ADDED UTILITY OF COMPUTED TOMOGRAPHY PERFUSION STUDY IN THE ASSESSMENT OF EARLY ISCHEMIC STROKE IN COMPARISON WITH NON- CONTRAST COMPUTED TOMOGRAPHY - A PROSPECTIVE OBSERVATIONAL STUDY

Objective: 1. T o study the added utility of computed tomography perfusion study in the assessment of early ischemic stroke in comparison with non-contrast computed tomography. 2. To study the role of computed tomography perfusion study in deciding thrombolytic treatment/ therapeutic protocols aimed at reversing the cerebral ischemic insult. Conclusions and Results: It was observed that 15 (46.68%) patients were in the 61-70 years of age group followed by 8 (25%) in the age group of 51-60 years. The mean age of the patients was 58.87 ±12.14 years. Ÿ Females were affected more i.e. 18 (56.25%) compared to the male patients 14 (43.75%). Ÿ Most observed co-morbid condition was hypertension in 9 (28.13%) patients followed by hypertension and diabetes in 7 (21.87%) patients and diabetes in 6 (18.75%) patients. Ÿ Among the study participants 4 (12.50%) were smokers followed by 6 (18.75%) were alcoholic and smokers & alcoholic (15.62%) respectively. Ÿ It was observed that the symptoms of palsy were present among 23 (71.88%) patients Ÿ The most commonly observed time of onset of symptoms was 3-5 hours in 23 (71.88%) patients followed by 1-3 hours (21.87%) and >5 hours in 2 (6.25%) patients. Ÿ NCCT ?ndings observed was de?nite signs of stroke in 12 (37.5%) patients followed by suspected signs of stroke on NCCT (25%) Ÿ It was observed that no sign of stroke was observed in 12 (37.5%) patients. Ÿ CT perfusion ?ndings observed was increased mean transient time (MTT) in all (100%) patients followed by decreased blood ?ow in all (100%) patients. It was observed that cerebral blood volume decreased in 12 (37.5%) patients, increased in 8 (25%) and normal in 12 (37.5%) patients. Ÿ The correlation of NCCT and CT perfusion ?ndings observed that out of total 32 patients NCCT study identi?es 20 patients while all 32 patients were identi?ed by CT perfusion study with sensitivity of 100%. Ÿ CT perfusion provides early diagnosis of ischemic stroke thus helps in management of stroke patients. Inference : The present study concludes that CT-perfusion had more sensitivity compared to NCCT in identifying early ischemic stroke. CT perfusion has additional utility in management of early ischemic stroke. CT Perfusion study provides important information to the neurologist and neuro-interventionalist when evaluating patients for endovascular reperfusion therapy by identifying the size of core infarction and penumbra

Case Report: Arterial Spin Labeling Perfusion MRI Contribution for Clinical Implementation of Brain Disease

@#Currently, ASL is widely used as an additional breakthrough sequence in MRI due to acquiring reliable results. The case report aims to prove the efficacy and effectiveness of a quantitative method of ASL sequence through the calculation of the cerebral blood flow (CBF) on CBF maps in different cases. ASL sequence has been done on four patients with different cases. Then, the authors put 2 regions of interest (ROI) for measurement in normal and different regions on CBF maps and then calculated the average value result from CBF maps. ASL has been proven as a reliable and breakthrough sequence in MRI for detecting brain disease with a non-invasive method through the calculation of CBF value. ASL should be used as an additional protocol in brain examinations because it allows radiologists to assess the significance of CBF values using a quantitative method that is more reliable and non-invasiv

Rare type I CBFβ/MYH11 fusion transcript in primary acute myeloid leukemia with inv(16)(p13.1q22): a case report

