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Cerebral arterial stiffness is linked to white matter hyperintensities and perivascular spaces in older adults - A 4D flow MRI study. 脑动脉僵化与老年人白质高密度和血管周围间隙有关--4D 流磁共振成像研究。
IF 4.9 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-08-01 Epub Date: 2024-02-05 DOI: 10.1177/0271678X241230741
Cecilia Björnfot, Anders Eklund, Jenny Larsson, William Hansson, Johan Birnefeld, Anders Garpebring, Sara Qvarlander, Lars-Owe D Koskinen, Jan Malm, Anders Wåhlin

White matter hyperintensities (WMH), perivascular spaces (PVS) and lacunes are common MRI features of small vessel disease (SVD). However, no shared underlying pathological mechanism has been identified. We investigated whether SVD burden, in terms of WMH, PVS and lacune status, was related to changes in the cerebral arterial wall by applying global cerebral pulse wave velocity (gcPWV) measurements, a newly described marker of cerebral vascular stiffness. In a population-based cohort of 190 individuals, 66-85 years old, SVD features were estimated from T1-weighted and FLAIR images while gcPWV was estimated from 4D flow MRI data. Additionally, the gcPWV's stability to variations in field-of-view was analyzed. The gcPWV was 10.82 (3.94) m/s and displayed a significant correlation to WMH and white matter PVS volume (r = 0.29, p < 0.001; r = 0.21, p = 0.004 respectively from nonparametric tests) that persisted after adjusting for age, blood pressure variables, body mass index, ApoB/A1 ratio, smoking as well as cerebral pulsatility index, a previously suggested early marker of SVD. The gcPWV displayed satisfactory stability to field-of-view variations. Our results suggest that SVD is accompanied by changes in the cerebral arterial wall that can be captured by considering the velocity of the pulse wave transmission through the cerebral arterial network.

白质高密度(WMH)、血管周围间隙(PVS)和裂隙是小血管病(SVD)常见的磁共振成像特征。然而,目前尚未发现共同的潜在病理机制。我们通过测量全局脑脉搏波速度(gcPWV)(一种新描述的脑血管僵硬度标记),研究了小血管病变的负荷(WMH、PVS和裂隙状态)是否与脑动脉壁的变化有关。在一个由 190 名 66-85 岁的人群组成的队列中,SVD 特征是通过 T1 加权和 FLAIR 图像估算的,而 gcPWV 则是通过四维血流 MRI 数据估算的。此外,还分析了 gcPWV 对视场变化的稳定性。gcPWV 为 10.82 (3.94) m/s,与 WMH 和白质 PVS 体积有显著相关性(r = 0.29,p<0.05)。
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引用次数: 0
Lower GLUT1 and unchanged MCT1 in Alzheimer's disease cerebrovasculature. 阿尔茨海默氏症脑血管中的 GLUT1 降低,MCT1 不变。
IF 4.9 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-08-01 Epub Date: 2024-03-05 DOI: 10.1177/0271678X241237484
Manon Leclerc, Cyntia Tremblay, Philippe Bourassa, Julie A Schneider, David A Bennett, Frédéric Calon

The brain is a highly demanding organ, utilizing mainly glucose but also ketone bodies as sources of energy. Glucose transporter-1 (GLUT1) and monocarboxylates transporter-1 (MCT1) respectively transport glucose and ketone bodies across the blood-brain barrier. While reduced glucose uptake by the brain is one of the earliest signs of Alzheimer's disease (AD), no change in the uptake of ketone bodies has been evidenced yet. To probe for changes in GLUT1 and MCT1, we performed Western immunoblotting in microvessel extracts from the parietal cortex of 60 participants of the Religious Orders Study. Participants clinically diagnosed with AD had lower cerebrovascular levels of GLUT1, whereas MCT1 remained unchanged. GLUT1 reduction was associated with lower cognitive scores. No such association was found for MCT1. GLUT1 was inversely correlated with neuritic plaques and cerebrovascular β-secretase-derived fragment levels. No other significant associations were found between both transporters, markers of Aβ and tau pathologies, sex, age at death or apolipoprotein-ε4 genotype. These results suggest that, while a deficit of GLUT1 may underlie the reduced transport of glucose to the brain in AD, no such impairment occurs for MCT1. This study thus supports the exploration of ketone bodies as an alternative energy source for the aging brain.

