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Cerebrovascular effects of endothelin-1 investigated using high-resolution magnetic resonance imaging in healthy volunteers 利用高分辨率磁共振成像技术研究内皮素-1对健康志愿者脑血管的影响
Pub Date : 2020-08-01 DOI: 10.1177/0271678X19874295
A. Hougaard, Samaira Younis, Afrim Iljazi, K. Haanes, U. Lindberg, Mark B. Vestergaard, F. Amin, K. Sugimoto, L. Kruse, C. Ayata, M. Ashina
Endothelin-1 (ET-1) is a highly potent vasoconstrictor peptide released from vascular endothelium. ET-1 plays a major role in cerebrovascular disorders and likely worsens the outcome of acute ischaemic stroke and aneurismal subarachnoid haemorrhage through vasoconstriction and cerebral blood flow (CBF) reduction. Disorders that increase the risk of stroke, including hypertension, diabetes mellitus, and acute myocardial infarction, are associated with increased plasma levels of ET-1. The in vivo human cerebrovascular effects of systemic ET-1 infusion have not previously been investigated. In a two-way crossover, randomized, double-blind design, we used advanced 3 tesla MRI methods to investigate the effects of high-dose intravenous ET-1 on intra- and extracranial artery circumferences, global and regional CBF, and cerebral metabolic rate of oxygen (CMRO2) in 14 healthy volunteers. Following ET-1 infusion, we observed a 14% increase of mean arterial blood pressure, a 5% decrease of middle cerebral artery (MCA) circumference, but no effects on extracerebral arteries and no effects on CBF or CMRO2. Collectively, the findings indicate MCA constriction secondarily to blood pressure increase and not due to a direct vasoconstrictor effect of ET-1. We suggest that, as opposed to ET-1 in the subarachnoid space, intravascular ET-1 does not exert direct cerebrovascular effects in humans.
内皮素-1 (ET-1)是一种从血管内皮中释放的高效血管收缩肽。ET-1在脑血管疾病中发挥重要作用,并可能通过血管收缩和脑血流量(CBF)减少而恶化急性缺血性卒中和动脉瘤性蛛网膜下腔出血的结局。高血压、糖尿病和急性心肌梗死等增加中风风险的疾病与血浆ET-1水平升高有关。全身ET-1输注对人体内脑血管的影响尚未被研究过。在双向交叉、随机、双盲设计中,我们使用先进的3特斯拉MRI方法研究了高剂量静脉注射ET-1对14名健康志愿者颅内内外动脉周长、整体和局部CBF以及脑氧代谢率(cro2)的影响。ET-1输注后,我们观察到平均动脉血压升高14%,大脑中动脉(MCA)周长降低5%,但对脑外动脉没有影响,对CBF或cmor2没有影响。总的来说,这些发现表明MCA收缩继发于血压升高,而不是由于ET-1的直接血管收缩作用。我们认为,与ET-1在蛛网膜下腔的作用相反,血管内ET-1对人类的脑血管没有直接作用。
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引用次数: 12
Distinct roles of ezrin, radixin and moesin in maintaining the plasma membrane localizations and functions of human blood–brain barrier transporters ezrin, radixin和moesin在维持人血脑屏障转运蛋白的质膜定位和功能中的独特作用
Pub Date : 2020-07-01 DOI: 10.1177/0271678X19868880
Yutaro Hoshi, Yasuo Uchida, T. Kuroda, M. Tachikawa, P. Couraud, Takashi Suzuki, T. Terasaki
The purpose of this study was to clarify the roles of ERM proteins (ezrin/radixin/moesin) in the regulation of membrane localization and transport activity of transporters at the human blood–brain barrier (BBB). Ezrin or moesin knockdown in a human in vitro BBB model cell line (hCMEC/D3) reduced both BCRP and GLUT1 protein expression levels on the plasma membrane. Radixin knockdown reduced not only BCRP and GLUT1, but also P-gp membrane expression. These results indicate that P-gp, BCRP and GLUT1 proteins are maintained on the plasma membrane via different ERM proteins. Furthermore, moesin knockdown caused the largest decrease of P-gp and BCRP efflux activity among the ERM proteins, whereas GLUT1 influx activity was similarly reduced by knockdown of each ERM protein. To investigate how moesin knockdown reduced P-gp efflux activity without loss of P-gp from the plasma membrane, we examined the role of PKCβI. PKCβI increased P-gp phosphorylation and reduced P-gp efflux activity. Radixin and moesin proteins were detected in isolated human brain capillaries, and their protein abundances were within a 3-fold range, compared with those in hCMEC/D3 cell line. These findings may mean that ezrin, radixin and moesin maintain the functions of different transporters in different ways at the human BBB.
