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Islam MZ, Räisänen SE, Schudel A, Wang K, He T, Kunz C, Li Y, Ma X, Serviento AM, Zeng Z, Wahl F, Zenobi R, Giannoukos S, Niu M. Exhalomics as a noninvasive method for assessing rumen fermentation in dairy cows: Can exhaled-breath metabolomics replace rumen sampling? J Dairy Sci 2024; 107:2099-2110. [PMID: 37949405 DOI: 10.3168/jds.2023-24124] [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: 09/05/2023] [Accepted: 10/20/2023] [Indexed: 11/12/2023]
Abstract
Previously, we used secondary electrospray ionization-mass spectrometry (SESI-MS) to investigate the diurnal patterns and signal intensities of exhaled (EX) volatile fatty acids (VFA) of dairy cows. The current study aimed to validate the potential of an exhalomics approach for evaluating rumen fermentation. The experiment was conducted in a switchback design, with 3 periods of 9 d each, including 7 d for adaptation and 2 d for sampling. Four rumen-cannulated original Swiss Brown (Braunvieh) cows were randomly assigned to 1 of 2 diet sequences (ABA or BAB): (A) low starch (LS; 6.31% starch on a dry matter basis) and (B) high starch (HS; 16.2% starch on a dry matter basis). Feeding was once per day at 0830 h. Exhalome (with the GreenFeed System), and rumen samples were collected 8 times to represent every 3 h of a day, and EX-VFA and ruminal (RM)-VFA were analyzed using SESI-MS and HPLC, respectively. Furthermore, the VFA concentration in the gas phase (HR-VFA) was predicted based on RM-VFA and Henry's Law (HR) constants. No interactions were identified between the types of diets (HS vs. LS) and the measurement methods on daily average VFA profiles (RM vs. EX or HR vs. EX), suggesting a consistent performance among the methods. Additionally, when the 3-h interval VFA data from HS and LS diets were analyzed separately, no interactions were observed between methods and time of day, indicating that the relative daily pattern of VFA molar proportions was similar regardless of the VFA measurement method used. The results revealed that the levels of acetate sharply increased immediately after feeding, trailed by an increase in the acetate:propionate ratio and a steady increase for propionate (2 h after feeding the HS diet, 4 h for LS), and butyrate. This change was more pronounced for the HS diet than the LS diet. However, there was no overall diet effect on the VFA molar proportions, although the measurement methods affected the molar proportions. Furthermore, we observed a strong positive correlation between the levels of RM and EX acetate for both diets (HS: r = 0.84; LS: r = 0.85), RM and EX propionate (r = 0.74), and RM and EX acetate:propionate ratio (r = 0.80). Both EX-VFA and RM-VFA exhibited similar responses to feeding and dietary treatments, suggesting that EX-VFA could serve as a useful proxy for characterizing RM-VFA molar proportions to evaluate rumen fermentation. Similar relationships were observed between RM-VFA and HR-VFA. In conclusion, this study underscores the potential of exhalomics as a reliable approach for assessing rumen fermentation. Moving forward, research should further explore the depth of exhalomics in ruminant studies to provide a comprehensive insight into rumen fermentation metabolites, especially across diverse dietary conditions.
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Affiliation(s)
- M Z Islam
- Department of Environmental Systems Science, Institute of Agricultural Sciences, ETH Zürich, 8092 Zürich, Switzerland
| | - S E Räisänen
- Department of Environmental Systems Science, Institute of Agricultural Sciences, ETH Zürich, 8092 Zürich, Switzerland
| | - A Schudel
- Department of Environmental Systems Science, Institute of Agricultural Sciences, ETH Zürich, 8092 Zürich, Switzerland
| | - K Wang
- Department of Environmental Systems Science, Institute of Agricultural Sciences, ETH Zürich, 8092 Zürich, Switzerland
| | - T He
- Department of Environmental Systems Science, Institute of Agricultural Sciences, ETH Zürich, 8092 Zürich, Switzerland
| | - C Kunz
- Department of Environmental Systems Science, Institute of Agricultural Sciences, ETH Zürich, 8092 Zürich, Switzerland
| | - Y Li
- Department of Environmental Systems Science, Institute of Agricultural Sciences, ETH Zürich, 8092 Zürich, Switzerland
| | - X Ma
- Department of Environmental Systems Science, Institute of Agricultural Sciences, ETH Zürich, 8092 Zürich, Switzerland
| | - A M Serviento
- Department of Environmental Systems Science, Institute of Agricultural Sciences, ETH Zürich, 8092 Zürich, Switzerland
| | - Z Zeng
- Department of Environmental Systems Science, Institute of Agricultural Sciences, ETH Zürich, 8092 Zürich, Switzerland
| | - F Wahl
- Food Microbial Systems Research Division, Agroscope, 3003 Bern, Switzerland
| | - R Zenobi
- Department of Chemistry and Applied Biosciences, Analytical Chemistry, ETH Zürich, 8093 Zürich, Switzerland
| | - S Giannoukos
- Department of Chemistry and Applied Biosciences, Analytical Chemistry, ETH Zürich, 8093 Zürich, Switzerland.
| | - M Niu
- Department of Environmental Systems Science, Institute of Agricultural Sciences, ETH Zürich, 8092 Zürich, Switzerland.