大脑是一个需要大量能量的器官,主要利用葡萄糖,但也利用酮体作为能量来源。葡萄糖转运体-1(GLUT1)和单羧酸盐转运体-1(MCT1)分别通过血脑屏障转运葡萄糖和酮体。大脑对葡萄糖的吸收减少是阿尔茨海默病(AD)最早出现的症状之一,但目前还没有证据表明酮体的吸收发生了变化。为了探究 GLUT1 和 MCT1 的变化,我们对 60 名宗教团体研究参与者顶叶皮层的微血管提取物进行了 Western 免疫印迹分析。临床诊断为AD的参与者脑血管中的GLUT1水平较低,而MCT1则保持不变。GLUT1 的降低与认知评分的降低有关。而 MCT1 则没有发现这种关联。GLUT1与神经斑块和脑血管β-分泌酶衍生片段水平成反比。在这两种转运体、Aβ和tau病理标记物、性别、死亡年龄或载脂蛋白-ε4基因型之间没有发现其他重要关联。这些结果表明,虽然GLUT1的缺失可能是导致AD患者大脑葡萄糖转运减少的原因,但MCT1却没有出现这种障碍。因此,这项研究支持探索将酮体作为衰老大脑的替代能源。
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引用次数: 0
The brain's "dark energy" puzzle: How strongly is glucose metabolism linked to resting-state brain activity? 大脑的 "暗能量 "之谜:葡萄糖代谢与静息状态大脑活动的联系有多强?
IF 4.9 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-08-01 Epub Date: 2024-03-05 DOI: 10.1177/0271678X241237974
Tommaso Volpi, Erica Silvestri, Marco Aiello, John J Lee, Andrei G Vlassenko, Manu S Goyal, Maurizio Corbetta, Alessandra Bertoldo

Brain glucose metabolism, which can be investigated at the macroscale level with [18F]FDG PET, displays significant regional variability for reasons that remain unclear. Some of the functional drivers behind this heterogeneity may be captured by resting-state functional magnetic resonance imaging (rs-fMRI). However, the full extent to which an fMRI-based description of the brain's spontaneous activity can describe local metabolism is unknown. Here, using two multimodal datasets of healthy participants, we built a multivariable multilevel model of functional-metabolic associations, assessing multiple functional features, describing the 1) rs-fMRI signal, 2) hemodynamic response, 3) static and 4) time-varying functional connectivity, as predictors of the human brain's metabolic architecture. The full model was trained on one dataset and tested on the other to assess its reproducibility. We found that functional-metabolic spatial coupling is nonlinear and heterogeneous across the brain, and that local measures of rs-fMRI activity and synchrony are more tightly coupled to local metabolism. In the testing dataset, the degree of functional-metabolic spatial coupling was also related to peripheral metabolism. Overall, although a significant proportion of regional metabolic variability can be described by measures of spontaneous activity, additional efforts are needed to explain the remaining variance in the brain's 'dark energy'.

