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Zaimoglu M, Gökalp E, Gurses ME, Ozpiskin O, Alpergin BC, Tekneci O, Eroglu U. A Novel Foley Catheter-Based Brain Retraction Method for the Interhemispheric Approach: Technical Considerations and an Illustrative Video. World Neurosurg 2024:S1878-8750(24)00390-5. [PMID: 38479640 DOI: 10.1016/j.wneu.2024.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 03/02/2024] [Accepted: 03/04/2024] [Indexed: 04/01/2024]
Abstract
BACKGROUND Management of interhemispheric pathologies requires surgical intervention through a restricted anatomical corridor ensconced within critical cerebral structures. The use of retractors to facilitate operative access may cause damage to cerebral tissue. The development of an innovative retraction technique designed to alleviate cerebral damage in such cases is imperative. In this study, we present a novel and gentle retraction method to facilitate the interhemisferic approach. METHODS We retrospectively examined data of 9 right-handed patients who underwent surgical resection of interhemispheric lesions between 2021 and 2022. All patients underwent surgery for the first time because of this pathology. All operative specimens were histologically confirmed. Clinical characteristics, operative details, and follow-up data were retrospectively analyzed. RESULTS The new retraction technique was successfully applied to 8 tumor patients and 1 patient with an aneurysm. Eight patients had an anterior interhemispheric approach, and 1 patient had a posterior interhemispheric approach. Complete surgical excision was achieved in all patients with no postoperative complications. Postoperative Gadolinium (Gd)-enhanced magnetic resonance imaging (MRI) showed no signs of ischemia or contusion. All patients exhibited significant improvements in their symptoms. An illustrative video that elucidates the removal of an interhemispheric epidermoid tumor, employing the anterior ipsilateral interhemispheric approach, featuring the novel retraction method. CONCLUSIONS The ideal retraction technique during the interhemispheric approach is still a challenge. Our novel retraction technique may help minimize brain parenchymal damage during surgical resection of interhemispheric lesions.
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Affiliation(s)
- Murat Zaimoglu
- Department of Neurosurgery, School of Medicine, Ankara University, Ankara, Turkey
| | - Elif Gökalp
- Department of Neurosurgery, School of Medicine, Ankara University, Ankara, Turkey
| | - Muhammet Enes Gurses
- Department of Neurosurgery, Miller School of Medicine, University of Miami, Miami, Florida
| | - Omer Ozpiskin
- Department of Neurosurgery, School of Medicine, Ankara University, Ankara, Turkey
| | - Baran Can Alpergin
- Department of Neurosurgery, School of Medicine, Ankara University, Ankara, Turkey
| | - Ozan Tekneci
- Department of Neurosurgery, School of Medicine, Ankara University, Ankara, Turkey
| | - Umit Eroglu
- Department of Neurosurgery, School of Medicine, Ankara University, Ankara, Turkey.
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Abayi DAM, Assoumou PA, Matsanga OR, Brahime F, Aki TM, Mengome EM. [Oculopalpebral trauma in domestic violence]. J Fr Ophtalmol 2023; 46:1155-1160. [PMID: 37867124 DOI: 10.1016/j.jfo.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 06/22/2023] [Accepted: 06/28/2023] [Indexed: 10/24/2023]
Abstract
INTRODUCTION Oculopalpebral trauma in domestic violence is defined as ophthalmological injuries caused by a spouse. PURPOSE To describe the epidemiology and management of oculopalpebral injuries caused by domestic violence. PATIENTS AND METHODS Retrospective descriptive study carried out over a period of 5 years in patients who suffered oculopalpebral trauma from domestic violence. VARIABLES STUDIED age, sex, profession, visual acuity, blunt instruments, type of injury, treatments. Data processing by Excel 2013 and WPS Office software. RESULTS We collected 31 patients with a mean age of 34.5±7 years and a sex ratio of 0.3. The most commonly found functional sign was decreased VA in 100% of patients. The mechanism of injury was punching in 71%. Visual acuity was less than 1/20 in 9.7%. Contusion was the most commonly found trauma in 74.19% of cases, and conjunctival hyperemia was seen in 68.2% of cases. Eight patients (25.8%) had undergone surgical treatment. CONCLUSION Oculopalpebral trauma by domestic violence is serious. Both sexes can be victims. The lesions encountered can affect the functional or even anatomical prognosis of the eye.
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Affiliation(s)
| | - P A Assoumou
- Service d'ophtalmologie, HIA OBO (GABON), 20404 Libreville, Gabon
| | - O R Matsanga
- Service d'ophtalmologie, HIA OBO (GABON), 20404 Libreville, Gabon
| | - F Brahime
- Service d'ophtalmologie, HIA OBO (GABON), 20404 Libreville, Gabon
| | - T Mba Aki
- Service d'ophtalmologie, HIA OBO (GABON), 20404 Libreville, Gabon
| | - E Mvé Mengome
- Service d'ophtalmologie, HIA OBO (GABON), 20404 Libreville, Gabon
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van Erp IAM, van Essen TA, Lingsma H, Pisica D, Singh RD, van Dijck JTJM, Volovici V, Kolias A, Peppel LD, Heijenbrok-Kal M, Ribbers GM, Menon DK, Hutchinson P, Depreitere B, Steyerberg EW, Maas AIR, de Ruiter GCW, Peul WC. Early surgery versus conservative treatment in patients with traumatic intracerebral hematoma: a CENTER-TBI study. Acta Neurochir (Wien) 2023; 165:3217-3227. [PMID: 37747570 PMCID: PMC10624744 DOI: 10.1007/s00701-023-05797-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 09/06/2023] [Indexed: 09/26/2023]
Abstract
PURPOSE Evidence regarding the effect of surgery in traumatic intracerebral hematoma (t-ICH) is limited and relies on the STITCH(Trauma) trial. This study is aimed at comparing the effectiveness of early surgery to conservative treatment in patients with a t-ICH. METHODS In a prospective cohort, we included patients with a large t-ICH (< 48 h of injury). Primary outcome was the Glasgow Outcome Scale Extended (GOSE) at 6 months, analyzed with multivariable proportional odds logistic regression. Subgroups included injury severity and isolated vs. non-isolated t-ICH. RESULTS A total of 367 patients with a large t-ICH were included, of whom 160 received early surgery and 207 received conservative treatment. Patients receiving early surgery were younger (median age 54 vs. 58 years) and more severely injured (median Glasgow Coma Scale 7 vs. 10) compared to those treated conservatively. In the overall cohort, early surgery was not associated with better functional outcome (adjusted odds ratio (AOR) 1.1, (95% CI, 0.6-1.7)) compared to conservative treatment. Early surgery was associated with better outcome for patients with moderate TBI and isolated t-ICH (AOR 1.5 (95% CI, 1.1-2.0); P value for interaction 0.71, and AOR 1.8 (95% CI, 1.3-2.5); P value for interaction 0.004). Conversely, in mild TBI and those with a smaller t-ICH (< 33 cc), conservative treatment was associated with better outcome (AOR 0.6 (95% CI, 0.4-0.9); P value for interaction 0.71, and AOR 0.8 (95% CI, 0.5-1.0); P value for interaction 0.32). CONCLUSIONS Early surgery in t-ICH might benefit those with moderate TBI and isolated t-ICH, comparable with results of the STITCH(Trauma) trial.
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Affiliation(s)
- Inge A M van Erp
- University Neurosurgical Centre Holland, LUMC, HMC, HAGA, Leiden and The Hague, The Netherlands.
| | - Thomas A van Essen
- University Neurosurgical Centre Holland, LUMC, HMC, HAGA, Leiden and The Hague, The Netherlands
| | - Hester Lingsma
- Centre for Medical Decision Making, Department of Public Health, Erasmus MC-University Medical Centre, Rotterdam, The Netherlands
| | - Dana Pisica
- Centre for Medical Decision Making, Department of Public Health, Erasmus MC-University Medical Centre, Rotterdam, The Netherlands
- Department of Neurosurgery, Erasmus MC-University Medical Centre, Rotterdam, The Netherlands
| | - Ranjit D Singh
- University Neurosurgical Centre Holland, LUMC, HMC, HAGA, Leiden and The Hague, The Netherlands
| | - Jeroen T J M van Dijck
- University Neurosurgical Centre Holland, LUMC, HMC, HAGA, Leiden and The Hague, The Netherlands
| | - Victor Volovici
- Centre for Medical Decision Making, Department of Public Health, Erasmus MC-University Medical Centre, Rotterdam, The Netherlands
- Department of Neurosurgery, Erasmus MC-University Medical Centre, Rotterdam, The Netherlands
| | - Angelos Kolias
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge and Addenbrooke's Hospital, Cambridge, UK
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Lianne D Peppel
- Rijndam Rehabilitation and Department of Rehabilitation Medicine, Erasmus MC-University Medical Centre, Rotterdam, The Netherlands
| | - Majanka Heijenbrok-Kal
- Rijndam Rehabilitation and Department of Rehabilitation Medicine, Erasmus MC-University Medical Centre, Rotterdam, The Netherlands
| | - Gerard M Ribbers
- Rijndam Rehabilitation and Department of Rehabilitation Medicine, Erasmus MC-University Medical Centre, Rotterdam, The Netherlands
| | - David K Menon
- Division of Anaesthesia, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Peter Hutchinson
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge and Addenbrooke's Hospital, Cambridge, UK
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Bart Depreitere
- Department of Neurosurgery, University Hospital KU Leuven, Leuven, Belgium
| | - Ewout W Steyerberg
- University Neurosurgical Centre Holland, LUMC, HMC, HAGA, Leiden and The Hague, The Netherlands
- Centre for Medical Decision Making, Department of Public Health, Erasmus MC-University Medical Centre, Rotterdam, The Netherlands
- Department of Biomedical Data Sciences, Leiden University Medical Centre and Haaglanden Medical Centre, Leiden and The Hague, The Netherlands
| | - Andrew I R Maas
- Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Edegem, Antwerp, Belgium
| | - Godard C W de Ruiter
- University Neurosurgical Centre Holland, LUMC, HMC, HAGA, Leiden and The Hague, The Netherlands
| | - Wilco C Peul
- University Neurosurgical Centre Holland, LUMC, HMC, HAGA, Leiden and The Hague, The Netherlands
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Hubscher CH, Gumbel JH, Armstrong JE, Montgomery LR. Impact of activity-based recovery training and desmopressin on spinal cord injury-induced polyuria in Wistar rats. J Spinal Cord Med 2023; 46:910-916. [PMID: 35604340 PMCID: PMC10653760 DOI: 10.1080/10790268.2022.2069538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Activity-based recovery training (ABRT) reverses spinal cord injury (SCI) induced polyuria and alterations of biomarkers involved with fluid balance, including expression levels of kidney vasopressin 2 receptors. However, void volumes do not return to pre-injury baseline levels, indicating a combinatorial approach may be necessary. In the current study, acute effects of a pharmacological intervention versus placebo were examined in male rats that had received 70 daily ABRT sessions. The treatment, desmopressin (DDAVP - synthetic analogue of arginine vasopressin), an antidiuretic therapy used for the management of bedwetting in children and central diabetes insipidus, has previously shown some promise in a few limited cohorts of SCI individuals having nocturnal polyuria. A total of 70 sessions of ABRT over a 10-week timeframe again reduced the overproduction of urine, but not completely to pre-SCI baseline levels. DDAVP treatment maintained but did not further reduce the level of urine output in the ABRT group without continuous exercise, demonstrating either intervention/treatment alone is effective, despite no additive effect. Although intake did not change from pre-injury levels despite polyuria, DDAVP treatment also reduced drink volume. Further studies are needed as the mechanisms underlying changes in fluid and solute balance are likely multi-factorial involving a complex interaction between the neural (both central and peripheral) control of systems mediating thirst, urinary output, and cardiovascular regulation.
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Affiliation(s)
- Charles H. Hubscher
- Department of Anatomical Sciences & Neurobiology, University of Louisville, Louisville, KY, USA
- Kentucky Spinal Cord Research Center, Louisville, KY, USA
| | - Jason H. Gumbel
- Department of Anatomical Sciences & Neurobiology, University of Louisville, Louisville, KY, USA
| | - James E. Armstrong
- Department of Anatomical Sciences & Neurobiology, University of Louisville, Louisville, KY, USA
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Danner SM, Shepard CT, Hainline C, Shevtsova NA, Rybak IA, Magnuson DSK. Spinal control of locomotion before and after spinal cord injury. Exp Neurol 2023; 368:114496. [PMID: 37499972 PMCID: PMC10529867 DOI: 10.1016/j.expneurol.2023.114496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 07/10/2023] [Accepted: 07/23/2023] [Indexed: 07/29/2023]
Abstract
Thoracic spinal cord injury affects long propriospinal neurons that interconnect the cervical and lumbar enlargements. These neurons are crucial for coordinating forelimb and hindlimb locomotor movements in a speed-dependent manner. However, recovery from spinal cord injury is usually studied over a very limited range of speeds that may not fully expose circuitry dysfunction. To overcome this limitation, we investigated overground locomotion in rats trained to move over an extended distance with a wide range of speeds both pre-injury and after recovery from thoracic hemisection or contusion injuries. In this experimental context, intact rats expressed a speed-dependent continuum of alternating (walk and trot) and non-alternating (canter, gallop, half-bound gallop, and bound) gaits. After a lateral hemisection injury, rats recovered the ability to locomote over a wide range of speeds but lost the ability to use the highest-speed gaits (half-bound gallop and bound) and predominantly used the limb contralateral to the injury as lead during canter and gallop. A moderate contusion injury caused a greater reduction in maximal speed, loss of all non-alternating gaits, and emergence of novel alternating gaits. These changes resulted from weak fore-hind coupling together with appropriate control of left-right alternation. After hemisection, animals expressed a subset of intact gaits with appropriate interlimb coordination even on the side of the injury, where the long propriospinal connections were severed. These observations highlight how investigating locomotion over the full range of speeds can reveal otherwise hidden aspects of spinal locomotor control and post-injury recovery.
