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Myers MI, Hines KJ, Gray A, Spagnuolo G, Rosenwasser R, Iacovitti L. Intracerebral Transplantation of Autologous Mesenchymal Stem Cells Improves Functional Recovery in a Rat Model of Chronic Ischemic Stroke. Transl Stroke Res 2023:10.1007/s12975-023-01208-7. [PMID: 37917400 DOI: 10.1007/s12975-023-01208-7] [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: 10/18/2023] [Revised: 10/18/2023] [Accepted: 10/23/2023] [Indexed: 11/04/2023]
Abstract
While treatments exist for the acute phase of stroke, there are limited options for patients with chronic infarcts and long-term disability. Allogenic mesenchymal stem cells (alloMSCs) show promise for the treatment of stroke soon after ischemic injury. There is, however, no information on the use of autologous MSCs (autoMSCs), delivered intracerebrally in rats with a chronic infarct. In this study, rats underwent middle cerebral artery occlusion (MCAO) to induce stroke followed by bone marrow aspiration and MSC expansion in a closed bioreactor. Four weeks later, brain MRI was obtained and autoMSCs (1 × 106, 2.5 × 106 or 5 × 106; n = 6 each) were stereotactically injected into the peri-infarct and compared to controls (MCAO only; MCAO + PBS; n = 6-9). Behavior was assessed using the modified neurological severity score (mNSS). For comparison, an additional cohort of MCAO rats were implanted with 2.5 × 106 alloMSCs generated from a healthy rat. All doses of autoMSCs produced significant improvement (54-70%) in sensorimotor function 60 days later. In contrast, alloMSCs improved only 31.7%, similar to that in PBS controls 30%. Quantum dot-labeled auto/alloMSCs were found exclusively at the implantation site throughout the post-transplantation period with no tumor formation on MRI or Ki67 staining of engrafted MSCs. Small differences in stroke volume and no differences in corpus callosum width were observed after MSC treatment. Stroke-induced glial reactivity in the peri-infarct was long-lasting and unabated by auto/alloMSC transplantation. These studies suggest that intracerebral transplantation of autoMSCs as compared to alloMSCs may be a promising treatment in chronic stroke.
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Affiliation(s)
- Max I Myers
- Department of Neuroscience, Sidney Kimmel Medical College, Thomas Jefferson University, 900 Walnut Street, Suite 462, Philadelphia, PA, 19107, USA
- The Joseph and Marie Field Cerebrovascular Research Laboratory, Sidney Kimmel Medical College, Thomas Jefferson University, 900 Walnut Street, Suite 462, Philadelphia, PA, 19107, USA
- Vickie & Jack Farber Institute for Neuroscience, Sidney Kimmel Medical College, Thomas Jefferson University, 900 Walnut Street, Suite 462, Philadelphia, PA, 19107, USA
| | - Kevin J Hines
- Department of Neurological Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, 900 Walnut Street, Suite 462, Philadelphia, PA, 19107, USA
| | - Andrew Gray
- Department of Neuroscience, Sidney Kimmel Medical College, Thomas Jefferson University, 900 Walnut Street, Suite 462, Philadelphia, PA, 19107, USA
- The Joseph and Marie Field Cerebrovascular Research Laboratory, Sidney Kimmel Medical College, Thomas Jefferson University, 900 Walnut Street, Suite 462, Philadelphia, PA, 19107, USA
- Vickie & Jack Farber Institute for Neuroscience, Sidney Kimmel Medical College, Thomas Jefferson University, 900 Walnut Street, Suite 462, Philadelphia, PA, 19107, USA
| | - Gabrielle Spagnuolo
- Department of Neuroscience, Sidney Kimmel Medical College, Thomas Jefferson University, 900 Walnut Street, Suite 462, Philadelphia, PA, 19107, USA
- The Joseph and Marie Field Cerebrovascular Research Laboratory, Sidney Kimmel Medical College, Thomas Jefferson University, 900 Walnut Street, Suite 462, Philadelphia, PA, 19107, USA
- Vickie & Jack Farber Institute for Neuroscience, Sidney Kimmel Medical College, Thomas Jefferson University, 900 Walnut Street, Suite 462, Philadelphia, PA, 19107, USA
| | - Robert Rosenwasser
- The Joseph and Marie Field Cerebrovascular Research Laboratory, Sidney Kimmel Medical College, Thomas Jefferson University, 900 Walnut Street, Suite 462, Philadelphia, PA, 19107, USA
- Vickie & Jack Farber Institute for Neuroscience, Sidney Kimmel Medical College, Thomas Jefferson University, 900 Walnut Street, Suite 462, Philadelphia, PA, 19107, USA
- Department of Neurological Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, 900 Walnut Street, Suite 462, Philadelphia, PA, 19107, USA
| | - Lorraine Iacovitti
- Department of Neuroscience, Sidney Kimmel Medical College, Thomas Jefferson University, 900 Walnut Street, Suite 462, Philadelphia, PA, 19107, USA.