脑糖代谢可通过[18F]FDG PET进行宏观研究,但其区域变异性很大,原因尚不清楚。静息态功能磁共振成像(rs-fMRI)可以捕捉到这种异质性背后的一些功能驱动因素。然而,基于 fMRI 的大脑自发活动描述能在多大程度上描述局部新陈代谢还不得而知。在这里,我们利用两个健康参与者的多模态数据集,建立了一个功能-代谢关联的多变量多层次模型,评估了多种功能特征,描述了 1)rs-fMRI 信号、2)血液动力学响应、3)静态和 4)时变功能连接,作为人脑代谢结构的预测因子。完整模型在一个数据集上进行了训练,并在另一个数据集上进行了测试,以评估其可重复性。我们发现,整个大脑的功能-代谢空间耦合是非线性和异质性的,rs-fMRI 活动和同步的局部测量与局部代谢的耦合更为紧密。在测试数据集中,功能-代谢空间耦合的程度也与外周代谢有关。总之,尽管自发活动的测量方法可以描述相当一部分区域代谢变异,但要解释大脑 "暗能量 "的其余变异还需要更多努力。
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引用次数: 0
Critical role of Slc22a8 in maintaining blood-brain barrier integrity after experimental cerebral ischemia-reperfusion. Slc22a8 在实验性脑缺血再灌注后维持血脑屏障完整性的关键作用
IF 4.9 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-07-28 DOI: 10.1177/0271678X241264401
Yangyang Liu, Xiang Li, Chang Cao, Haojie Ding, Xuan Shi, Juyi Zhang, Haiying Li

Blood-brain barrier (BBB) damage significantly affects the prognosis of ischemic stroke patients. This project employed multi-omics analysis to identify key factors regulating BBB disruption during cerebral ischemia-reperfusion. An integrated analysis of three transcriptome sequencing datasets from mouse middle cerebral artery occlusion/reperfusion (MCAO/R) models identified eight downregulated genes in endothelial cells. Additionally, transcriptome analysis of BBB (cortex) and non-BBB (lung) endothelium of E13.5 mice revealed 2,102 upregulated genes potentially associated with BBB integrity. The eight downregulated genes were intersected with the 2,102 BBB-related genes and mapped using single-cell RNA sequencing data, revealing that solute carrier family 22 member 8 (Slc22a8) is specifically expressed in endothelial cells and pericytes and significantly decreases after MCAO/R. This finding was validated in the mouse MCAO/R model at both protein and mRNA levels in this study. External overexpression of Slc22a8 using a lentivirus carrying Tie2 improved Slc22a8 and tight junction protein levels and reduced BBB leakage after MCAO/R, accompanied by Wnt/β-catenin signaling activation. In conclusion, this study suggested that MCAO/R-induced downregulation of Slc22a8 expression may be a crucial mechanism underlying BBB disruption. Interventions that promote Slc22a8 expression or enhance its function hold promise for improving the prognosis of patients with cerebral ischemia.

血脑屏障(BBB)损伤严重影响缺血性脑卒中患者的预后。本项目采用多组学分析方法确定脑缺血再灌注过程中调控血脑屏障破坏的关键因素。通过对小鼠大脑中动脉闭塞/再灌注(MCAO/R)模型的三个转录组测序数据集进行综合分析,确定了内皮细胞中八个下调基因。此外,对E13.5小鼠BBB(大脑皮层)和非BBB(肺部)内皮细胞的转录组分析发现了2102个可能与BBB完整性相关的上调基因。利用单细胞 RNA 测序数据将 8 个下调基因与 2,102 个 BBB 相关基因进行交叉和映射,发现溶质运载家族 22 成员 8 (Slc22a8) 在内皮细胞和周细胞中特异性表达,并在 MCAO/R 后显著下降。本研究在小鼠 MCAO/R 模型的蛋白质和 mRNA 水平上验证了这一发现。使用携带 Tie2 的慢病毒外部过表达 Slc22a8 可提高 Slc22a8 和紧密连接蛋白水平,并减少 MCAO/R 后的 BBB 渗漏,同时激活 Wnt/β-catenin 信号。总之,这项研究表明,MCAO/R诱导的Slc22a8表达下调可能是BBB破坏的一个关键机制。促进Slc22a8表达或增强其功能的干预措施有望改善脑缺血患者的预后。
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引用次数: 0
Exploring ischemic core growth rate and endovascular therapy benefit in large core patients. 探索大核心患者的缺血核心生长率和血管内治疗的益处。
IF 4.9 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-07-26 DOI: 10.1177/0271678X241242911
Longting Lin, Yueming Wang, Chushuang Chen, Andrew Bivard, Kenneth Butcher, Carlos Garcia-Esperon, Neil J Spratt, Christopher R Levi, Xin Cheng, Qiang Dong, Mark W Parsons