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Islam MZ, Giannoukos S, Räisänen SE, Wang K, Ma X, Wahl F, Zenobi R, Niu M. Exhaled volatile fatty acids, ruminal methane emission, and their diurnal patterns in lactating dairy cows. J Dairy Sci 2023; 106:6849-6859. [PMID: 37210352 DOI: 10.3168/jds.2023-23301] [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: 01/25/2023] [Accepted: 04/08/2023] [Indexed: 05/22/2023]
Abstract
To date, the commonly used methods to assess rumen fermentation are invasive. Exhaled breath contains hundreds of volatile organic compounds (VOC) that can reflect animal physiological processes. In the present study, for the first time, we aimed to use a noninvasive metabolomics approach based on high-resolution mass spectrometry to identify rumen fermentation parameters in dairy cows. Enteric methane (CH4) production from 7 lactating cows was measured 8 times over 3 consecutive days using the GreenFeed system (C-Lock Technology Inc.). Simultaneously, exhalome samples were collected in Tedlar gas sampling bags and analyzed offline using a secondary electrospray ionization high-resolution mass spectrometry system. In total, 1,298 features were detected, among them targeted exhaled volatile fatty acids (eVFA; i.e., acetate, propionate, butyrate), which were putatively annotated using their exact mass-to-charge ratio. The intensity of eVFA, in particular acetate, increased immediately after feeding and followed a similar pattern to that observed for ruminal CH4 production. The average total eVFA concentration was 35.5 count per second (CPS), and among the individual eVFA, acetate had the greatest concentration, averaging 21.3 CPS, followed by propionate at 11.5 CPS, and butyrate at 2.67 CPS. Further, exhaled acetate was on average the most abundant of the individual eVFA at around 59.3%, followed by 32.5 and 7.9% of the total eVFA for propionate and butyrate, respectively. This corresponds well with the previously reported proportions of these VFA in the rumen. The diurnal patterns of ruminal CH4 emission and individual eVFA were characterized using a linear mixed model with cosine function fit. The model characterized similar diurnal patterns for eVFA and ruminal CH4 and H2 production. Regarding the diurnal patterns of eVFA, the phase (time of peak) of butyrate occurred first, followed by that of acetate and propionate. Importantly, the phase of total eVFA occurred around 1 h before that of ruminal CH4. This corresponds well with existing data on the relationship between rumen VFA production and CH4 formation. Results from the present study revealed a great potential to assess the rumen fermentation of dairy cows using exhaled metabolites as a noninvasive proxy for rumen VFA. Further validation, with comparisons to rumen fluid, and establishment of the proposed method are required.
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Affiliation(s)
- M Z Islam
- ETH Zürich, Department of Environmental Systems Science, Institute of Agricultural Sciences, 8092 Zürich, Switzerland
| | - S Giannoukos
- ETH Zürich, Department of Chemistry and Applied Biosciences, Analytical Chemistry, 8093 Zürich, Switzerland.
| | - S E Räisänen
- ETH Zürich, Department of Environmental Systems Science, Institute of Agricultural Sciences, 8092 Zürich, Switzerland
| | - K Wang
- ETH Zürich, Department of Environmental Systems Science, Institute of Agricultural Sciences, 8092 Zürich, Switzerland
| | - X Ma
- ETH Zürich, Department of Environmental Systems Science, Institute of Agricultural Sciences, 8092 Zürich, Switzerland
| | - F Wahl
- Food Microbial Systems Research Division, Agroscope, 3003 Bern, Switzerland
| | - R Zenobi
- ETH Zürich, Department of Chemistry and Applied Biosciences, Analytical Chemistry, 8093 Zürich, Switzerland
| | - M Niu
- ETH Zürich, Department of Environmental Systems Science, Institute of Agricultural Sciences, 8092 Zürich, Switzerland.
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Hoedlmoser H, Brönner J, Bandalo V, Wahl F, Greiter MB. SIMULATION OF OSL AND TLD DOSEMETER RESPONSE FOR THE DEVELOPMENT OF NEW EXTREMITY DOSEMETERS. Radiat Prot Dosimetry 2019; 185:222-230. [PMID: 30668850 DOI: 10.1093/rpd/ncy299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 12/12/2018] [Accepted: 12/19/2018] [Indexed: 06/09/2023]
Abstract
The individual monitoring service at the Helmholtz Zentrum München is currently developing a new eye lens dosemeter to be integrated in radiation protection glasses and a new ring dosemeter using a new BeOSL detector element for extremity dosimetry developed by Dosimetrics. In the design process for the new eye lens dosemeter, MCNP6 Monte Carlo simulations were used to model the energy and angular response of new dosemeters before ordering the expensive tools for injection molding. This study describes the simulation of the dosemeter and detector, and the involved calculations do obtain the response in terms of the radiation protection quantity Hp(3). Simulations were carried out also for existing whole body dosemeters and TLD rings in order to verify the MC tools. With the final dosemeter prototypes becoming available earlier this year, all MC models could be verified and show very good agreement with experimental data.
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Affiliation(s)
- H Hoedlmoser
- Individual Monitoring Service, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Otto-Hahn-Ring 6, München, Germany
| | - J Brönner
- Individual Monitoring Service, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Otto-Hahn-Ring 6, München, Germany
| | - V Bandalo
- Individual Monitoring Service, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Otto-Hahn-Ring 6, München, Germany
| | - F Wahl
- Dosimetrics GmbH Otto-Hahn-Ring 6, München, Germany
| | - M B Greiter
- Individual Monitoring Service, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Otto-Hahn-Ring 6, München, Germany
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Abstract
Für eine Stufenversetzung im KCl-Kristall werden die Lagen der Gitterbausteine und die Verzerrungsenergie ausgerechnet. Die ermittelten Auslenkungen sind in einer Abbildung übersichtlich eingetragen. Die numerische Rechnung wird in den Grundzügen ausgeführt, aber nicht in allen Einzelheiten gebracht. Eine Anzahl mathematischer Hilfsmittel sind in den anschließenden Paragraphen zusammengestellt. Konvergenz- und Divergenzprobleme werden untersucht und die Ergebnisse diskutiert. Bei der Energieberechnung sind noch Einzelbetrachtungen notwendig.
