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Dutta UP, Bhatt JH, Nagori I, Kagathara N, Zalavadiya R, Sapkota D. Multidisciplinary approach for acute MI complicated by ventricular tachycardia, stent thrombosis, and multi-organ failure: A case report. Clin Case Rep 2024; 12:e8442. [PMID: 38292223 PMCID: PMC10823560 DOI: 10.1002/ccr3.8442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 12/31/2023] [Accepted: 01/07/2024] [Indexed: 02/01/2024] Open
Abstract
Key Clinical Message The case highlights the imperative requirement for multidisciplinary action in handling a myocardial infarction case, complicated by rare and severe events like ventricular tachycardia, stent thrombosis, hypoxic brain injury, and multi-organ failure. Abstract This article presents a case of a 53-year-old male, who presented with myocardial infarction that was managed by percutaneous coronary intervention and stent placement. However, it progressed to multiple complications in sequence (ventricular tachycardia, stent thrombosis, hypoxic brain injury, and multi-organ failure). Hopefully, the condition of the patient improved after 2 months from GSC-4 to GCS-9 by a multidisciplinary approach and was discharged for home-based treatment.
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Affiliation(s)
- Ujjwal P. Dutta
- Department of Internal MedicineGMERS Medical College GotriVadodaraGujaratIndia
| | - Jugal Hiren Bhatt
- Department of Internal MedicineGMERS Medical College GotriVadodaraGujaratIndia
| | - Irfan Nagori
- Department of Internal MedicineGMERS Medical College GotriVadodaraGujaratIndia
| | - Nency Kagathara
- Department of Internal MedicineZydus Medical College and HospitalDahodIndia
| | - Rushit Zalavadiya
- Department of Internal MedicineGMERS Medical College GotriVadodaraGujaratIndia
| | - Dilip Sapkota
- Department of MedicineBharatpur HospitalChitwanNepal
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Haertel F, Babst J, Bruening C, Bogoviku J, Otto S, Fritzenwanger M, Gecks T, Ebelt H, Moebius-Winkler S, Schulze PC, Pfeifer R. Effect of Hemolysis Regarding the Characterization and Prognostic Relevance of Neuron Specific Enolase (NSE) after Cardiopulmonary Resuscitation with Extracorporeal Circulation (eCPR). J Clin Med 2023; 12:jcm12083015. [PMID: 37109353 PMCID: PMC10146981 DOI: 10.3390/jcm12083015] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/26/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Hemolysis, a common adverse event associated with veno-arterial extracorporeal membrane oxygenation (VA-ECMO), may affect neuron-specific enolase (NSE) levels and potentially confound its prognostic value in predicting neurological outcomes in resuscitated patients without return of spontaneous circulation (ROSC) that require extracorporeal cardiopulmonary resuscitation (eCPR). Therefore, a better understanding of the relationship between hemolysis and NSE levels could help to improve the accuracy of NSE as a prognostic marker in this patient population. METHODS We retrospectively analyzed the records of patients who received a VA-ECMO for eCPR between 2004 and 2021 and were treated in the medical intensive care unit (ICU) of the University Hospital Jena. The outcome was measured clinically by using the Cerebral Performance Category Scale (CPC) four weeks after eCPR. The serum concentration of NSE (baseline until 96 h) was analyzed by enzyme-linked immunosorbent assay (ELISA). To evaluate the ability of individual NSE measurements to discriminate, receiver operating characteristic (ROC) curves were calculated. Serum-free hemoglobin (fHb, baseline until 96 h) served as a marker for identifying a confounding effect of parallel hemolysis. RESULTS 190 patients were included in our study. A total of 86.8% died within 4 weeks after ICU admission or remained unconscious (CPC 3-5), and 13.2% survived with a residual mild to moderate neurological deficit (CPC 1-2). Starting 24h after CPR, NSE was significantly lower and continued to decrease in patients with CPC 1-2 compared to the group with an unfavorable outcome of CPC 3-5. In addition, when evaluating on the basis of receiver operating characteristic curves (ROC), relevant and stable area under the curve (AUC) values for NSE could be calculated (48 h: 0.85 // 72 h: 0.84 // 96 h: 0.80; p < 0.01), and on the basis of a binary logistic regression model, relevant odds ratios for the NSE values were found even after adjusting for fHb regarding the prediction of an unfavorable outcome of CPC 3-5. The respective adjusted AUCs of the combined predictive probabilities were significant (48 h: 0.79 // 72 h: 0.76 // 96 h: 0.72; p ≤ 0.05). CONCLUSIONS Our study confirms NSE as a reliable prognostic marker for poor neurological outcomes in resuscitated patients receiving VA-ECMO therapy. Furthermore, our results demonstrate that potential hemolysis during VA-ECMO does not significantly impact NSE's prognostic value. These findings are crucial for clinical decision making and prognostic assessment in this patient population.
