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Basilio AV, Zeng D, Pichay LA, Ateshian GA, Xu P, Maas SA, Morrison B. Simulating Cerebral Edema and Ischemia After Traumatic Acute Subdural Hematoma Using Triphasic Swelling Biomechanics. Ann Biomed Eng 2024; 52:2818-2830. [PMID: 38532172 DOI: 10.1007/s10439-024-03496-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 03/14/2024] [Indexed: 03/28/2024]
Abstract
Poor outcome following traumatic acute subdural hematoma (ASDH) is associated with the severity of the primary injury and secondary injury including cerebral edema and ischemia. However, the underlying secondary injury mechanism contributing to elevated intracranial pressure (ICP) and high mortality rate remains unclear. Cerebral edema occurs in response to the exposure of the intracellular fixed charge density (FCD) after cell death, causing ICP to increase. The increased ICP from swollen tissue compresses blood vessels in adjacent tissue, restricting blood flow and leading to ischemic damage. We hypothesize that the mass occupying effect of ASDH exacerbates the ischemic injury, leading to ICP elevation, which is an indicator of high mortality rate in the clinic. Using FEBio (febio.org) and triphasic swelling biomechanics, this study modeled clinically relevant ASDHs and simulated post-traumatic brain swelling and ischemia to predict ICP. Results showed that common convexity ASDH significantly increased ICP by exacerbating ischemic injury, and surgical removal of the convexity ASDH may control ICP by preventing ischemia progression. However, in cases where the primary injury is very severe, surgical intervention alone may not effectively decrease ICP, as the contribution of the hematoma to the elevated ICP is insignificant. In addition, interhemispheric ASDH, located between the cerebral hemispheres, does not significantly exacerbate ischemia, supporting the conservative surgical management generally recommended for interhemispheric ASDH. The joint effect of the mass occupying effect of the blood clot and resulting ischemia contributes to elevated ICP which may increase mortality. Our novel approach may improve the fidelity of predicting patient outcome after motor vehicle crashes and traumatic brain injuries due to other causes.
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Affiliation(s)
- Andrew V Basilio
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace MC 8904, 1210 Amsterdam Avenue, New York, NY, 10027, USA
| | - Delin Zeng
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace MC 8904, 1210 Amsterdam Avenue, New York, NY, 10027, USA
| | - Leanne A Pichay
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace MC 8904, 1210 Amsterdam Avenue, New York, NY, 10027, USA
| | - Gerard A Ateshian
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace MC 8904, 1210 Amsterdam Avenue, New York, NY, 10027, USA
- Department of Mechanical Engineering, Columbia University, 220 S. W. Mudd Building, 500 West 120th Street, New York, NY, 10027, USA
| | - Peng Xu
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace MC 8904, 1210 Amsterdam Avenue, New York, NY, 10027, USA
| | - Steve A Maas
- Department of Bioengineering, University of Utah, 36 S. Wasatch Drive, SMBB 3100, Salt Lake City, UT, 84112, USA
| | - Barclay Morrison
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace MC 8904, 1210 Amsterdam Avenue, New York, NY, 10027, USA.
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Kim HB, Hong JPJ, Suh HP. Comparative Study of Small Vessel (under 0.8 mm) Anastomosed Free Flap and Larger Vessel (over 0.8 mm) Anastomosed Free Flap: Does Supermicrosurgery Provide Sufficient Blood Flow to the Free Flap? J Reconstr Microsurg 2024; 40:452-457. [PMID: 37935411 DOI: 10.1055/a-2205-2292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
BACKGROUND This study aimed to quantify the blood flow of free flaps and compare the blood flow of small vessel (<0.8 mm) and larger vessel (>0.8 mm) anastomosed free flaps. METHODS This retrospective study included patients treated successfully with a perforator free flap in the lower extremity between June 2015 and March 2017. A color duplex ultrasound system measured the flow volume through the pedicle by analyzing the mean flow peak velocity, flow volume, and flow volume per 100 g of the flap. RESULTS A total of 69 patients were enrolled in this study. There was no statistical difference in peak velocity between the small vessel anastomosed free flap (25.2 ± 5.6) and larger vessel anastomosed free flap (26.5 ± 5.4). Flow volume (6.8 ± 4.2 vs. 6.3 ± 3.6) and flow volume/100 g (3.6 ± 3.9 vs. 6.2 ± 6.9) also did not show significant differences. CONCLUSION Small vessel (<0.8 mm) free flaps showed similar flow velocity and flow volume to larger vessel (>0.8 mm) anastomosed free flaps. Blood flow to the small vessel anastomosed free flap was sufficient despite its small vessel size.
