Malignant infarction in cats following prolonged middle cerebral artery occlusion : volumes of severe blood flow reduction predict fatal outcome

Severity and duration of cerebral blood flow (CBF) reduction are main determinants of injury in core and penumbra zones of focal brain ischemia. To study the putative role and predictive significance of the volume of these zones for induction of a malignant course due to edema formation in large hemispheric stroke, we examined reduction of CBF and oxygen metabolism (CMRO2) by sequential positron emission tomography (PET) in a transient ischemia model in cats that is susceptible to secondary deterioration after reperfusion.peer-reviewe

No secondary elevation of extracellular adenosine in malignant edema formation following transient MCA occlusion

Malignant edema is a relevant, serious complication in various clinical situations including large hemispheric stroke. To date, the roles of purine catabolites and amino acids in the course of malignant edema formation remain obscure. We examined the correlation between secondary perfusional disturbance and elevation of extracellular purine catabolites and amino acids in a transient focal ischemia model in cats that is prone to develop malignant edema and thereby secondary ischemia during reperfusionpeer-reviewe

Glutamate and purine catabolites in relation to free radical production during focal ischemia-reperfusion : an in vivo study in cats

The in-vivo interrelation between excitotoxicity and oxidative stress following cerebral ischemia in cats was investigated. To elucidate the role of this mechanism in cerebral ischemia, the study presented herein sought to investigate the spatial and temporal features of the free radical response to elevations of glutamate and purine catabolites in a reproducible model of in vivo focal ischemia/reperfusion. The time course of neurochemical and Reactive Oxygen Species (ROS) were simultaneously conducted in ischemic focus and perifocal region of the brain.peer-reviewe

Extracellular glutamate accumulates only in final, ischemic stage of progressive epidural mass lesion in cats

Epidural mass lesions may cause ischemia due to progressive intracranial hypertension. In order to 1) investigate the impact of intracranial pressure (ICP) on accumulation of neuroactive substances, and 2) test the significance of neurochemical monitoring for early prediction of fatal outcome, we gradually raised ICP in cats by inflation of an epidural balloon: We assessed extracellular substrate alterations in the contralateral cortex in relation to changes of ICP, cerebral perfusion pressure (CPP) and mean arterial blood pressure (MABP). In a complementary experiment, regional cerebral blood flow was assessed by sequential positron emission tomography (PET).peer-reviewe

ШЛЯХИ ПІДВИЩЕННЯ ЕФЕКТИВНОСТІ РЕГУЛЮЮЧОЇ ФУНКЦІЇ ДЕРЖАВИ У СФЕРІ ІННОВАЦІЙ

У статті розглядається регулююча функція держави щодо активізації інноваційно- інвестиційної діяльності в Україні, здійснюється порівняння з аналогічною практикою у розвинутих країнах і розробляються напрямки підвищення ефективності механізмів саморегулювання інноваційної діяльності.In article regulating function of the state concerning activization innovatively - investment activity in Ukraine is considered, comparison with similar practice in the developed countries is carried out and directions of increase of efficiency of mechanisms of self-regulation of innovative activity are developed

An integrated MR/PET system: prospective applications

Radiology is strongly depending on medical imaging technology and consequently directing technological progress. A novel technology can only be established, however, if improved diagnostic accuracy influence on therapeutic management and/or overall reduced cost can be evidenced. It has been demonstrated recently that Magnetic Resonance Imaging (MRI) and Positron Emission Tomography (PET) can technologically be integrated into one single hybrid system. Some scientific arguments on the benefits are obvious, e.g., that simultaneous imaging of morphological and functional information will improve tissue characterization. However, crossfire of questions still remains: What unmet radiological needs are addressed by the novel system? What level of hardware integration is reasonable, or would software-based image co-registration be sufficient? Will MR/PET achieve higher diagnostic accuracy compared to separate imaging? What is the added value compared to other hybrid imaging modalities like PET/CT? And finally, is the system economically reasonable and has the potential to reduce overall costs for therapy planning and monitoring? This article tries to highlight some perspectives of applying an integrated MR/PET system for simultaneous morphologic and functional imaging

Differential effects of speech and Language therapy and rTMS in chronic versus subacute post-stroke aphasia: Results of the NORTHSTAR-CA trial