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Affiliation(s)
- Franz Haertel
- Department of Cardiology and Intensive Care, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Josephine Babst
- Department of Cardiology and Intensive Care, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Christiane Bruening
- Department of Cardiology and Intensive Care, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Jurgen Bogoviku
- Department of Cardiology and Intensive Care, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Sylvia Otto
- Department of Cardiology and Intensive Care, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Michael Fritzenwanger
- Department of Cardiology and Intensive Care, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Thomas Gecks
- Department of Cardiology and Intensive Care, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Henning Ebelt
- Department of Cardiology and Intensive Care, University Hospital Halle (Saale), Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany
- Department for Internal Medicine II, Katholisches Krankenhaus "St. Johann Nepomuk", Haarbergstr. 72, 99097 Erfurt, Germany
| | - Sven Moebius-Winkler
- Department of Cardiology and Intensive Care, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - P Christian Schulze
- Department of Cardiology and Intensive Care, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Ruediger Pfeifer
- Department of Cardiology and Intensive Care, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
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Kılınç Z, Ayyıldız EA, Kaya E, Sahin AS. The Effect of Oxygenation on Mortality in Patients With Head Injury. Cureus 2023; 15:e34385. [PMID: 36874741 PMCID: PMC9976649 DOI: 10.7759/cureus.34385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2023] [Indexed: 02/03/2023] Open
Abstract
Introduction In this study, we planned to investigate the effect of hyperoxygenation on mortality and morbidity in patients with head trauma who were followed and treated in the intensive care unit (ICU). Methods Head trauma cases (n = 119) that were followed in the mixed ICU of a 50-bed tertiary care center in Istanbul between January 2018 and December 2019 were retrospectively analyzed for the negative effects of hyperoxia. Age, gender, height/weight, additional diseases, medications used, ICU indication, Glasgow Coma Scale score recorded during ICU follow-up, Acute Physiology and Chronic Health Evaluation (APACHE) II score, length of hospital/ICU stay, the presence of complications, number of reoperations, length of intubation, and the patient's discharge or death status were evaluated. The patients were divided into three groups according to the highest partial pressure of oxygen (PaO2) value (200 mmHg) in the arterial blood gas (ABG) taken on the first day of admission to the ICU, and ABGs on the day of ICU admission and discharge were compared. Results In comparison, the first arterial oxygen saturation and initial PaO2 mean values were found to be statistically significantly different. There was a statistically significant difference in mortality and reoperation rates between groups. The mortality was higher in groups 2 and 3, and the rate of reoperation was higher in group 1. Conclusion In our study, mortality was found to be high in groups 2 and 3, which we considered hyperoxic. In this study, we tried to draw attention to the negative effects of common and easily administered oxygen therapy on mortality and morbidity in ICU patients.
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Affiliation(s)
- Zehra Kılınç
- Anesthesiology and Reanimation, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, TUR
| | - Elif Aybike Ayyıldız
- Anesthesiology and Reanimation, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, TUR
| | - Ebru Kaya
- Intensive Care Unit, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, TUR
| | - Ayca Sultan Sahin
- Anesthesiology and Reanimation, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, TUR
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Chen X, Chen D, Chen P, Chen A, Deng J, Wei J, Zeng W, Zheng X. Dexmedetomidine Attenuates Apoptosis and Neurological Deficits by Modulating Neuronal NADPH Oxidase 2-Derived Oxidative Stress in Neonates Following Hypoxic Brain Injury. Antioxidants (Basel) 2022; 11:2199. [PMID: 36358571 PMCID: PMC9686745 DOI: 10.3390/antiox11112199] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/26/2022] [Accepted: 11/04/2022] [Indexed: 08/31/2023] Open
Abstract
Hypoxic-ischemic brain injury is an important cause of neonatal neurological deficits. Our previous study demonstrated that dexmedetomidine (Dex) provided neuroprotection against neonatal hypoxic brain injury; however, the underlying mechanisms remain incompletely elucidated. Overactivation of NADPH oxidase 2 (NOX2) can cause neuronal apoptosis and neurological deficits. Hence, we aimed to investigate the role of neuronal NOX2 in Dex-mediated neuroprotection and to explore its potential mechanisms. Hypoxic injury was modeled in neonatal rodents in vivo and in cultured hippocampal neurons in vitro. Our results showed that pre- or post-treatment with Dex improved the neurological deficits and alleviated the hippocampal neuronal damage and apoptosis caused by neonatal hypoxia. In addition, Dex treatment significantly suppressed hypoxia-induced neuronal NOX2 activation; it also reduced oxidative stress, as evidenced by decreases in intracellular reactive oxygen species (ROS) production, malondialdehyde, and 8-hydroxy-2-deoxyguanosine, as well as increases in the antioxidant enzymatic activity of superoxide dismutase and glutathione peroxidase in neonatal rat hippocampi and in hippocampal neurons. Lastly, the posthypoxicneuroprotective action of Dex was almost completely abolished in NOX2-deficient neonatal mice and NOX2-knockdown neurons. In conclusion, our data demonstrated that neuronal NOX2-mediated oxidative stress is involved in the neuroprotection that Dex provides against apoptosis and neurological deficits in neonates following hypoxia.