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Affiliation(s)
- Hyung Bae Kim
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Joon Pio Jp Hong
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hyunsuk Peter Suh
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Gobert F, Dailler F, Rheims S, André-Obadia N, Balança B. Electrophysiological monitoring of neurological functions at the acute phase of brain injury: An overview of current knowledge and future perspectives in the adult population. EUROPEAN JOURNAL OF ANAESTHESIOLOGY AND INTENSIVE CARE 2024; 3:e0044. [PMID: 39917609 PMCID: PMC11798378 DOI: 10.1097/ea9.0000000000000044] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/09/2025]
Abstract
The continuous monitoring of physiological parameters is now considered as a standard of care in intensive care units (ICU). While multiple techniques are available to guide hemodynamic or respiratory management, the monitoring of neurological function in unconscious patients is usually limited to discontinuous bedside neurological examination or morphological brain imaging. However, cortical activity is accessible at the bedside with electroencephalography (EEG), electrocorticography (ECoG) or evoked potentials. The analysis of the unprocessed signal requires a trained neurophysiologist and could be time consuming. During the past decades, advances in neurophysiological signal acquisition make it possible to calculate quantified EEG parameters in real-time. New monitors also provide ICU friendly display for a dynamic and live assessment of neurological function changes. In this review, we will describe the technical aspects of EEG, ECoG and evoked potentials required for a good signal quality before interpretation. We will discuss how to use those electrophysiological techniques in the ICU to assess neurological function in comatose patients at the acute phase of brain injuries such as traumatic brain injuries, haemorrhagic or ischemic stroke. We will discuss, which quantitative EEG or evoked potentials monitoring parameters can be used at the bedside to guide sedation, evaluate neurological function during awaking and look for new neurological (encephalic or brainstem) injuries. We will present the state of the art and discuss some analyses, which may develop shortly.
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Affiliation(s)
- Florent Gobert
- From the Département d'anesthésie réanimation neurologique, Hospices Civils de Lyon, Hôpital Pierre Wertheimer (FG, FD, BB), Lyon Neuroscience Research Centre, Inserm U1028, CNRS UMR 5292 (FG, SR, NA-O, BB) and Département de neurophysiologie clinique et épileptologie, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Bron, France (SR, NA-O)
| | - Frédéric Dailler
- From the Département d'anesthésie réanimation neurologique, Hospices Civils de Lyon, Hôpital Pierre Wertheimer (FG, FD, BB), Lyon Neuroscience Research Centre, Inserm U1028, CNRS UMR 5292 (FG, SR, NA-O, BB) and Département de neurophysiologie clinique et épileptologie, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Bron, France (SR, NA-O)
| | - Sylvain Rheims
- From the Département d'anesthésie réanimation neurologique, Hospices Civils de Lyon, Hôpital Pierre Wertheimer (FG, FD, BB), Lyon Neuroscience Research Centre, Inserm U1028, CNRS UMR 5292 (FG, SR, NA-O, BB) and Département de neurophysiologie clinique et épileptologie, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Bron, France (SR, NA-O)
| | - Nathalie André-Obadia
- From the Département d'anesthésie réanimation neurologique, Hospices Civils de Lyon, Hôpital Pierre Wertheimer (FG, FD, BB), Lyon Neuroscience Research Centre, Inserm U1028, CNRS UMR 5292 (FG, SR, NA-O, BB) and Département de neurophysiologie clinique et épileptologie, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Bron, France (SR, NA-O)
| | - Baptiste Balança
- From the Département d'anesthésie réanimation neurologique, Hospices Civils de Lyon, Hôpital Pierre Wertheimer (FG, FD, BB), Lyon Neuroscience Research Centre, Inserm U1028, CNRS UMR 5292 (FG, SR, NA-O, BB) and Département de neurophysiologie clinique et épileptologie, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Bron, France (SR, NA-O)
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4
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Li Z, Zhang H, Hu G, Zhang G. Post-traumatic hydrocephalus: An overview of classification, diagnosis, treatment, and post-treatment imaging evaluation. Brain Res Bull 2023; 205:110824. [PMID: 37995869 DOI: 10.1016/j.brainresbull.2023.110824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 11/02/2023] [Accepted: 11/20/2023] [Indexed: 11/25/2023]
Abstract
The syndrome of post-traumatic hydrocephalus (PTH) has been recognized since Dandy's report in 1914. The pathogenesis of PTH has not been fully clarified. At present, it is believed that the obstacles of cerebrospinal fluid (CSF) secretion, absorption and circulation pathways are the reasons for the development of PTH. However, recent studies have also suggested that the osmotic pressure load of CSF and the pathological changes of CSF dynamics are caused by the development of hydrocephalus. Therefore, a better understanding of the definition, classification, diagnostic criteria, treatment, and evaluation of post-treatment effects of PTH is critical for the effective prevention and treatment of PTH. In this paper, we reviewed the classification and diagnosis of PTH and focused on the treatment and the imaging evaluation of post-treatment effects of PTH. This review might provide a judgment criterion for diagnosis of PTH and a basis for the effective prevention and treatment of PTH in the future.
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Affiliation(s)
- Zhao Li
- Department of Neurosurgery, Shengzhou Hospital of Traditional Chinese Medicine, Shengzhou City, Zhejiang Province 312400, China
| | - Han Zhang
- Department of Neurosurgery, Shengzhou People's Hospital, Shengzhou City, Zhejiang Province 312400, China
| | - Guojie Hu
- Department of Neurosurgery, Shengzhou Hospital of Traditional Chinese Medicine, Shengzhou City, Zhejiang Province 312400, China
| | - Guohai Zhang
- Department of Neurosurgery, Shengzhou Hospital of Traditional Chinese Medicine, Shengzhou City, Zhejiang Province 312400, China.