本研究的目的是阐明ERM蛋白(ezrin/radixin/moesin)在调节人血脑屏障(BBB)转运蛋白的膜定位和转运活性中的作用。在体外血脑屏障模型细胞系(hCMEC/D3)中,Ezrin或moesin敲低可降低质膜上BCRP和GLUT1蛋白的表达水平。radxin的下调不仅降低了BCRP和GLUT1的表达,还降低了P-gp膜的表达。这些结果表明,P-gp、BCRP和GLUT1蛋白通过不同的ERM蛋白维持在质膜上。此外,moesin敲低引起ERM蛋白中P-gp和BCRP外排活性的最大下降,而GLUT1内流活性也同样因敲低ERM蛋白而降低。为了研究moesin敲除如何在不损失P-gp的情况下降低P-gp外排活性,我们研究了PKCβI的作用。pkc β 1增加P-gp磷酸化,降低P-gp外排活性。在离体人脑毛细血管中检测到Radixin和moesin蛋白,与hCMEC/D3细胞系相比,其蛋白丰度在3倍范围内。这些发现可能意味着ezrin, radixin和moesin在人类血脑屏障中以不同的方式维持不同转运蛋白的功能。
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引用次数: 16
Calibrated fMRI for dynamic mapping of CMRO2 responses using MR-based measurements of whole-brain venous oxygen saturation 校准的fMRI动态映射cmoro2反应使用基于核磁共振测量全脑静脉氧饱和度
Pub Date : 2020-07-01 DOI: 10.1177/0271678X19867276
Erin K. Englund, M. Fernández-Seara, Ana E. Rodriguez-Soto, Hyunyeol Lee, Zachary B. Rodgers, M. Vidorreta, J. Detre, F. Wehrli
Functional MRI (fMRI) can identify active foci in response to stimuli through BOLD signal fluctuations, which represent a complex interplay between blood flow and cerebral metabolic rate of oxygen (CMRO2) changes. Calibrated fMRI can disentangle the underlying contributions, allowing quantification of the CMRO2 response. Here, whole-brain venous oxygen saturation (Y v ) was computed alongside ASL-measured CBF and BOLD-weighted data to derive the calibration constant, M, using the proposed Y v -based calibration. Data were collected from 10 subjects at 3T with a three-part interleaved sequence comprising background-suppressed 3D-pCASL, 2D BOLD-weighted, and single-slice dual-echo GRE (to measure Y v via susceptometry-based oximetry) acquisitions while subjects breathed normocapnic/normoxic, hyperoxic, and hypercapnic gases, and during a motor task. M was computed via Y v -based calibration from both hypercapnia and hyperoxia stimulus data, and results were compared to conventional hypercapnia or hyperoxia calibration methods. Mean M in gray matter did not significantly differ between calibration methods, ranging from 8.5 ± 2.8% (conventional hyperoxia calibration) to 11.7 ± 4.5% (Yv-based calibration in response to hyperoxia), with hypercapnia-based M values between (p = 0.56). Relative CMRO2 changes from finger tapping were computed from each M map. CMRO2 increased by ∼20% in the motor cortex, and good agreement was observed between the conventional and proposed calibration methods.