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Affiliation(s)
- Xiaohui Chen
- Department of Anesthesiology, Shengli Clinical Medical College, Fujian Medical University, Fujian Provincial Hospital, Fuzhou 350001, China
| | - Dongtai Chen
- Department of Anesthesiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou 510060, China
| | - Pinzhong Chen
- Department of Anesthesiology, Shengli Clinical Medical College, Fujian Medical University, Fujian Provincial Hospital, Fuzhou 350001, China
| | - Andi Chen
- Department of Anesthesiology, Shengli Clinical Medical College, Fujian Medical University, Fujian Provincial Hospital, Fuzhou 350001, China
| | - Jianhui Deng
- Department of Anesthesiology, Shengli Clinical Medical College, Fujian Medical University, Fujian Provincial Hospital, Fuzhou 350001, China
| | - Jianjie Wei
- Department of Anesthesiology, Shengli Clinical Medical College, Fujian Medical University, Fujian Provincial Hospital, Fuzhou 350001, China
| | - Weian Zeng
- Department of Anesthesiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou 510060, China
| | - Xiaochun Zheng
- Department of Anesthesiology, Shengli Clinical Medical College, Fujian Medical University, Fujian Provincial Hospital, Fuzhou 350001, China
- Fujian Provincial Key Laboratory of Emergency Medicine, Fujian Provincial Key Laboratory of Critical Care Medicine, Fujian Provincial Co-Constructed Laboratory of “Belt and Road”, Fuzhou 350001, China
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Lee JW, Jeong WH, Kim EJ, Choi I, Song MK. Regulation of Genes Related to Cognition after tDCS in an Intermittent Hypoxic Brain Injury Rat Model. Genes (Basel) 2022; 13:genes13101824. [PMID: 36292709 PMCID: PMC9601999 DOI: 10.3390/genes13101824] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/07/2022] [Accepted: 10/07/2022] [Indexed: 11/04/2022] Open
Abstract
Background: Hypoxic brain injury is a condition caused by restricted oxygen supply to the brain. Several studies have reported cognitive decline, particularly in spatial memory, after exposure to intermittent hypoxia (IH). However, the effect and mechanism of action of IH exposure on cognition have not been evaluated by analyzing gene expression after transcranial direct current stimulation (tDCS). Hence, the purpose of this study was to investigate the effects of tDCS on gene regulation and cognition in a rat model of IH-induced brain injury. Methods: Twenty-four 10-week-old male Sprague−Dawley rats were divided into two groups: IH exposed rats with no stimulation and IH-exposed rats that received tDCS. All rats were exposed to a hypoxic chamber containing 10% oxygen for twelve hours a day for five days. The stimulation group received tDCS at an intensity of 200 µA over the frontal bregma areas for 30 min each day for a week. As a behavior test, the escape latency on the Morris water maze (MWM) test was measured to assess spatial memory before and after stimulation. After seven days of stimulation, gene microarray analysis was conducted with a KEGG mapper tool. Results: Although there were no significant differences between the groups before and after stimulation, there was a significant effect of time and a significant time × group interaction on escape latency. In the microarray analysis, significant fold changes in 12 genes related to neurogenesis were found in the stimulation group after tDCS (p < 0.05, fold change > 2 times, the average of the normalized read count (RC) > 6 times). The highly upregulated genes in the stimulation group after tDCS were SOS, Raf, PI3K, Rac1, IRAK, and Bax. The highly downregulated genes in the stimulation group after tDCS were CHK, Crk, Rap1, p38, Ras, and NF-kB. Conclusion: In this study, we confirmed that SOS, Raf, PI3K, Rac1, IRAK, and Bax were upregulated and that CHK, Crk, Rap1, p38, Ras, and NF-kB were downregulated in a rat model of IH-induced brain injury after application of tDCS.
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Affiliation(s)
- Jin-Won Lee
- Department of Physical & Rehabilitation Medicine, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju 61479, Korea
| | - Won-Hyeong Jeong
- Department of Physical & Rehabilitation Medicine, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju 61479, Korea
| | - Eun-Jong Kim
- Department of Physical & Rehabilitation Medicine, Chonnam National University Medical School, 160, Baekseo-Ro, Dong-Gu, Gwangju 61469, Korea
| | - Insung Choi
- Department of Physical & Rehabilitation Medicine, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju 61479, Korea
- Correspondence: (I.C.); (M.-K.S.); Tel.: +82-62-220-5198 (I.C.); +82-62-220-5186 (M.-K.S.); Fax: +82-62-228-5975 (I.C. & M.-K.S.)
| | - Min-Keun Song
- Department of Physical & Rehabilitation Medicine, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju 61479, Korea
- Department of Physical & Rehabilitation Medicine, Chonnam National University Medical School, 160, Baekseo-Ro, Dong-Gu, Gwangju 61469, Korea
- Correspondence: (I.C.); (M.-K.S.); Tel.: +82-62-220-5198 (I.C.); +82-62-220-5186 (M.-K.S.); Fax: +82-62-228-5975 (I.C. & M.-K.S.)