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5
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Cruz Navarro J, Ponce Mejia LL, Robertson C. A Precision Medicine Agenda in Traumatic Brain Injury. Front Pharmacol 2022; 13:713100. [PMID: 35370671 PMCID: PMC8966615 DOI: 10.3389/fphar.2022.713100] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 02/25/2022] [Indexed: 11/13/2022] Open
Abstract
Traumatic brain injury remains a leading cause of death and disability across the globe. Substantial uncertainty in outcome prediction continues to be the rule notwithstanding the existing prediction models. Additionally, despite very promising preclinical data, randomized clinical trials (RCTs) of neuroprotective strategies in moderate and severe TBI have failed to demonstrate significant treatment effects. Better predictive models are needed, as the existing validated ones are more useful in prognosticating poor outcome and do not include biomarkers, genomics, proteonomics, metabolomics, etc. Invasive neuromonitoring long believed to be a "game changer" in the care of TBI patients have shown mixed results, and the level of evidence to support its widespread use remains insufficient. This is due in part to the extremely heterogenous nature of the disease regarding its etiology, pathology and severity. Currently, the diagnosis of traumatic brain injury (TBI) in the acute setting is centered on neurological examination and neuroimaging tools such as CT scanning and MRI, and its treatment has been largely confronted using a "one-size-fits-all" approach, that has left us with many unanswered questions. Precision medicine is an innovative approach for TBI treatment that considers individual variability in genes, environment, and lifestyle and has expanded across the medical fields. In this article, we briefly explore the field of precision medicine in TBI including biomarkers for therapeutic decision-making, multimodal neuromonitoring, and genomics.
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Affiliation(s)
- Jovany Cruz Navarro
- Departments of Anesthesiology and Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Lucido L. Ponce Mejia
- Departments of Neurosurgery and Neurology, LSU Health Science Center, New Orleans, LA, United States
| | - Claudia Robertson
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
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6
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Sharma HS, Muresanu DF, Sahib S, Tian ZR, Lafuente JV, Buzoianu AD, Castellani RJ, Nozari A, Li C, Zhang Z, Wiklund L, Sharma A. Cerebrolysin restores balance between excitatory and inhibitory amino acids in brain following concussive head injury. Superior neuroprotective effects of TiO 2 nanowired drug delivery. PROGRESS IN BRAIN RESEARCH 2021; 266:211-267. [PMID: 34689860 DOI: 10.1016/bs.pbr.2021.06.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Concussive head injury (CHI) often associated with military personnel, soccer players and related sports personnel leads to serious clinical situation causing lifetime disabilities. About 3-4k head injury per 100k populations are recorded in the United States since 2000-2014. The annual incidence of concussion has now reached to 1.2% of population in recent years. Thus, CHI inflicts a huge financial burden on the society for rehabilitation. Thus, new efforts are needed to explore novel therapeutic strategies to treat CHI cases to enhance quality of life of the victims. CHI is well known to alter endogenous balance of excitatory and inhibitory amino acid neurotransmitters in the central nervous system (CNS) leading to brain pathology. Thus, a possibility exists that restoring the balance of amino acids in the CNS following CHI using therapeutic measures may benefit the victims in improving their quality of life. In this investigation, we used a multimodal drug Cerebrolysin (Ever NeuroPharma, Austria) that is a well-balanced composition of several neurotrophic factors and active peptide fragments in exploring its effects on CHI induced alterations in key excitatory (Glutamate, Aspartate) and inhibitory (GABA, Glycine) amino acids in the CNS in relation brain pathology in dose and time-dependent manner. CHI was produced in anesthetized rats by dropping a weight of 114.6g over the right exposed parietal skull from a distance of 20cm height (0.224N impact) and blood-brain barrier (BBB), brain edema, neuronal injuries and behavioral dysfunctions were measured 8, 24, 48 and 72h after injury. Cerebrolysin (CBL) was administered (2.5, 5 or 10mL/kg, i.v.) after 4-72h following injury. Our observations show that repeated CBL induced a dose-dependent neuroprotection in CHI (5-10mL/kg) and also improved behavioral functions. Interestingly when CBL is delivered through TiO2 nanowires superior neuroprotective effects were observed in CHI even at a lower doses (2.5-5mL/kg). These observations are the first to demonstrate that CBL is effectively capable to attenuate CHI induced brain pathology and behavioral disturbances in a dose dependent manner, not reported earlier.