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Affiliation(s)
- F. Wahl
- Aus dem Institut für theoretische und angewandte Physik der Technischen Hochschule Stuttgart
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Eichhorn KWG, Westphal R, Rilk M, Wahl F, Bootz F. Evaluation of Path Planning Processes for Robot-Guided Endoscopy at the Anterior Skull Base. Skull Base Surg 2012. [DOI: 10.1055/s-0032-1314331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Affiliation(s)
- F. RÖHRDANZ
- a Institute of Robotics and Process Control, Technical University of Braunschweig, Hamburger Strasse 267, 38114 Braunschweig, Germany
| | - H. Mosemann
- b Institute of Robotics and Process Control, Technical University of Braunschweig, Hamburger Strasse 267, 38114 Braunschweig, Germany
| | - F. Wahl
- c Institute of Robotics and Process Control, Technical University of Braunschweig, Hamburger Strasse 267, 38114 Braunschweig, Germany
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Weber-Spickschen TS, Oszwald M, Westphal R, Krettek C, Wahl F, Gosling T. Development of a fixation device for robot assisted fracture reduction of femoral shaft fractures: a biomechanical study. Technol Health Care 2010; 18:207-16. [PMID: 20639597 DOI: 10.3233/thc-2010-0583] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Robot assisted fracture reduction of femoral shaft fractures provides precise alignment while reducing the amount of intraoperative imaging. The connection between the robot and the fracture fragment should allow conventional intramedullary nailing, be minimally invasive and provide interim fracture stability. In our study we tested three different reduction tools: a conventional External Fixator, a Reposition-Plate and a Three-Point-Device with two variations (a 40 degrees and a 90 degrees version). We measured relative movements between the tools and the bone fragments in all translation and rotation planes. The Three-Point-Device 90 degrees showed the smallest average relative displacement and was the only device able to withstand the maximum applied load of 70 Nm without failure of any bone fragment. The Three-Point-Device 90 degrees complies with all the stipulated requirements and is a suitable interface for robot assisted fracture reduction of femoral shaft fractures.
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Affiliation(s)
- T S Weber-Spickschen
- Department of Orthopaedics and Traumatology, Robert-Koch-Hospital Gehrden, Gehrden, Germany.
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Wahl F. Erfahrungen und grundsätzliche Stellungnahme zur Frage des Flüssigkeitsersatzes bei akuten Blutverlusten. Dtsch Med Wochenschr 2009; 73:400-2. [DOI: 10.1055/s-0028-1118162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Gosling T, Westphal R, Hufner T, Faulstich J, Kfuri M, Wahl F, Krettek C. Robot-assisted fracture reduction: a preliminary study in the femur shaft. Med Biol Eng Comput 2005; 43:115-20. [PMID: 15742728 DOI: 10.1007/bf02345131] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Reduction in femoral shaft fractures can be difficult to achieve with minimally invasive techniques. Malalignment and high intra-operative radiation exposure can result. The hypothesis was that robot-assisted fracture reduction could improve the quality of reduction while reducing the amount of radiation exposure. A robot system was developed that allows fracture manipulation with a joystick as input device. The system provides the surgeon with haptic and metric feedback. Fifteen synthetic femurs were broken and reduced by simulated open (group A) and closed techniques (group B). These techniques were compared with the robot-assisted reduction with (group C) and without (group D) haptic and metric information. An image intensifier was simulated with two orthogonal cameras. All reduction techniques showed minor malalignment. In group C, the alignment was: procurvatum/recurvatum 0.6 degrees (0-2.0 degrees); varus/valgus 0.8 degrees (0-3.0 degrees); and axial rotation 0.8 degrees (0-3.1 degrees). A significant difference was seen between the groups (two-way ANOVA, p < 0.001). Axial rotation was significantly lower in group C than in group B (1.9 degrees; p < 0.001). The residual varus and valgus deviation was higher in group C compared with group A (0.4 degrees, p = 0.03). The median number of simulated radiographs was significantly less in group C (35) compared with group D (72; p < 0.001) and group B (49; p = 0.01). Robot-assisted fracture reduction of the femur provides high precision in alignment while reducing the amount of intraoperative imaging. Further research in this field is worthwhile.
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Affiliation(s)
- T Gosling
- Trauma Department, Hannover Medical School, Hannover, Germany.
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Piot-Grosjean O, Wahl F, Gobbo O, Stutzmann JM. Assessment of sensorimotor and cognitive deficits induced by a moderate traumatic injury in the right parietal cortex of the rat. Neurobiol Dis 2001; 8:1082-93. [PMID: 11741403 DOI: 10.1006/nbdi.2001.0450] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The purpose of this study was to set-up a battery of behavioral tests to assess sensorimotor and cognitive deficits following a moderate traumatic brain injury (TBI) in rats. Coordinated walking ability was evaluated in an accelerated rotarod test. Vestibulomotor function and fine motor coordination were assessed by using a beam-walking task. Rotarod and beam-walking performances were both altered in injured rats compared to sham-operated and control rats. A more pronounced and longer-lasting deficit was measured in the beam-walking test. Cognitive function was studied by using the Lashley maze paradigm. A spatial localization deficit was significant for 4 weeks posttrauma in TBI rats. The beam-walking task and the Lashley maze are robust and sensitive methods in detecting sensorimotor and cognitive impairment after TBI in rats, respectively. These tests are proposed for evaluating the ability of new pharmacological agents to improve the functional recovery after a TBI in rats.