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Klepper S, Jung S, Dittmann L, Geppert CI, Hartmann A, Beier N, Trollmann R. Further Evidence of Neuroprotective Effects of Recombinant Human Erythropoietin and Growth Hormone in Hypoxic Brain Injury in Neonatal Mice. Int J Mol Sci 2022; 23:ijms23158693. [PMID: 35955834 PMCID: PMC9368903 DOI: 10.3390/ijms23158693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 07/29/2022] [Accepted: 07/30/2022] [Indexed: 02/04/2023] Open
Abstract
Experimental in vivo data have recently shown complementary neuroprotective actions of rhEPO and growth hormone (rhGH) in a neonatal murine model of hypoxic brain injury. Here, we hypothesized that rhGH and rhEPO mediate stabilization of the blood−brain barrier (BBB) and regenerative vascular effects in hypoxic injury to the developing brain. Using an established model of neonatal hypoxia, neonatal mice (P7) were treated i.p. with rhGH (4000 µg/kg) or rhEPO (5000 IU/kg) 0/12/24 h after hypoxic exposure. After a regeneration period of 48 h or 7 d, cerebral mRNA expression of Vegf-A, its receptors and co-receptors, and selected tight junction proteins were determined using qRT-PCR and ELISA. Vessel structures were assessed by Pecam-1 and occludin (Ocln) IHC. While Vegf-A expression increased significantly with rhGH treatment (p < 0.01), expression of the Vegfr and TEK receptor tyrosine kinase (Tie-2) system remained unchanged. RhEPO increased Vegf-A (p < 0.05) and Angpt-2 (p < 0.05) expression. While hypoxia reduced the mean vessel area in the parietal cortex compared to controls (p < 0.05), rhGH and rhEPO prevented this reduction after 48 h of regeneration. Hypoxia significantly reduced the Ocln+ fraction of cortical vascular endothelial cells. Ocln signal intensity increased in the cortex in response to rhGH (p < 0.05) and in the cortex and hippocampus in response to rhEPO (p < 0.05). Our data indicate that rhGH and rhEPO have protective effects on hypoxia-induced BBB disruption and regenerative vascular effects during the post-hypoxic period in the developing brain.
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Affiliation(s)
- Simon Klepper
- Division of Pediatric Neurology, Department of Pediatrics, Friedrich-Alexander Universität Erlangen-Nürnberg, Loschgestr. 15, 91054 Erlangen, Germany
| | - Susan Jung
- Division of Pediatric Neurology, Department of Pediatrics, Friedrich-Alexander Universität Erlangen-Nürnberg, Loschgestr. 15, 91054 Erlangen, Germany
| | - Lara Dittmann
- Division of Pediatric Neurology, Department of Pediatrics, Friedrich-Alexander Universität Erlangen-Nürnberg, Loschgestr. 15, 91054 Erlangen, Germany
| | - Carol I. Geppert
- Institute of Pathology, Friedrich-Alexander Universität Erlangen-Nürnberg, Krankenhausstr. 8, 91054 Erlangen, Germany
| | - Arnd Hartmann
- Institute of Pathology, Friedrich-Alexander Universität Erlangen-Nürnberg, Krankenhausstr. 8, 91054 Erlangen, Germany
| | - Nicole Beier
- Division of Pediatric Neurology, Department of Pediatrics, Friedrich-Alexander Universität Erlangen-Nürnberg, Loschgestr. 15, 91054 Erlangen, Germany
| | - Regina Trollmann
- Division of Pediatric Neurology, Department of Pediatrics, Friedrich-Alexander Universität Erlangen-Nürnberg, Loschgestr. 15, 91054 Erlangen, Germany
- Correspondence: ; Tel.: +49-9131-8533753; Fax: +49-9131-8533389
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Ryczek R, Kwasiborski PJ, Rzeszotarska A, Dymus J, Galas A, Kaźmierczak-Dziuk A, Karasek AM, Mielniczuk M, Buksińska-Lisik M, Korsak J, Krzesiński P. Neuron-Specific Enolase and S100B: The Earliest Predictors of Poor Outcome in Cardiac Arrest. J Clin Med 2022; 11:2344. [PMID: 35566469 PMCID: PMC9102826 DOI: 10.3390/jcm11092344] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 04/03/2022] [Accepted: 04/18/2022] [Indexed: 02/05/2023] Open
Abstract
Background: Proper prognostication is critical in clinical decision-making following out-of-hospital cardiac arrest (OHCA). However, only a few prognostic tools with reliable accuracy are available within the first 24 h after admission. Aim: To test the value of neuron-specific enolase (NSE) and S100B protein measurements at admission as early biomarkers of poor prognosis after OHCA. Methods: We enrolled 82 consecutive patients with OHCA who were unconscious when admitted. NSE and S100B levels were measured at admission, and routine blood tests were performed. Death and poor neurological status at discharge were considered as poor clinical outcomes. We evaluated the optimal cut-off levels for NSE and S100B using logistic regression and receiver operating characteristic (ROC) analyses. Results: High concentrations of both biomarkers at admission were significantly associated with an increased risk of poor clinical outcome (NSE: odds ratio [OR] 1.042 per 1 ng/dL, [1.007−1.079; p = 0.004]; S100B: OR 1.046 per 50 pg/mL [1.004−1.090; p < 0.001]). The dual-marker approach with cut-off values of ≥27.6 ng/mL and ≥696 ng/mL for NSE and S100B, respectively, identified patients with poor clinical outcomes with 100% specificity. Conclusions: The NSE and S100B-based dual-marker approach allowed for early discrimination of patients with poor clinical outcomes with 100% specificity. The proposed algorithm may shorten the time required to establish a poor prognosis and limit the volume of futile procedures performed.