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Affiliation(s)
- Simon M Danner
- Department of Neurobiology and Anatomy, College of Medicine, Drexel University, Philadelphia, PA, USA.
| | - Courtney T Shepard
- Interdisciplinary Program in Translational Neuroscience, University of Louisville School of Medicine, Health Sciences Campus, Louisville, KY, USA
| | - Casey Hainline
- Speed School of Engineering, University of Louisville School of Medicine, Health Sciences Campus, Louisville, KY, USA
| | - Natalia A Shevtsova
- Department of Neurobiology and Anatomy, College of Medicine, Drexel University, Philadelphia, PA, USA
| | - Ilya A Rybak
- Department of Neurobiology and Anatomy, College of Medicine, Drexel University, Philadelphia, PA, USA
| | - David S K Magnuson
- Department of Neurological Surgery, University of Louisville School of Medicine, Health Sciences Campus, Louisville, KY, USA; Kentucky Spinal Cord Injury Research Center, University of Louisville School of Medicine, Health Sciences Campus, Louisville, KY, USA
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Martins L, Amorim WW, Gregnani MF, de Carvalho Araújo R, Qadri F, Bader M, Pesquero JB. Kinin receptors regulate skeletal muscle regeneration: differential effects for B1 and B2 receptors. Inflamm Res 2023; 72:1583-1601. [PMID: 37464053 PMCID: PMC10499706 DOI: 10.1007/s00011-023-01766-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 06/20/2023] [Accepted: 07/02/2023] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVE AND DESIGN After traumatic skeletal muscle injury, muscle healing is often incomplete and produces extensive fibrosis. Bradykinin (BK) reduces fibrosis in renal and cardiac damage models through the B2 receptor. The B1 receptor expression is induced by damage, and blocking of the kallikrein-kinin system seems to affect the progression of muscular dystrophy. We hypothesized that both kinin B1 and B2 receptors could play a differential role after traumatic muscle injury, and the lack of the B1 receptor could produce more cellular and molecular substrates for myogenesis and fewer substrates for fibrosis, leading to better muscle healing. MATERIAL AND METHODS To test this hypothesis, tibialis anterior muscles of kinin receptor knockout animals were subjected to traumatic injury. Myogenesis, angiogenesis, fibrosis, and muscle functioning were evaluated. RESULTS Injured B1KO mice showed a faster healing progression of the injured area with a larger amount of central nucleated fiber post-injury when compared to control mice. In addition, they exhibited higher neovasculogenic capacity, maintaining optimal tissue perfusion for the post-injury phase; had higher amounts of myogenic markers with less inflammatory infiltrate and tissue destruction. This was followed by higher amounts of SMAD7 and lower amounts of p-SMAD2/3, which resulted in less fibrosis. In contrast, B2KO and B1B2KO mice showed more severe tissue destruction and excessive fibrosis. B1KO animals had better results in post-injury functional tests compared to control animals. CONCLUSIONS We demonstrate that injured skeletal muscle tissues have a better repair capacity with less fibrosis in the presence of B2 receptor and absence of B1 receptor, including better performances in functional tests.
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Affiliation(s)
- Leonardo Martins
- Division of Medical Sciences, Laboratory of Transcriptional Regulation, Institute of Medical Biology of Polish Academy of Sciences (IMB-PAN), 3a Tylna St., 90-364, Łódź, Poland.
- Center for Research and Molecular Diagnosis of Genetic Diseases, Federal University of São Paulo, Rua Pedro de Toledo 669, 9th Floor, São Paulo, 04039032, Brazil.
- Department of Biochemistry and Molecular Biology, Federal University of São Paulo, Rua Três de Maio 100, 4th Floor, São Paulo, 04044-020, Brazil.
| | - Weslley Wallace Amorim
- Center for Research and Molecular Diagnosis of Genetic Diseases, Federal University of São Paulo, Rua Pedro de Toledo 669, 9th Floor, São Paulo, 04039032, Brazil
| | - Marcos Fernandes Gregnani
- Laboratory of Exercise Genetics and Metabolism, Federal University of São Paulo, Rua Pedro de Toledo 669, 9th Floor, São Paulo, 04039032, Brazil
| | - Ronaldo de Carvalho Araújo
- Laboratory of Exercise Genetics and Metabolism, Federal University of São Paulo, Rua Pedro de Toledo 669, 9th Floor, São Paulo, 04039032, Brazil
| | - Fatimunnisa Qadri
- Max-Delbrück Center for Molecular Medicine (MDC), Robert-Rössle-Str. 10, 13125, Berlin, Germany
| | - Michael Bader
- Max-Delbrück Center for Molecular Medicine (MDC), Robert-Rössle-Str. 10, 13125, Berlin, Germany
- Institute for Biology, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
- Charité University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Potsdamer Str. 58, 10785, Berlin, Germany
| | - João Bosco Pesquero
- Center for Research and Molecular Diagnosis of Genetic Diseases, Federal University of São Paulo, Rua Pedro de Toledo 669, 9th Floor, São Paulo, 04039032, Brazil.
- Department of Biophysics, Federal University of São Paulo, Rua Botucatu 862, 6th Floor, São Paulo, 04023-062, Brazil.
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Emigh B, Grigorian A, Dilday J, Condon F, Nahmias J, Schellenberg M, Martin M, Matsushima K, Inaba K. Risk factors and outcomes in pediatric blunt cardiac injuries. Pediatr Surg Int 2023; 39:195. [PMID: 37160488 DOI: 10.1007/s00383-023-05478-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/23/2023] [Indexed: 05/11/2023]
Abstract
PURPOSE Unlike adults, less is known of the etiology and risk factors for blunt cardiac injury (BCI) in children. Identifying risk factors for BCI in pediatric patients will allow for more specific screening practices following blunt trauma. METHODS A retrospective review was performed using the Trauma Quality Improvement Program (TQIP) database from 2017 to 2019. All patients ≤ 16 years injured following blunt trauma were included. Demographics, mechanism, associated injuries, injury severity, and outcomes were collected. Univariate and multivariate regression was used to determine specific risk factors for BCI. RESULTS Of 266,045 pediatric patients included in the analysis, the incidence of BCI was less than 0.2%. The all-cause mortality seen in patients with BCI was 26%. Motor-vehicle collisions (MVCs) were the most common mechanism, although no association with seatbelt use was seen in adolescents (p = 0.158). The strongest independent risk factors for BCI were pulmonary contusions (OR 15.4, p < 0.001) and hemothorax (OR 8.9, p < 0.001). CONCLUSIONS Following trauma, the presence of pulmonary contusions or hemothorax should trigger additional screening investigations specific for BCI in pediatric patients.
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Affiliation(s)
- Brent Emigh
- Division of Trauma and Critical Care, Department of Surgery, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA.
- Department of Surgery, Rhode Island Hospital, 593 Eddy Street, APC 454, Providence, RI, 02903, USA.
| | - Areg Grigorian
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, Orange, CA, USA
| | - Joshua Dilday
- Division of Trauma and Surgical Critical Care, Department of Surgery, LAC+USC, University of Southern California, Los Angeles, CA, USA
| | - Freeman Condon
- Division of General Surgery, Department of Surgery, Tripler Army Medical Center, Honolulu, HI, USA
| | - Jeffry Nahmias
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, Orange, CA, USA
| | - Morgan Schellenberg
- Division of Trauma and Surgical Critical Care, Department of Surgery, LAC+USC, University of Southern California, Los Angeles, CA, USA
| | - Matthew Martin
- Division of Trauma and Surgical Critical Care, Department of Surgery, LAC+USC, University of Southern California, Los Angeles, CA, USA
| | - Kazuhide Matsushima
- Division of Trauma and Surgical Critical Care, Department of Surgery, LAC+USC, University of Southern California, Los Angeles, CA, USA
| | - Kenji Inaba
- Division of Trauma and Surgical Critical Care, Department of Surgery, LAC+USC, University of Southern California, Los Angeles, CA, USA
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Diouf A, Machnowska M. Conventional MR Imaging in Trauma Management in Adults. Neuroimaging Clin N Am 2023; 33:235-249. [PMID: 36965942 DOI: 10.1016/j.nic.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
MR imaging has been shown to have higher sensitivity than computed tomography (CT) for traumatic intracranial soft tissue injuries as well as most cases of intracranial hemorrhage, thus making it a significant adjunct to CT in the management of traumatic brain injury, mostly in the subacute to chronic phase, but may also be of use in the acute phase, when there are persistent neurologic symptoms unexplained by prior imaging.
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Affiliation(s)
- Ange Diouf
- Department of Radiology, Radio-Oncology and Nuclear Medicine Faculty of Medicine, University of Montré al, Montré al, QC, Canada; Interventional Neuroradiology Clinical Fellow at St. Michael's Hospital, University of Toronto, Toronto, ON, Canada; Department of Radiology, Centre Hospitalier de l'Université de Montré al (CHUM), 1051 Sanguinet Street, Montré al, QC H2X 0C1, Canada
| | - Matylda Machnowska
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada.
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Branson HM, Martinez-Rios C. Conventional MR Imaging in Trauma Management in Pediatrics. Neuroimaging Clin N Am 2023; 33:251-260. [PMID: 36965943 DOI: 10.1016/j.nic.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Traumatic brain injury (TBI) is a major cause of death and disability in children across the world. The aim of initial brain trauma management of pediatric patients is to diagnose the extent of TBI and to determine if immediate neurosurgical intervention is required. A noncontrast computed tomography is the recommended diagnostic imaging choice for all patients with acute moderate to severe TBI. This article outlines the current use of conventional MR imaging in the management of pediatric head trauma and discusses potential future recommendations.
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Affiliation(s)
- Helen M Branson
- Department of Diagnostic Imaging, SickKids, University of Toronto, 555 University Avenue, Toronto, Ontario M5G1X8, Canada.
| | - Claudia Martinez-Rios
- Department of Diagnostic Imaging, SickKids, University of Toronto, 555 University Avenue, Toronto, Ontario M5G1X8, Canada; Department of Medical Imaging, CHEO, University of Ottawa, 401 Smyth Road, Ottawa, Ontario K1H 8L1, Canada
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Tian X, Gao Z, Yin D, Hu Y, Fang B, Li C, Lou S, Rao Z, Shi R. 17beta-estradiol alleviates contusion-induced skeletal muscle injury by decreasing oxidative stress via SIRT1/PGC-1α/Nrf2 pathway. Steroids 2023; 191:109160. [PMID: 36574869 DOI: 10.1016/j.steroids.2022.109160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 11/28/2022] [Accepted: 12/18/2022] [Indexed: 12/25/2022]
Abstract
PURPOSE This study aimed to investigate the role of 17β-estradiol (E2) in the repair of contusion-induced myoinjury in mice and to identify the underlying molecular mechanisms. METHODS In vivo, contusion protocol was performed for preparing mice myoinjury model, and Injection (i.p.) of 17β-estradiol (E2) or estrogen receptor antagonist ICI 182,780, or ovariectomy (OVX), was used to alter estrogen level of animal models. In vitro, C2C12 myoblasts were treated with H2O2 (oxidative stress inducer), SIRT1 inhibitor EX527, or aromatase inhibitor anastrozole. Serum E2 level was assessed by enzyme-linked immunosorbent assay (ELISA). Muscle damage repair was evaluated by H&E staining and the activities of serum creatine kinase (CK) and lactate dehydrogenase (LDH). The oxidative stress was estimated by the levels of catalase (CAT), superoxide dismutase (SOD), and malondialdehyde (MDA). Western blot was performed to measure the protein expressions of SIRT1, PGC-1α, Nrf2, and HO-1. RESULTS We observed the elevated serum E2 levels and the upregulated oxidative stress in damaged muscle in female mice after contusion-induction. The E2 administration in vivo alleviated contusion-induced myoinjury in OVX mice by reducing CK and LDH activities, suppressing oxidative stress, and enhancing the expression levels of SIRT1, PGC-1α, Nrf2, and HO-1. These effects were inhibited by treatment with an ERα/β antagonist. Moreover, EX527 or anastrozole treatment exacerbated H2O2-induced growth inhibition and oxidative stress, and expression downregulation of SIRT1, PGC-1α, Nrf2, and HO-1 in C2C12 cells in vitro. CONCLUSION Our results suggest that E2 is a positive intervention factor for muscle repair followed contusion-induced myoinjury, through its effects on suppressing oxidative stress via activating the SIRT1/PGC-1α/Nrf2 pathway.
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Affiliation(s)
- Xu Tian
- School of Kinesiology, Shanghai University of Sport, 188 Hengren Road, Yangpu District, Shanghai, China
| | - Zelin Gao
- School of Kinesiology, Shanghai University of Sport, 188 Hengren Road, Yangpu District, Shanghai, China
| | - Danyang Yin
- School of Kinesiology, Shanghai University of Sport, 188 Hengren Road, Yangpu District, Shanghai, China
| | - Yi Hu
- School of Kinesiology, Shanghai University of Sport, 188 Hengren Road, Yangpu District, Shanghai, China
| | - Biqing Fang
- School of Kinesiology, Shanghai University of Sport, 188 Hengren Road, Yangpu District, Shanghai, China
| | - Cong Li
- School of Kinesiology, Shanghai University of Sport, 188 Hengren Road, Yangpu District, Shanghai, China
| | - Shujie Lou
- School of Kinesiology, Shanghai University of Sport, 188 Hengren Road, Yangpu District, Shanghai, China
| | - Zhijian Rao
- College of Physical Education, Shanghai Normal University, Shanghai, China
| | - Rengfei Shi
- School of Kinesiology, Shanghai University of Sport, 188 Hengren Road, Yangpu District, Shanghai, China.
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11
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Nair L, Winkle B, Senanayake E. Managing blunt cardiac injury. J Cardiothorac Surg 2023; 18:71. [PMID: 36765392 PMCID: PMC9912488 DOI: 10.1186/s13019-023-02146-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 01/09/2023] [Indexed: 02/12/2023] Open
Abstract
Blunt cardiac injury (BCI) encompasses a spectrum of pathologies ranging from clinically silent, transient arrhythmias to deadly cardiac wall rupture. Of diagnosed BCIs, cardiac contusion is most common. Suggestive symptoms may be unrelated to BCI, while some injuries may be clinically asymptomatic. Cardiac rupture is the most devastating complication of BCI. Most patients who sustain rupture of a heart chamber do not reach the emergency department alive. The incidence of BCI following blunt thoracic trauma remains variable and no gold standard exists to either diagnose cardiac injury or provide management. Diagnostic tests should be limited to identifying those patients who are at risk of developing cardiac complications as a result of cardiac in jury. Therapeutic interventions should be directed to treat the complications of cardiac injury. Prompt, appropriate and well-orchestrated surgical treatment is invaluable in the management of the unstable patients.
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Affiliation(s)
- Lawrence Nair
- Department of Cardiothoracic Surgery, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD, 4032, Australia.
| | - Brendan Winkle
- Department of Surgery, Royal Darwin Hospital, Darwin, NT, Australia
| | - Eshan Senanayake
- Department of Cardiothoracic Surgery, Queen Elizabeth Hospital, Birmingham, United Kingdom
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12
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Sydney-Smith JD, Koltchev AM, Moon LDF, Warren PM. Delayed viral vector mediated delivery of neurotrophin-3 improves skilled hindlimb function and stability after thoracic contusion. Exp Neurol 2023; 360:114278. [PMID: 36455639 DOI: 10.1016/j.expneurol.2022.114278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 11/07/2022] [Accepted: 11/19/2022] [Indexed: 11/30/2022]
Abstract
Intramuscular injection of an Adeno-associated viral vector serotype 1 (AAV1) encoding Neurotrophin-3 (NT3) into hindlimb muscles 24 h after a severe T9 spinal level contusion in rats has been shown to induce lumbar spinal neuroplasticity, partially restore locomotive function and reduce spasms during swimming. Here we investigate whether a targeted delivery of NT3 to lumbar and thoracic motor neurons 48 h following a severe contusive injury aids locomotive recovery in rats. AAV1-NT3 was injected bilaterally into the tibialis anterior, gastrocnemius and rectus abdominus muscles 48-h following trauma, persistently elevating serum levels of the neurotrophin. NT3 modestly improved trunk stability, accuracy of stepping during skilled locomotion, and alternation of the hindlimbs during swimming, but it had no effect on gross locomotor function in the open field. The number of vGlut1+ boutons, likely arising from proprioceptive afferents, on gastrocnemius α-motor neurons was increased after injury but normalised following NT3 treatment, suggestive of a mechanism in which functional benefits may be mediated through proprioceptive feedback. Ex vivo MRI revealed substantial loss of grey and white matter at the lesion epicentre but no effect of delayed NT3 treatment to induce neuroprotection. Lower body spasms and hyperreflexia of an intrinsic paw muscle were not reliably induced in this severe injury model suggesting a more complex anatomical or physiological cause to their induction. We have shown that delayed intramuscular AAV-NT3 treatment can promote recovery in skilled stepping and coordinated swimming, supporting a role for NT3 as a therapeutic strategy for spinal injuries potentially through modulation of somatosensory feedback.