功能磁共振成像(fMRI)可以通过BOLD信号波动识别对刺激反应的活动病灶,BOLD信号波动代表了血流量和脑氧代谢率(cro2)变化之间的复杂相互作用。校准的功能磁共振成像可以解开潜在的贡献,允许量化cmor2反应。在这里,计算全脑静脉氧饱和度(Y v)与asl测量的CBF和bold加权数据一起,使用提出的基于Y v的校准,得出校准常数M。数据来自10名受试者,在3T时,当受试者呼吸正氧/正氧、高氧和高氧气体时,通过三部分交错序列收集数据,包括背景抑制的3D-pCASL、2D bold加权和单层双回波GRE(通过基于电纳的氧饱和度测量Y v)采集。根据高碳酸血症和高氧刺激数据,通过基于Y v的校准计算M,并将结果与传统的高碳酸血症或高氧校准方法进行比较。两种校准方法之间灰质的平均M值无显著差异,从8.5±2.8%(常规高氧校准)到11.7±4.5%(高氧条件下基于yv的校准),基于高氧的M值介于两者之间(p = 0.56)。从每个M图中计算手指轻敲引起的相对cro2变化。运动皮层中的cmoro2增加了~ 20%,在常规校准方法和提出的校准方法之间观察到良好的一致性。
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引用次数: 6
Within-lesion heterogeneity of subcortical DWI lesion evolution, and stroke outcome: A voxel-based analysis 皮质下DWI病变演变和脑卒中结局的病变内异质性:基于体素的分析
Pub Date : 2020-07-01 DOI: 10.1177/0271678X19865916
M. Duering, Ruth Adam, F. Wollenweber, Anna Bayer-Karpinska, E. Baykara, Leidy Y Cubillos-Pinilla, B. Gesierich, M. Á. Araque Caballero, Sophia Stoecklein, M. Ewers, O. Pasternak, M. Dichgans
The fate of subcortical diffusion-weighted imaging (DWI) lesions in stroke patients is highly variable, ranging from complete tissue loss to no visible lesion on follow-up. Little is known about within-lesion heterogeneity and its relevance for stroke outcome. Patients with subcortical stroke and recruited through the prospective DEDEMAS study (NCT01334749) were examined at baseline (n = 45), six months (n = 45), and three years (n = 28) post-stroke. We performed high-resolution structural MRI including DWI. Tissue fate was determined voxel-wise using fully automated tissue segmentation. Within-lesion heterogeneity at baseline was assessed by free water diffusion imaging measures. The majority of DWI lesions (66%) showed cavitation on six months follow-up but the proportion of tissue turning into a cavity was small (9 ± 13.5% of the DWI lesion). On average, 69 ± 25% of the initial lesion resolved without any visually apparent signal abnormality. The extent of cavitation at six months post-stroke was independently associated with clinical outcome, i.e. modified Rankin scale score at six months (OR = 4.71, p = 0.005). DWI lesion size and the free water-corrected tissue mean diffusivity at baseline independently predicted cavitation. In conclusion, the proportion of cavitating tissue is typically small, but relevant for clinical outcome. Within-lesion heterogeneity at baseline on advanced diffusion imaging is predictive of tissue fate.