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Affiliation(s)
- Robert Ryczek
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, 04-141 Warsaw, Poland; (R.R.); (A.G.); (A.K.-D.); (A.M.K.); (M.M.); (P.K.)
| | - Przemysław J. Kwasiborski
- Department of Internal Diseases and Cardiology, Regional Hospital in Miedzylesie, 04-749 Warsaw, Poland
| | - Agnieszka Rzeszotarska
- Department of Clinical Transfusion, Military Institute of Medicine, 04-141 Warsaw, Poland; (A.R.); (J.K.)
| | - Jolanta Dymus
- Department of Laboratory Diagnostics, Military Institute of Medicine, 04-141 Warsaw, Poland;
| | - Agata Galas
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, 04-141 Warsaw, Poland; (R.R.); (A.G.); (A.K.-D.); (A.M.K.); (M.M.); (P.K.)
| | - Anna Kaźmierczak-Dziuk
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, 04-141 Warsaw, Poland; (R.R.); (A.G.); (A.K.-D.); (A.M.K.); (M.M.); (P.K.)
| | - Anna M. Karasek
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, 04-141 Warsaw, Poland; (R.R.); (A.G.); (A.K.-D.); (A.M.K.); (M.M.); (P.K.)
| | - Marta Mielniczuk
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, 04-141 Warsaw, Poland; (R.R.); (A.G.); (A.K.-D.); (A.M.K.); (M.M.); (P.K.)
| | - Małgorzata Buksińska-Lisik
- Third Department of Internal Diseases and Cardiology, Second Faculty of Medicine, Medical University of Warsaw, 04-749 Warsaw, Poland;
| | - Jolanta Korsak
- Department of Clinical Transfusion, Military Institute of Medicine, 04-141 Warsaw, Poland; (A.R.); (J.K.)
| | - Paweł Krzesiński
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, 04-141 Warsaw, Poland; (R.R.); (A.G.); (A.K.-D.); (A.M.K.); (M.M.); (P.K.)
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Saleem GT, Fitzpatrick JM, Haider MN, Valera EM. COVID-19-induced surge in the severity of gender-based violence might increase the risk for acquired brain injuries. SAGE Open Med 2021; 9:20503121211050197. [PMID: 34707866 PMCID: PMC8543566 DOI: 10.1177/20503121211050197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 09/14/2021] [Indexed: 12/18/2022] Open
Abstract
While initial reports have emphasized a global rise in the frequency of intimate partner violence following COVID-19, emerging data are now showing a concerning surge in the severity of COVID-19-induced physical intimate partner violence. One of the most dangerous, frequent, yet hidden consequences of severe physical intimate partner violence is acquired brain injury, including repetitive mild traumatic brain injury and hypoxic brain injury. Although the increase in high-risk physical abuse during COVID-19 is gaining recognition, what still remains absent is the urgent discussion on intimate partner violence-related acquired brain injury during these times. The potential analogous surge in intimate partner violence-related acquired brain injury may have implications for both healthcare providers and healthcare actions/policies as repeated brain injuries have been associated with residual functional deficits and chronic disability. In addition, even in the pre-pandemic times, intimate partner violence-related acquired brain injury is likely unrecognized and/or misclassified due to overlap in symptoms with other comorbid disorders. This review aimed to raise awareness about intimate partner violence-related acquired brain injury within the context of COVID-19. Health actions and policies that should be considered as part of the pandemic response to minimize adverse outcomes associated with intimate partner violence-related acquired brain injury have also been discussed.
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Orekhova K, Mazzariol S, Sussan B, Bucci M, Bonsembiante F, Verin R, Centelleghe C. Immunohistochemical Markers of Apoptotic and Hypoxic Damage Facilitate Evidence-Based Assessment in Pups with Neurological Disorders. Vet Sci 2021; 8:vetsci8100203. [PMID: 34679033 PMCID: PMC8537515 DOI: 10.3390/vetsci8100203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/14/2021] [Accepted: 09/18/2021] [Indexed: 12/15/2022] Open
Abstract
Seizures in puppies often present a diagnostic challenge in terms of identifying and treating the underlying cause. Dog breeds with mutations of the MDR1-gene are known to show adverse reactions to certain drugs, yet metabolic imbalance exacerbated by physiologically immature organs and other contributing pathologies require consideration before arriving at a diagnosis. This study analysed the brains of two male, 5-week-old Australian Shepherd siblings that died after displaying severe neurological symptoms upon administration of MilproVet® to treat severe intestinal helminth infection. Despite the initial symptoms being similar, their case histories varied in terms of the symptom duration, access to supportive therapy and post-mortem interval. Histopathology and immunohistochemistry were used to obtain more information about the phase of the pathological processes in the brain, employing protein markers associated with acute hypoxic damage (β-amyloid precursor protein/APP) and apoptosis (diacylglycerolkinase-ζ/DGK-ζ, apoptotic protease activating factor 1/Apaf1, and B-cell lymphoma related protein 2/Bcl-2). The results seem to reflect the course of the animals' clinical deterioration, implicating that the hypoxic damage to the brains was incompatible with life, and suggesting the usefulness of the mentioned immunohistochemical markers in clarifying the cause of death in animals with acute neurological deficits.
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Affiliation(s)
- Ksenia Orekhova
- Department of Comparative Biomedicine and Food Science, University of Padova AGRIPOLIS, viale dell’Università 16, 35020 Legnaro, Italy; (S.M.); (F.B.); (R.V.); (C.C.)