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Affiliation(s)
- Jared D Sydney-Smith
- The Wolfson Centre for Age-Related Diseases, Guy's Campus, King's College London, London Bridge, London SE1 1UL, UK
| | - Alice M Koltchev
- The Wolfson Centre for Age-Related Diseases, Guy's Campus, King's College London, London Bridge, London SE1 1UL, UK
| | - Lawrence D F Moon
- The Wolfson Centre for Age-Related Diseases, Guy's Campus, King's College London, London Bridge, London SE1 1UL, UK
| | - Philippa M Warren
- The Wolfson Centre for Age-Related Diseases, Guy's Campus, King's College London, London Bridge, London SE1 1UL, UK.
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13
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Dubey A, Rupani R, Sharma V, Singh RK, Kumari S, Verma AK. Reflected near-infrared photography: Digging deeper into post-mortem examination. J Forensic Leg Med 2022; 90:102397. [PMID: 35841695 DOI: 10.1016/j.jflm.2022.102397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 06/27/2022] [Accepted: 07/06/2022] [Indexed: 11/27/2022]
Abstract
AIM This research aims to investigate the utility of the Near Infra-Red (NIR) photographic technique in visualizing forensic evidence in a post-mortem examination. MATERIAL AND METHODS A total of twenty-six deceased (male: n = 15; female: n = 11) were brought to the Mortuary of King George's Medical University, Chowk, Lucknow, Uttar Pradesh, India (226003), and were used to investigate the applicability of the human visible spectrum (HVS) & near-infrared photography. In the investigation, a modified Nikon D5300 crop-framed digital single-lens reflex camera was used for NIR Photography in combination with a Micro-Nikkor 105 mm, f/2.8, (Nikon Inc., Melville, NY, USA), Hoya R72 (760nm-860nm) infrared filter and a Nikon D5600 crop-framed digital single-lens reflex camera in combination with Nikkor 50mm lens for Human Visible Spectrum (HVS) Photography. RESULTS The finding of the study reported that the application of the NIR photography would be the best of the investigative techniques for visualization and photo-documentation of forensically relevant post-mortem findings, such as - trace evidences (e.g., blood spots & soil particles on dark clothing), in external findings (e.g., contusion on victim's body) also for internal findings in a road traffic accident (RTA), gunshot, and drowning victim (e.g., mud particles in the trachea of drowning victim & localizing contusion of the scalp in road traffic accident cases). CONCLUSION Human visible spectrum (HVS) photographs taken with Nikon D5600 provides substantial evidence for documentation purpose, the best results for trace evidence & contusion visualization in Post-mortem examination of the deceased were achieved with the NIR Photography in combination with indirect sunlight & room light as an infrared light source. (At a wavelength of 760nm-860nm).
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Affiliation(s)
- Anurag Dubey
- Forensic Medicine & Toxicology Department, KGMU, India.
| | - Raja Rupani
- Forensic Medicine & Toxicology Department, KGMU, India.
| | - Vishal Sharma
- Forensic Medicine & Toxicology Department, KGMU, India.
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14
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Abdolrahimzadeh Fard H, Mahmudi-Azer S, Abdulzahraa Yaqoob Q, Sabetian G, Iranpour P, Shayan Z, Bolandparvaz S, Abbasi HR, Aminnia S, Salimi M, Mahmoudi MM, Paydar S, Borazjani R, Taheri Akerdi A, Zare M, Shayan L, Sasani M. Comparison of chest CT scan findings between COVID-19 and pulmonary contusion in trauma patients based on RSNA criteria: Established novel criteria for trauma victims. Chin J Traumatol 2022; 25:170-176. [PMID: 35101294 PMCID: PMC8769602 DOI: 10.1016/j.cjtee.2022.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 11/26/2021] [Accepted: 12/15/2021] [Indexed: 02/04/2023] Open
Abstract
PROPOSE In this study, we re-assessed the criteria defined by the radiological society of North America (RSNA) to determine novel radiological findings helping the physicians differentiating COVID-19 from pulmonary contusion. METHODS All trauma patients with blunt chest wall trauma and subsequent pulmonary contusion, COVID-19-related signs and symptoms before the trauma were enrolled in this retrospective study from February to May 2020. Included patients (Group P) were then classified into two groups based on polymerase chain reaction tests (Group Pa for positive patients and Pb for negative ones). Moreover, 44 patients from the pre-pandemic period (Group PP) were enrolled. They were matched to Group P regarding age, sex, and trauma-related scores. Two radiologists blindly reviewed the CT images of all enrolled patients according to criteria defined by the RSNA criteria. The radiological findings were compared between Group P and Group PP; statistically significant ones were re-evaluated between Group Pa and Group Pb thereafter. Finally, the sensitivity and specificity of each significant findings were calculated. The Chi-square test was used to compare the radiological findings between Group P and Group PP. RESULTS In the Group PP, 73.7% of all ground-glass opacities (GGOs) and 80% of all multiple bilateral GGOs were detected (p < 0.001 and p = 0.25, respectively). Single bilateral GGOs were only seen among the Group PP. The Chi-square tests showed that the prevalence of diffused GGOs, multiple unilateral GGOs, multiple consolidations, and multiple bilateral consolidations were significantly higher in the Group P (p = 0.001, 0.01, 0.003, and 0.003, respectively). However, GGOs with irregular borders and single consolidations were more significant among the Group PP (p = 0.01 and 0.003, respectively). Of note, reticular distortions and subpleural spares were exclusively detected in the Group PP. CONCLUSION We concluded that the criteria set by RSNA for the diagnosis of COVID-19 are not appropriate in trauma patients. The clinical signs and symptoms are not always useful either. The presence of multiple unilateral GGOs, diffused GGOs, and multiple bilateral consolidations favor COVID-19 with 88%, 97.62%, and 77.7% diagnostic accuracy.
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Affiliation(s)
- Hossein Abdolrahimzadeh Fard
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Salahaddin Mahmudi-Azer
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Golnar Sabetian
- Department of Intensive Care Medicine, Trauma Research Center, Shahid Rajaee (Emtiaz) Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Pooya Iranpour
- Department of Radiology, Medical Imaging Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Shayan
- Department of Biostatistics, Trauma Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shahram Bolandparvaz
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamid Reza Abbasi
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shiva Aminnia
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Salimi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Mehdi Mahmoudi
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shahram Paydar
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Roham Borazjani
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Taheri Akerdi
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Masome Zare
- Trauma Intensive Care Unit, Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Leila Shayan
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammadreza Sasani
- Department of Radiology, Medical Imaging Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran,Corresponding author.
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15
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Hashemizadeh S, Pourkhodadad S, Hosseindoost S, Pejman S, Kamarehei M, Badripour A, Omidi A, Pestehei SK, Seifalian AM, Hadjighassem M. Ac-SDKP peptide improves functional recovery following spinal cord injury in a preclinical model. Neuropeptides 2022; 92:102228. [PMID: 35101843 DOI: 10.1016/j.npep.2022.102228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 12/16/2021] [Accepted: 01/11/2022] [Indexed: 02/08/2023]
Abstract
Damage to the spinal cord triggers a local complex inflammatory reaction that results in irreversible impairments or complete loss of motor function. The evidence suggested that inhibiting the pro-inflammatory macrophage/microglia (M1 subsets) and stimulating the anti-inflammatory macrophage/microglia (M2 subsets) are potential strategies for the treatment of neuroinflammation-related diseases. We evaluated the potentially protective effect of Ac-SDKP as an endogenous tetrapeptide on rat spinal cord injury (SCI). Wistar rats were subjected to a weight-drop contusion model and were treated with Ac-SDKP (0.8 mg/kg) given subcutaneously once a day for 7 days starting at two clinically relevant times, at 2 h or 6 h post-injury. The effect of Ac-SDKP was assessed by motor functional analysis, real-time PCR (CD86 and CD206 mRNA), western blot (caspase-3), ELISA (TNF-a, IL-10), and histological analysis (toluidine blue staining). Ac-SDKP improved locomotor recovery and rescue motor neuron loss after SCI. Moreover, a decreased in TNF-a level as well as caspase 3 protein levels occurred in the lesion epicenter of the spinal cord following treatment. In addition, CD206 mRNA expression level increased significantly in Ac-SDKP treated rats compared with SCI. Together these data suggest that Ac-SDKP might be a novel immunomodulatory drug. It may be beneficial for the treatment of SCI with regards to increasing CD206 gene expression and suppress inflammatory cytokine to improve motor function and reducing histopathological lesion.
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Affiliation(s)
- Shiva Hashemizadeh
- Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Saereh Hosseindoost
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sina Pejman
- Institute of Biochemistry and Biophysics, University of Tehran, Tehran, Iran
| | - Maryam Kamarehei
- Institute of Biochemistry and Biophysics, University of Tehran, Tehran, Iran
| | - Abolfazl Badripour
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.; Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ameneh Omidi
- Department of Anatomical Sciences, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Seyed Khalil Pestehei
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.; Department of Anesthesiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Alexander M Seifalian
- Nanotechnology & Regenerative Medicine Commercialisation Centre (NanoRegMed Ltd), London BioScience Innovation Centre, London, United Kingdom
| | - Mahmoudreza Hadjighassem
- Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran.; Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran..
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16
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Shih YJ, Liu YL, Zhou JT, Zhang Y, Chen JH, Chen TY, Yang CC, Su MY. Usage of image registration and three-dimensional visualization tools on serial computed tomography for the analysis of patients with traumatic intraparenchymal hemorrhages. J Clin Neurosci 2022; 98:154-161. [PMID: 35180506 DOI: 10.1016/j.jocn.2022.01.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 12/17/2021] [Accepted: 01/24/2022] [Indexed: 11/30/2022]
Abstract
The aim of this study was to apply registration and three-dimensional (3D) display tools to assess the evolution of intraparenchymal hemorrhage (IPH) in patients with traumatic brain injury (TBI). We identified 109 TBI patients who had two computed tomography (CT) scans within 4 days retrospectively. The IPH was manually outlined. The registration was performed in 39 lesions from 29 patients with lesion volume < 1.5 cm on both baseline and follow-up CT. The center of mass (COM) of each lesion was calculated, and the distance between baseline and follow-up CT was used to evaluate the registration effect. The mean distances of COM before registration in the XYZ, XY, and YZ coordinates were 20.5 ± 10.2 mm, 17.8 ± 9.4 mm, and 15.9 ± 9.4 mm, respectively, which decreased significantly (p < 0.001) to 7.9 ± 4.9, 7.8 ± 5.0, and 6.1 ± 4.1 mm after registration. A 3D short video displaying the rendering view of all lesions in 34 randomly selected patients from baseline and follow-up scans were presented side-by-side for comparison. The detection rate of new IPH lesions increased in 3D videos (100%) as compared with axial CT slices (78.6-92.9%). A very high interrater agreement (k = 0.856) on perceiving IPH lesion progression upon viewing 3D video was noted, and the absolute volume increase was significantly higher (p < 0.001) for progressive lesions (median 7.36 cc) over non-progressive lesions (median 0.01 cc). Compared to patients with spontaneous hemorrhagic stroke, evaluation of multiple small traumatic hemorrhages in TBI is more challenging. The applied image analysis and visualization methods may provide helpful tools for comparing changes between serial CT scans.
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Affiliation(s)
- Yun-Ju Shih
- Department of Medical Imaging, Chi Mei Medical Center, Tainan, Taiwan
| | - Yan-Lin Liu
- Department of Radiological Sciences, University of California, Irvine, CA, USA
| | - Jonathan T Zhou
- Department of Radiological Sciences, University of California, Irvine, CA, USA
| | - Yang Zhang
- Department of Radiological Sciences, University of California, Irvine, CA, USA; Department of Radiation Oncology, Rutgers-Cancer Institute of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Jeon-Hor Chen
- Department of Radiological Sciences, University of California, Irvine, CA, USA; Department of Radiology, E-Da Hospital/ I-Shou University, Kaohsiung, Taiwan.
| | - Tai-Yuan Chen
- Department of Medical Imaging, Chi Mei Medical Center, Tainan, Taiwan; Graduate Institute of Medical Sciences, Chang Jung Christian University, Tainan, Taiwan
| | - Cheng-Chun Yang
- Department of Medical Imaging, Chi Mei Medical Center, Tainan, Taiwan
| | - Min-Ying Su
- Department of Radiological Sciences, University of California, Irvine, CA, USA; Department of Medical Imaging and Radiological Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
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17
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Abstract
Death of central nervous system neurons is a critical feature of spinal cord injury (SCI). The Infinite Horizon spinal cord impactor can be used to create both contusion and compression SCI, with a high degree of reproducibility. The device can also be positioned at different locations along the spinal cord to evaluate how the location of injury may alter neuronal death and functional recovery. A mouse with a successful SCI can experience a period of loss of bladder function, weight loss, and paralysis of the hind limbs, with more severe injuries resulting in further deficits. This chapter describes the surgical protocol along with pre- and postoperative care, as well as mitigation strategies for any setbacks that might occur.
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Affiliation(s)
- Courtney A Bannerman
- Department of Biomedical & Molecular Sciences, Queen's University, Kingston, ON, Canada
| | - Nader Ghasemlou
- Department of Biomedical & Molecular Sciences, Queen's University, Kingston, ON, Canada.
- Department of Anesthesiology & Perioperative Medicine, Queen's University, Kingston, ON, Canada.
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada.