Background & objective: Contralesional 1-Hz repetitive transcranial magnetic stimulation (rTMS) over the right pars triangularis combined with speech-language therapy (SLT) has shown positive results on the recovery of naming in subacute (5–45 days) post-stroke aphasia. NORTHSTAR-CA is an extension of the previously reported NORTHSTAR trial to chronic aphasia (\u3e6 months post-stroke) designed to compare the effectiveness of the same rTMS protocol in both phases. Methods: Sixty-seven patients with left middle cerebral artery infarcts (28 chronic, 39 subacute) were recruited (01-2014 to 07-2019) and randomized to receive rTMS (N = 34) or sham stimulation (N = 33) with SLT for 10 days. Primary outcome variables were Z-score changes in naming, semantic fluency and comprehension tests and adverse event frequency. Intention-to-treat analyses tested between-group effects at days 1 and 30 post-treatment. Chronic and subacute results were compared. Results: Adverse events were rare, mild, and did not differ between groups. Language outcomes improved significantly in all groups irrespective of treatment and recovery phase. At 30-day follow-up, there was a significant interaction of stimulation and recovery phase on naming recovery (P \u3c.001). Naming recovery with rTMS was larger in subacute (Mdn = 1.91/IQR =.77) than chronic patients (Mdn =.15/IQR = 1.68/P =.015). There was no significant rTMS effect in the chronic aphasia group. Conclusions: The addition of rTMS to SLT led to significant supplemental gains in naming recovery in the subacute phase only. While this needs confirmation in larger studies, our results clarify neuromodulatory vs training-induced effects and indicate a possible window of opportunity for contralesional inhibitory stimulation interventions in post-stroke aphasia. NORTHSTAR trial registration: https://clinicaltrials.gov/ct2/show/NCT02020421

[11C]-l-Methionine positron emission tomography in the management of children and young adults with brain tumors

Only a few Methyl-[11C]-l-methionine (MET) positron emission tomography (PET) studies have focused on children and young adults with brain neoplasm. Due to radiation exposure, long scan acquisition time, and the need for sedation in young children MET-PET studies should be restricted to this group of patients when a decision for further therapy is not possible from routine diagnostic procedures alone, e.g., structural imaging. We investigated the diagnostic accuracy of MET-PET for the differentiation between tumorous and non-tumorous lesions in this group of patients. Forty eight MET-PET scans from 39 patients aged from 2 to 21 years (mean 15 ± 5.0 years) were analyzed. The MET tumor-uptake relative to a corresponding control region was calculated. A receiver operating characteristic (ROC) was performed to determine the MET-uptake value that best distinguishes tumorous from non-tumorous brain lesions. A differentiation between tumorous (n = 39) and non-tumorous brain lesions (n = 9) was possible at a threshold of 1.48 of relative MET-uptake with a sensitivity of 83% and a specificity of 92%, respectively. A differentiation between high grade malignant lesions (mean MET-uptake = 2.00 ± 0.46) and low grade tumors (mean MET-uptake = 1.84 ± 0.31) was not possible. There was a significant difference in MET-uptake between the histologically homogeneous subgroups of astrocytoma WHO grade II and anaplastic astrocytoma WHO grade III (P = 0.02). MET-PET might be a useful tool to differentiate tumorous from non-tumorous lesions in children and young adults when a decision for further therapy is difficult or impossible from routine structural imaging procedures alone

Post-stroke dementia - a comprehensive review

Post-stroke dementia (PSD) or post-stroke cognitive impairment (PSCI) may affect up to one third of stroke survivors. Various definitions of PSCI and PSD have been described. We propose PSD as a label for any dementia following stroke in temporal relation. Various tools are available to screen and assess cognition, with few PSD-specific instruments. Choice will depend on purpose of assessment, with differing instruments needed for brief screening (e.g., Montreal Cognitive Assessment) or diagnostic formulation (e.g., NINDS VCI battery). A comprehensive evaluation should include assessment of pre-stroke cognition (e.g., using Informant Questionnaire for Cognitive Decline in the Elderly), mood (e.g., using Hospital Anxiety and Depression Scale), and functional consequences of cognitive impairments (e.g., using modified Rankin Scale). A large number of biomarkers for PSD, including indicators for genetic polymorphisms, biomarkers in the cerebrospinal fluid and in the serum, inflammatory mediators, and peripheral microRNA profiles have been proposed. Currently, no specific biomarkers have been proven to robustly discriminate vulnerable patients (‘at risk brains’) from those with better prognosis or to discriminate Alzheimer’s disease dementia from PSD. Further, neuroimaging is an important diagnostic tool in PSD. The role of computerized tomography is limited to demonstrating type and location of the underlying primary lesion and indicating atrophy and severe white matter changes. Magnetic resonance imaging is the key neuroimaging modality and has high sensitivity and specificity for detecting pathological changes, including small vessel disease. Advanced multi-modal imaging includes diffusion tensor imaging for fiber tracking, by which changes in networks can be detected. Quantitative imaging of cerebral blood flow and metabolism by positron emission tomography can differentiate between vascular dementia and degenerative dementia and show the interaction between vascular and metabolic changes. Additionally, inflammatory changes after ischemia in the brain can be detected, which may play a role together with amyloid deposition in the development of PSD. Prevention of PSD can be achieved by prevention of stroke. As treatment strategies to inhibit the development and mitigate the course of PSD, lowering of blood pressure, statins, neuroprotective drugs, and anti-inflammatory agents have all been studied without convincing evidence of efficacy. Lifestyle interventions, physical activity, and cognitive training have been recently tested, but large controlled trials are still missing