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Affiliation(s)
- Hari Shanker Sharma
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Department of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden.
| | - Dafin F Muresanu
- Department of Clinical Neurosciences, University of Medicine & Pharmacy, Cluj-Napoca, Romania; "RoNeuro" Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
| | - Seaab Sahib
- Department of Chemistry & Biochemistry, University of Arkansas, Fayetteville, AR, United States
| | - Z Ryan Tian
- Department of Chemistry & Biochemistry, University of Arkansas, Fayetteville, AR, United States
| | - José Vicente Lafuente
- LaNCE, Department of Neuroscience, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain
| | - Anca D Buzoianu
- Department of Clinical Pharmacology and Toxicology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Rudy J Castellani
- Department of Pathology, University of Maryland, Baltimore, MD, United States
| | - Ala Nozari
- Anesthesiology & Intensive Care, Massachusetts General Hospital, Boston, MA, United States
| | - Cong Li
- Department of Neurosurgery, Chinese Medicine Hospital of Guangdong Province; The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Yuexiu District, Guangzhou, China
| | - Zhiquiang Zhang
- Department of Neurosurgery, Chinese Medicine Hospital of Guangdong Province; The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Yuexiu District, Guangzhou, China
| | - Lars Wiklund
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Department of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden
| | - Aruna Sharma
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Department of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden.
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7
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Abbott NT, Baker CJ, Chen C, Liu TT, Love TE. Defining Hypoperfusion in Chronic Aphasia: An Individualized Thresholding Approach. Brain Sci 2021; 11:491. [PMID: 33924446 PMCID: PMC8070458 DOI: 10.3390/brainsci11040491] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/06/2021] [Accepted: 04/12/2021] [Indexed: 01/01/2023] Open
Abstract
Within the aphasia literature, it is common to link location of lesioned brain tissue to specific patterns of language impairment. This has provided valuable insight into the relationship between brain structure and function, but it does not capture important underlying alterations in function of regions that remain structurally intact. Research has demonstrated that in the chronic stage of aphasia, variable patterns of reduced cerebral blood flow (CBF; hypoperfusion) in structurally intact regions of the brain contribute to persisting language impairments. However, one consistent issue in this literature is a lack of clear consensus on how to define hypoperfusion, which may lead to over- or underestimation of tissue functionality. In the current study, we conducted an exploratory analysis in six individuals with chronic aphasia (>1 year post-onset) using perfusion imaging to (1) suggest a new, individualized metric for defining hypoperfusion; (2) identify the extent of hypoperfused tissue in perilesional bands; and (3) explore the relationship between hypoperfusion and language impairment. Results indicated that our individualized metric for defining hypoperfusion provided greater precision when identifying functionally impaired tissue and its effects on language function in chronic aphasia. These results have important implications for intervention approaches that target intact (or impaired) brain tissue.
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Affiliation(s)
- Noelle T. Abbott
- San Diego State University and University of California San Diego Joint Doctoral Program in Language and Communicative Disorders, San Diego, CA 92182, USA; (C.J.B.); (T.E.L.)
| | - Carolyn J. Baker
- San Diego State University and University of California San Diego Joint Doctoral Program in Language and Communicative Disorders, San Diego, CA 92182, USA; (C.J.B.); (T.E.L.)
| | - Conan Chen
- Center for Functional MRI and Department of Radiology, University of California San Diego, San Diego, CA 92093, USA; (C.C.); (T.T.L.)
| | - Thomas T. Liu
- Center for Functional MRI and Department of Radiology, University of California San Diego, San Diego, CA 92093, USA; (C.C.); (T.T.L.)
| | - Tracy E. Love
- San Diego State University and University of California San Diego Joint Doctoral Program in Language and Communicative Disorders, San Diego, CA 92182, USA; (C.J.B.); (T.E.L.)
- School of Speech, Language, and Hearing Sciences, San Diego State University, San Diego, CA 92182, USA
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8
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Slessarev M, Mahmoud O, McIntyre CW, Ellis CG. Cerebral Blood Flow Deviations in Critically Ill Patients: Potential Insult Contributing to Ischemic and Hyperemic Injury. Front Med (Lausanne) 2021; 7:615318. [PMID: 33553208 PMCID: PMC7854569 DOI: 10.3389/fmed.2020.615318] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 12/14/2020] [Indexed: 11/27/2022] Open
Abstract
Background: Ischemic and hyperemic injury have emerged as biologic mechanisms that contribute to cognitive impairment in critically ill patients. Spontaneous deviations in cerebral blood flow (CBF) beyond ischemic and hyperemic thresholds may represent an insult that contributes to this brain injury, especially if they accumulate over time and coincide with impaired autoregulation. Methods: We used transcranial Doppler to measure the proportion of time that CBF velocity (CBFv) deviated beyond previously reported ischemic and hyperemic thresholds in a cohort of critically ill patients with respiratory failure and/or shock within 48 h of ICU admission. We also assessed whether these CBFv deviations were more common during periods of impaired dynamic autoregulation, and whether they are explained by concurrent variations in mean arterial pressure (MAP) and end-tidal PCO2 (PetCO2). Results: We enrolled 12 consecutive patients (three females) who were monitored for a mean duration of 462.6 ± 39.8 min. Across patients, CBFv deviated by more than 20–30% from its baseline for 17–24% of the analysis time. These CBFv deviations occurred equally during periods of preserved and impaired autoregulation, while concurrent variations in MAP and PetCO2 explained only 13–21% of these CBFv deviations. Conclusion: CBFv deviations beyond ischemic and hyperemic thresholds are common in critically ill patients with respiratory failure or shock. These deviations occur irrespective of the state of dynamic autoregulation and are not explained by changes in MAP and CO2. Future studies should explore mechanisms responsible for these CBFv deviations and establish whether their cumulative burden predicts poor neurocognitive outcomes.
