarction. Also, with prompt and effective reperfusion therapy, a portion of the diffusion lesion is potentially reversible. Therefore, advanced imaging that provides improved ischemic tissue characterization may enable new experimental stroke therapeutics and eventually further individualize stroke treatment upon translation to the clinical setting. Specifically, pH imaging captures tissue of altered metabolic state that demarcates the hypoperfused lesion into ischemic penumbra and benign oligemia, which remains promising to define the ischemic penumbra's outer boundary. On the other hand, diffusion kurtosis imaging (DKI) differentiates the most severely damaged and irreversibly injured diffusion lesion from the portion of diffusion lesion that is potentially reversible, refining the inner boundary of the penumbra. Altogether, the development of advanced imaging has the potential to not only transform the experimental stroke research but also aid clinical translation and patient management.
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Affiliation(s)
- Jesse Cheung
- Emory College of Arts and Sciences, Emory University, Atlanta, GA, 30329, USA
- Yerkes Imaging Center, Yerkes National Primate Research Center, Emory University, Atlanta, GA, 30329, USA
| | - Madeline Doerr
- Yerkes Imaging Center, Yerkes National Primate Research Center, Emory University, Atlanta, GA, 30329, USA
- Dartmouth College, Hanover, NH, 03755, USA
| | - Ranliang Hu
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton RD NE, Atlanta, GA, 30322, USA
| | - Phillip Zhe Sun
- Yerkes Imaging Center, Yerkes National Primate Research Center, Emory University, Atlanta, GA, 30329, USA.
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton RD NE, Atlanta, GA, 30322, USA.
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Timing the Ischemic Stroke by Multiparametric Quantitative Magnetic Resonance Imaging. Stroke 2021. [DOI: 10.36255/exonpublications.stroke.timingischemicstroke.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Li CW, Hsu AL, Huang CWC, Yang SH, Lin CY, Shieh CC, Chan WP. Reliability of Synthetic Brain MRI for Assessment of Ischemic Stroke with Phantom Validation of a Relaxation Time Determination Method. J Clin Med 2020; 9:jcm9061857. [PMID: 32545907 PMCID: PMC7356822 DOI: 10.3390/jcm9061857] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 06/08/2020] [Accepted: 06/10/2020] [Indexed: 12/30/2022] Open
Abstract
The reliability of relaxation time measures in synthetic magnetic resonance images (MRIs) of homemade phantoms were validated, and the diagnostic suitability of synthetic imaging was compared to that of conventional MRIs for detecting ischemic lesions. Phantoms filled with aqueous cupric-sulfate (CuSO4) were designed to mimic spin-lattice (T1) and spin-spin (T2) relaxation properties and were used to compare their accuracies and stabilities between synthetic and conventional scans of various brain tissues. To validate the accuracy of synthetic imaging in ischemic stroke diagnoses, the synthetic and clinical scans of 18 patients with ischemic stroke were compared, and the quantitative contrast-to-noise ratios (CNRs) were measured, using the Friedman test to determine significance in differences. Results using the phantoms showed no significant differences in the interday and intersession synthetic quantitative T1 and T2 values. However, between synthetic and referenced T1 and T2 values, differences were larger for longer relaxation times, showing that image intensities in synthetic scans are relatively inaccurate in the cerebrospinal fluid (CSF). Similarly, CNRs in CSF regions of stroke patients were significantly different on synthetic T2-weighted and T2-fluid-attenuated inversion recovery images. In contrast, differences in stroke lesions were insignificant between the two. Therefore, interday and intersession synthetic T1 and T2 values are highly reliable, and discrepancies in synthetic T1 and T2 relaxation times and image contrasts in CSF regions do not affect stroke lesion diagnoses. Additionally, quantitative relaxation times from synthetic images allow better estimations of ischemic stroke onset time, consequently increasing confidence in synthetic MRIs as diagnostic tools for ischemic stroke.
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Affiliation(s)
- Chia-Wei Li
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan; (C.-W.L.); (A.-L.H.); (C.-W.C.H.); (S.-H.Y.)
| | - Ai-Ling Hsu
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan; (C.-W.L.); (A.-L.H.); (C.-W.C.H.); (S.-H.Y.)
| | - Chi-Wen C. Huang
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan; (C.-W.L.); (A.-L.H.); (C.-W.C.H.); (S.-H.Y.)
- Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Shih-Hung Yang
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan; (C.-W.L.); (A.-L.H.); (C.-W.C.H.); (S.-H.Y.)
- Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | | | | | - Wing P. Chan
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan; (C.-W.L.); (A.-L.H.); (C.-W.C.H.); (S.-H.Y.)
- Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- Medical Innovation Development Center, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan
- Correspondence: ; Tel.: +886-2-2930-7930 (ext. 1300); Fax: +886-2-2931-6809
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Wu L, Jiang L, Sun PZ. Investigating the origin of pH-sensitive magnetization transfer ratio asymmetry MRI contrast during the acute stroke: Correction of T 1 change reveals the dominant amide proton transfer MRI signal. Magn Reson Med 2020; 84:2702-2712. [PMID: 32416012 DOI: 10.1002/mrm.28313] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 03/22/2020] [Accepted: 04/17/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE Amide proton transfer (APT) MRI is promising to serve as a surrogate metabolic imaging biomarker of acute stroke. Although the magnetization transfer ratio asymmetry (MTRasym ) has been used commonly, the origin of pH-weighted MRI effect remains an area of investigation, including contributions from APT, semisolid MT contrast asymmetry, and nuclear Overhauser enhancement effects. Our study aimed to determine the origin of pH-weighted MTRasym contrast following acute stroke. METHODS Multiparametric MRI, including T1 , T2 , diffusion and Z-spectrum, were performed in rats after middle cerebral artery occlusion. We analyzed the conventional Z-spectrum I Δ ω I 0 and the apparent exchange spectrum R ex Δ ω , being the difference between the relaxation-scaled inverse Z-spectrum and the intrinsic spinlock relaxation rate R 1 · cos 2 θ · I 0 I Δ ω - R 1 ρ Δ ω . The ischemia-induced change was calculated as the spectral difference between the diffusion lesion and the contralateral normal area. RESULTS The conventional Z-spectrum signal change at -3.5 ppm dominates that at +3.5 ppm (-1.16 ± 0.39% vs. 0.76 ± 0.26%, P < .01) following acute stroke. In comparison, the magnitude of ΔRex change at 3.5 ppm becomes significantly larger than that at -3.5 ppm (-2.80 ± 0.40% vs. -0.94 ± 0.80%, P < .001), with their SNR being 7.0 and 1.2, respectively. We extended the magnetization transfer and relaxation normalized APT concept to the apparent exchange-dependent relaxation image, documenting an enhanced pH contrast between the ischemic lesion and the intact tissue, over that of MTRasym . CONCLUSION Our study shows that after the relaxation-effect correction, the APT effect is the dominant contributing factor to pH-weighted MTRasym following acute stroke.
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Affiliation(s)
- Limin Wu
- Neuroscience Center and Department of Pediatrics, Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts, USA
| | - Liang Jiang
- Department of Otolaryngology, Head and Neck Surgery, Affiliated Hospital of Southwestern Medical University, Luzhou, Sichuan, China.,Yerkes Imaging Center, Yerkes National Primate Research Center, Emory University, Atlanta, Georgia, USA
| | - Phillip Zhe Sun
- Yerkes Imaging Center, Yerkes National Primate Research Center, Emory University, Atlanta, Georgia, USA.,Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts, USA
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Son SH, Lee IH, Park JS, Yoo IS, Kim SW, Lee JW, Ryu S, You Y, Min JH, Cho YC, Jeong WJ, Oh SK, Cho SU, Ahn HJ, Kang C, Lee DH, Lee BK, Youn CS. Does Combining Biomarkers and Brain Images Provide Improved Prognostic Predictive Performance for Out-Of-Hospital Cardiac Arrest Survivors before Target Temperature Management? J Clin Med 2020; 9:jcm9030744. [PMID: 32164225 PMCID: PMC7141362 DOI: 10.3390/jcm9030744] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 02/26/2020] [Accepted: 03/06/2020] [Indexed: 12/18/2022] Open
Abstract
We examined whether combining biomarkers measurements and brain images early after the return of spontaneous circulation improves prognostic performance compared with the use of either biomarkers or brain images for patients with cardiac arrest following target temperature management (TTM). This retrospective observational study involved comatose out-of-hospital cardiac arrest survivors. We analyzed neuron-specific enolase levels in serum (NSE) or cerebrospinal fluid (CSF), grey-to-white matter ratio by brain computed tomography, presence of high signal intensity (HSI) in diffusion-weighted imaging (DWI), and voxel-based apparent diffusion coefficient (ADC). Of the 58 patients, 33 (56.9%) had poor neurologic outcomes. CSF NSE levels showed better prognostic performance (area under the curve (AUC) 0.873, 95% confidence interval (CI) 0.749–0.950) than serum NSE levels (AUC 0.792, 95% CI 0.644–0.888). HSI in DWI showed the best prognostic performance (AUC 0.833, 95% CI 0.711–0.919). Combining CSF NSE levels and HSI in DWI had better prognostic performance (AUC 0.925, 95% CI 0.813–0.981) than each individual method, followed by the combination of serum NSE levels and HSI on DWI and that of CSF NSE levels and the percentage of voxels of ADC (AUC 0.901, 95% CI 0.792–0.965; AUC 0.849, 95% CI 0.717–0.935, respectively). Combining CSF/serum NSE levels and HSI in DWI before TTM improved the prognostic performance compared to either each individual method or other combinations.