After stroke onset, ischemic brain tissue will progress to infarction unless blood flow is restored. Core growth rate measures the infarction speed from stroke onset. This multicenter cohort study aimed to explore whether core growth rate influences benefit from the reperfusion treatment of endovascular thrombectomy in large ischemic core stroke patients. It identified 134 patients with large core volume >70 mL assessed on brain perfusion image within 9 hours of stroke onset. Of 134 patients, 71 received endovascular thrombectomy and 63 did not receive the treatment. Overall, poor outcomes were frequent, with 3-month severed disability or death rate at 56% in treatment group and 68% in no treatment group (p = 0.156). Patients were then stratified by core growth rate. For patients with 'ultrafast core growth' of >70 mL/hour, rates of poor outcome were especially high in patients without endovascular thrombectomy (n = 13/14, 93%) and relatively lower in patients received the treatment (n = 12/20, 60%, p = 0.033). In contrast, for patients with core growth rate <70 mL/hour, there was not a large difference in poor outcomes between patients with and without the treatment (55% vs. 61%, p = 0.522). Therefore, patients with 'ultrafast core growth' might stand to benefit the most from endovascular treatment.

中风发生后,除非血流得到恢复,否则缺血性脑组织将发展为梗死。核心生长速度测量的是从脑卒中发生开始的梗死速度。这项多中心队列研究旨在探讨核心增长速度是否会影响大核心缺血性卒中患者从血管内血栓切除术再灌注治疗中获益。研究确定了 134 名在中风发生后 9 小时内通过脑灌注图像评估出大核心体积大于 70 毫升的患者。在 134 名患者中,71 人接受了血管内血栓切除术,63 人未接受治疗。总体而言,患者的预后较差,治疗组患者 3 个月后残疾或死亡的比例为 56%,未接受治疗组患者的比例为 68%(P = 0.156)。然后根据核心生长速度对患者进行分层。对于核心生长速度大于 70 毫升/小时的 "超快核心生长 "患者,未接受血管内血栓切除术的患者预后不佳的比例尤其高(n = 13/14,93%),而接受治疗的患者预后不佳的比例相对较低(n = 12/20,60%,p = 0.033)。相比之下,核心生长率
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引用次数: 0
Preliminary investigations into human neurofluid transport using multiple novel non-contrast MRI methods. 利用多种新型非对比核磁共振成像方法对人体神经流体传输的初步研究。
IF 4.9 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-07-25 DOI: 10.1177/0271678X241264407
Swati Rane Levendovszky, Jaqueline Flores, Elaine R Peskind, Lena Václavů, Matthias Jp van Osch, Jeffrey Iliff

We discuss two potential non-invasive MRI methods to study phenomena related to subarachnoid cerebrospinal fluid (CSF) motion and perivascular fluid transport, and their association with sleep and aging. We apply diffusion-based intravoxel incoherent motion (IVIM) imaging to evaluate pseudodiffusion coefficient, D*, or CSF movement across large spaces like the subarachnoid space (SAS). We also performed perfusion-based multi-echo, Hadamard encoded arterial spin labeling (ASL) to evaluate whole brain cortical cerebral blood flow (CBF) and trans-endothelial exchange (Tex) of water from the vasculature into the perivascular space and parenchyma. Both methods were used in young adults (N = 9, 6 F, 23 ± 3 years old) in the setting of sleep and sleep deprivation. To study aging, 10 older adults (6 F, 67 ± 3 years old) were imaged after a night of normal sleep and compared with the young adults. D* in SAS was significantly (p < 0.05) reduced with sleep deprivation (0.016 ± 0.001 mm2/s) compared to normal sleep (0.018 ± 0.001 mm2/s) and marginally reduced with aging (0.017 ± 0.001 mm2/s, p = 0.029). Cortical CBF and Tex were unchanged with sleep deprivation but significantly lower in older adults (37 ± 3 ml/100 g/min, 578 ± 61 ms) than in young adults (42 ± 2 ml/100 g/min, 696 ± 62 ms). IVIM was sensitive to sleep physiology and aging, and multi-echo, multi-delay ASL was sensitive to aging.