Inv(16)(p13.1q22) in acute myeloid leukemia (AML) is a common chromosomal abnormality. It leads to the core-binding factor ß-subunit (CBFβ)/smooth muscle myosin heavy chain 11 (MYH11) fusion gene. Different breakpoints were observed in the CBFβ gene at 16q22 and the MYH11 gene at 16p13.1. For this reason, different CBFβ/MYH11 fusion genes are generated, with more than 13 types having been reported to date. Type I CBFβ/MYH11 fusion transcripts are very rare, with only 10 cases being reported to date. This case report describes a primary AML patient with inv(16)(p13.1q22) and a rare type I CBFβ/MYH11 fusion gene. The morphological analysis did not conform to the typical M4eo. Abnormal eosinophils were less than 5%, and there was obvious dysgranulopoiesis. The patient was in hematological and genetic remission for 487 days after the initial chemotherapy cycles. However, the CBFβ/MYH11 fusion had been constantly positive. Moreover, the presence of non-type A fusions may affect its biology and clinical prognosis. Therefore, further studies on understanding its biological and prognostic significance are essential.

Comparative Analysis of C-repeat Binding Factors (CBFs) in Tomato and Arabidopsis

Abstract Cold stress is one of the limiting factors of plant production that plants use different mechanisms for cold tolerance. CBF genes play critical role to regulate the cold responsive genes. To better understand of CBF gene functions, the tomato-CBFs and Arabidopsis-CBFs were evaluated using bioinformatics tools, and finally the expression patterns of SlCBF1 gene were analyzed under 10 and 4˚C in two contrasting tomato species (Solanum lycopersicum and S. habrochaites). The different cis regulatory elements were observed in promoter region of SlCBF1 and AtCBF1 genes, and ICE1, COR and HOS1 proteins exhibited high interaction with CBFs. The results of Real time PCR of SlCBF1 exhibited that under 10 and 4 ˚C, SlCBF1 was down regulated in cold sensitive tomato genotype while it was slightly up-regulated in cold tolerant genotype at 4 ˚C. The results showed that the SlCBF1 and AtCBF1 genes have differential expression in cold stress.

La biología molecular en la precisión diagnósticade las leucemias / Molecular biology in the diagnostic accuracy of leukemia

Los estudios de citogenética y biología molecular permiten correlacionar la presencia de determinadas anomalías cromosómicas y moleculares con tipos específicos de leucemias y linfomas. Este conocimiento ha hecho posible el perfeccionamiento progresivo del sistema de clasificación de las enfermedades oncohematológicas. Actualmente la presencia de ciertas anomalías citogenéticas o moleculares son suficientes para identificar algunas de estas entidades y en ocasiones, el diagnóstico cambia después de un análisis integrado de la citomorfología con la citogenética y la biología molecular. Este reporte pretende resaltar la importancia del estudio molecular cuando la citomorfología es compleja y propicia diagnósticos erróneos. Mediante la reacción en cadena de la polimerasa, previa reverso-transcripción del ARN aislado de sangre medular, se estudiaron cuatro biomarcadores: los genes de fusión AML1-ETO, BCR-ABL, CBFβ-MYH11 y PML-RARα. Fueron estudiados 14 pacientes con diagnósticos inicial citomorfológico de: leucemia promielocítica (n= 6), leucemia aguda de linaje indefinido (n= 3) y dudoso entre leucemia mieloide crónica en crisis blástica mieloide y leucemia mieloide aguda (LMA) (n= 5). Al culminar la caracterización molecular todos fueron diagnosticados como LMA. Los resultados ilustran la importancia del estudio molecular en la clasificación de las leucemias, lo cual redunda en que el paciente reciba el tratamiento más adecuado y alcance una mejor respuesta.

Cytogenetic and molecular studies have correlated the presence of certain chromosomal and molecular anomalies with leukemia and lymphomas specific types. These evidences have allowed the progressive improvement of the system of classification of the oncohematological entities. Currently, the presence of certain cytogenetic or molecular anomalies is sufficient to identify specific entities and, in some occasions, the diagnostic changes after an integral analysis of cytomorfologic, cytogenetic and molecular studies. T This report aims to highlight the importance of molecular study when cytomorphology is complex and leads to erroneous diagnoses. Through polymerase chain reaction, prior reverse transcription of the RNA isolated from medullary blood, four biomarkers were studied: the fusion genes AML1-ETO, BCR-ABL, CBFβ-MYH11 and PML-RARα. Fourteen patients with initial diagnosis of: promyelocytic leukemia (n= 6), acute leukemia without lineage definition (n= 3) and chronic myeloid leukemia in myeloid blastic crisis or acute myeloid leukemia (AML) (n= 5) were studied. At the end of the molecular characterization all were diagnosed as AML. These results enlightened the role of the molecular studies in the classification of leukemia, which permit the patient receives the more appropriate treatment and achieve a better response.