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Affiliation(s)
- Seung Ha Son
- Department of Emergency Medicine, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon 35015, Korea; (S.H.S.); (I.S.Y.); (S.W.K.); (J.W.L.); (S.R.); (Y.Y.); (J.H.M.); (Y.C.C.); (W.J.J.); (S.K.O.); (S.U.C.); (H.J.A.); (C.K.)
| | - In Ho Lee
- Department of Radiology, College of Medicine, Chungnam National University, 266, Munhwa-ro, Jung-gu, Daejeon 35015, Korea;
| | - Jung Soo Park
- Department of Emergency Medicine, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon 35015, Korea; (S.H.S.); (I.S.Y.); (S.W.K.); (J.W.L.); (S.R.); (Y.Y.); (J.H.M.); (Y.C.C.); (W.J.J.); (S.K.O.); (S.U.C.); (H.J.A.); (C.K.)
- Department of Emergency Medicine, College of Medicine, Chungnam National University, Daejeon 35015, Korea
- Correspondence: ; Tel.: +82-4-2280-6002
| | - In Sool Yoo
- Department of Emergency Medicine, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon 35015, Korea; (S.H.S.); (I.S.Y.); (S.W.K.); (J.W.L.); (S.R.); (Y.Y.); (J.H.M.); (Y.C.C.); (W.J.J.); (S.K.O.); (S.U.C.); (H.J.A.); (C.K.)
- Department of Radiology, College of Medicine, Chungnam National University, 266, Munhwa-ro, Jung-gu, Daejeon 35015, Korea;
| | - Seung Whan Kim
- Department of Emergency Medicine, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon 35015, Korea; (S.H.S.); (I.S.Y.); (S.W.K.); (J.W.L.); (S.R.); (Y.Y.); (J.H.M.); (Y.C.C.); (W.J.J.); (S.K.O.); (S.U.C.); (H.J.A.); (C.K.)
- Department of Emergency Medicine, College of Medicine, Chungnam National University, Daejeon 35015, Korea
| | - Jin Woong Lee
- Department of Emergency Medicine, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon 35015, Korea; (S.H.S.); (I.S.Y.); (S.W.K.); (J.W.L.); (S.R.); (Y.Y.); (J.H.M.); (Y.C.C.); (W.J.J.); (S.K.O.); (S.U.C.); (H.J.A.); (C.K.)
| | - Seung Ryu
- Department of Emergency Medicine, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon 35015, Korea; (S.H.S.); (I.S.Y.); (S.W.K.); (J.W.L.); (S.R.); (Y.Y.); (J.H.M.); (Y.C.C.); (W.J.J.); (S.K.O.); (S.U.C.); (H.J.A.); (C.K.)
| | - Yeonho You
- Department of Emergency Medicine, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon 35015, Korea; (S.H.S.); (I.S.Y.); (S.W.K.); (J.W.L.); (S.R.); (Y.Y.); (J.H.M.); (Y.C.C.); (W.J.J.); (S.K.O.); (S.U.C.); (H.J.A.); (C.K.)
| | - Jin Hong Min
- Department of Emergency Medicine, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon 35015, Korea; (S.H.S.); (I.S.Y.); (S.W.K.); (J.W.L.); (S.R.); (Y.Y.); (J.H.M.); (Y.C.C.); (W.J.J.); (S.K.O.); (S.U.C.); (H.J.A.); (C.K.)