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Affiliation(s)
- Marat Slessarev
- Department of Medicine, Western University, London, ON, Canada.,Department of Medical Biophysics, Western University, London, ON, Canada.,Brain & Mind Institute, Western University, London, ON, Canada
| | - Ossama Mahmoud
- Department of Computer Science, Western University, London, ON, Canada
| | - Christopher W McIntyre
- Department of Medicine, Western University, London, ON, Canada.,Department of Medical Biophysics, Western University, London, ON, Canada
| | - Christopher G Ellis
- Department of Medical Biophysics, Western University, London, ON, Canada.,Robarts Research Institute, Western University, London, ON, Canada
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Friedman R, Haimy A, Epstein Y, Gefen A. Evaluation of helmet and goggle designs by modeling non-penetrating projectile impacts. Comput Methods Biomech Biomed Engin 2018; 22:229-242. [DOI: 10.1080/10255842.2018.1549238] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Rinat Friedman
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Ayelet Haimy
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Yoram Epstein
- Heller Institute of Medical Research, Sheba Medical Center, Ramat Gan and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amit Gefen
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
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Lazaridis C, Maas AIR, Souter MJ, Martin RH, Chesnut RM, DeSantis SM, Sung G, Leroux PD, Suarez JI. Alternative clinical trial design in neurocritical care. Neurocrit Care 2016; 22:378-84. [PMID: 25894451 DOI: 10.1007/s12028-015-0135-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Neurocritical care involves the care of highly complex patients with combinations of physiologic derangements in the brain and in extracranial organs. The level of evidence underpinning treatment recommendations remains low due to a multitude of reasons including an incomplete understanding of the involved physiology; lack of good quality, prospective, standardized data; and the limited success of conventional randomized controlled trials. Comparative effectiveness research can provide alternative perspectives and methods to enhance knowledge and evidence within the field of neurocritical care; these include large international collaborations for generation and maintenance of high quality data, statistical methods that incorporate heterogeneity and individualize outcome prediction, and finally advanced bioinformatics that integrate large amounts of variable-source data into patient-specific phenotypes and trajectories.
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Affiliation(s)
- Christos Lazaridis
- Division of Neurocritical Care and Vascular Neurology, Department of Neurology, Baylor College of Medicine, 6501 Fannin Street, MS: NB320, Houston, TX, 77030, USA,
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Traumatic Brain Injury in the Military: Biomechanics and Finite Element Modelling. STUDIES IN MECHANOBIOLOGY, TISSUE ENGINEERING AND BIOMATERIALS 2016. [DOI: 10.1007/8415_2016_189] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Fluid responsiveness and brain tissue oxygen augmentation after subarachnoid hemorrhage. Neurocrit Care 2014; 20:247-54. [PMID: 24078486 DOI: 10.1007/s12028-013-9910-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND The objective of this study was to investigate the relationship between cardiac index (CI) response to a fluid challenge and changes in brain tissue oxygen pressure (PbtO(2)) in patients with subarachnoid hemorrhage (SAH). METHODS Prospective observational study was conducted in a neurological intensive care unit of a university hospital. Fifty-seven fluid challenges were administered to ten consecutive comatose SAH patients that underwent multimodality monitoring of CI, intracranial pressure (ICP), and PbtO(2), according to a standardized fluid management protocol. RESULTS The relationship between CI and PbtO(2) was analyzed with logistic regression utilizing generalized estimating equations. Of the 57 fluid boluses analyzed, 27 (47 %) resulted in a ≥ 10 % increase in CI. Median absolute (+5.8 vs. +1.3 mmHg) and percent (20.7 vs. 3.5 %) changes in PbtO(2) were greater in CI responders than in non-responders within 30 min after the end of the fluid bolus infusion. In a multivariable model, a CI response was independently associated with PbtO(2) response (adjusted odds ratio 21.5, 95 % CI 1.4-324, P = 0.03) after adjusting for mean arterial pressure change and end-tidal CO(2). Stroke volume variation showed a good ability to predict CI and PbtO(2) response with areas under the ROC curve of 0.86 and 0.81 with the best cut-off values of 9 % for both responses. CONCLUSION Bolus fluid resuscitation resulting in augmentation of CI can improve cerebral oxygenation after SAH.
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Weiss HR, Grayson J, Liu X, Barsoum S, Shah H, Chi OZ. Cerebral Ischemia and Reperfusion Increases the Heterogeneity of Local Oxygen Supply/Consumption Balance. Stroke 2013; 44:2553-8. [DOI: 10.1161/strokeaha.113.001172] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background and Purpose—
After cerebral vessel blockage, local blood flow and O
2
consumption becomes lower and oxygen extraction increases. With reperfusion, blood flow is partially restored. We examined the effects of ischemia-reperfusion on the heterogeneity of local venous oxygen saturation in rats in order to determine the pattern of microregional O
2
supply/consumption balance in reperfusion.