The Effect of Contusion and Exhaustive Exercise on Satellite Cells Activation and Pax7/CBF1/DAPT Contents in Skeletal Muscles of Rats / 中国运动医学杂志

Objective To study the effect of contusion and exhaustive exercise on satellite cells' activation and Pax7/CBF1/DAPT contents in skeletal muscles of rats,and reveal the repair mechanism of the skeletal muscle injury.Methods Twenty-four seven-week-old male Sprague-Dawley(SD)rats were randomly divided into a control(C)group,an immediately after exhaustive exercise(E0)group,a 24 hours after exhaustive exercise(E24)group and a 48 hours after exhaustive exercise(E48)group,each of 6.Other 18 SD rats were randomly divided into 3 groups,6 rats in each group:an immediately after contusion group(D0),a 24h post-contusion group(D24)and a 48h post-contusion group(D48).All groups were killed at different time points after exhaustive exercise and the contusion respectively while the control group was at resting state,and their serum was extracted.The right gastrocnemius muscles were resected and divided into 2 parts:one was used immediately for culturing satellite cells,while the other was stored in the bridge at-80℃.All the serum and gastrocnemius muscles were tested for Pax7,CBF1 and DAPT contents using the enzyme-linked immunosorbent assay(ELISA).Moreover,three-day-old newborn rats were also slaughtered for the above experiment.Results The results of culture in vitro showed that one day after the culture began a small amount of spindle satellite cells could be seen in the newborn rats,but the satellite cells of other groups were growing slowly.However,on the third day and the fifth day,the spindle satellite cells of each group began to proliferate in quantity and reached the peak.Then all the satellite cells had a good proliferation until the seventh day after serial passage,and some patial fusions to microtubules occurred.The biggest cell number and proliferation rate was in newborn rats,but no skeletal muscle satellite cell was found in the control group.At the same time,the number and the proliferation rate of skeletal muscle satellite cells in contusion groups were significantly higher than the exhaustive exercise groups.The results of Elisa showed that the contents of CBF1 and Pax7 in skeletal muscles in exhaustive groups and contusion groups,were significantly upregulated,compared to the control group(P＜0.05).Amomg them,the CBF1 content in group D0,together with the Pax7 content in group D24 and D48,was significantly higher than that of the other groups(P＜0.05).On the other hand,the content of DAPT in skeletal muscles of exhaustive groups and contusion groups,compared to the control group,was significantly downregulated (P＜0.05).To be more specific,the value of group D0 was significantly lower than that of the other groups (P＜0.05).However,there was no significant difference in it among group E0,E24 and E48.Conclusions Contusion and exhaustive exercise can activate the skeletal muscle satellite cells to proliferate and differentiate.The number of activated skeletal muscle satellite cells in the contusion groups is significantly larger than that of exhaustive groups maybe due to the stronger stimulating by contusion.Both contusion and exhaustive exercise increase the contents of Pax7 and CBF1 in skeletal muscles,but decrease that of DAPT.The Pax7 and CBF1 may play a positive regulating role in terms of activating skeletal satellite cells and repairing skeletal muscle injury,while DAPT may play a negative regulating role.