我们讨论了两种潜在的无创磁共振成像方法,用于研究蛛网膜下腔脑脊液(CSF)运动和血管周围液体运输的相关现象,以及它们与睡眠和衰老的关系。我们应用基于扩散的体外非相干运动(IVIM)成像来评估假扩散系数 D* 或 CSF 在蛛网膜下腔(SAS)等大空间的运动。我们还进行了基于灌注的多回波、哈达玛编码动脉自旋标记(ASL),以评估全脑皮质脑血流(CBF)和从血管进入血管周围间隙和实质的水的跨内皮交换(Tex)。这两种方法均用于睡眠和睡眠剥夺环境下的年轻成人(N = 9,6 名女性,23 ± 3 岁)。为了研究衰老问题,10 名老年人(6 名女性,67 ± 3 岁)在一夜正常睡眠后接受了成像,并与年轻人进行了比较。与正常睡眠(0.018 ± 0.001 mm2/s)相比,SAS 中的 D* 明显降低(p 2/s),并且随着年龄的增长而略有降低(0.017 ± 0.001 mm2/s,p = 0.029)。皮层 CBF 和 Tex 随睡眠剥夺而变化,但老年人(37 ± 3 ml/100 g/min,578 ± 61 ms)明显低于年轻人(42 ± 2 ml/100 g/min,696 ± 62 ms)。IVIM 对睡眠生理和衰老敏感,而多回波、多延迟 ASL 对衰老敏感。
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引用次数: 0
Static autoregulation in humans. 人体的静态自动调节
IF 4.9 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-07-25 DOI: 10.1177/0271678X241258701
Olaf B Paulson, Svend Strandgaard, Jes Olesen, Jean-Claude Baron

A recent publication in JCBFM, "Static autoregulation in humans" gives rise to critical comments. Autoregulation of cerebral blood flow implies that flow is rather constant within a certain blood pressure (BP) range with a lower and an upper pressure limit. The physiology at the two limits is very different, making comparison of the brain's vulnerability at the limits questionable. The recent publication in JCBFM claims a narrow autoregulatory range based on pooling of data from several studies. However, we argue that such pooling blurs the autoregulatory limits. We summarize the classical literature, therefrom we argue for a broad autoregulatory range.

JCBFM 最近发表的一篇题为 "人类的静态自动调节 "的文章引起了批评。脑血流的自动调节意味着,在一定的血压(BP)范围内,血流是相当恒定的,有一个血压下限和一个血压上限。这两个极限的生理学原理截然不同,因此,比较大脑在这两个极限的脆弱性是值得商榷的。JCBFM 上最近发表的一篇文章称,根据对多项研究数据的汇总,自动调节范围较窄。然而,我们认为这种数据汇集模糊了自动调节极限。我们总结了经典文献,并据此提出了宽泛的自动调节范围的观点。
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引用次数: 0
Pericyte response to ischemic stroke precedes endothelial cell death and blood-brain barrier breakdown. 缺血性中风的周细胞反应先于内皮细胞死亡和血脑屏障破坏。
IF 4.9 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-07-25 DOI: 10.1177/0271678X241261946
Michaela Roth, Robert Carlsson, Carolina Buizza, Andreas Enström, Gesine Paul

Stroke is one of the leading causes of death and disability, yet the cellular response to the ischemic insult is poorly understood limiting therapeutic options. Brain pericytes are crucial for maintaining blood-brain barrier (BBB) integrity and are known to be one of the first responders to ischemic stroke. The exact timeline of cellular events after stroke, however, remains elusive. Using the permanent middle cerebral artery occlusion stroke model, we established a detailed timeline of microvascular events after experimental stroke. Our results show that pericytes respond already within 1 hour after the ischemic insult. We find that approximately 30% of the pericyte population dies as early as 1 hour after stroke, while ca 50% express markers that indicate activation. A decrease of endothelial tight junctions, signs of endothelial cell death and reduction in blood vessel length are only detected at time points after the initial pericyte response. Consistently, markers of BBB leakage are observed several hours after pericyte cell death and/or vascular detachment. Our results suggest that the pericyte response to stroke occurs early and precedes both the endothelial response and the BBB breakdown. This highlights pericytes as an important target cell type to develop new diagnostic and therapeutic tools.