- Correspondence:
| | - Sandro Mazzariol
- Department of Comparative Biomedicine and Food Science, University of Padova AGRIPOLIS, viale dell’Università 16, 35020 Legnaro, Italy; (S.M.); (F.B.); (R.V.); (C.C.)
| | - Beatrice Sussan
- Department of Animal Medicine, Production and Health, University of Padova AGRIPOLIS, viale dell’Università 16, 35020 Legnaro, Italy; (B.S.); (M.B.)
| | - Massimo Bucci
- Department of Animal Medicine, Production and Health, University of Padova AGRIPOLIS, viale dell’Università 16, 35020 Legnaro, Italy; (B.S.); (M.B.)
| | - Federico Bonsembiante
- Department of Comparative Biomedicine and Food Science, University of Padova AGRIPOLIS, viale dell’Università 16, 35020 Legnaro, Italy; (S.M.); (F.B.); (R.V.); (C.C.)
- Department of Animal Medicine, Production and Health, University of Padova AGRIPOLIS, viale dell’Università 16, 35020 Legnaro, Italy; (B.S.); (M.B.)
| | - Ranieri Verin
- Department of Comparative Biomedicine and Food Science, University of Padova AGRIPOLIS, viale dell’Università 16, 35020 Legnaro, Italy; (S.M.); (F.B.); (R.V.); (C.C.)
| | - Cinzia Centelleghe
- Department of Comparative Biomedicine and Food Science, University of Padova AGRIPOLIS, viale dell’Università 16, 35020 Legnaro, Italy; (S.M.); (F.B.); (R.V.); (C.C.)
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10
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Abstract
Oxycodone-induced leukoencephalopathy is a rare diagnosis that should be considered in unconscious patients with appropriate history. We describe a case of a 57-year-old unconscious woman who required intubation and did not respond to naloxone infusion. The unconsciousness was initially thought to be due to hypoxic brain injury. However, a further review of brain imaging showed characteristic features of oxycodone-induced leukoencephalopathy. We describe the pathological and radiological features of this condition, and provide a concise review of the limited literature on this condition. Accurate diagnosis of this condition will be valuable to clinicians and patients in terms of their medium-term and long-term prognosis, and potential for rehabilitation.
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11
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Ryczek R, Kwasiborski PJ, Dymus J, Galas A, Kaźmierczak-Dziuk A, Karasek AM, Mielniczuk M, Buksińska-Lisik M, Krzesiński P. Neuron-specific enolase concentrations for the prediction of poor prognosis of comatose patients after out-of-hospital cardiac arrest: an observational cohort study. Kardiol Pol 2021; 79:546-553. [PMID: 34125928 DOI: 10.33963/kp.15917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 06/08/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Neuron-specific enolase (NSE) is a biomarker for neurological outcomes after cardiac arrest with the most evidence collected thus far; however, recommended prognostic cutoff values are lacking owing to the discrepancies in the published data. AIMS The aim of the study was to establish NSE cutoff values for prognostication in the environment of a cardiac intensive care unit following out-of-hospital cardiac arrest (OHCA). METHODS A consecutive series of 82 patients admitted after OHCA were enrolled. Blood samples for the measurement of NSE levels were collected at admission and after 1 hour, 3, 12, 24, 48, and 72 hours. Neurological outcomes were quantified using the cerebral performance category (CPC) index. Each patient was classified into either the good (CPC ≤2) or poor prognosis (CPC ≥3) group. RESULTS Median NSE concentrations were higher in the poor prognosis group, and the difference reached statistical significance at 48 and 74 hours (84.4 ng/ml vs 22.9 ng/ml at 48 hours and 152.1 ng/ml vs 18.7 ng/ml at 72 hours; P <0.001, respectively). Moreover, in the poor prognosis group, NSE increased significantly between 24 and 72 hours (P <0.001). NSE cutoffs for the prediction of poor prognosis after OHCA were 39.8 ng/ml, 78.7 ng/ml, and 46.2 ng/ml for 24, 48, and 72 hours, respectively. The areas under the curve were significant at each time point, with the highest values at 48 and 72 hours after admission (0.849 and 0.964, respectively). CONCLUSIONS Elevated NSE concentrations with a rise in levels in serial measurements may be utilized in the prognostication algorithm after OHCA.
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Affiliation(s)
- Robert Ryczek
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warszawa, Poland.
| | - Przemysław J Kwasiborski
- 3rd Department of Internal Diseases and Cardiology, Second Faculty of Medicine, Medical University of Warsaw, Warszawa, Poland
| | - Jolanta Dymus
- Department of Laboratory Diagnostics, Military Institute of Medicine, Warszawa, Poland
| | - Agata Galas
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warszawa, Poland
| | - Anna Kaźmierczak-Dziuk
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warszawa, Poland
| | - Anna M Karasek
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warszawa, Poland
| | - Marta Mielniczuk
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warszawa, Poland
| | - Małgorzata Buksińska-Lisik
- 3rd Department of Internal Diseases and Cardiology, Second Faculty of Medicine, Medical University of Warsaw, Warszawa, Poland
| | - Paweł Krzesiński
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warszawa, Poland
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12
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Węgrzyn D, Kutwin-Chojnacka A, Bilski J, Mroszczyk K, Węgrzyn K. Neurotrophic Factors in the Treatment of Acute Brain Hypoxia Secondary to Cardiac Arrest: a Case Report. J Med Life 2019; 12:233-235. [PMID: 31666823 PMCID: PMC6814887 DOI: 10.25122/jml-2019-1007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Finding neuroprotective agents to counteract the deleterious effects of hypoxia on neuronal cells successfully is one of the most critical targets of clinical research since preclinical studies have identified potential neuroprotective strategies. In clinical practice, amantadine and piracetam are used with reasonable success. We present the cases of three patients with acute brain hypoxia secondary to cardiac arrest, to whom Cerebrolysin was added to the standard neuroprotective treatment regimen, leading to a notable improvement in functional outcome.