Transcriptome sequencing analysis of alfalfa reveals CBF genes potentially playing important roles in response to freezing stress

Abstract Alfalfa (Medicago sativa L.) is an important perennial forage, with high nutritional value, which is widely grown in the world. Because of low freezing tolerance, its distribution and production are threatened and limited by winter weather. To understand the complex regulation mechanisms of freezing tolerance in alfalfa, we performed transcriptome sequencing analysis under cold (4 °C) and freezing (-8 °C) stresses. More than 66 million reads were generated, and we identified 5767 transcripts differentially expressed in response to cold and/or freezing stresses. These results showed that these genes were mainly classified as response to stress, transcription regulation, hormone signaling pathway, antioxidant, nodule morphogenesis, etc., implying their important roles in response to cold and freezing stresses. Furthermore, nine CBF transcripts differentially expressed were homologous to CBF genes of Mt-FTQTL6 site, conferring freezing tolerance in M. truncatula, which indicated that a genetic mechanism controlling freezing tolerance was conservative between M. truncatula and M. sativa. In summary, this transcriptome dataset highlighted the gene regulation response to cold and/or freezing stresses in alfalfa, which provides a valuable resource for future identification and functional analysis of candidate genes in determining freezing tolerance.

Effective antimicrobial activity of Cbf-14-2 against penicillin-resistant bacteria in vitro and in vivo / 中国药科大学学报

The antibacterial activity and mechanism of the antimicrobial peptide mutant Cbf-14-2 against NDM-1 carrying recombinant bacteria (E.coli BL21 (DE3)-NDM-1) was investigated in this study.The minimum inhibitory concentration (MIC),minimum bactericidal concentration (MBC) and killing curves (KCs) in vitro were determined by the broth microdilution method.Mice septicemia model was established by interaperitotoneal injection of E.coli BL21 (DE3)-NDM-1 to evaluate the antibacterial activity of this peptide in vivo.Results showed that Cbf-14-2 exhibited a potent antibacterial activity with MIC of 16 μg/mL and killed almost all recombinant bacteria within 120 min.Meanwhile,it significantly improved the survival rate of infected mice up to 70％ with the decreasing of bacterial load in mice lung,liver,spleen and kidney.This powerful clearance ability of Cbf-14-2 against bacteria mainly related to its enhanced membrane penetration ability through neutralizing the negative charges and disrupting the integrity of the bacterial cell membrane.Therefore,Cbf-14-2 is expected to be a potential antimicrobial agent for the treatment of infection induced by multi-drug resistant bacteria,especially for the NDM-1carrying bacteria.

Functional Magnetic Resonance Imaging with Arterial Spin Labeling: Techniques and Potential Clinical and Research Applications

PURPOSE: To describe technical methods for functional magnetic resonance imaging (fMRI) study with arterial spin labeling (ASL) compared to blood oxygenation level-dependent (BOLD) technique and discuss the potential of ASL for research and clinical practice. MATERIALS AND METHODS: Task-based (n = 1) and resting-state fMRI (rs-fMRI) (n = 20) were performed using ASL and BOLD techniques. Results of both techniques were compared. RESULTS: For task-based fMRI with finger-tapping, the primary motor cortex of the contralateral frontal lobe and the ipsilateral cerebellum were activated by both BOLD and ASL fMRI. For rs-fMRI of sensorimotor network, functional connectivity showed similar results between BOLD and ASL. CONCLUSION: ASL technique has potential application in clinical and research fields because all brain perfusion imaging, CBF measurement, and rs-fMRI study can be performed in a single acquisition.

Functional Magnetic Resonance Imaging with Arterial Spin Labeling: Techniques and Potential Clinical and Research Applications

PURPOSE: To describe technical methods for functional magnetic resonance imaging (fMRI) study with arterial spin labeling (ASL) compared to blood oxygenation level-dependent (BOLD) technique and discuss the potential of ASL for research and clinical practice. MATERIALS AND METHODS: Task-based (n = 1) and resting-state fMRI (rs-fMRI) (n = 20) were performed using ASL and BOLD techniques. Results of both techniques were compared. RESULTS: For task-based fMRI with finger-tapping, the primary motor cortex of the contralateral frontal lobe and the ipsilateral cerebellum were activated by both BOLD and ASL fMRI. For rs-fMRI of sensorimotor network, functional connectivity showed similar results between BOLD and ASL. CONCLUSION: ASL technique has potential application in clinical and research fields because all brain perfusion imaging, CBF measurement, and rs-fMRI study can be performed in a single acquisition.