脑卒中患者皮质下弥散加权成像(DWI)病变的命运是高度可变的,从完全的组织丢失到随访时没有可见的病变。我们对病变内异质性及其与脑卒中预后的相关性知之甚少。通过前瞻性DEDEMAS研究(NCT01334749)招募的皮质下脑卒中患者在脑卒中后基线(n = 45)、6个月(n = 45)和3年(n = 28)进行了检查。我们进行了高分辨率结构MRI包括DWI。使用全自动组织分割确定组织命运体素。通过自由水扩散成像措施评估基线时病变内异质性。多数DWI病变(66%)在随访6个月时出现空化,但组织变为空化的比例很小(占DWI病变的9±13.5%)。平均69±25%的初始病变消失,无任何明显的视觉信号异常。脑卒中后6个月的空化程度与临床结果独立相关,即6个月时的改良Rankin量表评分(OR = 4.71, p = 0.005)。DWI病变大小和自由水校正组织的基线平均扩散率独立预测空化。总之,空化组织的比例通常很小,但与临床结果有关。病灶内弥散成像基线异质性可预测组织预后。
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引用次数: 10
Physiologic predictors of collateral circulation and infarct growth during anesthesia – Detailed analyses of the GOLIATH trial 麻醉期间侧支循环和梗死生长的生理预测因素- GOLIATH试验的详细分析
Pub Date : 2020-06-01 DOI: 10.1177/0271678X19865219
R. Raychev, D. Liebeskind, A. Yoo, M. Rasmussen, D. Arnaudov, Scott C. Brown, J. Saver, C. Simonsen
Collateral circulation plays a pivotal role in acute ischemic stroke due to large vessel occlusion (LVO) and may be affected by multiple variables during sedation for endovascular therapy (EVT). We conducted detailed analyses of the GOLIATH trial to identify predictors of collateral circulation grade and infarct growth. We also modified the ASITN collateral grading scale and sought to determine its impact on clinical outcome and infarct growth. Multivariable analysis was used to identify predictors of collaterals and infarct growth. Ordinal analysis demonstrated nominal, but non-significant association between modified ASITN scale and infarct growth. Among all analyzed baseline clinical and procedural variables, the most significant predictors of infarct growth at 24 h were phenylephrine dose (estimate 6.78; p = 0.014) and baseline infarct volume (estimate 0.93; p = 0.03). The most significant predictors of worse collateral grade were mean arterial pressure (MAP) <70 mmHg (OR 0.35; p = 0.048) and baseline infarct volume (OR 0.96; p = 0.003). Hypotension during sedation for EVT for LVO negatively impacts collateral circulation, while higher pressor dose is a strong predictor of infarct growth. Avoidance of anesthesia-induced hypotension and consequent need for pressor therapy may prevent collateral failure and minimize infarct growth.
侧支循环在大血管闭塞(LVO)引起的急性缺血性卒中中起着关键作用,在血管内镇静治疗(EVT)过程中可能受到多种因素的影响。我们对GOLIATH试验进行了详细的分析,以确定侧枝循环分级和梗死生长的预测因子。我们还修改了ASITN侧支分级量表,并试图确定其对临床结果和梗死生长的影响。多变量分析用于确定侧枝和梗死生长的预测因子。顺序分析显示,修改后的ASITN量表与梗死生长之间存在名义上但不显著的关联。在所有分析的基线临床和程序变量中,24小时梗死生长最显著的预测因子是苯肾上腺素剂量(估计6.78;P = 0.014)和基线梗死面积(估计0.93;p = 0.03)。侧支血管等级较差的最显著预测因子是平均动脉压(MAP) <70 mmHg (OR 0.35;p = 0.048)和基线梗死体积(OR 0.96;p = 0.003)。LVO EVT镇静期间的低血压会对侧支循环产生负面影响,而较高的加压剂量是梗死生长的有力预测因子。避免麻醉引起的低血压和随后的降压治疗可以防止侧支衰竭和减少梗死的增长。
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引用次数: 26
Brain endothelial specific gene therapy improves experimental Sandhoff disease 脑内皮特异性基因治疗改善实验性山德霍夫病
Pub Date : 2020-06-01 DOI: 10.1177/0271678X19865917
Godwin K. Dogbevia, H. Grasshoff, A. Othman, Anke Penno, M. Schwaninger
In Tay-Sachs and Sandhoff disease, a deficiency of the lysosomal enzyme β-hexosaminidase causes GM2 and other gangliosides to accumulate in neurons and triggers neurodegeneration. Although the pathology centers on neurons, β-hexosaminidase is mainly expressed outside of neurons, suggesting that gene therapy of these diseases should target non-neuronal cells to reconstitute physiological conditions. Here, we tested in Hexb−/− mice, a model of Sandhoff disease, to determine whether endothelial expression of the genes for human β-hexosaminidase subunit A and B (HEXA, HEXB) is able to reduce disease symptoms and prolong survival of the affected mice. The brain endothelial selective vectors AAV-BR1-CAG-HEXA and AAV-BR1-CAG-HEXB transduced brain endothelial cells, which subsequently released β-hexosaminidase enzyme. In vivo intravenous administration of the gene vectors to adult and neonatal mice prolonged survival. They improved neurological function and reduced accumulation of the ganglioside GM2 and the glycolipid GA2 as well as astrocytic activation. Overall, the data demonstrate that endothelial cells are a suitable target for intravenous gene therapy of GM2 gangliosidoses and possibly other lysosomal storage disorders.