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Affiliation(s)
- D Węgrzyn
- Anesthesiology and Intensive Care Department, Maria Sklodowska-Curie's District Hospital, Skarzysko Kamienna, Poland
| | - A Kutwin-Chojnacka
- Anesthesiology and Intensive Care Department, Maria Sklodowska-Curie's District Hospital, Skarzysko Kamienna, Poland
| | - J Bilski
- Anesthesiology and Intensive Care Department, Maria Sklodowska-Curie's District Hospital, Skarzysko Kamienna, Poland
| | - K Mroszczyk
- Danylo Halytskyi, Lviv National Medical University, Lviv, Ukraine
| | - K Węgrzyn
- Danylo Halytskyi, Lviv National Medical University, Lviv, Ukraine
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13
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Shavelle RM, Brooks JC, Strauss DJ. An update on survival after anoxic brain injury in adolescents and young adults. Brain Inj 2018; 32:1879. [PMID: 30373386 DOI: 10.1080/02699052.2018.1541100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
While much is known about long-term survival after traumatic brain injury, less is known about survival after anoxic/hypoxic brain injury. We previously compared the two and found no significant difference (hazard ratio [HR] 0.97, p=0.92) after controlling for age, sex, and severity of disability. The present study updates this, based on 1,802 patients with TBI and 380 with anoxic, aged 15 to 25, evaluated in 1986 or later, and who survived one year post injury. The anoxic group had higher mortality (HR = 1.13), though again the difference was not statistically significant (p=0.58).
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14
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Forgacs PB, Fridman EA, Goldfine AM, Schiff ND. Isolation Syndrome after Cardiac Arrest and Therapeutic Hypothermia. Front Neurosci 2016; 10:259. [PMID: 27375420 PMCID: PMC4899438 DOI: 10.3389/fnins.2016.00259] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 05/23/2016] [Indexed: 11/23/2022] Open
Abstract
Here, we present the first description of an isolation syndrome in a patient who suffered prolonged cardiac arrest and underwent a standard therapeutic hypothermia protocol. Two years after the arrest, the patient demonstrated no motor responses to commands, communication capabilities, or visual tracking at the bedside. However, resting neuronal metabolism and electrical activity across the entire anterior forebrain was found to be normal despite severe structural injuries to primary motor, parietal, and occipital cortices. In addition, using quantitative electroencephalography, the patient showed evidence for willful modulation of brain activity in response to auditory commands revealing covert conscious awareness. A possible explanation for this striking dissociation in this patient is that altered neuronal recovery patterns following therapeutic hypothermia may lead to a disproportionate preservation of anterior forebrain cortico-thalamic circuits even in the setting of severe hypoxic injury to other brain areas. Compared to recent reports of other severely brain-injured subjects with such dissociation of clinically observable (overt) and covert behaviors, we propose that this case represents a potentially generalizable mechanism producing an isolation syndrome of blindness, motor paralysis, and retained cognition as a sequela of cardiac arrest and therapeutic hypothermia. Our findings further support that highly-preserved anterior cortico-thalamic integrity is associated with the presence of conscious awareness independent from the degree of injury to other brain areas.
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Affiliation(s)
- Peter B Forgacs
- Feil Family Brain and Mind Research Institute, Weill Cornell Medical CollegeNew York, NY, USA; Department of Neurology, Weill Cornell Medical CollegeNew York, NY, USA; The Rockefeller UniversityNew York, NY, USA
| | - Esteban A Fridman
- Feil Family Brain and Mind Research Institute, Weill Cornell Medical College New York, NY, USA
| | - Andrew M Goldfine
- Department of Neurology, SUNY Stony Brook Medical Center Stony Brook, NY, USA
| | - Nicholas D Schiff
- Feil Family Brain and Mind Research Institute, Weill Cornell Medical CollegeNew York, NY, USA; Department of Neurology, Weill Cornell Medical CollegeNew York, NY, USA; The Rockefeller UniversityNew York, NY, USA
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15
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Rana KS, Narwal V, Chauhan L, Singh G, Sharma M, Chauhan S. Structural and Perfusion Abnormalities of Brain on MRI and Technetium-99m-ECD SPECT in Children With Cerebral Palsy: A Comparative Study. J Child Neurol 2016; 31:589-92. [PMID: 26353878 DOI: 10.1177/0883073815604224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 07/31/2015] [Indexed: 11/16/2022]
Abstract
Cerebral palsy has traditionally been associated with hypoxic ischemic brain damage. This study was undertaken to demonstrate structural and perfusion brain abnormalities. Fifty-six children diagnosed clinically as having cerebral palsy were studied between 1 to 14 years of age and were subjected to 3 Tesla magnetic resonance imaging (MRI). Brain and Technetium-99m-ECD brain single-photon emission computed tomography (SPECT) scan. Male to female ratio was 1.8:1 with a mean age of 4.16 ± 2.274 years. Spastic cerebral palsy was the most common type, observed in 91%. Birth asphyxia was the most common etiology (69.6%). White matter changes (73.2%) such as periventricular leukomalacia and corpus callosal thinning were the most common findings on MRI. On SPECT all cases except one revealed perfusion impairments in different regions of brain. MRI is more sensitive in detecting white matter changes, whereas SPECT is better in detecting cortical and subcortical gray matter abnormalities of perfusion.