中风是导致死亡和残疾的主要原因之一,但人们对缺血性损伤的细胞反应知之甚少,从而限制了治疗方案的选择。脑周细胞对维持血脑屏障(BBB)的完整性至关重要,是缺血性中风的第一反应者之一。然而,中风后细胞事件的确切时间表仍然难以确定。利用永久性大脑中动脉闭塞中风模型,我们建立了实验性中风后微血管事件的详细时间表。我们的研究结果表明,周细胞在缺血损伤后 1 小时内就已做出反应。我们发现,早在中风后 1 小时,约 30% 的周细胞就已死亡,而约 50% 的周细胞表达了表明其活化的标记物。内皮紧密连接的减少、内皮细胞死亡的迹象和血管长度的减少只有在最初的周细胞反应之后的时间点才能检测到。同样,在周细胞死亡和/或血管脱落数小时后,才会观察到 BBB 渗漏的标志物。我们的研究结果表明,周细胞对中风的反应发生得很早,而且先于内皮反应和 BBB 破坏。这突显了周细胞是开发新诊断和治疗工具的重要靶细胞类型。
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引用次数: 0
Spreading depolarization causes reversible neuronal mitochondria fragmentation and swelling in healthy, normally perfused neocortex. 在正常灌注的健康新皮质中,蔓延性去极化会导致可逆的神经元线粒体破碎和肿胀。
IF 4.9 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-07-25 DOI: 10.1177/0271678X241257887
Jeremy Sword, Ioulia V Fomitcheva, Sergei A Kirov

Mitochondrial function is tightly linked to morphology, and fragmentation of dendritic mitochondria during noxious conditions suggests loss of function. In the normoxic cortex, spreading depolarization (SD) is a phenomenon underlying migraine aura. It is unknown whether mitochondria structure is affected by normoxic SD. In vivo two-photon imaging followed by quantitative serial section electron microscopy (ssEM) was used to monitor dendritic mitochondria in the normoxic cortex of urethane-anesthetized mature male and female mice during and after SD initiated by focal KCl microinjection. Structural dynamics of dendrites and their mitochondria were visualized by transfecting excitatory, glutamatergic neurons of the somatosensory cortex with bicistronic AAV, which induced tdTomoto labeling in neuronal cytoplasm and mitochondria labeling with roGFP. Normoxic SD triggered rapidly reversible fragmentation of dendritic mitochondria alongside dendritic beading; however, mitochondria took significantly longer to recover. Several rounds of SD resulted in transient mitochondrial fragmentation and dendritic beading without accumulating injury, as both recovered. SsEM corroborated normoxic SD-elicited dendritic and mitochondrial swelling and transformation of the filamentous mitochondrial network into shorter, swollen tubular, and globular structures. Our results revealed normoxic SD-induced disruption of the dendritic mitochondrial structure that might impact mitochondrial bioenergetics during migraine with aura.