- Department of Emergency Medicine, College of Medicine, Chungnam National University, Daejeon 35015, Korea
| | - Yong Chul Cho
- Department of Emergency Medicine, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon 35015, Korea; (S.H.S.); (I.S.Y.); (S.W.K.); (J.W.L.); (S.R.); (Y.Y.); (J.H.M.); (Y.C.C.); (W.J.J.); (S.K.O.); (S.U.C.); (H.J.A.); (C.K.)
| | - Won Joon Jeong
- Department of Emergency Medicine, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon 35015, Korea; (S.H.S.); (I.S.Y.); (S.W.K.); (J.W.L.); (S.R.); (Y.Y.); (J.H.M.); (Y.C.C.); (W.J.J.); (S.K.O.); (S.U.C.); (H.J.A.); (C.K.)
| | - Se Kwang Oh
- Department of Emergency Medicine, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon 35015, Korea; (S.H.S.); (I.S.Y.); (S.W.K.); (J.W.L.); (S.R.); (Y.Y.); (J.H.M.); (Y.C.C.); (W.J.J.); (S.K.O.); (S.U.C.); (H.J.A.); (C.K.)
| | - Sung Uk Cho
- Department of Emergency Medicine, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon 35015, Korea; (S.H.S.); (I.S.Y.); (S.W.K.); (J.W.L.); (S.R.); (Y.Y.); (J.H.M.); (Y.C.C.); (W.J.J.); (S.K.O.); (S.U.C.); (H.J.A.); (C.K.)
| | - Hong Joon Ahn
- Department of Emergency Medicine, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon 35015, Korea; (S.H.S.); (I.S.Y.); (S.W.K.); (J.W.L.); (S.R.); (Y.Y.); (J.H.M.); (Y.C.C.); (W.J.J.); (S.K.O.); (S.U.C.); (H.J.A.); (C.K.)
| | - Changshin Kang
- Department of Emergency Medicine, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon 35015, Korea; (S.H.S.); (I.S.Y.); (S.W.K.); (J.W.L.); (S.R.); (Y.Y.); (J.H.M.); (Y.C.C.); (W.J.J.); (S.K.O.); (S.U.C.); (H.J.A.); (C.K.)
| | - Dong Hun Lee
- Department of Emergency Medicine, Chonnam National University Medical School, Gwangju 61469, Korea; (D.H.L.); (B.K.L.)
| | - Byung Kook Lee
- Department of Emergency Medicine, Chonnam National University Medical School, Gwangju 61469, Korea; (D.H.L.); (B.K.L.)
| | - Chun Song Youn
- Department of Emergency Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul 06591, Korea;
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Change in CSF Dynamics Responsible for ICP Elevation After Ischemic Stroke in Rats: a New Mechanism for Unexplained END? Transl Stroke Res 2019; 11:310-318. [PMID: 31418164 DOI: 10.1007/s12975-019-00719-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 06/06/2019] [Accepted: 07/15/2019] [Indexed: 01/25/2023]
Abstract
It has been proposed that intracranial pressure (ICP) elevation and collateral failure are responsible for unexplained early neurological deterioration (END) in stroke. The study's aims were to investigate whether cerebral spinal fluid (CSF) dynamics, rather than edema, are responsible for elevation of ICP after ischemic stroke. Permanent middle cerebral artery occlusion (pMCAO) was induced with an intraluminal filament. At 24 h after stroke, baseline ICP was measured and CSF dynamics were probed via a steady-state infusion method. Diffusion-weighted imaging (DWI) and T2-weighted magnetic resonance imaging were performed to define cerebral ischemic damage and the volume of brain swelling. We found that the pMCAO group exhibited a significant increase in CSF outflow resistance (2.27 ± 0.15 mmHg μL-1 min) compared with the sham group (0.93 ± 0.06 mmHg μL-1 min, p = 0.002). There was no correlation between mean ICP at 24 h post-pMCAO and edema (r2 = - 0.03, p = 0.5) or infarct volumes (r2 = 0.09, p = 0.5). However, for the first time, we found a significant correlation between the baseline ICP at 24 h post-stroke and the value of CSF outflow resistance. Results show that CSF outflow resistance, rather than edema, was the mechanism responsible for ICP elevation following ischemic stroke. This challenges current concepts and suggests the possibility that intracranial hypertension may be occurring undetected in a much wider range of stroke patients than is currently considered to be the case. In addition, this further supports the hypothesis that unexplained early neurological deterioration is the result of elevated ICP, leading to reduced collateral flow and cerebral perfusion.
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