Dynamic changes of blood flow in frontal cortex of diabetic rats / 中国药理学通报

Aim To investigate the changes of cerebral blood flow in rats with diabetic cognitive impairment by two-channel laser Doppler flowmeter,and to explore the changes of cerebral blood flow in diabetic rats with cognitive impairment and to investigate the changes of cerebral blood flow lesions and the central nervous system function changes in the study to provide pre-foundation.Methods Thirty-four male Wistar rats were randomly divided into two groups:blank control group and diabetic model group.The rats in the model group were treated with streptozotocin (STZ) 60 mg · kg-1,and the glucose oxidase method was used to determine fasting blood glucose ≥ 16.7 mmol · L-1 as the standard of the model.The Water maze was used to observe the behavioral changes of diabetic rats.Dual-channel laser doppler flowmeter was used to measure cerebral blood flow in diabetic rats with cognitive impairment.Another 34 male Wistar rats were randomly divided into two groups:control group and diabetic model group.Dual-channel laser doppler flowmeter was used to dynamically monitor cerebral blood flow on 0 d,7 d,14 d,21 d,28 d,35 d,42 d,56 d and 75 d.ELISA was applied to detect the concentration of iNOS,eNOS and ET-1 in cerebrospinal fluid.Results Morris water maze test showed that the time of the platform (latency) was significantly longer than that of the blank control group(P ＜0.05).The cerebral blood flow/100 g of diabetic rats with cognitive impairment was significantly lower than that of the control group (P ＜ O.05),and the blood flow in the model group was significantly lower than that in the model group (P ＜ 0.05).Compared with control group,iNOS and eNOS concentrations were markedly elevated,while ET-1 concentration obviously decreased.Conclusions The decrease of blood flow in the frontal cortex of diabetic rats with cognitive impairment suggests that it may be one of the factors leading to cognitive impairment in diabetes mellitus.Cerebral blood flow reduction occurs in the early stages of diabetes,followed by no significant deterioration.Cerebral blood flow may not be related to the changes of NO and ET-1,but the trend of cerebral blood flow may be related to the change of the two.

Expression of Bitter Taste Receptors in Human Nasal Respiratory Epithelium

The nasal cavity encounters various irritants during inhalation such as dust and pathogens. To detect and remove these irritants, it has been postulated that the nasal mucosa epithelium has a specialized sensing system. The oral cavity, on the other hand, is known to have bitter taste receptors (T2Rs) that can detect harmful substances to prevent ingestion. Recently, solitary chemosensory cells expressing T2R subtypes have been found in the respiratory epithelium of rodents. In addition, T2Rs have been identified in the human airway epithelia. However, it is not clear which T2Rs are expressed in the human nasal mucosa epithelium and whether they mediate the removal of foreign materials through increased cilia movement. In our current study, we show that human T2R receptors indeed function also in the nasal mucosa epithelium. Our RT-PCR data indicate that the T2R subtypes (T2R3, T2R4, T2R5, T2R10, T2R13, T2R14, T2R39, T2R43, T2R44, T2R 45, T2R46, T2R47, T2R48, T2R49, and T2R50) are expressed in human nasal mucosa. Furthermore, we have found that T2R receptor activators such as bitter chemicals augments the ciliary beating frequency. Our results thus demonstrate that T2Rs are likely to function in the cleanup of inhaled dust and pathogens by increasing ciliary movement. This would suggest that T2Rs are feasible molecular targets for the development of novel treatment strategies for nasal infection and inflammation.