- The Joseph and Marie Field Cerebrovascular Research Laboratory, Sidney Kimmel Medical College, Thomas Jefferson University, 900 Walnut Street, Suite 462, Philadelphia, PA, 19107, USA.
- Vickie & Jack Farber Institute for Neuroscience, Sidney Kimmel Medical College, Thomas Jefferson University, 900 Walnut Street, Suite 462, Philadelphia, PA, 19107, USA.
- Department of Neurological Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, 900 Walnut Street, Suite 462, Philadelphia, PA, 19107, USA.
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Sahoo M, Dubey B, Vani K, Maria A. Changes in cerebral blood flow parameters among preterm 30-34 week neonates who are initiated on kangaroo mother care - A prospective analytical observational study. Early Hum Dev 2023; 180:105764. [PMID: 37031613 DOI: 10.1016/j.earlhumdev.2023.105764] [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] [Received: 07/19/2022] [Revised: 01/30/2023] [Accepted: 03/25/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND Kangaroo mother care (KMC) is recommended standard of care for preterm neonates. They are vulnerable for cerebral blood flow (CBF) fluctuations linked to intraventricular hemorrhage and periventricular leukomalacia, which have implications on neurodevelopment. This study was designed to document any change in CBF in middle cerebral artery (MCA) of stabilized preterm 30-34 weeks neonates who are initiated on KMC. METHODS We designed a prospective analytical observational study in a tertiary care neonatal unit. We enrolled 30-34 weeks preterm neonates eligible for KMC after their stabilization (n = 40). CBF was measured in supine position via right MCA Doppler through the temporal window before any KMC, after 2 h of 1st KMC session and following 24 h of 1st session. CBF was quantified in terms of pulsatility index (PI), Resistive Index (RI), peak systolic velocity (PSV), end-diastolic velocity (EDV), mean velocity (MV) and values were compared against the existing normative values. RESULTS Mean gestation of study population was 31.91 weeks with a mean birth weight of 1432.75 g. Median day of initiation of KMC was 7 days with mean duration of KMC on day 1 was 4.56 h. We could find statistically significant decrease in the values of PI and RI from 90th centile towards 50th centile of normative values with a mean difference of 0.22 (99 % CI 0.02-0.43, p 0.005) for PI and 0.05 (99 % CI 0.02-0.07, p = 0.000) for RI post the first session of KMC. Following 24 h of 1st KMC session, we could find a significant increase in values of PSV, EDV and MV comparing values of pre-initiation with day 2 pre-KMC but values of PI and RI were not significantly different. CONCLUSION CBF among 30-34 week preterm neonates tend to optimize after initiation of KMC.
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Affiliation(s)
- Manaswinee Sahoo
- Department of neonatology, Atal Bihari Vajpayee Institute of Medical Sciences and Ram Manohar Lohia Institute of Medical Sciences, New Delhi, India.