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Affiliation(s)
- O Piot-Grosjean
- Aventis Pharma, Neurodegeneration Disease Group, CRVA, 13 quai Jules Guesde, Vitry-sur-Seine Cedex, 94403, France
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Abstract
BACKGROUND AND PURPOSE Heparin and heparinoids have long been proposed for stroke treatment. This study investigates the effect of enoxaparin (Lovenox, Clexane), a low-molecular-weight heparin, on functional outcome (neuroscore) and lesion size in stroke models with reversible and irreversible cerebral ischemia using middle cerebral artery occlusion (MCAO) in the rat. METHODS Ischemia was induced in rats by transient occlusion for 2 hours or by permanent electrocoagulation of the left MCA. Forty-eight hours after ischemia, neurological deficit was evaluated by scoring sensorimotor functions and ischemic damage was quantified by histological evaluation of lesion volumes. RESULTS After transient MCAO, enoxaparin at 2x1.5 mg/kg IV (2 and 24 hours after insult) significantly reduced lesion size by 30% (P<0.05) and improved neuroscore (P<0.01). This significant effect on lesion size and neuroscore was still evident when treatment was started 5 hours after insult. Administered under the same protocol with a 5 hours delay post permanent MCAO, enoxaparin reduced lesion size by 49% (P<0.05) and improved neuroscore (P<0.01). CONCLUSIONS This study indicates that standard nonhemorrhagic doses of enoxaparin reduce ischemic damage with a wide therapeutic window. In addition to its anticoagulant properties, other properties of enoxaparin could act in synergy to explain its neuroprotective profile in ischemia. Thus clinical application of enoxaparin treatment in stroke warrants serious consideration.
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Affiliation(s)
- V Mary
- CNS Research, Aventis Pharma, CRVA, Vitry-sur-seine, France.
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Wahl F, Grosjean-Piot O, Bareyre F, Uzan A, Stutzmann JM. Enoxaparin reduces brain edema, cerebral lesions, and improves motor and cognitive impairments induced by a traumatic brain injury in rats. J Neurotrauma 2000; 17:1055-65. [PMID: 11101208 DOI: 10.1089/neu.2000.17.1055] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Traumatic brain injury (TBI) is often accompanied by secondary ischemia due, in part, to edema-induced blood vessel compression. Enoxaparin, a low-molecular weight heparin, which is efficacious in models of myocardial and brain ischemia was studied in lateral fluid percussion-induced TBI in rats. Enoxaparin was administered 2 h post-TBI at 0.5 mg/kg i.v. followed by 4 x 0.5, 4 x 1, or 4 x 2 mg/kg s.c. over 30 h. Brain edema was measured in the hippocampus, temporal cortex and parietal cortex. Edema was reduced by enoxaparin (0.5 + 4 x 0.5 mg/kg) in the hippocampus (-53%, p = 0.07) and the parietal cortex (-39%, ns). At 0.5 + 4 x 1 mg/kg edema was reduced in the hippocampus (-63%, p < 0.05) and the parietal cortex (-47%, p = 0.06). At 0.5 + 4 x 2 mg/kg, the reduction was more important in the hippocampus (-69%, p < 0.01) and in the parietal cortex (-50%, p < 0.05). No reduction was seen in the temporal cortex. The lesion size was reduced by enoxaparin at 0.5 + 4 x 1 mg/kg (-50%, p < 0.05), and at 0.5 + 4 x 2 mg/kg (-35%, ns). The neurological deficit evaluated with a 9-point scale was also improved with enoxaparin at 0.5 + 4 x 1 mg/kg 1 week post-TBI (p < 0.05). The cognitive impairment evaluated with a Lashley maze task was improved with enoxaparin (0.5 + 4 x 1 mg/kg) from 48 h (p < 0.05) to 2 weeks post-TBI (p < 0.01). Our results demonstrate for the first time that enoxaparin significantly reduces the brain contusion and edema, and improves the functional outcomes induced by a TBI. Therefore, enoxaparin could be a candidate drug to treat acute brain-injured patients.
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Affiliation(s)
- F Wahl
- Aventis Pharma, CNS Research, Ischemia-Trauma Department, Vitry-sur-Seine, France.
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Abstract
Most pharmacologic studies on brain trauma in animals are performed while the animals are under general anesthesia, which can interfere with brain metabolism and modify the experimental results. This study investigates the effects of three anesthetic drugs (halothane 2% and 4%, propofol at 10 mg/kg, and chloral hydrate at 400 mg/kg) on the traumatic brain injury-induced neurologic deficit in mice. Trauma was induced with a weight-drop device. For each drug, animals were divided into four groups; the first did not receive either anesthesia or trauma, the second received anesthesia but no trauma, the third received a trauma without anesthesia, and the fourth received anesthesia before the trauma. A neurologic examination using two different scorings (string and grip test) was performed 1 hour and 24 hours after the trauma. Mortality after trauma was increased for halothane 4% (48% versus 20% in unanesthetized mice), propofol (80% versus 30%), and chloral hydrate (70% versus 44%). Halothane 2% did not increase the mortality in traumatized mice. Halothane 2% or 4% anesthesia did not modify the string score after the trauma. Grip score after the trauma was better in mice anesthetized with halothane at either 2% or 4%. Mice injured under anesthesia with chloral hydrate had worse grip and string scores (P < .05) than unanesthetized mice. These results lead us to question the influence of anesthesia on the results obtained in experimental neuropharmacologic studies, particularly when there are discrepancies between two studies on the same pharmacologic treatment, which differ in their anesthesia protocols.