Comportamiento fractal espacial en la expansión de la distribución del flujo sanguíneo cerebral en Alzheimer / Spatial fractal behavior in the lengthening of cerebral bloodstream distribution in Alzheimer disease

El Alzheimer es una enfermedad neurodegenerativa que afecta a millones de personas alrededor del mundo. Las causas de esta aún son desconocidas. La geometría fractal es una teoría matemática que permite medir objetivamente la irregularidad de los objetos o procesos naturales; las estructuras y los comportamientos fisiológicos del cuerpo humano se pueden caracterizar matemáticamente a través de la dimensión fractal, la cual mide el grado de irregularidad o complejidad del fractal. La distribución del flujo sanguíneo cerebral en Alzheimer es notablemente irregular, por ello la dimensión fractal es una medida objetiva, la cual suponemos, cuantifica esta distribución. El coeficiente de expansión fractal se define para aquellos objetos dinámicos que poseen dimensión fractal y estima la expansión del fractal sobre su espacio circundante. Este coeficiente se asocia con el grado de conectividad que pueda poseer el fractal para expandirse. En el presente trabajo se determinaron los coeficientes de expansión fractal para la distribución del flujo sanguíneo cerebral en 21 pacientes con Alzheimer y en 11 sujetos normales en las zonas cerebrales posterior y anterior (tomados de la literatura). Los valores de los coeficientes resultaron ser mayores en Alzheimer respecto a los normales en las dos zonas, valores comparados respecto al espacio circundante en que sucede la expansión. Esto último sugiere el comportamiento de las conexiones neuronales en las zonas evaluadas.

Alzheimer disease is a neurodegenerative process affecting millions of persons at world scale. Even nowadays its causes are unknown. The fractal geometry is a mathematical theory allows to measure objectively the irregularity of objects or the natural processes; structures and physiologic behaviors of human body may be in a mathematical way be characterized through the fractal dimension, which to measure the irregularity or complexity degree of fractal. Distribution of cerebral blood flow in Alzheimer's disease is very irregular, thus the fractal dimension is an objective measure, which supposedly to quantify this distribution. The fractal expansion coefficient is defined for those dynamic objects having fractal dimension and estimates the fractal expansion on its surrounding space. This coefficient is associated with the connection that may to has the fractal for its expansion. The objective of present paperwas to determine the fractal expansion coefficients for the cerebral blood flow distribution in 21 patients presenting with Alzheimer's disease and in 11 normal subjects in the posterior and anterior cerebral zones, compared values regarding the surrounding space where expansion occur. This latter suggest the behavior of neuronal connections in assessed zones.

The variation of cerebral brain flow (CBF) and pathological characteristics in peripheral brain tissue of nidns after microsurgical resection of brain arterivanous malformations (BAVM) / 中华显微外科杂志

@#Objective To observe the variation of cerebral brain flow (CBF)and pathological characteristics in peripheral brain tissue of nidus after operation of brain arterivenous malformations (BAVM) and explore the mechanism and theaputic strategy of normal perfusion pressure breakdown (NPPB)after microsurgery. Methods 12 cases of BAVM that have received surgical resection were analyzed prospectively, and 8 cases of them were embolized with Onyx. The pathological characteristics of the nidus and peripheral brain tissue was observed with microscope and electron microscope. The variation of CBF in peripheral brain tissue of the nidus following microsurgical resection was observed by using Laser Doppuler Perfusion Imaging (LDPI) system. The monitering result of CBF in little meniugioma(n=6) during surgery was used as the control. Results There was small vessel expantion, neuron necrosis, gliocyte hyperplasia and blood brain barriar (BBB) destruction in peripheral brain tissue of BAVM nidus, the visibal brain tissue edema and inflammatory cell infiltration in peripheral brain tissue of the nidus and the revascularization in the emolized nidus vessels were observed after embolization with Onyx. There was significant change of CBF between pre-and post-operation (P<0.05),and after controlling depressurization during surgery was the increasing CBF step down (P<0.05). Conclusion The BBB breakdown and increasing CBF of peripheral brain tissue of the nidus may be the pathological foundation of brain hemorrhage and edema after BAVM microsurgical resection. So embolization before the operation, controlling depressuriation during and after surgery is the important methods for preventing and curing the NPPB of BAVM after microsurgery.