| | - Bhawna Dubey
- Department of neonatology, Atal Bihari Vajpayee Institute of Medical Sciences and Ram Manohar Lohia Institute of Medical Sciences, New Delhi, India
| | - Kavita Vani
- Department of Radio diagnosis, Atal Bihari Vajpayee Institute of Medical Sciences and Ram Manohar Lohia Institute of Medical Sciences, New Delhi, India
| | - Arti Maria
- Department of neonatology, Atal Bihari Vajpayee Institute of Medical Sciences and Ram Manohar Lohia Institute of Medical Sciences, New Delhi, India
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Wu J, Wang P, Zhou L, Zhang D, Chen Q, Mao C, Su W, Huo Y, Peng J, Yin X, Chen G. Hemodynamics derived from computational fluid dynamics based on magnetic resonance angiography is associated with functional outcomes in atherosclerotic middle cerebral artery stenosis. Quant Imaging Med Surg 2022; 12:688-698. [PMID: 34993111 DOI: 10.21037/qims-21-337] [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: 03/26/2021] [Accepted: 07/23/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND To investigate the relationship between fluid-attenuated inversion recovery (FLAIR) vascular hyperintensity (FVH), hemodynamics, and functional outcome in atherosclerotic middle cerebral artery (MCA) stenosis using a computational fluid dynamics (CFD) model based on magnetic resonance angiography (MRA), according to a modified Rankin Scale (mRS) at 3 months. METHODS A total of 120 patients with 50-99% atherosclerotic MCA stenosis were included. The training and internal validation groups were composed of 99 participants and 21 participants, respectively. Demographic, imaging data, and functional outcome (mRS at 3 months) were collected. Hemodynamic parameters were obtained from the CFD model. The FVH score was based on the number of territories where FVH is positive, according to the spatial distribution in the Alberta Stroke Program Early Computed Tomography Score (ASPECTS). The prediction models were constructed according to clinical and hemodynamic parameters using multivariate logistic analysis. The DeLong test compared areas under the curves (AUCs) of the models. RESULTS The multivariable logistic regression analysis showed that the National Institute of Health Stroke Scale (NIHSS) at admission, hypertension, hyperlipidemia, the ratio of wall shear stress before treatment (WSSRbefore), and difference in the ratio of wall shear stress (WSSR) were independently associated with functional outcome (all P<0.05). In the training group before treatment, the AUC of model 1a (only clinical variables) and 2a (clinical variables with addition of WSSRbefore) were 0.750 and 0.802. After treatment, the AUC of model 1b (only clinical variables) and 2b (clinical variables with addition of difference in WSSR) were 0.815 and 0.883, respectively. The AUC of models with hemodynamic parameters was significantly higher than the models based on clinical variables only (all P<0.05, DeLong test). In the internal validation group before treatment, the AUC of the model (clinical variables) was 0.782, and that of the model (clinical variables and WSSRbefore) was 0.800. After treatment, the AUC of the model (clinical variables) was 0.833, and that of the model (clinical variables and difference in WSSR) was 0.861. There were no significant differences between the good and the poor functional outcome group concerning FVHbefore scores before treatment (0.30±0.81 vs. 0.26±0.97; P=0.321) and FVHafter scores after treatment (0.08±0.39 vs. 0.00±0.00; P=0.244). CONCLUSIONS Hemodynamics was associated with functional outcomes in patients with ischemic stroke attributed to atherosclerotic MCA stenosis, while FVH was not. Hemodynamic parameters were of great importance in the prediction models.
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Affiliation(s)
- Jiahua Wu
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.,Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Peng Wang
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Leilei Zhou
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Danfeng Zhang
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Qian Chen
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Cunnan Mao
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Wen Su
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yingsong Huo
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jin Peng
- Intervention Department, Chenggong Hospital Affiliated to Xiamen University, Xiamen, China
| | - Xindao Yin
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Guozhong Chen
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
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Kant A, Seth N, Rastogi D. Comparison of Outcome of Normal and High-Risk Pregnancies Based Upon Cerebroplacental Ratio Assessed by Doppler Studies. J Obstet Gynaecol India 2017; 67:173-177. [PMID: 28546663 DOI: 10.1007/s13224-016-0946-3] [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] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Accepted: 11/10/2016] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVES To evaluate the cerebroplacental ratio which is the ratio of pulsatility index of fetal middle cerebral and umbilical arteries, in normal and high-risk pregnancies during 30-36 weeks of gestation. METHODS In this study, we included 70 patients, who were scanned for Doppler parameters of Middle cerebral artery and Umbilical artery pulsatility index ratio of fetus, between 30 and 36 weeks, and then were followed till delivery. Thirty-five patients with normal pregnancy and 35 patients with high-risk pregnancy were included. Perinatal outcome was evaluated in relation to indices ratio. RESULTS There was cerebroplacental ratio of <1.00 in eight cases of the study group in comparison with the control group in which there is no case of <1.00 value. It was associated with poor perinatal outcome in terms of need for lower segment cesarean section for fetal distress, Apgar <8 at 5 min, and admission to nursery. CONCLUSION Cerebroplacental ratio is highly sensitive in diagnosing hemodynamically compromised fetuses and very useful for the prediction of adverse perinatal outcome in these fetuses.