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Affiliation(s)
- E Tecoult
- Centre Hospitalier Universitaire de Limoges, Département Anesthésie-Réanimation, France
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Abstract
Physical injury to the central nervous system (CNS) remains one of the main causes of mortality and disability in young adults. Numerous therapies have been successfully evaluated in experimental traumatic brain or spinal cord injuries (TBI, SCI) and, although some of them are currently under clinical trials for these indications, no drug therapy is at present available. Thus, an interesting approach to reduce the CNS injury-induced damage could be the blockade of Na(+)-channels by drugs such as riluzole which is neuroprotective in models of TBI or SCI as summarized in this review. Repeated doses ranging from 2 to 8 mg/kg were administered between 24 h to 10 days post-injury, with a first administration given either at 15 min or up to 6 h post-injury. In these models riluzole was found to reduce both the size of spinal cord and brain lesions as well as brain edema, and to restore the neurological, motor and cognitive impairments consequent of these injuries. The largest therapeutic time window obtained was 1 to 6 h in TBI. This such a compound should be considered as an interesting candidate for the treatment or SCI or TBI.
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Affiliation(s)
- F Wahl
- Neurodegenerative Diseases Department, Rhône-Poulenc Rorer, CRVA, France
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Abstract
The aim of our study was to assess polymorphonuclear neutrophil infiltration into the injured parenchyma after a traumatic brain injury (TBI). Myeloperoxidase (MPO) activity was assayed on the hippocampus, temporal and parietal cortex 6, 24, 48, 72, and 120 h post-trauma. MPO activity occurred in these structures from 6 h post-trauma and was maximum at 24-48 h. It was resolved by 72 h in the hippocampus and the parietal cortex, but persisted in the temporal cortex until 120 h after trauma. This suggests that neutrophil infiltration is a delayed phenomenon in the physiopathology of TBI. Considering that a large therapeutic window may be crucial in the management of TBI, inhibition of neutrophil infiltration needs to be further investigated following cerebral trauma.
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Affiliation(s)
- N C Royo
- Rhône-Poulenc Rorer S.A., Pharmaceutical Discovery, Ischemia/Trauma Dept., Vitry-sur-Seine, France
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Zhang C, Raghupathi R, Saatman KE, Smith DH, Stutzmann JM, Wahl F, McIntosh TK. Riluzole attenuates cortical lesion size, but not hippocampal neuronal loss, following traumatic brain injury in the rat. J Neurosci Res 1998; 52:342-9. [PMID: 9590442 DOI: 10.1002/(sici)1097-4547(19980501)52:3<342::aid-jnr10>3.0.co;2-8] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The neuroprotective effects of Riluzole, a compound with several mechanisms of action including the inhibition of sodium channel activity and glutamate release, were evaluated in a rat model of parasagittal fluid-percussion (FP) brain injury. Male Sprague-Dawley rats (350-400 g, n = 17) were anesthetized with sodium pentobarbital (60 mg/kg i.p.) and subjected to parasagittal FP brain injury of moderate severity (2.3-2.5 atm). Fifteen min following injury, animals randomly received an i.v. bolus of either Riluzole (8 mg/kg, n = 8) or vehicle (n = 9), followed by subcutaneous injections (identical dose) at 6 hr and 24 hr. Two weeks after injury and drug treatment, animals were sacrificed and a series of brain sections, stained with Hematoxylin and Eosin (H&E) or cresyl violet, were evaluated for quantitative cortical lesion volume and cell counts of hippocampal CA3 neurons, respectively, using a computerized image analysis system. Administration of Riluzole significantly reduced FP-induced tissue loss in the temporal/occipital cortices ipsilateral to the site of impact by 46%, compared to vehicle-treated, brain-injured animals (P = 0.01). In contrast, the selective neuronal loss observed in the CA3 region of the ipsilateral hippocampus was unaffected by Riluzole treatment. The present study demonstrates that Riluzole can attenuate cortical lesion size following brain trauma. These neuroprotective effects may be related to the synergy of the different mechanisms of action of Riluzole.