Usefulness of CT Perfusion in the Postoperative Evaluation of Ruptured Aneurysm / 대한뇌혈관외과학회지

OBJECTIVE: Our goal was to evaluate the usefulness of CT perfusion (CTP) in early detection of the post operative cerebral ischemia, alteration of treatment modality and patient prognosis in cerebral aneurysm patients. METHODS: 24 patients who underwent either surgical operation or endovascular coiling for ruptured aneurysms were selected. All patients undertook an angiogram, conventional CT, and CTP scan immediately following surgical operation or endovascular coiling. All patients performed a CT 2 weeks after treatment to evaluate possible development of a cerebral infarction. Postoperative CT results of patients with abnormal postoperative CTP scan findings were compared, and these results were compared with the CT results and clinical symptoms of patients who developed infarction or not. RESULTS: Of the 24 patients evaluated, 11 patients showed abnormal findings on CTP. 9 patients were diagnosed with cerebral infarction through a CT scan done 2 weeks after treatment; all exhibited abnormal CTP results immediately after treatment. Abnormal CTP findings were divided into two groups; patients with abnormal CBF and MTT maps, but with normal CBV maps, and patients with abnormal CBF, CBV and MTT maps. A correlation was seen between abnormality on CBV maps and cerebral infarction. Patients with abnormal CTP findings also exhibited poorer prognostic value. CONCLUSION: Postoperative CTP in ruptured aneurysm patients is a very useful and objective tool in evaluating abnormal cerebral hemodynamics. The CBV map of CTP is the most precisely predictable value of postoperative patient's status and alteration of treatement modality.

Neurological Improvement after Cranioplasty in Patients with Surgical Bony Defects : The Usefulness of Acetazolamide Activated (99m)Tc-HMPAO SPECT

OBJECTIVE: The purpose of this study is to examine the influence of cranioplasty on dynamics of cerebral blood flow(CBF) and cerebrovascular reserve capacity(CVRC), and to investigate the usefulness of single photon emission computed tomography (SPECT) as a prognostic factor for neurological improvement after cranioplasty. METHODS: Between March 2003 and December 2005, a prospective study was performed on 24 patients who had undergone total 25 cranioplasty operations. Cerebral blood flow velocities in the middle cerebral artery(MCA) and internal carotid artery (ICA) were obtained by transcranial Doppler ultrasonography(TCD). The CVRC was assessed by SPECT in the natural state and after stimulation with 1g of acetazolamide. Neurological improvement after cranioplasty was compared between patients who showed hyperactivity to acetazolamide-activated SPECT (Group 1, n=7) and hypoactivity to acetazolamide-activated SPECT (Group 2, n=17). These measurements were obtained two weeks prior to and two weeks after cranioplasty. RESULTS: The blood flow velocities at the opposite site to the cranioplasty as well as at the cranioplasty site were significantly increased (P<0.05). Compared with Group 2, there was significant increase in CBF and neurological imrovement after cranioplasty in Group 1. CONCLUSION: Among patients with surgical bony defects, the patients who had normal reactivity of the CVRC showed a significant increase in CBF and neurological improvement after cranioplasty. The authors suggest that CVRC measurement prior to surgery may be an important prognostic factor for neurological improvement after cranioplasty.

Early Effect of Endotoxin on Cerebral Autoregulation / 대한마취과학회지

BACKGROUND: Under normal conditions, cerebral blood flow is regulated as cerebral perfusion pressure changes (autoregulation). Inflammatory conditions like bacterial meiningitis result in a loss of cerebral autoregulation several hours after exposure to bacterial endotoxin. Endotoxin appears to produce effects via the production of reactive oxygen species, such as the superoxide anion. METHODS: Cerebral blood flow (CBF) was measured by hydrogen clearance in anesthetized rats 30 minutes after intravenous endotoxin 5 mg/kg or normal saline (control). Mean arterial pressure was reduced from 100 mmHg to 80 mmHg and 60 mmHg by hemorragic hypotension, and cerebral blood flow was measured at each pressure. RESULTS: In the control group, CBF did not change when arterial pressure was reduced to 80 mmHg (113.9 ml vs 111.9 ml), but declined significantly at 60 mmHg (113.9 ml vs 88.4 ml). In the group treated with endotoxin, both a reduction of mean arterial pressure to 80 mmHg (129.8 ml vs 101.8 ml) and 60 mmHg (129.8 ml vs 78.4 ml) caused a significant reduction in CBF, indicating that autoregualtion had been abolished. CONCLUSIONS: The results of this study indicate that within minutes of endotoxin exposure, CBF markedly increased, and that the autoregualtion of CBF was inhibited.