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Affiliation(s)
- Anita Kant
- Asian Institute of Medical Sciences, H.NO 93 SECTOR 16 A, Faridabad, Haryana India
| | - Namrata Seth
- Asian Institute of Medical Sciences, H.NO 461 SECTOR 30, Faridabad, Haryana India
| | - Deepti Rastogi
- Asian Institute of Medical Sciences, Faridabad, Haryana India
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Shen J, Stevenson J, Geng X, Yang J, Yin C, Li F, Wang S, Du H, Ji X, Ding Y. A new clinically relevant model for intracranial atherosclerosis in rats. Neurol Res 2016; 38:817-22. [PMID: 27477859 DOI: 10.1080/01616412.2016.1211232] [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] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Intracranial atherosclerotic stenosis (ICAS) is one of the most common causes of stroke worldwide and, in particular, has been implicated as a leading cause of recurrent ischemic stroke. We developed a new rat model to study intracranial atherosclerosis. METHODS Twelve-week-old male Sprague-Dawley rats were divided into a control (on a maintain diet) and a high-cholesterol group (on a daily 1% cholesterol diet) for up to 6 weeks. During the first two weeks, NG-nitro-L-arginine methylester (L-NAME, 3 mg/mL) was added to the drinking water in the high-cholesterol group to induce intimal changes making the rats susceptible to atherosclerosis. Blood lipids, including low-density lipoprotein (LDL), cholesterol (CHO), triglycerides (TG), and high-density lipoprotein (HDL), were measured after 3 and 6 weeks. Histological sections of the brains, including internal carotid artery (ICA), middle cerebral artery (MCA), and basilar artery (BA), were prepared to study intracranial artery morphometry and intimal thickening. The levels of CD68, an inflammatory marker, within the vessel walls as determined by immunohistochemistry were also measured. RESULTS The high-cholesterol diet increased the levels of classic blood markers of atherosclerosis, LDL, CHO, and TG as well as decreased HDL, which became progressively more intensive with time. Rats showed increased intimal thickening in the ICA, MCA, and BA. This protocol also increased the levels of CD68 immunoreactivity within the vessel walls. CONCLUSIONS A rat model of intracranial atherosclerosis was effectively developed by high-cholesterol diet and L-NAME administration. This clinically relevant model would be beneficial for studying ICAS.
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Affiliation(s)
- Jiamei Shen
- a China-America Institute of Neuroscience , Beijing Luhe Hospital, Capital Medical University , Beijing , China
| | - James Stevenson
- b Department of Neurological Surgery , Wayne State University School of Medicine , Detroit , MI , USA
| | - Xiaokun Geng
- a China-America Institute of Neuroscience , Beijing Luhe Hospital, Capital Medical University , Beijing , China.,b Department of Neurological Surgery , Wayne State University School of Medicine , Detroit , MI , USA.,c Department of Neurology , Beijing Luhe Hospital, Capital Medical University , Beijing , China
| | - Jianjie Yang
- d Department of Pathology , Beijing Luhe Hospital, Capital Medical University , Beijing , China
| | - Changbin Yin
- e Department of Clinical Laboratory , Beijing Luhe Hospital, Capital Medical University , Beijing , China
| | - Fengwu Li
- a China-America Institute of Neuroscience , Beijing Luhe Hospital, Capital Medical University , Beijing , China
| | - Sainan Wang
- a China-America Institute of Neuroscience , Beijing Luhe Hospital, Capital Medical University , Beijing , China
| | - Huishan Du
- a China-America Institute of Neuroscience , Beijing Luhe Hospital, Capital Medical University , Beijing , China.,c Department of Neurology , Beijing Luhe Hospital, Capital Medical University , Beijing , China
| | - Xunming Ji
- a China-America Institute of Neuroscience , Beijing Luhe Hospital, Capital Medical University , Beijing , China
| | - Yuchuan Ding
- a China-America Institute of Neuroscience , Beijing Luhe Hospital, Capital Medical University , Beijing , China.,b Department of Neurological Surgery , Wayne State University School of Medicine , Detroit , MI , USA
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Najam R, Gupta S, Shalini. Predictive Value of Cerebroplacental Ratio in Detection of Perinatal Outcome in High-Risk Pregnancies. J Obstet Gynaecol India 2016; 66:244-7. [PMID: 27382217 DOI: 10.1007/s13224-015-0671-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 01/03/2015] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE To assess the predictive value of cerebroplacental ratio (i.e., S/D ratio of middle cerebral artery to S/D ratio of Umbilical artery) in detection of perinatal outcome in high-risk pregnancies. MATERIAL AND METHOD This retrospective study was conducted on 150 patients between 28 and 40 weeks of gestation (25 low risk and 125 high risk) who attended OPD and indoor wards of Teerthanker Mahaveer medical college and research center, Moradabad. All patients had serial color Doppler ultrasounds done after taking informed consent which was repeated at 2 weeks interval, and data were collected with regard to perinatal outcome. RESULT AND CONCLUSION Cerebroplacental ratio is having higher sensitivity and negative predictive value in detection of IUGR, Meconium aspiration syndrome, operative interference for fetal distress, and NICU admissions in comparison to its components. So, better prediction of neonatal outcome can be done by C/U ratio.
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