线粒体的功能与形态密切相关,有害条件下树突线粒体的碎裂表明线粒体功能丧失。在常氧皮层中,扩散性去极化(SD)是偏头痛先兆的一种基本现象。线粒体结构是否会受到常氧 SD 的影响尚不清楚。研究人员利用活体双光子成像技术和定量序列切片电子显微镜(ssEM),在局灶氯化钾显微注射引发SD期间和之后,对尿烷麻醉的成熟雌雄小鼠常氧皮层中的树突线粒体进行了监测。用双组分 AAV 转染躯体感觉皮层的兴奋性谷氨酸能神经元,诱导神经元胞质中的tdTomoto 标记和线粒体上的 roGFP 标记,从而观察树突及其线粒体的结构动态。常氧标本诱导树突线粒体快速可逆地破碎,同时出现树突串珠;然而,线粒体需要更长的时间才能恢复。几轮 SD 会导致一过性的线粒体破碎和树突串珠,但不会造成累积性损伤,因为两者都会恢复。SsEM 证实了常氧 SD 引发的树突和线粒体肿胀,以及丝状线粒体网络向较短、肿胀的管状和球状结构的转变。我们的研究结果表明,常氧 SD 诱导的树突状线粒体结构破坏可能会影响有先兆偏头痛患者的线粒体生物能。
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引用次数: 0
Intraoperative evaluation of local cerebral hemodynamic change by laser speckle contrast imaging for predicting postoperative cerebral hyperperfusion during STA-MCA bypass in adult patients with moyamoya disease. 通过激光斑点对比成像术中评估局部脑血流动力学变化,预测moyamoya病成人患者STA-MCA搭桥术术后脑过度灌注的情况。
IF 6.3 2区 医学 Q1 Medicine Pub Date : 2024-07-01 Epub Date: 2024-01-17 DOI: 10.1177/0271678X241226483
Tianshu Tao, Wenting Zhu, Jin Yu, Xiang Li, Wei Wei, Miao Hu, Mingrui Luo, Guiping Wan, Pengcheng Li, Jincao Chen, Jianjian Zhang

Cerebral hyperperfusion (CHP) occurred frequently after direct superficial temporal artery-middle cerebral artery (STA-MCA) bypass surgery for moyamoya disease (MMD). We analyzed cortical microvascular density (CMD) and the change of cerebral blood flow (LΔCBF) using intraoperative laser speckle contrast imaging (LSCI) on 130 hemispheres of 95 consecutive adult patients with MMD. The demographic characteristics, cortical hemodynamic sources, bypass methods, intraoperative blood flow data, and relative CBF changes on single-photon emission computed tomography (SPECT) examination (SΔrCBF) were compared between the groups with and without CHP. The median values for CMD, LΔCBF, and SΔrCBF were significantly higher in the CHP group than in the non-CHP group (CMD 0.240 vs 0.206, P = 0.004; LΔCBF 2.285 vs 1.870, P < 0.001; SΔCBF 1.535 vs 1.260, P < 0.001). Multivariate analysis revealed that hemodynamic sources of recipient parasylvian cortical arteries from MCA (M-PSCAs), end-to-side (E-S) bypass method, CMD ≥ 0.217, and LΔCBF ≥ 1.985 were the risk factors for CHP. Intraoperative LSCI was useful for evaluating hemodynamics and predicting CHP in patients with MMD.

颞浅动脉-大脑中动脉(STA-MCA)直接搭桥手术治疗moyamoya病(MMD)后经常出现脑过度灌注(CHP)。我们使用术中激光斑点对比成像(LSCI)分析了连续95例成年MMD患者130个半球的皮质微血管密度(CMD)和脑血流(LΔCBF)的变化。研究人员比较了有CHP组和无CHP组的人口统计学特征、皮质血流动力学来源、分流方法、术中血流数据以及单光子发射计算机断层扫描(SPECT)检查的相对CBF变化(SΔrCBF)。CHP组的CMD、LΔCBF和SΔrCBF中值明显高于非CHP组(CMD 0.240 vs 0.206,P = 0.004;LΔCBF 2.285 vs 1.870,P 0.001;SΔCBF 1.535 vs 1.260,P 0.001)。多变量分析显示,MCA(M-PSCA)受体副皮质动脉的血流动力学来源、端对侧(E-S)旁路方法、CMD ≥ 0.217 和 LΔCBF ≥ 1.985 是 CHP 的风险因素。术中 LSCI 可用于评估 MMD 患者的血液动力学并预测 CHP。
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引用次数: 0
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Journal of Cerebral Blood Flow and Metabolism
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