Molecular mechanism of protective effects of estrogen on cerebral ischemia / 中国临床药理学与治疗学

Estrogen has the protective effect on cerebral ischemia in v ar ious ways. It not only can improve the regional cerebral blood flow during ische mia and rescue the remaining neurons alive, but also can reduce the injury of is chemia-reperfusion. In this article, we enumerate at the molecular level that e strogen has the properties of inhibiting the expression of VCAM and cytokines li ke TNF-? in the ischemia region, educing the overload of calcium and cytotoxic ity of EAA by modulating the calcium channels, and regulating related genes expr ession and anti-apoptosis. It is crucial for estrogen replacement therapy as a neutoprotectant clinically.

Pediatric Moyamoya Disease: Perioperative Cerebral Blood Flow and MR Angiography Studies

To assess the role of magnetic resonance angiography(MRA) and the effect of encephaloduroarteriosynangiosis (EDAS) on the pediatric moyamoya disease(MMD), we analyzed the findings of MRA comparing with conventional angiography(CA) and cerebral blood flow(CBF) studies using 99m Tc-HMPAO SPECT or H2O15-PET with or without diamox enhancement, and focusing on changes following surgery for EDAS. Our assessment involved 23 children with MMD, in whom 44 EDAS procedures were performed. On MRA compared with CA, stenosis of internal carotid arteries was accurately visualized in eight of 19 hemispheres (42%) and augmented in 11(58%). The visualization of basal moyamoya vessels was accurate in ten hemispheres (53%), underestimated in seven(37%) and non-visualized in two(11%). Changes in the middle and anterior cerebral artery were similarly visible in both MRA and CA studies. Evaluation of postoperative MRA showed that at the site of surgery, the major change was dilation of the superficial temporal artery, seen in 89% of cases; the presence of anastomoses in this artery was confirmed in 13 of 19 hemispheres(68%). In comparison with perioperative CBF studies, basal CBF improved in 23 of 36 hemispheres(64%) within one year of surgery. In particular, early improvement of basal CBF, within 3 months, was observed in seven hemispheres(30.4%). CBF studies with diamox enhancement showed that after surgery, vascular reserve was normal or improved in eight of 12 hemispheres(67%). In conclusion, it may be stated that although definitive diagnosis requires further improvement in the delineation of fine vasculature, MRA promises to become a useful alternative to conventional angiography in the diagnosis and postoperative evaluation of MMD. To understand the effects of surgery on MMD, perioperative CBF studies are mandatory.

Postoperative Cerebral Blood Flow Evaluation by Stable Xenon Computed Tomography in Patients with a Ruptured Intracranial Aneurysm

In cerebrovascular disease, the measurement of cerebral blood flow(CBF) is an important indicator of a patient's clinical status, treatment and prognosis. The main advantage of Stable Xenon CT is that it noninvasively provides three-dimensional, high resolution, quantitative local cerebral blood flow information coupled to anatomic exposition. Using this modality, we measured postoperative CBF in 50 patients with subarachnoid hemorrhage from a ruptured intracranial aneurysm. The results were as follows : 1) There was a negative relationship between age and CBF. 2) Among postoperative disability patients, global and regional CBF were markedly diminished. 3) CBF on the ipsilateral side of a craniotomy site was markedly lower than on the contralateral side. Xenon CT is a very useful method for the evaluation of postoperative CBF in intracranial aneurysm patients.