Methods—
The middle cerebral artery was blocked for 1 hour using the internal carotid approach in 1 group (n=9) and was then reperfused for 2 hours in another group (n=9) of isoflurane-anesthetized rats. Regional cerebral blood flow was determined using a C
14
-iodoantipyrine autoradiographic technique. Regional small vessel arterial and venous oxygen saturations were determined microspectrophotometrically.
Results—
After 1 hour of ischemia, local cerebral blood flow (92±10 versus 50±10 mL/min per 100 g) and O
2
consumption (4.5±0.6 versus 2.7±0.5 mL O
2
/min per 100 g) decreased compared with the contralateral cortex. Oxygen extraction increased (4.7±0.2 versus 5.4±0.3 mL O
2
/100 mL) and the variation in small vein (20–60 μm) O
2
saturation as determined by its coefficient of variation (=100×SD/mean) increased (5.5 versus 10.5). With 2 hours of reperfusion, the blood flow decrement was reduced and O
2
consumption returned to the value in the contralateral cortex. Oxygen extraction remained elevated in the ischemic-reperfused area and the coefficient of variation of small vein O
2
saturation increased further (17.3).
Conclusions—
These data indicated continued reduction of O
2
supply/consumption balance with reperfusion. They also demonstrated many small regions of low oxygenation within the reperfused cortical region.
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Affiliation(s)
- Harvey R. Weiss
- From the Department of Neuroscience and Cell Biology (H.R.W., H.S.) and Department of Anesthesiology (J.G., X.L., S.B., O.Z.C.), Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
| | - Jeremy Grayson
- From the Department of Neuroscience and Cell Biology (H.R.W., H.S.) and Department of Anesthesiology (J.G., X.L., S.B., O.Z.C.), Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
| | - Xia Liu
- From the Department of Neuroscience and Cell Biology (H.R.W., H.S.) and Department of Anesthesiology (J.G., X.L., S.B., O.Z.C.), Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
| | - Sylviana Barsoum
- From the Department of Neuroscience and Cell Biology (H.R.W., H.S.) and Department of Anesthesiology (J.G., X.L., S.B., O.Z.C.), Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
| | - Harsh Shah
- From the Department of Neuroscience and Cell Biology (H.R.W., H.S.) and Department of Anesthesiology (J.G., X.L., S.B., O.Z.C.), Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
| | - Oak Z. Chi
- From the Department of Neuroscience and Cell Biology (H.R.W., H.S.) and Department of Anesthesiology (J.G., X.L., S.B., O.Z.C.), Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
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14
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Clond MA, Lee BS, Yu JJ, Singer MB, Amano T, Lamb AW, Drazin D, Kateb B, Ley EJ, Yu JS. Reactive oxygen species-activated nanoprodrug of Ibuprofen for targeting traumatic brain injury in mice. PLoS One 2013; 8:e61819. [PMID: 23637912 PMCID: PMC3634829 DOI: 10.1371/journal.pone.0061819] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 03/13/2013] [Indexed: 01/21/2023] Open
Abstract
Traumatic brain injury (TBI) is an enormous public health problem, with 1.7 million new cases of TBI recorded annually by the Centers for Disease Control. However, TBI has proven to be an extremely challenging condition to treat. Here, we apply a nanoprodrug strategy in a mouse model of TBI. The novel nanoprodrug contains a derivative of the nonsteroidal anti-inflammatory drug (NSAID) ibuprofen in an emulsion with the antioxidant α-tocopherol. The ibuprofen derivative, Ibu2TEG, contains a tetra ethylene glycol (TEG) spacer consisting of biodegradable ester bonds. The biodegradable ester bonds ensure that the prodrug molecules break down hydrolytically or enzymatically. The drug is labeled with the fluorescent reporter Cy5.5 using nonbiodegradable bonds to 1-octadecanethiol, allowing us to reliably track its accumulation in the brain after TBI. We delivered a moderate injury using a highly reproducible mouse model of closed-skull controlled cortical impact to the parietal region of the cortex, followed by an injection of the nanoprodrug at a dose of 0.2 mg per mouse. The blood brain barrier is known to exhibit increased permeability at the site of injury. We tested for accumulation of the fluorescent drug particles at the site of injury using confocal and bioluminescence imaging of whole brains and brain slices 36 hours after administration. We demonstrated that the drug does accumulate preferentially in the region of injured tissue, likely due to an enhanced permeability and retention (EPR) phenomenon. The use of a nanoprodrug approach to deliver therapeutics in TBI represents a promising potential therapeutic modality.