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Affiliation(s)
- C Zhang
- Department of Neurosurgery, University of Pennsylvania School of Medicine, Philadelphia 19104-6316, USA
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Bareyre F, Wahl F, McIntosh TK, Stutzmann JM. Time course of cerebral edema after traumatic brain injury in rats: effects of riluzole and mannitol. J Neurotrauma 1997; 14:839-49. [PMID: 9421455 DOI: 10.1089/neu.1997.14.839] [Citation(s) in RCA: 91] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Brain trauma is the main cause of morbidity and mortality in young adults. One delayed events that occurs after a head trauma and compromises the survival of patients is cerebral edema. The present study examined first the occurrence of cerebral edema after a traumatic brain injury (TBI) induced by moderate fluid percussion in rats. Brain water content was measured from 1 h to 7 days posttrauma, in the hippocampus and cortex, on both ipsi- and contralateral hemispheres. Second, the effects of mannitol, an osmotic agent frequently used in the clinic, and riluzole, a neuroprotective compound, were investigated on regional edema formation. After TBI, the ipsilateral edema began early at 1-6 h, was maximal at 48 h and was resorbed by 5-7 days. No edema was observed in the contralateral hemisphere. Mannitol at 1 g/kg or vehicle was administered iv 15 min, 2 h and 4 h postinjury. At this dose, mannitol significantly attenuated the ipsilateral injured cortex edema measured at 6 h (p < 0.05). Riluzole at 4 and 8 mg/kg or vehicle was administered 15 min (IV) and 6 h, 24 h, and 30 h (SC) post-TBI. Riluzole at 4 x 4 mg/kg significantly reduced edema measured at 48 h, in the ipsilateral hippocampus (p < 0.05), whereas at 4 x 8 mg/kg, the reduction was observed in the hippocampus (p < 0.01) and the injured cortex (p < 0.05). Our results demonstrate that (1) cerebral edema begins early after the injury and is resorbed over 1 week; (2) mannitol could attenuate cerebral edema; and (iii) riluzole in addition to its neuroprotective effects reduces the brain edema. Thus, riluzole could be useful in human TBI treatment.
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Affiliation(s)
- F Bareyre
- Rhône-Poulenc Rorrer S.A., Neurodegenerative Diseases Department, Vitry-Sur-Seine, France
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Mottet I, Demeure R, Rataud J, Lucas M, Wahl F, Warscotte V, Thiran JP, Goudemant JF, Maldague B, Maloteaux JM, Stutzmann JM. Effects of riluzole on the evolution of focal cerebral ischemia: a magnetic resonance imaging study. MAGMA 1997; 5:185-91. [PMID: 9351022 DOI: 10.1007/bf02594581] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The aim of this study was to investigate the effects of riluzole on the lesion induced by a permanent middle cerebral artery occlusion (MCAO) in rats. Riluzole at 4 or 8 mg/kg i.v. significantly reduced the cortical ischemic brain damage. With the most effective dose of 8 mg/kg, the time evolution of the lesion was assessed by T2-weighted magnetic resonance imaging (MRI) repeated on the same animals after MCAO. MRI obtained at 24, 48, and 72 hours after MCAO showed a progressive increase of the ischemic lesion, except in the cortex of the riluzole-treated rats (8 mg/kg i.v.). Furthermore, there was no difference between lesion volumes as measured by MRI or by histology. This study indicates that MRI may be a valuable method to quantify in vivo the neuroprotective profile of a drug.
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Affiliation(s)
- I Mottet
- Department of Radiology and Medical Imaging, Université Catholique de Louvain, Brussels, Belgium
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Palfi S, Riche D, Brouillet E, Guyot MC, Mary V, Wahl F, Peschanski M, Stutzmann JM, Hantraye P. Riluzole reduces incidence of abnormal movements but not striatal cell death in a primate model of progressive striatal degeneration. Exp Neurol 1997; 146:135-41. [PMID: 9225746 DOI: 10.1006/exnr.1997.6520] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Riluzole has been shown recently to increase life expectancy in patients with amyotrophic lateral sclerosis. A number of experimental studies also suggest that this compound may be a neuroprotectant. We have investigated in baboons whether riluzole would protect striatal neurons from a prolonged 3-nitropropionic acid (3NP) treatment and ameliorate the associated motor symptoms. In animals receiving 3NP and the solvent of riluzole, 12 weeks of high-dose 3NP treatment resulted in the appearance of persistent leg dystonia and significant increases in the incidence of three categories of abnormal movements and in the dyskinesia index in the apomorphine test (0.5 mg/kg i.m.). Quantitative assessment of these behavioral deficits using a video movement analysis system demonstrated a significant decrease in locomotor activity and peak tangential velocity in 3NP-treated animals compared to controls. Histological analysis showed the presence of severe, bilateral, striatal lesions, localized in both caudate and putamen. Cotreatment with riluzole (4 mg/kg i.p., twice daily) significantly reduced the dyskinesia index (-35%, P < 0.02) in the apomorphine test. In the quantitative behavioral analysis, riluzole significantly ameliorated the decrease in peak tangential velocity (P < 0.02) but not the decrease in locomotor activity observed after 3NP. Comparative histological analysis of the two groups of treated animals did not demonstrate a clear neuroprotective effect of riluzole. The present study suggests that one potential therapeutic interest for riluzole in neurodegenerative disorders may reside in the reduction of motor symptoms associated with striatal lesions.
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Affiliation(s)
- S Palfi
- URA CEA/CNRS 2210 DRM, DSV, Service Hospitalier Frédéric Joliot, Orsay, France
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24
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Abstract
Riluzole (2-amino 6-trifluoromethoxy-benzothiazole) was studied in a rat model of traumatic brain injury (TBI) induced by a fluid percussion applied laterally to the right parietal cortex. Study I: vehicle or riluzole (4 or 8 mg/kg) was administered 15 min (i.v.), 6 h and 24 h (s.c.), after TBI. Brain lesions were quantified 1 week after insult. Riluzole significantly reduced the size of TBI-induced lesions by approximately 44% with either dose regime (P < 0.05). Study II: vehicle or riluzole (8 mg/kg) was administered 15 min (i.v.), 6 h (i.p.) and then twice daily (i.p.) for 6 days, after injury. One, 2 and 3 weeks after TBI, a neurological examination was performed. Control injured rats had a significant neurological deficit at 1, 2 and 3 weeks (P < 0.001). Riluzole treatment did not modify the neurological status evaluated for the first 2 weeks after TBI. However at 3 weeks, riluzole significant improved the neurological function of injured rats (P < 0.05). These results suggest that riluzole may be beneficial in the clinical treatment of TBI. The protective action of riluzole may result from (i) stabilization of the inactivated state of voltage-dependent sodium channels, (ii) indirect action on the glutamatergic pathway, and/or (iii) indirect neurotrophic effect.