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18
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Abdanipour A, Nikfar A, Nikbakht Rad M, Jafari Anarkooli I, Mansouri M. Neuroprotective effect of L-deprenyl on the expression level of the Mst1 gene and inhibition of apoptosis in rat-model spinal cord injury. Iran J Basic Med Sci 2022; 25:53-59. [PMID: 35656451 PMCID: PMC9118276 DOI: 10.22038/ijbms.2022.58031.12894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 12/26/2021] [Indexed: 11/06/2022]
Abstract
Objectives After primary tissue damage as a result of spinal cord injury (SCI), there is a period of secondary damage, which includes several cellular and inflammatory biochemical cascades. As a novel pro-apoptotic kinase, Mst1 (serine/threonine kinase 4) promotes programmed cell death in an inflammatory disease model. This study aimed to evaluate Mst1 gene expression levels in rats with spinal cord injury treated with L- deprenyl. Materials and Methods The rats were divided into control (contusion), laminectomy, sham-operated (contused rats received 1 ml normal saline intraperitoneal), and treatment (contused rats received 5 mg/kg of L-deprenyl intraperitoneal; once a day for 7 days). The BBB (Basso, Beattie, and Bresnahan) scales were performed to assess motor function following SCI. Rats were sacrificed 28 days after SCI and the spinal cord lesion area was removed. Apoptosis and cavity formation in the spinal cord were determined by H&E staining and TUNEL assay, respectively. The mRNA levels of the Mst1, Nrf2, Bcl-2, and PGC1 α genes were analyzed using real-time quantitative PCR. Results The results showed significant improvement in motor function in the L- deprenyl group compared with the untreated group. Histological analysis showed a significant reduction in the number of tunnel-positive cells after injection of L-deprenyl, as well as a decrease in the volume of the cavity. In addition, L-deprenyl treatment increased the expression of the Nrf2, Bcl-2, and PGC1 α genes, while reducing the expression of the Mst1 gene in the spinal nerves. Conclusion These results suggest that L-deprenyl is a promising treatment for spinal cord injury.
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Affiliation(s)
- Alireza Abdanipour
- Department of Anatomy, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran,Corresponding author: Alireza Abdanipour. Department of Anatomy, School of Medicine, Zanjan University of Medical Sciences (ZUMS), Zanjan, Iran. Tel: +98-2433018632; Fax: +98-24-33449553. ;
| | - Ali Nikfar
- Department of Genetics and Molecular Medicine, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Mahsa Nikbakht Rad
- Department of Anatomy, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Iraj Jafari Anarkooli
- Department of Anatomy, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Mojdeh Mansouri
- Department of Genetics and Molecular Medicine, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
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19
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Tanji C, Hashimoto M, Furuya T, Saito J, Miyamoto T, Koda M. Sigma 1 receptor agonist cutamesine promotes plasticity of serotonergic boutons in lumbar enlargement in spinal cord injured rats. Neurosci Lett 2021; 759:135971. [PMID: 34023415 DOI: 10.1016/j.neulet.2021.135971] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 03/11/2021] [Accepted: 05/17/2021] [Indexed: 11/30/2022]
Abstract
Cutamesine, a sigma-1 receptor agonist, functions in both neuroprotection and neurite outgrowth. We assessed the therapeutic effects of cutamesine in a rodent spinal cord injury (SCI) model to demonstrate pre-clinical proof-of-concept. First of all, in order to determine optimal cutamesine dose, cutamesine was administered to normal rats and BDNF protein levels in the lumbar spinal cord were assessed by Western blot. Next, for the SCI model, spinal cords of adult female Sprague-Dawley rats were contused using an Infinite Horizon Impactor. Two weeks post-injury, rats were randomly assigned to receive daily subcutaneous injections of either cutamesine (3.0 mg/kg/day) or saline (as a control) for another two weeks. Immunohistochemistry for BDNF and 5-HT was assessed at four and twelve weeks post-injury in the lumbar spinal cord. Locomotor function was assessed weekly using the BBB locomotor scale until twelve weeks after SCI and CatWalk XT 10.5 gait analysis was conducted at twelve weeks after SCI. In normal rats, cutamesine treatment (3.0 mg/kg/day) significantly up-regulated BDNF expression in the lumbar spinal cord. In SCI rats, cutamesine treatment (3.0 mg/kg/day) significantly increased the fluorescence intensity of neuronal BDNF and serotonin boutons in the injured spinal cord compared to saline. However, cutamesine treatment did not promote significant locomotor recovery. Recent work indicates that cutamesine treatment alone did not promote locomotor recovery in spite of immunohistological changes. Future work will explore the influence of combining cutamesine with other treatment promoting plasticity (e.g. rehabilitative training) in SCI rats.
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Affiliation(s)
- Chihiro Tanji
- Department of Rehabilitation Therapy, Chiba Rehabilitation Center, Chiba, Japan
| | | | - Takeo Furuya
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | | | - Takuya Miyamoto
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Masao Koda
- Department of Orthopedic Surgery, University of Tsukuba, Ibaraki, Japan.
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20
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Mardi A, Biglar A, Nejatbakhsh R, Abdanipour A. Valproic Acid Ameliorates Locomotor Function in the Rat Model of Contusion via Alteration of Mst1, Bcl-2, and Nrf2 Gene Expression. Iran Biomed J 2021; 25:303-7. [PMID: 34217161 DOI: 10.52547/ibj.25.4.303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: In animal models of inflammatory diseases, Mst1 facilitates the programmed cell death as a novel pro-apoptotic kinase. This research aimed to determine the expression level of Mst1 gene in a rat model of SCI treated with VPA. Methods: Severe rat model contusion was used for evaluation of the neuroprotective effect of valproic acid. The BBB test, was performed to determine locomotor functions. H&E staining and TUNEL assay were performed to detect cavity formation and apoptosis, respectively. The mRNA levels of the genes Mst1, Nrf2, and Bcl-2 were evaluated, using quantitative RT-PCR. Results: The results revealed that Mst1 gene expression and TUNEL-positive cells in the VPA-treated group were significantly reduced as compared to the untreated group (p ≤ 0.05). Conclusion: Our findings indicate that VPA has therapeutic potential and can be a candidate for the treatment of neurodegenerative disorders and traumatic injury as a promising drug.
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21
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Brown EV, Falnikar A, Heinsinger N, Cheng L, Andrews CE, DeMarco M, Lepore AC. Cervical spinal cord injury-induced neuropathic pain in male mice is associated with a persistent pro-inflammatory macrophage/microglial response in the superficial dorsal horn. Exp Neurol 2021; 343:113757. [PMID: 33991526 DOI: 10.1016/j.expneurol.2021.113757] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 05/03/2021] [Accepted: 05/10/2021] [Indexed: 01/31/2023]
Abstract
A significant portion of individuals living with traumatic spinal cord injury (SCI) experiences some degree of debilitating neuropathic pain (NP). This pain remains largely intractable in a majority of cases, due in part to an incomplete understanding of its underlying mechanisms. Central sensitization, an increase in excitability of pain transmission neurons located in superficial dorsal horn (sDH), plays a key role in development and maintenance of SCI-induced NP. Resident microglia and peripheral monocyte-derived macrophages (referred to collectively as MMΦ) are involved in promoting SCI-induced DH neuron hyperexcitability. Importantly, these MMΦ consist of populations of cells that can exert pro-inflammatory or anti-inflammatory signaling within injured spinal cord. It is critical to spatiotemporally characterize this heterogeneity to understand MMΦ contribution to NP after SCI. Given that a majority of SCI cases are cervical in nature, we used a model of unilateral C5/C6 contusion that results in persistent at-level thermal hyperalgesia and mechanical allodynia, two forms of NP-related behavior, in the forepaw. The aim of this study was to characterize the sDH MMΦ response within intact cervical spinal cord segments caudal to the lesion (i.e. the location of primary afferent nociceptive input from the forepaw plantar surface). Cervical SCI promoted a persistent MMΦ response in sDH that coincided with the chronic NP phenotype. Using markers of pro- and anti-inflammatory MMΦ, we found that the MMΦ population within sDH exhibited significant heterogeneity that evolved over time post-injury, including a robust and persistent increase in pro-inflammatory MMΦ that was especially pronounced at later times. C5/C6 contusion SCI also induced below-level thermal hyperalgesia and mechanical allodynia in the hindpaw; however, we did not observe a pronounced MMΦ response in sDH of L4/L5 spinal cord, suggesting that different inflammatory cell mechanisms occurring in sDH may be involved in at-level versus below-level NP following SCI. In conclusion, our findings reveal significant MMΦ heterogeneity both within and across pain transmission locations after SCI. These data also show a prominent and persistent pro-inflammatory MMΦ response, suggesting a possible role in DH neuron hyperexcitability and NP.
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Affiliation(s)
- Eric V Brown
- Department of Neuroscience, Vickie and Jack Farber Institute for Neuroscience, Sidney Kimmel Medical College at Thomas Jefferson University, 233 South 10th Street, BLSB 245, Philadelphia, PA 19107, United States
| | - Aditi Falnikar
- Department of Neuroscience, Vickie and Jack Farber Institute for Neuroscience, Sidney Kimmel Medical College at Thomas Jefferson University, 233 South 10th Street, BLSB 245, Philadelphia, PA 19107, United States
| | - Nicolette Heinsinger
- Department of Neuroscience, Vickie and Jack Farber Institute for Neuroscience, Sidney Kimmel Medical College at Thomas Jefferson University, 233 South 10th Street, BLSB 245, Philadelphia, PA 19107, United States
| | - Lan Cheng
- Department of Neuroscience, Vickie and Jack Farber Institute for Neuroscience, Sidney Kimmel Medical College at Thomas Jefferson University, 233 South 10th Street, BLSB 245, Philadelphia, PA 19107, United States
| | - Carrie E Andrews
- Department of Neuroscience, Vickie and Jack Farber Institute for Neuroscience, Sidney Kimmel Medical College at Thomas Jefferson University, 233 South 10th Street, BLSB 245, Philadelphia, PA 19107, United States
| | - Michael DeMarco
- Department of Neuroscience, Vickie and Jack Farber Institute for Neuroscience, Sidney Kimmel Medical College at Thomas Jefferson University, 233 South 10th Street, BLSB 245, Philadelphia, PA 19107, United States
| | - Angelo C Lepore
- Department of Neuroscience, Vickie and Jack Farber Institute for Neuroscience, Sidney Kimmel Medical College at Thomas Jefferson University, 233 South 10th Street, BLSB 245, Philadelphia, PA 19107, United States.
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22
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Abstract
Secondary injuries remain an important cause of the morbidity and mortality associated with traumatic brain injury (TBI). Progression of cerebral contusions occurs in up to 75% of patients with TBI, and this contributes to subsequent clinical deterioration and requirement for surgical intervention. Despite this, the role of early clinical and radiological factors in predicting contusion progression remains relatively poorly defined due to studies investigating progression of all types of hemorrhagic injuries as a combined cohort. In this review, we summarize data from recent studies on factors which predict contusion progression, and the effect of contusion progression on clinical outcomes.
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Affiliation(s)
- Krishma Adatia
- Division of Anaesthesia, University of Cambridge, Cambridge, UK.
| | | | - David K Menon
- Division of Anaesthesia, University of Cambridge, Cambridge, UK
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Martins L, Gallo CC, Honda TSB, Alves PT, Stilhano RS, Rosa DS, Koh TJ, Han SW. Skeletal muscle healing by M1-like macrophages produced by transient expression of exogenous GM-CSF. Stem Cell Res Ther 2020; 11:473. [PMID: 33158459 DOI: 10.1186/s13287-020-01992-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/22/2020] [Indexed: 12/23/2022] Open
Abstract
Background After traumatic skeletal muscle injury, muscle healing is often incomplete and produces extensive fibrosis. The sequence of M1 and M2 macrophage accumulation and the duration of each subtype in the injured area may help to direct the relative extent of fibrogenesis and myogenesis during healing. We hypothesized that increasing the number of M1 macrophages early after traumatic muscle injury would produce more cellular and molecular substrates for myogenesis and fewer substrates for fibrosis, leading to better muscle healing. Methods To test this hypothesis, we transfected skeletal muscle with a plasmid vector to transiently express GM-CSF shortly after injury to drive the polarization of macrophages towards the M1 subset. C57BL/6 mouse tibialis anterior (TA) muscles were injured by contusion and electroporated with uP-mGM, which is a plasmid vector that transiently expresses GM-CSF. Myogenesis, angiogenesis, and fibrosis were evaluated by histology, immunohistochemistry, and RT-qPCR; subpopulations of macrophages by flow cytometry; and muscle functioning by the maximum running speed on the treadmill and the recovery of muscle mass. Results Muscle injury increased the number of local M1-like macrophages and decreased the number of M2-like macrophages on day 4, and uP-mGM treatment enhanced this variation. uP-mGM treatment decreased TGF-β1 protein expression on day 4, and the Sirius Red-positive area decreased from 35.93 ± 15.45% (no treatment) to 2.9% ± 6.5% (p < 0.01) on day 30. uP-mGM electroporation also increased Hgf, Hif1α, and Mtor gene expression; arteriole density; and muscle fiber number during regeneration. The improvement in the quality of the muscle tissue after treatment with uP-mGM affected the increase in the TA muscle mass and the maximum running speed on a treadmill. Conclusion Collectively, our data show that increasing the number of M1-like macrophages immediately after traumatic muscle injury promotes muscle recovery with less fibrosis, and this can be achieved by the transient expression of GM-CSF.
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Orem BC, Rajaee A, Stirling DP. IP 3R-mediated intra-axonal Ca 2+ release contributes to secondary axonal degeneration following contusive spinal cord injury. Neurobiol Dis 2020; 146:105123. [PMID: 33011333 DOI: 10.1016/j.nbd.2020.105123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/15/2020] [Accepted: 09/28/2020] [Indexed: 01/11/2023] Open
Abstract
Secondary axonal loss contributes to the persistent functional disability following trauma. Consequently, preserving axons following spinal cord injury (SCI) is a major therapeutic goal to improve neurological outcome; however, the complex molecular mechanisms that mediate secondary axonal degeneration remain unclear. We previously showed that IP3R-mediated Ca2+ release contributes to axonal dieback and axonal loss following an ex vivo laser-induced SCI. Nevertheless, targeting IP3R in a clinically relevant in vivo model of SCI and determining its contribution to secondary axonal degeneration has yet to be explored. Here we used intravital two-photon excitation microscopy to assess the role of IP3R in secondary axonal degeneration in real-time after a contusive-SCI in vivo. To visualize Ca2+ changes specifically in spinal axons over time, adult 6-8 week-old triple transgenic Avil-Cre:Ai9:Ai95 (sensory neuron-specific expression of tdTomato and the genetic calcium indicator GCaMP6f) mice were subjected to a mild (30 kdyn) T12 contusive-SCI and received delayed treatment with the IP3R blocker 2-APB (100 μM, intrathecal delivery at 3, and 24 h following injury) or vehicle control. To determine the IP3R subtype involved, we knocked-down IP3R3 using capped phosphodiester oligonucleotides. Delayed treatment with 2-APB significantly reduced axonal spheroids, increased axonal survival, and reduced intra-axonal Ca2+ accumulation within dorsal column axons at 24 h following SCI in vivo. Additionally, knockdown of IP3R3 yielded increased axon survival 24 h post-SCI. These results suggest that IP3R-mediated Ca2+ release contributes to secondary axonal degeneration in vivo following SCI.