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Affiliation(s)
| | - Varun Narwal
- Department of Pediatrics, Narayana Hrudayalaya, Bangalore, Karnataka, India
| | - Lokesh Chauhan
- Department of Pediatrics, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Giriraj Singh
- Department of Radiodiagnosis, Command Hospital, Southern Command, Pune, India
| | - Monica Sharma
- Department of Obstetrics and Gynaecology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Suneel Chauhan
- Department of Nuclear Medicine, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
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16
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Akdemir HU, Yardan T, Kati C, Duran L, Alacam H, Yavuz Y, Okuyucu A. The role of S100B protein, neuron-specific enolase, and glial fibrillary acidic protein in the evaluation of hypoxic brain injury in acute carbon monoxide poisoning. Hum Exp Toxicol 2014; 33:1113-20. [PMID: 24505052 DOI: 10.1177/0960327114521049] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The main purpose of this study was to assess the role of S100B protein, neuron-specific enolase (NSE), and glial fibrillary acidic protein (GFAP) in the evaluation of hypoxic brain injury in acute carbon monoxide (CO)-poisoned patients. This cross-sectional study was conducted among the patients with acute CO poisoning who referred to the emergency department in a 1-year period. Serum levels of S100B protein, NSE, and GFAP were determined on admission. A total of 55 CO-poisoned patients (mean age ± standard deviation, 45 ± 20.3 years; 60% women) were included in the study. The control group consisted of 25 healthy adults. The patients were divided into two groups according to whether they were conscious or unconscious. The serum levels of S100B, NSE, and GFAP were higher in patients than that in the control group. There was no significant difference between unconscious and conscious patients with respect to these markers. There was a statistically significant difference between the conscious and unconscious patients and the control group in terms of S100B and NSE levels. There was also a statistically significant difference between the unconscious patients and the control group in terms of GFAP levels. Increased serum S100B, NSE, and GFAP levels are associated with acute CO poisoning. These biomarkers can be useful in assessing the clinical status of patients with CO poisoning.
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Affiliation(s)
- H U Akdemir
- Faculty of Medicine, Department of Emergency Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - T Yardan
- Faculty of Medicine, Department of Emergency Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - C Kati
- Faculty of Medicine, Department of Emergency Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - L Duran
- Faculty of Medicine, Department of Emergency Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - H Alacam
- Department of Biochemistry, Ondokuz Mayis University, Samsun, Turkey
| | - Y Yavuz
- Faculty of Medicine, Department of Emergency Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - A Okuyucu
- Department of Biochemistry, Ondokuz Mayis University, Samsun, Turkey
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17
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Zhu BG, Sun Y, Sun ZQ, Yang G, Zhou CH, Zhu RS. Optimal dosages of fluoxetine in the treatment of hypoxic brain injury induced by 3-nitropropionic acid: implications for the adjunctive treatment of patients after acute ischemic stroke. CNS Neurosci Ther 2012; 18:530-5. [PMID: 22515819 PMCID: PMC6493556 DOI: 10.1111/j.1755-5949.2012.00315.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Revised: 01/16/2012] [Accepted: 01/20/2012] [Indexed: 01/03/2023] Open
Abstract
AIM The serotonin selective reuptake inhibitor fluoxetine (Flx) has tried to treat patients suffered acute ischemic stroke because of its possible neuroprotective actions. However, besides the neuroprotective effect, Flx at high concentration also induces some actions in contradiction to neuroprotection in the brain. The purpose of this study was to investigate whether Flx presents neuroprotective effect against 3-nitropropionic acid (3-NP)-induced hypoxic brain injury, and what is the most suitable dosage of Flx. METHODS Mouse model was established by subacute systemic administration of 3-NP. Rotarod and pole tests were used to evaluate motor deficit. The oxidative stress and oxidative DNA damage were assessed respectively by measuring malondialdehyde and 8-hydroxydeoxyguanosine content in brain homogenates. RESULTS According to measurements in the rotarod test, 7 days pretreatment plus 5 days treatment of Flx at low (2.5 mg/kg/day) and, to a lesser degree, medium (5 mg/kg/day) doses exerted a rapid and strong protection against the neurotoxicity induced by 3-NP, whereas Flx at high dose (10mg/kg/day) showed a much late and light effect. Similarly, in the pole test, Flx at 2.5 mg/kg/day had the strongest protective effects. Again, only Flx administration at 2.5 mg/kg/day canceled out the enhancement of malondialdehyde and 8-hydroxydeoxyguanosine in striatum following 3-NP neurotoxication. CONCLUSIONS Flx attenuated the motor deficits induced by 3-NP in a dose-dependent manner. In contrary to the high dose, Flx at the lower doses had a more remarkable effect against 3-NP insult, similar to acute ischemic stroke.
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Affiliation(s)
- Bing-Gen Zhu
- Department of Physiology, Tongji University School of Medicine, Shanghai, China.
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