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Affiliation(s)
- F Wahl
- Rhône-Poulenc Rorer, Pharmaceuticals Discovery, Neurodegenerative Diseases Department, Vitry sur Seine, France.
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Stutzmann JM, Wahl F, Pratt J, Mary V, Reibaud M, Tecoult E, Rataud J. Neuroprotective Profile of Riluzole in In Vivo Models of Acute Neurodegenerative Diseases. CNS Drug Reviews 1997. [DOI: 10.1111/j.1527-3458.1997.tb00318.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Mary V, Wahl F, Stutzmann JM. Effect of riluzole on quinolinate-induced neuronal damage in rats: comparison with blockers of glutamatergic neurotransmission. Neurosci Lett 1995; 201:92-6. [PMID: 8830323 DOI: 10.1016/0304-3940(95)12137-s] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Intrastriatal injection of quinolinate, an N-methyl-D-aspartate (NMDA) agonist, induces a local neuronal lesion, and provides an excitotoxic model of Huntington's disease. In this study, we investigated the effect of different agents acting at various levels of the glutamatergic neurotransmission: (i) dizocilpine (MK801) (0.5 mg/kg ip) significantly reduced the lesion by 74%; (ii) 6-(1-imidazolyl)-7-nitroquinoxaline-2,3(1H,4H)-dione (YM-90K) (3 x 10 and 3 x 20 mg/kg ip) and (iii) lamotrigine (50 mg/kg ip) had no effect; (iv) riluzole (4 and 8 mg/kg per os) significantly reduced the lesion by 35%. The inefficiency of YM-90K suggested that alpha-amino-3-hydroxy-5-methylisoxasole-4-propionate (AMPA) receptors do not participate to the quinolinate-induced excitotoxicity. The mechanism of action of riluzole may be related also to a combination of its different properties. This study indicates that riluzole may be useful for treatment of Huntington's disease.
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Affiliation(s)
- V Mary
- CNS Pharmaceutical Discovery Research, Neurological Diseases Group, Vitry-sur-Seine, France
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Mutter M, Nefzi A, Sato T, Sun X, Wahl F, Wöhr T. Pseudo-prolines (psi Pro) for accessing "inaccessible" peptides. Pept Res 1995; 8:145-53. [PMID: 7670229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Pseudo-prolines (psi Pro) are introduced as a temporary protection technique for serine, threonine and cysteine side chains in standard Fmoc/tBu solid-phase peptide synthesis (SPPS). The incorporation of these novel building blocks into a growing peptide chain proceeds by means of the coupling of preformed, suitably protected psi Pro dipeptides. For the example of representative model peptides used in protein de novo design, the potential of psi Pro to solubilize otherwise sparingly or completely insoluble peptides is demonstrated. Because of their intrinsic propensity for preventing peptide aggregation and beta-sheet formation, pseudo-prolines offer new possibilities for accessing large peptides by convergent strategies and chemoselective ligation techniques.
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Affiliation(s)
- M Mutter
- Institute of Organic Chemistry, University of Lausanne, Switzerland
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Wahl F, Obrenovitch TP, Hardy AM, Plotkine M, Boulu R, Symon L. Extracellular glutamate during focal cerebral ischaemia in rats: time course and calcium dependency. J Neurochem 1994; 63:1003-11. [PMID: 7914220 DOI: 10.1046/j.1471-4159.1994.63031003.x] [Citation(s) in RCA: 124] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The time course of changes in extracellular glutamic acid levels and their Ca2+ dependency were studied in the rat striatum during focal cerebral ischaemia, using microdialysis. Ischaemia-induced changes were compared with those produced by high K(+)-evoked local depolarization. To optimize time resolution, glutamate was analysed continuously as the dialysate emerged from the microdialysis probe by either enzyme fluorimetry or biosensor. The Ca2+ dependency of glutamate changes was examined by perfusing the probe with Ca(2+)-free medium. With normal artificial CSF, ischaemia produced a biphasic increase in extracellular glutamate, which started from the onset of ischaemia. During the first phase lasting approximately 10 min, dialysate glutamate level increased from 5.8 +/- 0.9 microM.min-1 to 35.8 +/- 6.2 microM where it stabilized for approximately 3 min. During the second phase dialysate glutamate increased progressively to its maximum (82 +/- 8 microM), reached after 55 min of ischaemia, where it remained for as long as it was recorded (3 h). The overall changes in extracellular glutamate were similar when Ca2+ was omitted from the perfusion medium, except that the first phase was no longer detectable and, early in ischaemia, extracellular glutamate increased at a significantly slower rate than in the control group (2.2 +/- 1 microM.min-1; p < 0.05). On the basis of these data, we propose that most of the glutamate released in the extracellular space in severe ischaemia is of metabolic origin, probably originating from both neurons and glia, and caused by altered glutamate uptake mechanisms.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- F Wahl
- Gough-Cooper Department of Neurological Surgery, Institute of Neurology, London, England
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Abstract
The purpose of this study was to examine the effects of blockade (sulpiride) and activation (quinpirole) of dopaminergic D2 (DA2) receptors on brain lesions subsequent to excessive activation of glutamate (GLU) receptors. Striatal lesions were produced by direct injection of quinolinic acid, an endogenous GLU receptor agonist. Sulpiride (100 mg kg-1 i.p., 30 min before quinolinic acid injection and 1 h after) significantly (p < or = 0.05) reduced the volume of the lesion by around 20%. Quinpirole (1.25 mg kg-1 i.p., 30 min before quinolinic acid injection) had no effect. The protective action of DA2 receptor blockade strongly suggests that quinolinic acid-induced excitotoxicity may be partly modulated by DA2 receptors.