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Affiliation(s)
- Ben C Orem
- Kentucky Spinal Cord Injury Research Center, University of Louisville, School of Medicine, Louisville, KY 40202, USA; Anatomical Sciences and Neurobiology, University of Louisville, School of Medicine, Louisville, KY 40202, USA
| | - Arezoo Rajaee
- Kentucky Spinal Cord Injury Research Center, University of Louisville, School of Medicine, Louisville, KY 40202, USA; Departments of Neurological Surgery, University of Louisville, School of Medicine, Louisville, KY 40202, USA
| | - David P Stirling
- Kentucky Spinal Cord Injury Research Center, University of Louisville, School of Medicine, Louisville, KY 40202, USA; Departments of Neurological Surgery, University of Louisville, School of Medicine, Louisville, KY 40202, USA; Anatomical Sciences and Neurobiology, University of Louisville, School of Medicine, Louisville, KY 40202, USA; Microbiology and Immunology, University of Louisville, School of Medicine, Louisville, KY 40202, USA.
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25
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Ma JJ, Zhang B. Diagnosis of an actively bleeding brachial artery hematoma by contrast-enhanced ultrasound: A case report. World J Clin Cases 2020; 8:3835-3840. [PMID: 32953861 PMCID: PMC7479570 DOI: 10.12998/wjcc.v8.i17.3835] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 07/16/2020] [Accepted: 07/30/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Active bleeding due to arterial injury following the acupuncture can sometimes represent a life-threatening complication. Only few reports of an actively bleeding hematoma diagnosed by contrast-enhanced ultrasound, which enables the depiction of vascular, have been reported.
CASE SUMMARY Here, we report the case of a 75-year-old woman, who presented with sudden swelling, ecchymosis, and pain in the upper left limb. She underwent an acupuncture treatment of traditional Chinese medicine followed by a deep shoulder massage 2 d before admission to hospital. A few hours after the massage, her left upper arm was red, swollen and progressively aggravated. Ultrasonography showed a large hematoma (11.2 cm × 3.5 cm × 3.4 cm) beside the left brachial artery. Color Doppler ultrasound revealed that blood flow signals of the arteries branched into the hematoma. The contrast-enhanced ultrasound showed microbubbles from the brachial artery passing into the hematoma, diffused within the hematoma with the local surge of red blood cells, and disappearing after approximately 17 s. The microbubbles were likely due to bleeding from the arteries. After pressure bandaging treatment, the hematoma became smaller (3.1 cm × 1.7 cm) and organized according to ultrasonography performed 20 d later.
CONCLUSION This case highlights the ultimate importance of contrast-enhanced ultrasound for the diagnosis of an actively bleeding hematoma.
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Affiliation(s)
- Jiao-Jiao Ma
- Department of Ultrasound, China-Japan Friendship Hospital, Beijing 100029, China
| | - Bo Zhang
- Department of Ultrasound, China-Japan Friendship Hospital, Beijing 100029, China
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26
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Mushlin HM, Lessing N, Wessell AP, Chryssikos T, Pratt N, Caffes N, Oliver J, Aarabi B, Schwartzbauer G. The Effect of Elevated Mean Arterial Blood Pressure in Cervical Traumatic Spinal Cord Injury with Hemorrhagic Contusion. World Neurosurg 2020; 144:e405-e413. [PMID: 32889182 DOI: 10.1016/j.wneu.2020.08.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 08/23/2020] [Accepted: 08/23/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Hemorrhagic contusion in cervical spinal cord injury (CSCI) is poorly understood. We investigated hemorrhagic expansion in patients with CSCI with an assigned elevated mean arterial pressure (MAP) goal of >85 mm Hg. The change in hemorrhagic area and long-term follow-up data ≥6 months after injury was studied. METHODS A retrospective review was performed from 2005 to 2016 to identify patients with motor complete CSCI with 2 cervical magnetic resonance imaging (MRI) scans within 7 days of injury showing evidence of hemorrhagic contusion and assigned a MAP goal of >85 mm Hg for 7 days. T2-weighted MRI was used to calculate the hemorrhagic surface area in the sagittal plane. A calculated MAP was recorded for each blood pressure measure between the initial and follow-up MRI scans. The American Spinal Injury Association impairment scale (AIS) and American Spinal Injury Association motor scores were recorded at the final follow-up examination at ≥6 months. RESULTS A total of 193 patients were identified. The mean change in the hemorrhagic area was 24.0 mm2. Of the 193 patients, the AIS grade was A for 114 and B for 79 patients. Multiple logistic regression analysis demonstrated that the MAP and systolic blood pressure were nonsignificant predictors of hemorrhagic contusion expansion. An increased hemorrhagic contusion area on the follow-up MRI scan was associated with a reduced odds of AIS improvement of ≥1 and ≥2 points (odds ratio, 0.97; 95% confidence interval, 0.87-0.97; P = 0.028; and odds ratio, 0.92; 95% confidence interval, 0.99-1.13; P = 0.008, respectively) at the final ≥6-month follow-up examination. CONCLUSION The present study investigated the clinical safety of elevated MAP goals for patients with CSCI and hemorrhagic contusion. Elevated MAPs did not significantly increase the risk of hemorrhagic expansion in those with CSCI. We have also reported the use of hemorrhagic contusion size as a potential radiographic biomarker for neurological outcomes.
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Affiliation(s)
- Harry M Mushlin
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland, USA.
| | - Noah Lessing
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Aaron P Wessell
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Timothy Chryssikos
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Nathan Pratt
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Nicholas Caffes
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jeffrey Oliver
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Bizhan Aarabi
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland, USA; Program in Trauma, R. Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Gary Schwartzbauer
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland, USA; Program in Trauma, R. Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, Maryland, USA
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27
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Diamond BR, Donald CLM, Frau-Pascual A, Snider SB, Fischl B, Dams-O'Connor K, Edlow BL. Optimizing the accuracy of cortical volumetric analysis in traumatic brain injury. MethodsX 2020; 7:100994. [PMID: 32760659 PMCID: PMC7393399 DOI: 10.1016/j.mex.2020.100994] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 07/08/2020] [Indexed: 01/21/2023] Open
Abstract
Cortical volumetric analysis is widely used to study the anatomic basis of neurological deficits in patients with traumatic brain injury (TBI). However, patients with TBI-related lesions are often excluded from MRI analyses because cortical lesions may compromise the accuracy of reconstructed surfaces upon which volumetric measurements are based. We developed a FreeSurfer-based lesion correction method and tested its impact on cortical volume measures in 87 patients with chronic moderate-to-severe TBI. We reconstructed cortical surfaces from T1-weighted MRI scans, then manually labeled and removed vertices on the cortical surfaces where lesions caused inaccuracies. Next, we measured the surface area of lesion overlap with seven canonical brain networks and the percent volume of each network affected by lesions.The lesion correction method revealed that cortical lesions in patients with TBI are preferentially located in the limbic and default mode networks (95.7% each), with the limbic network also having the largest average surface area (4.4+/−3.7%) and percent volume affected by lesions (12.7+/−9.7%). The method has the potential to improve the accuracy of cortical volumetric measurements and permit inclusion of patients with lesioned brains in MRI analyses. The method also provides new opportunities to elucidate network-based mechanisms of neurological deficits in patients with TBI.
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Affiliation(s)
- Bram R Diamond
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA.,Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA
| | | | - Aina Frau-Pascual
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA.,Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA
| | - Samuel B Snider
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Bruce Fischl
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA.,Harvard-MIT Health Sciences and Technology, Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, MA
| | - Kristen Dams-O'Connor
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY.,Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Brian L Edlow
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA.,Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA
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28
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Reinhardt DR, Stehlik KE, Satkunendrarajah K, Kroner A. Bilateral cervical contusion spinal cord injury: A mouse model to evaluate sensorimotor function. Exp Neurol 2020; 331:113381. [PMID: 32561411 DOI: 10.1016/j.expneurol.2020.113381] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/05/2020] [Accepted: 06/14/2020] [Indexed: 01/07/2023]
Abstract
Spinal cord injury is a severe condition, resulting in specific neurological symptoms depending on the level of damage. Approximately 60% of spinal cord injuries affect the cervical spinal cord, resulting in complete or incomplete tetraplegia and higher mortality rates than injuries of the thoracic or lumbar region. Although cervical spinal cord injuries frequently occur in humans, there are few clinically relevant models of cervical spinal cord injury. Animal models are critical for examining the cellular and molecular manifestations of human cervical spinal cord injury, which is not feasible in the clinical setting, and to develop therapeutic strategies. There is a limited number of studies using cervical, bilateral contusion SCI and providing a behavioral assessment of motor and sensory functions, which is partly due to the high mortality rate and severe impairment observed in severe cervical SCI models. The goal of this study was to develop a mouse model of cervical contusion injury with moderate severity, resulting in an apparent deficit in front and hindlimb function but still allowing for self-care of the animals. In particular, we aimed to characterize a mouse cervical injury model to be able to use genetic models and a wide range of viral techniques to carry out highly mechanistic studies into the cellular and molecular mechanisms of cervical spinal cord injury. After inducing a bilateral, cervical contusion injury at level C5, we followed the recovery of injured and sham-uninjured animals for eight weeks post-surgery. Hindlimb and forelimb motor functions were significantly impaired immediately after injury, and all mice demonstrated partial improvement over time that remained well below that of uninjured control mice. Mice also displayed a significant loss in their sensory function throughout the testing period. This loss of sensory and motor function manifested as a reduced ability to perform skilled motor tasks in all of the injured mice. Here, we describe a new mouse model of moderate bilateral cervical spinal cord injury that does not lead to mortality and provides a comprehensive assessment of histological and behavioral assessments. This model will be useful in enhancing our mechanistic understanding of cervical spinal cord injury and in the development of treatments targeted at promoting neuroprotection, neuroplasticity, and functional recovery after cervical SCI.
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Affiliation(s)
- Daniel R Reinhardt
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA; Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI, USA
| | - Kyle E Stehlik
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA; Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI, USA
| | - Kajana Satkunendrarajah
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA; Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI, USA; Department of Physiology, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Antje Kroner
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA; Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI, USA; Department of Microbiology and Immunology, Medical College of Wisconsin, Milwaukee, WI, USA.
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29
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Keskin Y, Bedel C, Gökben Beceren N. Investigation of histopathological and radiological effects of surfactant treatment in an experimental female rat model of lung contusion. Iran J Basic Med Sci 2020; 22:1153-1157. [PMID: 31998456 PMCID: PMC6885389 DOI: 10.22038/ijbms.2019.32357.8258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objective(s): Pulmonary contusion (PC) is a clinical entity that often accompanies blunt traumas. We aimed to investigate the radiological and histopathological effects of surfactant treatment in an experimental rat model in which lung contusion was formed by blunt thoracic trauma. Materials and Methods: 50 female Sprague-Dawley rats were used. Five groups were formed randomly. In groups 2, 4, and 5 lung contusion was made by the drop-weight method after anesthesia. Intratracheal surfactant was administered in the 4th hr in groups 3 and 4 and in the 24th hr in groups 4 and 5. All rats were sacrificed and their lungs removed at 48 hr after contusion. Alveolar edema, congestion, hemorrhage, destruction, leukocyte infiltration, immune staining were examined histopathologically. Results: When the first thoracic CT scans were evaluated, we observed two rats with rib fractures and four rats with pneumothorax. 4 and 48 hr thoracic CT evaluation contusion and atelectasis showed no statistically significant decrease (P>0.05). After sacrifice of group 2, in macroscopic evaluation, there was a heterogeneous contusion and hemorrhagic appearance in the lungs of rats and less hemorrhagic appearance was observed in Groups 4 and 5 than in Group 2. In comparison of Immunohistopathological findings, surfactant treatment showed a statistically significant decrease in leukocyte infiltration scores (P=0.046). Immunohistopathologically, surfactant group had more staining but only statistically significant when compared to groups 4 and sham. (P=0.036). Conclusion: Surfactant treatment may be of significant benefit in lung contusion secondary to blunt chest trauma, and further prospective evidence of its efficacy in such disorders is needed.
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Affiliation(s)
- Yasin Keskin
- Beyhekim State Hospital, Department of Emergency Medicine, Konya, Turkey
| | - Cihan Bedel
- Health Science University Antalya Training and Research Hospital, Department of Emergency Medicine, Antalya, Turkey
| | - Nesrin Gökben Beceren
- Süleyman Demirel University Faculty of Medicine, Department of Emergency Medicine, Isparta, Turkey
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30
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Ghosh B, Nong J, Wang Z, Urban MW, Heinsinger NM, Trovillion VA, Wright MC, Lepore AC, Zhong Y. A hydrogel engineered to deliver minocycline locally to the injured cervical spinal cord protects respiratory neural circuitry and preserves diaphragm function. Neurobiol Dis 2019; 127:591-604. [PMID: 31028873 DOI: 10.1016/j.nbd.2019.04.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 04/06/2019] [Accepted: 04/23/2019] [Indexed: 12/13/2022] Open
Abstract
We tested a biomaterial-based approach to preserve the critical phrenic motor circuitry that controls diaphragm function by locally delivering minocycline hydrochloride (MH) following cervical spinal cord injury (SCI). MH is a clinically-available antibiotic and anti-inflammatory drug that targets a broad range of secondary injury mechanisms via its anti-inflammatory, anti-oxidant and anti-apoptotic properties. However, MH is only neuroprotective at high concentrations that cannot be achieved by systemic administration, which limits its clinical efficacy. We have developed a hydrogel-based MH delivery system that can be injected into the intrathecal space for local delivery of high concentrations of MH, without damaging spinal cord tissue. Implantation of MH hydrogel after unilateral level-C4/5 contusion SCI robustly preserved diaphragm function, as assessed by in vivo recordings of compound muscle action potential (CMAP) and electromyography (EMG) amplitudes. MH hydrogel also decreased lesion size and degeneration of cervical motor neuron somata, demonstrating its central neuroprotective effects within the injured cervical spinal cord. Furthermore, MH hydrogel significantly preserved diaphragm innervation by the axons of phrenic motor neurons (PhMNs), as assessed by both detailed neuromuscular junction (NMJ) morphological analysis and retrograde PhMN labeling from the diaphragm using cholera toxin B (CTB). In conclusion, our findings demonstrate that local MH hydrogel delivery to the injured cervical spinal cord is effective in preserving respiratory function after SCI by protecting the important neural circuitry that controls diaphragm activation.