在Tay-Sachs病和Sandhoff病中,溶酶体酶β-己糖氨酸酶缺乏导致GM2和其他神经节苷类物质在神经元中积聚并引发神经变性。虽然病理以神经元为中心,但β-己糖氨酸酶主要在神经元外表达,提示这些疾病的基因治疗应针对非神经元细胞来重建生理状况。在这里,我们在Sandhoff病模型Hexb - / -小鼠中进行了测试,以确定内皮表达人β-己糖氨酸酶亚基a和B (HEXA, Hexb)基因是否能够减轻疾病症状并延长受影响小鼠的生存期。脑内皮选择载体AAV-BR1-CAG-HEXA和AAV-BR1-CAG-HEXB转导脑内皮细胞,随后释放β-己糖氨酸酶。成年和新生小鼠体内静脉注射基因载体延长了存活时间。它们改善了神经功能,减少了神经节苷脂GM2和糖脂GA2的积累以及星形胶质细胞的激活。总的来说,这些数据表明内皮细胞是静脉注射GM2神经节脂质剂量和其他溶酶体储存疾病基因治疗的合适靶点。
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引用次数: 14
Empathy in stroke rats is modulated by social settings 中风大鼠的同理心受到社会环境的调节
Pub Date : 2020-06-01 DOI: 10.1177/0271678X19867908
K. Shinozuka, N. Tajiri, H. Ishikawa, Julian P. Tuazon, Jea-Young Lee, P. Sanberg, Sydney Zarriello, Sydney Corey, Y. Kaneko, C. Borlongan
Rodents display “empathy” defined as perceived physical pain or psychological stress by cagemates when co-experiencing socially distinct traumatic events. The present study tested the hypothesis that empathy occurs in adult rats subjected to an experimental neurological disorder, by allowing co-experience of stroke with cagemates. Psychological stress was measured by general locomotor activity, Rat Grimace Scale (RGS), and plasma corticosterone. Physiological correlates were measured by Western blot analysis of advanced glycation endproducts (AGE)-related proteins in the thymus. General locomotor activity was impaired in stroke animals and in non-stroke rats housed with stroke rats suggesting transfer of behavioral manifestation of psychological stress from an injured animal to a non-injured animal leading to social inhibition. RGS was higher in stroke rats regardless of social settings. Plasma corticosterone levels at day 3 after stroke were significantly higher in stroke animals housed with stroke rats, but not with non-stroke rats, indicating that empathy upregulated physiological stress level. The expression of five proteins related to AGE in the thymus reflected the observed pattern of general locomotor activity, RGS, and plasma corticosterone levels. These results indicate that stroke-induced psychological stress manifested on both the behavioral and physiological levels and appeared to be affected by empathy-associated social settings.