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Affiliation(s)
- F Wahl
- Department of Neurological Surgery, Institute of Neurology, Queen Square, London, UK
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Abstract
The effects of riluzole, a putative inhibitor of glutamate release, on the histological and neurobehavioral consequences of middle cerebral artery occlusion were tested in Sprague-Dawley rats. Neurobehavioral studies (neurological examination, passive avoidance task) were carried out with sham-operated and occluded rats. Riluzole 4 and 8 mg/kg administered 30 min after occlusion reduced (P < 0.01) the cortical infarct (respectively 94 +/- 12 mm3 and 73 +/- 15 mm3 versus 139 +/- 8 mm3 for control rats). Striatum necrosis was not modified by the low dosage (46 +/- 3 mm3 versus 49 +/- 3 mm3 for control rats), whereas the high dosage increased it (61 +/- 3 mm3, P < 0.05). The ischemia-induced neurological and memory impairments were not improved by riluzole. Our results indicate that a drug depressing glutamatergic neurotransmission without blocking the glutamate receptors exerts anti-ischemic activity. Moreover, the results highlight the need for carrying out histological and neurobehavioral studies in parallel in this model.
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Affiliation(s)
- F Wahl
- Université René Descartes, Faculté des Sciences Pharmaceutiques et Biologiques, Laboratoire de Pharmacologie, Paris, France
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Abstract
BACKGROUND AND PURPOSE The aim of this study was to investigate the neurobehavioral consequences of focal ischemia in rats. METHODS We induced permanent occlusion of the left middle cerebral artery in 14 Sprague-Dawley rats, and used 13 sham-operated rats as controls. During surgery, brain temperature and body temperature were kept at normothermia. Neurobehavioral studies (neurological examination, passive avoidance task, Y maze test, and modified open-field test) were carried out 4 days after ischemia before killing the rats to evaluate histological damage. RESULTS Ischemia induced large infarcts in the cortex (138.6 +/- 8.5 mm3) and caudate-putamen (48.8 +/- 2.6 mm3) and, compared with sham-operated rats, produced a dramatic neurological deficit (p less than 0.001) characterized by sensorimotor dysfunctions and hemiplegia. Memory retention was significantly (p less than 0.05) impaired in the passive avoidance task, but neither vigilance and exploratory behavior measured in the modified open-field test nor working memory evaluated in the Y maze test were disturbed. Infarct size was not correlated with the neurological or behavioral deficits. CONCLUSIONS This lack of correlation indicates the necessity of carrying out parallel histological, neurological, and behavioral studies in any assays of new drugs using this model of focal ischemia.
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Affiliation(s)
- F Wahl
- Faculté des Sciences Pharmaceutiques et Biologiques, Université René Descartes, Paris, France
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Hau K, Frodl P, Gnirß M, Sommer F, Wahl F. A Microscopic Theory of α-Phase Hydrogen in Niobium*, **. Z PHYS CHEM 1989. [DOI: 10.1524/zpch.1989.163.part_2.0549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Wahl F, Enderlein G. [Calculation of standard reference numbers for environmental conditions]. Z Gesamte Hyg 1971; 17:811-5. [PMID: 5145761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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36
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Gaebelein H, Wahl F. [Illumination of large building sites with floodlight]. Z Gesamte Hyg 1970; 16:426-31. [PMID: 5512278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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37
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Brandt A, Grund W, Häublein HG, Küchler G, Quaas M, Thiele H, Wahl F. [Research on industrial hygiene in the 20th year of the German Democratic Republic]. Dtsch Gesundheitsw 1969; 24:1856-60. [PMID: 4916105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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38
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Regenberg F, Wahl F. [A new method for photometric evaluation of dust measurements by means of conimetry]. Z Gesamte Hyg 1969; 15:649-51. [PMID: 5372997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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39
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Kliche N, Meubrink H, Wahl F. [Chronic benzene poisoning in roof tilers]. Z Gesamte Hyg 1969; 15:310-6. [PMID: 5372525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Blum HL, Wahl F, Lemon GM, Jornlin R, Kent GW. The multipurpose worker and the neighborhood multiservice center: initial experiences and implications of the Rodeo Community Service Center. Am J Public Health Nations Health 1968; 58:458-68. [PMID: 5689213 PMCID: PMC1228285 DOI: 10.2105/ajph.58.3.458] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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41
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Panzke KJ, Renker U, Wahl F. [On the effect of whole body vibration]. Z Gesamte Hyg 1968; 14:1-6. [PMID: 4896855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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42
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Wahl F. [Lighting problems in home building]. Z Gesamte Hyg 1967; 13:594-5. [PMID: 5618443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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43
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Häublein HG, Stärtzel W, Wahl F. [On the hygienic construction of new heating power stations]. Z Gesamte Hyg 1966; 12:489-95. [PMID: 5924208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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44
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Wahl F. Wesen und Bekämpfung der Kachexie bei chronischen Unterleibsentzündungen der Frau. Dtsch Med Wochenschr 1948; 73:77-80. [DOI: 10.1055/s-0028-1118056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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