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Affiliation(s)
- Biswarup Ghosh
- Department of Neuroscience, Vickie and Jack Farber Institute for Neuroscience, Sidney Kimmel Medical College at Thomas Jefferson University, 233 S. 10th St., Bluemle Life Sciences Building - Room 245, Philadelphia, PA 19107, United States of America
| | - Jia Nong
- School of Biomedical Engineering, Science and Health Systems, Drexel University, 3141 Chestnut Street, Bossone 7-716, Philadelphia, PA 19104, United States of America
| | - Zhicheng Wang
- School of Biomedical Engineering, Science and Health Systems, Drexel University, 3141 Chestnut Street, Bossone 7-716, Philadelphia, PA 19104, United States of America
| | - Mark W Urban
- Department of Neuroscience, Vickie and Jack Farber Institute for Neuroscience, Sidney Kimmel Medical College at Thomas Jefferson University, 233 S. 10th St., Bluemle Life Sciences Building - Room 245, Philadelphia, PA 19107, United States of America
| | - Nicolette M Heinsinger
- Department of Neuroscience, Vickie and Jack Farber Institute for Neuroscience, Sidney Kimmel Medical College at Thomas Jefferson University, 233 S. 10th St., Bluemle Life Sciences Building - Room 245, Philadelphia, PA 19107, United States of America
| | - Victoria A Trovillion
- Department of Neuroscience, Vickie and Jack Farber Institute for Neuroscience, Sidney Kimmel Medical College at Thomas Jefferson University, 233 S. 10th St., Bluemle Life Sciences Building - Room 245, Philadelphia, PA 19107, United States of America
| | - Megan C Wright
- Department of Biology, Arcadia University, 450 S Easton Rd, 220 Boyer Hall, Glenside, PA 19038, United States of America
| | - Angelo C Lepore
- Department of Neuroscience, Vickie and Jack Farber Institute for Neuroscience, Sidney Kimmel Medical College at Thomas Jefferson University, 233 S. 10th St., Bluemle Life Sciences Building - Room 245, Philadelphia, PA 19107, United States of America.
| | - Yinghui Zhong
- School of Biomedical Engineering, Science and Health Systems, Drexel University, 3141 Chestnut Street, Bossone 7-716, Philadelphia, PA 19104, United States of America.
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Allen LL, Seven YB, Baker TL, Mitchell GS. Cervical spinal contusion alters Na +-K +-2Cl- and K +-Cl- cation-chloride cotransporter expression in phrenic motor neurons. Respir Physiol Neurobiol 2019; 261:15-23. [PMID: 30590202 PMCID: PMC6939623 DOI: 10.1016/j.resp.2018.12.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 12/21/2018] [Accepted: 12/23/2018] [Indexed: 12/11/2022]
Abstract
Spinal chloride-dependent synaptic inhibition is critical in regulating breathing and requires neuronal chloride gradients established by cation-chloride cotransporters Na+-K+-2Cl- (NKCC1) and K+-Cl- (KCC2). Spinal transection disrupts NKCC1/KCC2 balance, diminishing chloride gradients in neurons below injury, contributing to spasticity and chronic pain. It is not known if similar disruptions in NKCC1/KCC2 balance occur in respiratory motor neurons after incomplete cervical contusion (C2SC). We hypothesized that C2SC disrupts NKCC1/KCC2 balance in phrenic motor neurons. NKCC1 and KCC2 immunoreactivity was assessed in CtB-positive phrenic motor neurons. Five weeks post-C2SC: 1) neither membrane-bound nor cytosolic NKCC1 expression were significantly changed, although the membrane/cytosolic ratio increased, consistent with net chloride influx; and 2) both membrane and cytosolic KCC2 expression increased, although the membrane/cytosolic ratio decreased, consistent with net chloride efflux. Thus, contrary to our original hypothesis, complex shifts in NKCC1/KCC2 balance occur post-C2SC. The functional significance of these changes remains unclear.
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Affiliation(s)
- Latoya L Allen
- Department of Physical Therapy, University of Florida, Gainesville, FL 32611 USA; Department of Neuroscience, University of Florida, Gainesville, FL 32610 USA; Center for Respiratory Research and Rehabilitation, University of Florida, Gainesville, FL 32611 USA
| | - Yasin B Seven
- Department of Physical Therapy, University of Florida, Gainesville, FL 32611 USA; Center for Respiratory Research and Rehabilitation, University of Florida, Gainesville, FL 32611 USA
| | - Tracy L Baker
- Department of Comparative Biosciences, University of Wisconsin-Madison, Madison, WI 53706 USA
| | - Gordon S Mitchell
- Department of Physical Therapy, University of Florida, Gainesville, FL 32611 USA; Center for Respiratory Research and Rehabilitation, University of Florida, Gainesville, FL 32611 USA.
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32
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Abstract
Spinal cord contusion injury is one of the most serious nervous system disorders, characterized by high morbidity and disability. To mimic spinal cord contusion in humans, various animal models of spinal contusion injury have been developed. These models have been developed in rats, mice, and monkeys. However, most of these models are developed using rats. Two types of animal models, i.e. bilateral contusion injury and unilateral contusion injury models, are developed using either a weight drop method or impactor method. In the weight drop method, a specific weight or a rod, having a specific weight and diameter, is dropped from a specific height on to the exposed spinal cord. Low intensity injury is produced by dropping a 5 g weight from a height of 8 cm, moderate injury by dropping 10 g weight from a height of 12.5–25 mm, and high intensity injury by dropping a 25 g weight from a height of 50 mm. In the impactor method, injury is produced through an impactor by delivering a specific force to the exposed spinal cord area. Mild injury is produced by delivering 100 ± 5 kdyn of force, moderate injury by delivering 200 ± 10 kdyn of force, and severe injury by delivering 300 ± 10 kdyn of force. The contusion injury produces a significant development of locomotor dysfunction, which is generally evident from the 0–14th day of surgery and is at its peak after the 28–56th day. The present review discusses different animal models of spinal contusion injury.
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Affiliation(s)
- Renuka Verma
- Department of Pharmaceutical Sciences and Drug Research, Punjabi University Patiala, Patiala, India
| | - Jasleen Kaur Virdi
- Department of Pharmaceutical Sciences and Drug Research, Punjabi University Patiala, Patiala, India
| | - Nirmal Singh
- Department of Pharmaceutical Sciences and Drug Research, Punjabi University Patiala, Patiala, India
| | - Amteshwar Singh Jaggi
- Department of Pharmaceutical Sciences and Drug Research, Punjabi University Patiala, Patiala, India
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Sama DM, Carlson SW, Joseph B, Saenger S, Metzger F, Saatman KE. Assessment of systemic administration of PEGylated IGF-1 in a mouse model of traumatic brain injury. Restor Neurol Neurosci 2018; 36:559-569. [PMID: 29889090 DOI: 10.3233/rnn-180831] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Traumatic brain injury can result in lasting cognitive dysfunction due to degeneration of mature hippocampal neurons as well as the loss of immature neurons within the dentate gyrus. While endogenous neurogenesis affords a partial recovery of the immature neuron population, hippocampal neurogenesis may be enhanced through therapeutic intervention. Insulin-like growth factor-1 (IGF-1) has the potential to improve cognitive function and promote neurogenesis after TBI, but its short half-life in the systemic circulation makes it difficult to maintain a therapeutic concentration. IGF-1 modified with a polyethylene glycol moiety (PEG-IGF-1) exhibits improved stability and half-life while retaining its ability to enter the brain from the periphery, increasing its viability as a translational approach. OBJECTIVE The goal of this study was to evaluate the ability of systemic PEG-IGF-1 administration to attenuate acute neuronal loss and stimulate the recovery of hippocampal immature neurons in brain-injured mice. METHODS In a series of studies utilizing a well-established contusion brain injury model, PEG-IGF-1 was administered subcutaneously after injury. Serum levels of PEG were verified using ELISA and histological staining was used to investigate numbers of degenerating neurons and cortical contusion size at 24 h after injury. Immunofluorescent staining was used to evaluate numbers of immature neurons at 10 d after injury. RESULTS Although subcutaneous injections of PEG-IGF-1 increased serum IGF-1 levels in a dose-dependent manner, no effects were observed on cortical contusion size, neurodegeneration within the dentate gyrus, or recovery of hippocampal immature neuron numbers. CONCLUSIONS In contrast to its efficacy in rodent models of neurodegenerative diseases, PEG- IGF-1 was not effective in ameliorating early neuronal loss after contusion brain trauma.
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Affiliation(s)
- Diana M Sama
- Spinal Cord and Brain Injury Research Center, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Shaun W Carlson
- Spinal Cord and Brain Injury Research Center, University of Kentucky College of Medicine, Lexington, KY, USA.,Present address: Department of Neurological Surgery, Safar Center for Resuscitation Research, University of Pittsburgh, PA, USA
| | - Binoy Joseph
- Spinal Cord and Brain Injury Research Center, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Stefanie Saenger
- Roche Pharma Research and Early Development (pRED), Roche Innovation Center Basel, Grenzacherstrasse, Basel, Switzerland
| | - Friedrich Metzger
- Roche Pharma Research and Early Development (pRED), Roche Innovation Center Basel, Grenzacherstrasse, Basel, Switzerland.,Versameb AG, Peter Merian-Strasse, Basel, Switzerland
| | - Kathryn E Saatman
- Spinal Cord and Brain Injury Research Center, University of Kentucky College of Medicine, Lexington, KY, USA
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34
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Abdy NA, Martinez R, Chea I, Boczar B, Nuño T, Woolridge D. A pilot study demonstrating the efficacy of transcutaneous bilirubin meters to quantitatively differentiate contusions from Congenital Dermal Melanocytosis. Child Abuse Negl 2018; 80:108-112. [PMID: 29587197 DOI: 10.1016/j.chiabu.2018.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 02/27/2018] [Accepted: 03/12/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Congenital Dermal Melanocytosis (CDM) can be difficult to differentiate from contusions. The need for a prompt and accurate diagnosis is best illustrated in cases where child abuse and maltreatment is of concern. Transcutaneous bilirubin (TCB) spectrophotometry has been well established to measure bilirubin under the skin for jaundice in infants. The use of TCB spectrometry has not been used to identify or differentiate contusions from CDM. We hypothesized that bilirubin, a degradation product of hemoglobin, would be elevated in contusions but not in CDM thus demonstrating the efficacy of a novel diagnostic technique to compliment or improve on physical assessment alone. METHODS Pilot study with thirty-seven infants and children noted to have CDM and fifty-six infants, children and adults with contusions underwent measurement of their lesion with TCB spectrometry. In each patient, the affected skin was scanned along with the adjacent unaffected native skin allowing an internal control for individual pigment variation. RESULTS TCB measurements of CDM resulted in lower transcutaneous bilirubin values that were not significantly different from adjacent native skin pigmentation. This was in contrast to cutaneous contusions, which resulted in a higher measured value (mean 5.01 mg/dL) compared to adjacent native tissue (1.24 mg/dL) demonstrating a four-fold increase in measurement at the lesion site (P < 0.001). Direct comparison of a ΔTCB value (lesion measurement minus the adjacent tissue) demonstrated a significantly higher value in contusions compared to CDM with a mean value of 3.77 and 0.12 mg/dL, respectively (P < 0.001). CONCLUSIONS TCB Spectrometry as a novel diagnostic technique has the potential to discern contusions from CDM and may therefore have the ability to compliment the use of physical assessment alone.
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Affiliation(s)
- Nicole A Abdy
- Department of Pediatrics, University of Arizona, Tucson, AZ, United States; Banner University Medical Center Tucson, Tucson, AZ, United States
| | | | | | | | - Tomas Nuño
- Emergency Medicine, University of Arizona, Tucson, AZ, United States
| | - Dale Woolridge
- Department of Pediatrics, University of Arizona, Tucson, AZ, United States; Emergency Medicine, University of Arizona, Tucson, AZ, United States; Banner University Medical Center Tucson, Tucson, AZ, United States.
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35
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Abstract
Lung contusion usually follows blunt trauma to the chest. If not properly diagnosed and adequately treated, it could at times be fatal as well. This case is being presented to highlight the radiological findings of this condition.
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Affiliation(s)
- Padmanabhan Arjun
- Department of Respiratory Medicine, Kerala Institute of Medical Sciences, Trivandrum, Kerala, India
| | - Akbar Abdul Najeeb
- Department of General Surgery, Kerala Institute of Medical Sciences, Trivandrum, Kerala, India
| | - Rahul Ramachandran
- Department of Respiratory Medicine, Kerala Institute of Medical Sciences, Trivandrum, Kerala, India
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36
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Wang JC, Elliott AT. Acute transient large-angle exotropia caused by traumatic orbital contusion. Orbit 2018; 37:454-456. [PMID: 29482420 DOI: 10.1080/01676830.2018.1435696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
We report an unusual case of acute large-angle left exotropia associated with blunt orbital trauma in a healthy 8-year-old boy. Examination revealed a large-angle left exotropia with limitation in adduction of the left eye. Microhyphema and commotio retinae of the left eye were also present. High-resolution orbital magnetic resonance imaging (MRI) demonstrated perimuscular and intramuscular edema mostly involving the left medial rectus muscle but also involving the left lateral rectus muscle. The extraocular muscle insertions were intact. Complete resolution of the strabismus and adduction limitation occurred within 24 hours of starting systemic steroid therapy. This case highlights the utility of high-resolution imaging to assess for injury to the extraocular muscles. If disinsertion, transection, or rupture of the muscle is not present on imaging, resolution may occur with systemic steroid therapy and surgical intervention is not needed.
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Affiliation(s)
- Jay C Wang
- a Department of Ophthalmology, Massachusetts Eye and Ear , Harvard Medical School , Boston , MA , USA
| | - Alexandra T Elliott
- b Department of Ophthalmology , Boston Children's Hospital, Harvard Medical School , Boston , MA , USA
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37
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Tomazoni SS, Frigo L, Dos Reis Ferreira TC, Casalechi HL, Teixeira S, de Almeida P, Muscara MN, Marcos RL, Serra AJ, de Carvalho PDTC, Leal-Junior ECP. Effects of photobiomodulation therapy and topical non-steroidal anti-inflammatory drug on skeletal muscle injury induced by contusion in rats-part 2: biochemical aspects. Lasers Med Sci 2017; 32:1879-1887. [PMID: 28795275 DOI: 10.1007/s10103-017-2299-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Accepted: 07/31/2017] [Indexed: 12/25/2022]
Abstract
Muscle injuries trigger an inflammatory process, releasing important biochemical markers for tissue regeneration. The use of non-steroidal anti-inflammatory drugs (NSAIDs) is the treatment of choice to promote pain relief due to muscle injury. NSAIDs exhibit several adverse effects and their efficacy is questionable. Photobiomodulation therapy (PBMT) has been demonstrated to effectively modulate inflammation induced from musculoskeletal disorders and may be used as an alternative to NSAIDs. Here, we assessed and compared the effects of different doses of PBMT and topical NSAIDs on biochemical parameters during an acute inflammatory process triggered by a controlled model of contusion-induced musculoskeletal injury in rats. Muscle injury was induced by trauma to the anterior tibial muscle of rats. After 1 h, rats were treated with PBMT (830 nm, continuous mode, 100 mW of power, 35.71 W/cm2; 1, 3, and 9 J; 10, 30, and 90 s) or diclofenac sodium (1 g). Our results demonstrated that PBMT, 1 J (35.7 J/cm2), 3 J (107.1 J/cm2), and 9 J (321.4 J/cm2) reduced the expression of tumor necrosis factor alpha (TNF-α) and cyclooxygenase-2 (COX-2) genes at all assessed times as compared to the injury and diclofenac groups (p < 0.05). The diclofenac group showed reduced levels of COX-2 only in relation to the injury group (p < 0.05). COX-2 protein expression remained unchanged with all therapies except with PBMT at a 3-J dose at 12 h (p < 0.05 compared to the injury group). In addition, PBMT (1, 3, and 9 J) effectively reduced levels of cytokines TNF-α, interleukin (IL)-1β, and IL-6 at all assessed times as compared to the injury and diclofenac groups (p < 0.05). Thus, PBMT at a 3-J dose was more effective than other doses of PBMT and topical NSAIDs in the modulation of the inflammatory process caused by muscle contusion injuries.