啮齿类动物表现出“同理心”,即当共同经历不同的社会创伤事件时,同伴感受到的身体疼痛或心理压力。目前的研究通过允许与笼子里的同伴共同经历中风,测试了在遭受实验性神经紊乱的成年大鼠中发生共情的假设。通过一般运动活动、大鼠鬼脸量表(RGS)和血浆皮质酮测量心理应激。生理相关性通过胸腺晚期糖基化终末产物(AGE)相关蛋白的Western blot分析来测量。中风动物和与中风大鼠同住的非中风大鼠的一般运动活动受损,表明心理应激的行为表现从受伤动物转移到未受伤动物,导致社会抑制。无论社会环境如何,中风大鼠的RGS都更高。脑卒中后第3天,与脑卒中大鼠一起生活的脑卒中动物血浆皮质酮水平显著升高,而与非脑卒中大鼠一起生活的脑卒中动物血浆皮质酮水平显著升高,表明共情上调了生理应激水平。胸腺中与AGE相关的五种蛋白的表达反映了观察到的一般运动活动、RGS和血浆皮质酮水平的模式。这些结果表明,卒中诱发的心理应激表现在行为和生理两个层面,并似乎受到共情相关社会环境的影响。
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引用次数: 4
The functional role of hemojuvelin in acute ischemic stroke 血少年素在急性缺血性脑卒中中的功能作用
Pub Date : 2020-06-01 DOI: 10.1177/0271678X19861448
Guang-Huar Young, Sung-Chun Tang, Vincent Wu, Kuo-Chuan Wang, Jing-Yi Nong, Po-Yuan Huang, Chaur-Jong Hu, H. Chiou, J. Jeng, C. Hsu
Our study aimed to establish the role of hemojuvelin (HJV) in acute ischemic stroke (AIS). We performed immunohistochemistry for HJV expression in human brain tissues from 10 AIS and 2 non-stroke autopsy subjects. Plasma HJV was measured in 112 AIS patients within 48 h after stroke. The results showed significantly increased HJV expression in brain tissues from AIS patients compare to non-stroke subjects. After adjusting for clinical variables, plasma levels of HJV within 48 h after stroke were an independent predictor of poor functional outcome three months post-stroke (OR:1.78, 95% CI: 1.03–3.07; P = 0.038). In basic part, Western blotting showed that HJV expression in mice brains was apparent at 3 h after middle cerebral artery occlusion (MCAO), and increased significantly at 72 h. In cultured cortical neurons, expression of HJV protein increased remarkably 24 h after oxygen glucose deprivation (OGD), and small interfering RNAs (siHJV) transfected OGD neurons had a lower apoptotic rate. Importantly, 72 h post-MCAO, HJV knockout mice had significantly smaller infarcts and less expression of cleaved caspase-3 protein compared with wild-type mice. In summary, HJV participates in the mechanisms of post-stroke neuronal injury, and that plasma HJV levels can be a potential early outcome indicator for AIS patients.
我们的研究旨在确定血少年素(HJV)在急性缺血性脑卒中(AIS)中的作用。我们对10名AIS和2名非卒中尸检受试者的脑组织进行了HJV表达的免疫组织化学检测。112例AIS患者脑卒中后48 h内血浆HJV测定。结果显示,与非卒中受试者相比,AIS患者脑组织中HJV表达显著增加。在调整临床变量后,脑卒中后48小时内血浆HJV水平是脑卒中后3个月功能预后不良的独立预测因子(OR:1.78, 95% CI: 1.03-3.07;p = 0.038)。在基础部分,Western blotting显示HJV在大脑中动脉闭塞(MCAO)后3 h表达明显,在72 h表达明显增加。在体外培养的皮质神经元中,氧葡萄糖剥夺(OGD) 24 h后HJV蛋白表达显著升高,小干扰rna (siHJV)转染的OGD神经元的凋亡率较低。重要的是,mcao 72 h后,与野生型小鼠相比,HJV敲除小鼠的梗死灶明显缩小,cleaved caspase-3蛋白的表达明显减少。综上所述,HJV参与脑卒中后神经元损伤的机制,血浆HJV水平可作为AIS患者潜在的早期预后指标。
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引用次数: 12
MRI evaluation of cerebrovascular reactivity in obstructive sleep apnea 阻塞性睡眠呼吸暂停患者脑血管反应性的MRI评价
Pub Date : 2020-06-01 DOI: 10.1177/0271678X19862182
Pei-Hsin Wu, Ana E. Rodriguez-Soto, Zachary B. Rodgers, Erin K. Englund, A. Wiemken, M. Langham, J. Detre, R. Schwab, Wensheng Guo, F. Wehrli
Obstructive sleep apnea (OSA) is characterized by intermittent obstruction of the airways during sleep. Cerebrovascular reactivity (CVR) is an index of cerebral vessels' ability to respond to a vasoactive stimulus, such as increased CO2. We hypothesized that OSA alters CVR, expressed as a breath-hold index (BHI) defined as the rate of change in CBF or BOLD signal during a controlled breath-hold stimulus mimicking spontaneous apneas by being both hypercapnic and hypoxic. In 37 OSA and 23 matched non sleep apnea (NSA) subjects, we obtained high temporal resolution CBF and BOLD MRI data before, during, and between five consecutive BH stimuli of 24 s, each averaged to yield a single BHI value. Greater BHI was observed in OSA relative to NSA as derived from whole-brain CBF (78.6 ± 29.6 vs. 60.0 ± 20.0 mL/min2/100 g, P = 0.010) as well as from flow velocity in the superior sagittal sinus (0.48 ± 0.18 vs. 0.36 ± 0.10 cm/s2, P = 0.014). Similarly, BOLD-based BHI was greater in OSA in whole brain (0.19 ± 0.08 vs. 0.15 ± 0.03%/s, P = 0.009), gray matter (0.22 ± 0.09 vs. 0.17 ± 0.03%/s, P = 0.011), and white matter (0.14 ± 0.06 vs. 0.10 ± 0.02%/s, P = 0.010). The greater CVR is not currently understood but may represent a compensatory mechanism of the brain to maintain oxygen supply during intermittent apneas.