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Affiliation(s)
- Morgan A. Clond
- Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - Bong-Seop Lee
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - Jeffrey J. Yu
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - Matthew B. Singer
- Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - Takayuki Amano
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - Alexander W. Lamb
- Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - Doniel Drazin
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - Babak Kateb
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - Eric J. Ley
- Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - John S. Yu
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
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15
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Crupi R, Paterniti I, Campolo M, Di Paola R, Cuzzocrea S, Esposito E. Exogenous T3 administration provides neuroprotection in a murine model of traumatic brain injury. Pharmacol Res 2013; 70:80-9. [PMID: 23313345 DOI: 10.1016/j.phrs.2012.12.009] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 12/12/2012] [Accepted: 12/26/2012] [Indexed: 01/26/2023]
Abstract
Traumatic brain injury (TBI) induces primary and secondary damage in both the endothelium and the brain parenchyma. While neurons die quickly by necrosis, a vicious cycle of secondary injury in endothelial cells exacerbates the initial injury. Thyroid hormones are reported to be decreased in patients with brain injury. Controlled cortical impact injury (CCI) is a widely used, clinically relevant model of TBI. Here, using CCI in adult male mice, we set to determine whether 3,5,3'-triiodothyronine (T3) attenuates posttraumatic neurodegeneration and neuroinflammation in an experimental model of TBI. Treatment with T3 (1.2μg/100g body weight, i.p.) 1h after TBI resulted in a significant improvement in motor and cognitive recovery after CCI, as well as in marked reduction of lesion volumes. Mouse model for brain injury showed reactive astrocytes with increased glial fibrillary acidic protein, and formation of inducible nitric oxide synthase (iNOS). Western blot analysis revealed the ability of T3 to reduce brain trauma through modulation of cytoplasmic-nuclear shuttling of nuclear factor-κB (NF-κB). Twenty-four hours after brain trauma, T3-treated mice also showed significantly lower number of TUNEL(+) apoptotic neurons and curtailed induction of Bax, compared to vehicle control. In addition, T3 significantly enhanced the post-TBI expression of the neuroprotective neurotrophins (BDNF and GDNF) compared to vehicle. Our data provide an additional mechanism for the anti-inflammatory effects of thyroid hormone with critical implications in immunopathology at the cross-roads of the immune-endocrine circuits.
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Affiliation(s)
- Rosalia Crupi
- Department of Biological and Environmental Sciences, University of Messina, Italy
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16
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Administration of palmitoylethanolamide (PEA) protects the neurovascular unit and reduces secondary injury after traumatic brain injury in mice. Brain Behav Immun 2012; 26:1310-21. [PMID: 22884901 DOI: 10.1016/j.bbi.2012.07.021] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Revised: 07/27/2012] [Accepted: 07/27/2012] [Indexed: 12/22/2022] Open
Abstract
Traumatic brain injury (TBI) is a major cause of preventable death and morbidity in young adults. This complex condition is characterized by significant blood brain barrier leakage that stems from cerebral ischemia, inflammation, and redox imbalances in the traumatic penumbra of the injured brain. Recovery of function after TBI is partly through neuronal plasticity. In order to test whether treatments that enhance plasticity might improve functional recovery, a controlled cortical impact (CCI) in adult mice, as a model of TBI, in which a controlled cortical impactor produced full thickness lesions of the forelimb region of the sensorimotor cortex, was performed. Once trauma has occurred, combating these exacerbations is the keystone of an effective TBI therapy. The endogenous fatty acid palmitoylethanolamide (PEA) is one of the members of N-acyl-ethanolamines family that maintain not only redox balance but also inhibit the mechanisms of secondary injury. Therefore, we tested whether PEA shows efficacy in a mice model of experimental TBI. PEA treatment is able to reduced edema and brain infractions as evidenced by decreased 2,3,5-triphenyltetrazolium chloride staining across brain sections. PEA-mediated improvements in tissues histology shown by reduction of lesion size and improvement in apoptosis level further support the efficacy of PEA therapy. The PEA treatment blocked infiltration of astrocytes and restored CCI-mediated reduced expression of PAR, nitrotyrosine, iNOS, chymase, tryptase, CD11b and GFAP. PEA inhibited the TBI-mediated decrease in the expression of pJNK and NF-κB. PEA-treated injured animals improved neurobehavioral functions as evaluated by behavioral tests.
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17
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Maugans TA, Farley C, Altaye M, Leach J, Cecil KM. Pediatric sports-related concussion produces cerebral blood flow alterations. Pediatrics 2012; 129:28-37. [PMID: 22129537 PMCID: PMC3255471 DOI: 10.1542/peds.2011-2083] [Citation(s) in RCA: 257] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES The pathophysiology of sports-related concussion (SRC) is incompletely understood. Human adult and experimental animal investigations have revealed structural axonal injuries, decreases in the neuronal metabolite N-acetyl aspartate, and reduced cerebral blood flow (CBF) after SRC and minor traumatic brain injury. The authors of this investigation explore these possibilities after pediatric SRC. PATIENTS AND METHODS Twelve children, ages 11 to 15 years, who experienced SRC were evaluated by ImPACT neurocognitive testing, T1 and susceptibility weighted MRI, diffusion tensor imaging, proton magnetic resonance spectroscopy, and phase contrast angiography at <72 hours, 14 days, and 30 days or greater after concussion. A similar number of age- and gender-matched controls were evaluated at a single time point. RESULTS ImPACT results confirmed statistically significant differences in initial total symptom score and reaction time between the SRC and control groups, resolving by 14 days for total symptom score and 30 days for reaction time. No evidence of structural injury was found on qualitative review of MRI. No decreases in neuronal metabolite N-acetyl aspartate or elevation of lactic acid were detected by proton magnetic resonance spectroscopy. Statistically significant alterations in CBF were documented in the SRC group, with reduction in CBF predominating (38 vs 48 mL/100 g per minute; P = .027). Improvement toward control values occurred in only 27% of the participants at 14 days and 64% at >30 days after SRC. CONCLUSIONS Pediatric SRC is primarily a physiologic injury, affecting CBF significantly without evidence of measurable structural, metabolic neuronal or axonal injury. Further study of CBF mechanisms is needed to explain patterns of recovery.