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Affiliation(s)
- Shaiane Silva Tomazoni
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo (UNICID), Rua Cesário Galeno, 448/475, São Paulo, SP, 05508-900, Brazil.
| | - Lúcio Frigo
- Biological Sciences and Health Center, Cruzeiro do Sul University (UNICSUL), São Paulo, SP, Brazil
| | - Tereza Cristina Dos Reis Ferreira
- Laboratory of Phototherapy in Sports and Exercise, Nove de Julho University (UNINOVE), São Paulo, SP, Brazil.,Postgraduate Program in Rehabilitation Sciences, Nove de Julho University (UNINOVE), São Paulo, SP, Brazil
| | - Heliodora Leão Casalechi
- Laboratory of Phototherapy in Sports and Exercise, Nove de Julho University (UNINOVE), São Paulo, SP, Brazil
| | - Simone Teixeira
- Department of Pharmacology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, SP, Brazil
| | - Patrícia de Almeida
- Postgraduate Program in Biophotonics Applied to Health Sciences, Nove de Julho University (UNINOVE), São Paulo, SP, Brazil
| | - Marcelo Nicolas Muscara
- Department of Pharmacology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, SP, Brazil
| | - Rodrigo Labat Marcos
- Postgraduate Program in Biophotonics Applied to Health Sciences, Nove de Julho University (UNINOVE), São Paulo, SP, Brazil
| | - Andrey Jorge Serra
- Postgraduate Program in Biophotonics Applied to Health Sciences, Nove de Julho University (UNINOVE), São Paulo, SP, Brazil
| | - Paulo de Tarso Camillo de Carvalho
- Postgraduate Program in Rehabilitation Sciences, Nove de Julho University (UNINOVE), São Paulo, SP, Brazil.,Postgraduate Program in Biophotonics Applied to Health Sciences, Nove de Julho University (UNINOVE), São Paulo, SP, Brazil
| | - Ernesto Cesar Pinto Leal-Junior
- Laboratory of Phototherapy in Sports and Exercise, Nove de Julho University (UNINOVE), São Paulo, SP, Brazil.,Postgraduate Program in Rehabilitation Sciences, Nove de Julho University (UNINOVE), São Paulo, SP, Brazil
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38
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Abstract
Spinal cord injury (SCI) can lead to severe disability, paralysis, neurological deficits and even death. In humans, most spinal cord injuries are caused by transient compression or contusion of the spinal cord associated with motor vehicle accidents. Animal models of contusion mimic the typical SCI's found in humans and these models are key to the discovery of progressive secondary tissue damage, demyelination, and apoptosis as well as pathophysiological mechanisms post SCI. Here we describe a method for the establishment of an efficient and reproducible contusion model of SCI in adult rat.
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Affiliation(s)
- Chuan-Wen Chiu
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | - Henrich Cheng
- Neural Regeneration Laboratory, Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,Center for Neural Regeneration, Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shie-Liang Hsieh
- Genomics Research Center, Academia Sinica, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
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Faheem M, Jaiswal M, Ojha BK, Chandra A, Singh SK, Srivastava C, Saba NU. Disappearance of the Hemorrhagic Component of the Frontal Contusion Possibly due to Redistribution of the Hematoma within the Subarachnoid Space: A Case Report. Pediatr Neurosurg 2017; 52:268-270. [PMID: 28601873 DOI: 10.1159/000475532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 04/01/2017] [Indexed: 11/19/2022]
Abstract
Posttraumatic hemorrhagic contusions are a common sequel of traumatic brain injuries. They occur in around 8% of all traumatic brain injuries. Spontaneous resolution of acute subdural and acute extradural hematomas, although rare, is a recognized entity, but spontaneous resolution of the hemorrhagic component of a contusion within 24 h has not been reported in the literature. We present a patient in whom the hemorrhagic component of her contusion resolved spontaneously over a period of 24 h after injury. The rarity of this case prompted us to this study.
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Affiliation(s)
- Mohd Faheem
- Department of Neurosurgery, King George's Medical University, Lucknow, India
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40
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Abstract
OBJECTIVE Spinal cord injury (SCI) is a devastating condition causing neuronal loss. A key challenge in treatment of SCI is how to retain neurons after injury. Valproic acid (VPA) is a drug recently has been appreciated for its neuroprotective and neurotrophic properties in various SCI models. In this study the role of VPA was assessed in organotypic spinal cord slice culture following the contusion. DESIGN The lumbar enlargement of adult rat was cut transversely and slices were cultured. Seven days after culturing, injury was induced by dropping a 0.5 gram weight from 3 cm height on the slice surface. One hour after injury, the VPA was administered at 1, 5 and 10 µM concentrations. Afterward, at day 1 and 3 post injury (DPI: 1 and 3) propidium iodide (PI) and immunohistochemistry staining were performed to evaluate the cell death, NeuN and β-Tubulin expression, respectively. RESULTS The PI staining of slices at DPI: 1 and 3 following treatment with VPA revealed significant decreases in the cell death in all three concentrations comparing to the non-treated group. Also immunostaining showed VPA only at 5 µM concentration considerably rescued ventral horn' MNs from death and protected the neuronal integrity. CONCLUSION The results of this study indicate applying VPA one hour after injury can prevent the death of a majority of cells, importantly MNs and preserve the neuronal integrity. Since the first 24 hours after SCI is a critical period for employing any treatment, VPA can be considered as an option for further evaluation.
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Affiliation(s)
- Sareh Pandamooz
- Department of Animal Biology, Faculty of Biological Sciences, Kharazmi University, Tehran, Iran,Neuroscience Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Correspondence to: Sareh Pandamooz Department of Animal Biology, Faculty of Biological Sciences, Kharazmi University, Tehran, Iran.
| | - Mohammad Saied Salehi
- Neuroscience Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Nabiuni
- Department of Animal Biology, Faculty of Biological Sciences, Kharazmi University, Tehran, Iran
| | - Leila Dargahi
- NeuroBiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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41
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Abstract
Cerebral cortical contusions are one of the most common computed tomography findings in head-injured patients and common sequel of traumatic brain injury. These contusions tend to show a progressive increase in mass effect on repeated imaging, most small contusions do not require surgical evacuation. However, progression to subdural hematoma (SDH) in a late aspect is unique. Here we present a 71-year-old man with bifrontal contusion, who deteriorated 43 days after initial trauma with sudden onset of acute SDH. This unusual case suggests that neurosurgeons should be alert for the possibility of very late onset of acute SDH after bifrontal contusions.
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Affiliation(s)
- Bora Gürer
- Neurosurgery Clinic, Ministry of Health Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
| | - Hayri Kertmen
- Neurosurgery Clinic, Ministry of Health Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
| | - Habibullah Dolgun
- Neurosurgery Clinic, Ministry of Health Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
| | - Zeki Sekerci
- Neurosurgery Clinic, Ministry of Health Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
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42
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Öğrenci A, Ekşi MŞ, Gün B, Koban O. Traumatic basal ganglia hematoma following closed head injuries in children. Childs Nerv Syst 2016; 32:1237-43. [PMID: 26994013 DOI: 10.1007/s00381-016-3060-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Accepted: 03/09/2016] [Indexed: 11/27/2022]
Abstract
PURPOSE High-velocity trauma with acceleration/deceleration forces turns into shear stress over lenticulostriate or anterior choroidal arteries that lead to basal ganglia hemorrhage. Traumatic basal ganglia hematoma has rarely been described in pediatric population. The aim of this study was to present our clinical series of pediatric patients with traumatic basal ganglia hematoma and to analyze the prognostic indicators of traumatic basal ganglia hematoma. METHODS In this retrospective case series, emergency admissions of pediatric patients with traumatic basal ganglia hematoma due to closed head injury were analyzed. Demographic, clinical, and radiographical data of the patients were retrieved from patients' charts and picture archiving and communication system. RESULTS There were four children with traumatic basal ganglia hematoma (TBGH). All patients were male. Median age was 8 years (range = 7-16 years). Road accident (three) and fall (one) were the causes of the traumas. Basal ganglia hematoma was present on the right side in one patient and on the left side in three patients. Hematoma volumes ranged from 0.9 to 8.94 ml. All patients were treated conservatively. One patient recovered fully; two patients were moderately disabled at their last clinical follow-ups. The last patient with diffuse subarachnoidal hemorrhage and edema died despite all interventions. CONCLUSIONS Traumatic basal ganglia hematomas are unique and different from other kind of intracerebral hematomas. The eloquent nature of basal ganglia makes it more vulnerable to head trauma. Mechanism of injury, energy and velocity of injury are the most important prognostic criteria. Post-traumatic phase of injury should be carefully observed in patients with TBGH, especially when mechanism and velocity of injury are severe and high.
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Affiliation(s)
- Ahmet Öğrenci
- Department of Neurosurgery, Batman State Hospital, Batman, Turkey
| | - Murat Şakir Ekşi
- Department of Orthopedic Surgery, Spine Center, University of California at San Francisco, San Francisco, CA, USA. .,University of California at San Francisco, Medical Center, 500 Parnassus Avenue MU320 West, San Francisco, CA, 94143-0728, USA.
| | | | - Orkun Koban
- Department of Neurosurgery, Kurtköy Ersoy Hospital, Istanbul, Turkey
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Helm T, Bir C, Chilstrom M, Claudius I. Ultrasound characteristics of bruises and their correlation to cutaneous appearance. Forensic Sci Int 2016; 266:160-163. [PMID: 27281053 DOI: 10.1016/j.forsciint.2016.05.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 05/23/2016] [Accepted: 05/25/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The primary objective of this study was to compare the cutaneous size of a bruise on gross exam to the subcutaneous depth and height of the hematoma ascertained by ultrasound. The hypothesis was that there would be little correlation between the area of the bruise on cutaneous exam and the height when measured with ultrasound. METHODS Adult and pediatric patients with bruising were prospectively identified in the emergency department. Photographs and ultrasound images were collected of the bruises and epidemiologic information collected from the patients. The cutaneous area of the bruise was compared with the sonographic characteristics. RESULTS The subcutaneous depth and height of the hematomas defined by ultrasound did not correlate with the cutaneous area. CONCLUSIONS The cutaneous appearance of a bruise gives little indication of the depth and size of the subcutaneous bruise. Ultrasound can add information regarding these parameters.
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Affiliation(s)
- Travis Helm
- USC, School of Medicine, 1975 Zonal, KAM 500, Los Angeles, CA 90089-9034, United States.
| | - Cynthia Bir
- Department of Emergency Medicine, USC, Keck School of Medicine 1200 North State Street, 1011 , Los Angeles, CA 90033, United States.
| | - Mikaela Chilstrom
- Department of Emergency Medicine, USC, Keck School of Medicine 1200 North State Street, 1011 , Los Angeles, CA 90033, United States.
| | - Ilene Claudius
- Department of Emergency Medicine, USC, Keck School of Medicine 1200 North State Street, 1011 , Los Angeles, CA 90033, United States.
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44
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Serlin Y, Benifla M, Shelef I. Tonsillar contusion associated with benign tonsillar ectopia following minor head trauma. Childs Nerv Syst 2016; 32:881-5. [PMID: 26438549 DOI: 10.1007/s00381-015-2924-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 09/28/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE The relationship between tonsil position and symptomatic cerebellar contusion is unclear. To date, there are no reports of symptomatic traumatic brain injury associated with benign tonsillar ectopia. Reported cases are limited to prominent cerebellar tonsillar displacement by ≥5 mm (i.e., Chiari malformations). METHODS The authors describe a case of symptomatic concussion in a toddler with unusual computerized tomography (CT) presentation and incidental finding of benign tonsillar ectopia, hemorrhagic contusion of the tonsils, blood-brain barrier (BBB) disruption and delayed atrophy shown using magnetic resonance imaging (MRI) studies. The radiological presentation and the clinical challenges are discussed through a review of the literature. CONCLUSION This case suggests that damage to cerebellar structures is not limited only to overt tonsillar herniation. Benign tonsillar ectopia may predispose to cerebellar contusion even after minor concussion and thus has a clinical significance. The current paradigm viewing only noticeable tonsillar herniation as a risk factor for hindbrain injury should be revisited.
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Affiliation(s)
- Yonatan Serlin
- The Laboratory for Experimental Neurosurgery, Department of Physiology and Cell Biology, Zlotowski Center for Neuroscience, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, 8410501, Israel.
| | - Mony Benifla
- Department of Neurosurgery, Hadassah-Hebrew University Medical Center, P.O. Box 12000, Jerusalem, 91120, Israel
| | - Ilan Shelef
- Department of Radiology, Soroka Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, 8410501, Israel
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45
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Alborzi Z, Zangouri V, Paydar S, Ghahramani Z, Shafa M, Ziaeian B, Radpey MR, Amirian A, Khodaei S. Diagnosing Myocardial Contusion after Blunt Chest Trauma. J Tehran Heart Cent 2016; 11:49-54. [PMID: 27928254 PMCID: PMC5027160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A myocardial contusion refers to a bruise of the cardiac muscle, the severity of which can vary depending on the severity of the injury and when the injury occurs. It is a major cause of rapid death which happens after blunt chest trauma and should be suspected at triage in the emergency department. We demonstrated that suspected myocardial contusion patients who have normal electrocardiograms (ECGs) and biomarker tests can be safely discharged. However, if the test results are abnormal, the next steps should be echocardiography and more advanced measures. Diagnosing myocardial contusion is very difficult because of its nonspecific symptoms. If a myocardial contusion happens, cardiogenic shock or arrhythmia must be anticipated, and the patient must be carefully monitored.
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Affiliation(s)
- Zahra Alborzi
- Department of Cardiology, Medical School, Yasouj University of Medical Sciences, Yasouj, Iran.
| | - Vahid Zangouri
- Department of General Surgery, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Shahram Paydar
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.,Corresponding Author: Shahram Paydar, Associate Professor of Trauma Surgery, Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Chamran Boulevard, Shiraz, Iran. 71948-15711. Tel: +98 71 36360697. Fax: +98 71 36254206..
| | - Zahra Ghahramani
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Masih Shafa
- Department of Cardiac Surgery, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Bizhan Ziaeian
- Department of Thoracic Surgery, Shiraz Universityof Medical Sciences, Shiraz, Iran.
| | - Mohammad Reza Radpey
- Department of Vascular Surgery, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Armin Amirian
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Shahin Khodaei
- Department of General Surgery, Shiraz University of Medical Sciences, Shiraz, Iran.