阻塞性睡眠呼吸暂停(OSA)的特点是睡眠时气道间歇性阻塞。脑血管反应性(CVR)是脑血管对血管活性刺激(如二氧化碳增加)作出反应能力的指标。我们假设OSA改变CVR,以屏气指数(BHI)表示,BHI定义为在控制屏气刺激期间CBF或BOLD信号的变化率,通过高碳酸血症和低氧模拟自发呼吸暂停。在37名OSA和23名匹配的非睡眠呼吸暂停(NSA)受试者中,我们在连续5次24秒的BH刺激之前、期间和之间获得了高时间分辨率的CBF和BOLD MRI数据,每次平均产生一个BHI值。由于全脑CBF(78.6±29.6 vs. 60.0±20.0 mL/min / 2/100 g, P = 0.010)和上矢状窦血流速度(0.48±0.18 vs. 0.36±0.10 cm/s2, P = 0.014), OSA患者的BHI高于NSA患者。同样,OSA中基于bold的BHI在全脑(0.19±0.08比0.15±0.03%/s, P = 0.009)、灰质(0.22±0.09比0.17±0.03%/s, P = 0.011)和白质(0.14±0.06比0.10±0.02%/s, P = 0.010)中更高。更大的CVR目前尚不清楚,但可能代表大脑在间歇性呼吸暂停期间维持氧气供应的代偿机制。
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引用次数: 15
A combination of Deferoxamine mesylate and minimally invasive surgery with hematoma lysis for evacuation of intracerebral hemorrhage 甲磺酸去铁胺联合微创血肿溶解手术治疗脑出血
Pub Date : 2019-12-02 DOI: 10.1177/0271678X19892660
A. Pandey, B. Daou, N. Chaudhary, G. Xi
Intracerebral hemorrhage is associated with significant morbidity and mortality. Some clinical trials demonstrated a trend towards benefit with surgical evacuation of intracerebral hemorrhage, without strong statistically significant results. Subsequent studies focused on minimally invasive techniques. Improved outcomes were more likely with surgical reduction of intracerebral hemorrhage volume to ≤15 mL. Deferoxamine is currently being evaluated as a therapeutic tool in intracerebral hemorrhage with promising results. There continues to be a lack of level I evidence supporting medical and surgical tools for intracerebral hemorrhage evacuation. Could a combination of minimally invasive surgery with hematoma lysis and Deferoxamine result in more effective hematoma evacuation?
脑出血与显著的发病率和死亡率相关。一些临床试验显示脑出血手术引流有获益的趋势,但没有明显的统计学意义。随后的研究集中在微创技术上。手术减少脑出血容量至≤15ml更有可能改善预后。去铁胺目前正被评估为脑出血的治疗工具,具有良好的效果。仍然缺乏一级证据支持脑出血后送的医疗和手术工具。微创手术联合血肿溶解和去铁胺是否能更有效地清除血肿?
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引用次数: 10
期刊
Journal of Cerebral Blood Flow & Metabolism
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