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Affiliation(s)
- Todd A. Maugans
- Division of Neurosurgery, Department of Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio,Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Chad Farley
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Mekibib Altaye
- Division of Epidemiology and Biostatistics,Department of Pediatrics
| | - James Leach
- Department of Pediatrics,,Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Kim M. Cecil
- Department of Pediatrics,,Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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18
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Widmayer MA, Browning JL, Gopinath SP, Robertson CS, Baskin DS. Increased intracranial pressure is associated with elevated cerebrospinal fluid ADH levels in closed-head injury. Neurol Res 2010; 32:1021-6. [PMID: 20810023 DOI: 10.1179/016164110x12714125204155] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES Head injury frequently results in increased intracranial pressure and brain edema. Investigators have demonstrated that ischemic injury causes an increase in cerebrospinal fluid (CSF) levels of antidiuretic hormone (ADH); increased CSF ADH levels exacerbate cerebral edema, and inhibition of the ADH system with specific ADH antagonists reduces cerebral edema. The current study was designed to test the hypothesis that elevated levels of ADH are present in the CSF of subjects with head injury. METHODS Ventricular CSF and blood samples were taken from 11 subjects with head injury and 12 subjects with no known head trauma or injury. ADH levels were analyzed using radioimmunoassay. Severity of increased intracranial pressure (ICP) was rated in head-injured subjects using a four-point ordinal scale, based on which treatments were necessary to reduce ICP. RESULTS Subjects with head injury had higher CSF (3.2 versus 1.2 pg/ml; P<0.02) and plasma (4.1 versus 1.4 pg/ml; P<0.02) levels of ADH than did control subjects. In head-injured subjects, CSF ADH levels positively correlated with severity of ICP. DISCUSSION The results of this study suggest that ADH plays a role in brain edema associated with closed head injury.
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Affiliation(s)
- Marsha A Widmayer
- Department of Neurosurgery, The Methodist Hospital, Houston, TX 77030, USA
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19
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Khan M, Im YB, Shunmugavel A, Gilg AG, Dhindsa RK, Singh AK, Singh I. Administration of S-nitrosoglutathione after traumatic brain injury protects the neurovascular unit and reduces secondary injury in a rat model of controlled cortical impact. J Neuroinflammation 2009; 6:32. [PMID: 19889224 PMCID: PMC2777134 DOI: 10.1186/1742-2094-6-32] [Citation(s) in RCA: 120] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2009] [Accepted: 11/04/2009] [Indexed: 12/04/2022] Open
Abstract
Background Traumatic brain injury (TBI) is a major cause of preventable death and serious morbidity in young adults. This complex pathological condition is characterized by significant blood brain barrier (BBB) leakage that stems from cerebral ischemia, inflammation, and redox imbalances in the traumatic penumbra of the injured brain. Once trauma has occurred, combating these exacerbations is the keystone of an effective TBI therapy. Following other brain injuries, nitric oxide modulators such as S-nitrosoglutathione (GSNO) maintain not only redox balance but also inhibit the mechanisms of secondary injury. Therefore, we tested whether GSNO shows efficacy in a rat model of experimental TBI. Methods TBI was induced by controlled cortical impact (CCI) in adult male rats. GSNO (50 μg/kg body weight) was administered at two hours after CCI. GSNO-treated injured animals (CCI+GSNO group) were compared with vehicle-treated injured animals (CCI+VEH group) in terms of tissue morphology, BBB leakage, edema, inflammation, cell death, and neurological deficit. Results Treatment of the TBI animals with GSNO reduced BBB disruption as evidenced by decreased Evan's blue extravasation across brain, infiltration/activation of macrophages (ED1 positive cells), and reduced expression of ICAM-1 and MMP-9. The GSNO treatment also restored CCI-mediated reduced expression of BBB integrity proteins ZO-1 and occludin. GSNO-mediated improvements in tissue histology shown by reduction of lesion size and decreased loss of both myelin (measured by LFB staining) and neurons (assayed by TUNEL) further support the efficacy of GSNO therapy. GSNO-mediated reduced expression of iNOS in macrophages as well as decreased neuronal cell death may be responsible for the histological improvement and reduced exacerbations. In addition to these biochemical and histological improvements, GSNO-treated injured animals recovered neurobehavioral functions as evaluated by the rotarod task and neurological score measurements. Conclusion GSNO is a promising candidate to be evaluated in humans after brain trauma because it not only protects the traumatic penumbra from secondary injury and improves overall tissue structure but also maintains the integrity of BBB and reduces neurologic deficits following CCI in a rat model of experimental TBI.
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Affiliation(s)
- Mushfiquddin Khan
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC 29425, USA.
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20
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Managing traumatic brain injury: What is the evidence?*. Crit Care Med 2008; 36:3116-7. [DOI: 10.1097/ccm.0b013e31818bdb06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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