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Xiao W, Liu Y, Luo B, Zhao L, Liu X, Zeng Z, Chen P. Time-dependent gene expression analysis after mouse skeletal muscle contusion. J Sport Health Sci 2016; 5:101-108. [PMID: 30356928 PMCID: PMC6191981 DOI: 10.1016/j.jshs.2016.01.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 09/06/2015] [Accepted: 10/16/2015] [Indexed: 06/08/2023]
Abstract
BACKGROUND Though the mechanisms of skeletal muscle regeneration are deeply understood, those involved in muscle contusion, one of the most common muscle injuries in sports medicine clinics, are not. The objective of this study is to explore the mechanisms involved in muscle regeneration after contusion injury. METHODS In this study, a total of 72 mice were used. Eight of them were randomly chosen for the control group, while the rest were subjected to muscle contusion. Subsequently, their gastrocnemius muscles were harvested at different time points. The changes in muscle morphology were assessed by hematoxylin and eosin (HE) stain. In addition, the gene expression was analyzed by real-time polymerase chain reaction. RESULTS The data showed that the expression of many genes, i.e., specific markers of immune cells and satellite cells, regulatory factors for muscle regeneration, cytokines, and chemokines, increased in the early stages of recovery, especially in the first 3 days. Furthermore, there were strict rules in the expression of these genes. However, almost all the genes returned to normal at 14 days post-injury. CONCLUSION The sequence of immune cells invaded after muscle contusion was neutrophils, M1 macrophages and M2 macrophages. Some CC (CCL2, CCL3, and CCL4) and CXC (CXCL10) chemokines may be involved in the chemotaxis of these immune cells. HGF may be the primary factor to activate the satellite cells after muscle contusion. Moreover, 2 weeks are needed to recover when acute contusion happens as used in this study.
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Affiliation(s)
- Weihua Xiao
- School of Kinesiology, Shanghai University of Sport, Shanghai 200438, China
| | - Yu Liu
- School of Kinesiology, Shanghai University of Sport, Shanghai 200438, China
- Department of Exercise Science, Shenyang Sport University, Shenyang 110001, China
| | - Beibei Luo
- School of Kinesiology, Shanghai University of Sport, Shanghai 200438, China
| | - Linlin Zhao
- School of Kinesiology, Shanghai University of Sport, Shanghai 200438, China
| | - Xiaoguang Liu
- School of Kinesiology, Shanghai University of Sport, Shanghai 200438, China
| | - Zhigang Zeng
- School of Kinesiology, Shanghai University of Sport, Shanghai 200438, China
| | - Peijie Chen
- School of Kinesiology, Shanghai University of Sport, Shanghai 200438, China
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Ma Z, Zhang YP, Liu W, Yan G, Li Y, Shields LBE, Walker M, Chen K, Huang W, Kong M, Lu Y, Brommer B, Chen X, Xu XM, Shields CB. A controlled spinal cord contusion for the rhesus macaque monkey. Exp Neurol 2016; 279:261-273. [PMID: 26875994 DOI: 10.1016/j.expneurol.2016.02.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 02/07/2016] [Accepted: 02/09/2016] [Indexed: 01/23/2023]
Abstract
Most in vivo spinal cord injury (SCI) experimental models use rodents. Due to the anatomical and functional differences between rodents and humans, reliable large animal models, such as non-human primates, of SCI are critically needed to facilitate translation of laboratory discoveries to clinical applications. Here we report the establishment of a controlled spinal contusion model that produces severity-dependent functional and histological deficits in non-human primates. Six adult male rhesus macaque monkeys underwent mild to moderate contusive SCI using 1.0 and 1.5mm tissue displacement injuries at T9 or sham laminectomy (n=2/group). Multiple assessments including motor-evoked potential (MEP), somatosensory-evoked potential (SSEP), MR imaging, and monkey hindlimb score (MHS) were performed. Monkeys were sacrificed at 6 months post-injury, and the lesion area was examined for cavitation, axons, myelin, and astrocytic responses. The MHS demonstrated that both the 1.0 and 1.5mm displacement injuries created discriminative neurological deficits which were severity-dependent. The MEP response rate was depressed after a 1.0mm injury and was abolished after a 1.5mm injury. The SSEP response rate was slightly decreased following both the 1.0 and 1.5mm SCI. MRI imaging demonstrated an increase in T2 signal at the lesion site at 3 and 6months, and diffusion tensor imaging (DTI) tractography showed interrupted fiber tracts at the lesion site at 4h and at 6 months post-SCI. Histologically, severity-dependent spinal cord atrophy, axonal degeneration, and myelin loss were found after both injury severities. Notably, strong astrocytic gliosis was not observed at the lesion penumbra in the monkey. In summary, we describe the development of a clinically-relevant contusive SCI model that produces severity-dependent anatomical and functional deficits in non-human primates. Such a model may advance the translation of novel SCI repair strategies to the clinic.
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Affiliation(s)
- Zhengwen Ma
- Department of Laboratory Animal Sciences, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, PR China
| | - Yi Ping Zhang
- Norton Neuroscience Institute, Norton Healthcare, Louisville, KY 40202, USA
| | - Wei Liu
- Department of Laboratory Animal Sciences, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, PR China
| | - Guofeng Yan
- Department of Laboratory Animal Sciences, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, PR China
| | - Yao Li
- Department of Laboratory Animal Sciences, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, PR China
| | - Lisa B E Shields
- Norton Neuroscience Institute, Norton Healthcare, Louisville, KY 40202, USA
| | - Melissa Walker
- Spinal Cord and Brain Injury Research Group, Stark Neurosciences Research Institute, Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Kemin Chen
- Department of Radiology, Ruijing Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, PR China
| | - Wei Huang
- Department of Radiology, Ruijing Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, PR China
| | - Maiying Kong
- Department of Bioinformatics and Biostatistics, SPHIS, University of Louisville School of Medicine, Louisville, KY 40292, USA
| | - Yi Lu
- Department of Neurosurgery, Harvard Medical School, Boston, MA 02115, USA
| | - Benedikt Brommer
- Department of Neurology, Harvard Medical School, Boston, MA 02115, USA
| | - Xuejin Chen
- Department of Laboratory Animal Sciences, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, PR China.
| | - Xiao-Ming Xu
- Department of Laboratory Animal Sciences, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, PR China; Spinal Cord and Brain Injury Research Group, Stark Neurosciences Research Institute, Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
| | - Christopher B Shields
- Norton Neuroscience Institute, Norton Healthcare, Louisville, KY 40202, USA; Department of Anatomical Sciences and Neurobiology, University of Louisville School of Medicine, Louisville, KY 40292, USA.
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48
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Zhang B, Bailey WM, Braun KJ, Gensel JC. Age decreases macrophage IL-10 expression: Implications for functional recovery and tissue repair in spinal cord injury. Exp Neurol 2015; 273:83-91. [PMID: 26263843 DOI: 10.1016/j.expneurol.2015.08.001] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 07/31/2015] [Accepted: 08/03/2015] [Indexed: 12/14/2022]
Abstract
Macrophages with different activation states are present after spinal cord injury (SCI). M1 macrophages purportedly promote secondary injury processes while M2 cells support axon growth. The average age at the time of SCI has increased in recent decades, however, little is known about how different physiological factors contribute to macrophage activation states after SCI. Here we investigate the effect of age on IL-10, a key indicator of M2 macrophage activation. Following mild-moderate SCI in 4 and 14 month old (MO) mice we detected significantly reduced IL-10 expression with age in the injured spinal cord. Specifically, CD86/IL-10 positive macrophages, also known as M2b or regulatory macrophages, were reduced in 14 vs. 4 MO SCI animals. This age-dependent shift in macrophage phenotype was associated with impaired functional recovery and enhanced tissue damage in 14-month-old SCI mice. In vitro, M2b macrophages release anti-inflammatory cytokines without causing neurotoxicity, suggesting that imbalances in the M2b response in 14-month-old mice may be contributing to secondary injury processes. Our data indicate that age is an important factor that regulates SCI inflammation and recovery even to mild-moderate injury. Further, alterations in macrophage activation states may contribute to recovery and we have identified the M2b phenotype as a potential target for therapeutic intervention.
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Affiliation(s)
- Bei Zhang
- Spinal Cord and Brain Injury Research Center, Department of Physiology, University of Kentucky, Lexington, KY 40536, United States
| | - William M Bailey
- Spinal Cord and Brain Injury Research Center, Department of Physiology, University of Kentucky, Lexington, KY 40536, United States
| | - Kaitlyn J Braun
- Spinal Cord and Brain Injury Research Center, Department of Physiology, University of Kentucky, Lexington, KY 40536, United States
| | - John C Gensel
- Spinal Cord and Brain Injury Research Center, Department of Physiology, University of Kentucky, Lexington, KY 40536, United States.
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49
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Wang J, Hu B, Cao F, Sun S, Zhang Y, Zhu Q. Down regulation of lncSCIR1 after spinal cord contusion injury in rat. Brain Res 2015; 1624:314-320. [PMID: 26254726 DOI: 10.1016/j.brainres.2015.07.052] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 07/29/2015] [Accepted: 07/30/2015] [Indexed: 12/19/2022]
Abstract
Extensive changes occur at transcriptional level after traumatic spinal cord injury (SCI). In this study, we performed a large scale screening of expression changes of long (>200 nt) RNA transcripts including both coding and non-coding RNA species in a rat contusion SCI model. We validated significant down-regulation of one long non-coding RNA (lncSCIR1) at 1, 4, and 7 days postinjury. lncSCIR1 knockdown promoted astrocyte proliferation and migration in vitro. We further validated the strong association between lncSCIR1 knock down and the expression changes of four mRNAs after injury. Our data indicated that lncSCIR1 down-regulation might play a detrimental role in the pathophysiology of traumatic SCI and thereby provided new insights into the studies of potential therapeutic targets for traumatic central nervous system (CNS) injuries.
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Affiliation(s)
- Jing Wang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 JieFang Avenue, Wuhan 430022, China
| | - Bo Hu
- Deparment of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 JieFang Avenue, Wuhan 430022, China
| | - Fei Cao
- Deparment of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 JieFang Avenue, Wuhan 430022, China
| | - Shenggang Sun
- Deparment of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 JieFang Avenue, Wuhan 430022, China
| | - Yunjian Zhang
- Deparment of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 JieFang Avenue, Wuhan 430022, China
| | - Qing Zhu
- Deparment of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 JieFang Avenue, Wuhan 430022, China.
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50
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Kilbaugh TJ, Karlsson M, Byro M, Bebee A, Ralston J, Sullivan S, Duhaime AC, Hansson MJ, Elmér E, Margulies SS. Mitochondrial bioenergetic alterations after focal traumatic brain injury in the immature brain. Exp Neurol 2015; 271:136-44. [PMID: 26028309 DOI: 10.1016/j.expneurol.2015.05.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 05/12/2015] [Accepted: 05/13/2015] [Indexed: 12/30/2022]
Abstract
Traumatic brain injury (TBI) is one of the leading causes of death in children worldwide. Emerging evidence suggests that alterations in mitochondrial function are critical components of secondary injury cascade initiated by TBI that propogates neurodegeneration and limits neuroregeneration. Unfortunately, there is very little known about the cerebral mitochondrial bioenergetic response from the immature brain triggered by traumatic biomechanical forces. Therefore, the objective of this study was to perform a detailed evaluation of mitochondrial bioenergetics using high-resolution respirometry in a high-fidelity large animal model of focal controlled cortical impact injury (CCI) 24h post-injury. This novel approach is directed at analyzing dysfunction in electron transport, ADP phosphorylation and leak respiration to provide insight into potential mechanisms and possible interventions for mitochondrial dysfunction in the immature brain in focal TBI by delineating targets within the electron transport system (ETS). Development and application of these methodologies have several advantages, and adds to the interpretation of previously reported techniques, by having the added benefit that any toxins or neurometabolites present in the ex-vivo samples are not removed during the mitochondrial isolation process, and simulates the in situ tricarboxylic acid (TCA) cycle by maximizing key substrates for convergent flow of electrons through both complexes I and II. To investigate alterations in mitochondrial function after CCI, ipsilateral tissue near the focal impact site and tissue from the corresponding contralateral side were examined. Respiration per mg of tissue was also related to citrate synthase activity (CS) and calculated flux control ratios (FCR), as an attempt to control for variability in mitochondrial content. Our biochemical analysis of complex interdependent pathways of electron flow through the electron transport system, by most measures, reveals a bilateral decrease in complex I-driven respiration and an increase in complex II-driven respiration 24h after focal TBI. These alterations in convergent electron flow though both complex I and II-driven respiration resulted in significantly lower maximal coupled and uncoupled respiration in the ipsilateral tissue compared to the contralateral side, for all measures. Surprisingly, increases in complex II and complex IV activities were most pronounced in the contralateral side of the brain from the focal injury, and where oxidative phosphorylation was increased significantly compared to sham values. We conclude that 24h after focal TBI in the immature brain, there are significant alterations in cerebral mitochondrial bioenergetics, with pronounced increases in complex II and complex IV respiration in the contralateral hemisphere. These alterations in mitochondrial bioenergetics present multiple targets for therapeutic intervention to limit secondary brain injury and support recovery.
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Affiliation(s)
- Todd J Kilbaugh
- Perelman School of Medicine at the University of Pennsylvania, Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, 34th & Civic Center Blvd., Philadelphia, PA 19104, USA.
| | - Michael Karlsson
- Mitochondrial Medicine, Department of Clinical Sciences, Lund University, BMC A13, SE-221 84 Lund, Sweden.
| | - Melissa Byro
- Department of Bioengineering, University of Pennsylvania, 210 South 33rd Street, Philadelphia, PA 19104, USA.
| | - Ashley Bebee
- Department of Bioengineering, University of Pennsylvania, 210 South 33rd Street, Philadelphia, PA 19104, USA.
| | - Jill Ralston
- Department of Bioengineering, University of Pennsylvania, 210 South 33rd Street, Philadelphia, PA 19104, USA.
| | - Sarah Sullivan
- Department of Bioengineering, University of Pennsylvania, 210 South 33rd Street, Philadelphia, PA 19104, USA.
| | - Ann-Christine Duhaime
- Department of Neurosurgery, Massachusetts General Hospital, 15 Parkman Street, Boston, MA 02114, USA.
| | - Magnus J Hansson
- Mitochondrial Medicine, Department of Clinical Sciences, Lund University, BMC A13, SE-221 84 Lund, Sweden.
| | - Eskil Elmér
- Mitochondrial Medicine, Department of Clinical Sciences, Lund University, BMC A13, SE-221 84 Lund, Sweden.
| | - Susan S Margulies
- Department of Bioengineering, University of Pennsylvania, 210 South 33rd Street, Philadelphia, PA 19104, USA.
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