Journal articles on the topic 'Brain damage – Complications – Treatment'
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1
Sangi, Sibghatullah Muhammad Ali, and Nora Abdulaziz Al Jalaud. "Prevention and treatment of brain damage in streptozotocin induced diabetic rats with Metformin, Nigella sativa, Zingiber officinale, and Punica granatum." Biomedical Research and Therapy 6, no. 7 (July 5, 2019): 3274–85. http://dx.doi.org/10.15419/bmrat.v6i7.554.
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Introduction: Diabetes mellitus (DM) is well-known metabolic disorder, which causes serious effects on human health with its complications. Many mechanisms has been postulated to cause DM related complications. One of the main complications is neuronal damage, for which no proper preventive and curative therapies are available.
Methods: In this study the effects of Ginger, Nigella sativa, Punica granatum and Metformin were seen on the prevention and treatment of brain damage caused by diabetes mellitus in streptozotocin (STZ)- induced diabetes in rats. 50 adult Wistar albino male rats were used in the study, the rats were divided in 10 study groups. The body weight, serum glucose levels were measured, and histopathological examination was performed.
Results: In comparison to the diabetic control rats, significant increase in weight was found in animals of all the studied groups. Serum glucose levels reduced significantly in comparison to the STZ induced diabetic rats in all the animals. Histopathological examination showed prevention from brain damage and repair of the neuronal tissues by Ginger, Nigella sativa, Punica granatum and Metformin.
Conclusion: The studied substances were observed to possess preventive and curative effects on the brain damage caused by diabetes mellitus.
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Ali Mohamed, Daoud, Arthur Semedo, Boris Adeyemi, Leila Hessissen, Maria El Kababri, Nazik Allali, Latifa Chat, and Siham El Haddad. "Reversible Encepahlopathy Induced by Ifosfamide with Brain Imaging." Global Pediatric Health 8 (January 2021): 2333794X2110304. http://dx.doi.org/10.1177/2333794x211030415.
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Chemotherapy may be responsible for central and/or peripheral neurotoxicity. These neurological complications are frequent but little known. Some molecules are more providers, responsible for acute or late complications, sometimes not reversible. Some manifestations such as acute encephalopathy and acute reversible encephalopathy are increasingly understood. We report here a case of acute ifosfamide-induced encephalopathy (EII) with brain damage resolved after discontinuation of this treatment in a 13-years-old child.
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Shmelev, V. V., and M. I. Neymark. "Markers of ischemic neuronal damage, neurological complications of carotid endarterectomy and their management depending on anesthesia type." Kazan medical journal 94, no. 1 (February 15, 2013): 13–17. http://dx.doi.org/10.17816/kmj1761.
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Aim. to identify the anesthesia method for carotid endarterectomy providing minimal ischemic neuronal damage and decreasing the number of post-surgical complications; to adjust the optimal treatment for associated neurological disorders. Methods. An assessment of anesthesia methods was performed in 190 patients who underwent the carotid endarterectomy. The intravenous anesthesia with propofol (first group, 60 patients), regional anesthesia using deep cervical plexus block (second group, 60 patients), and inhalational anesthesia with sevoflurane (third group, 70 patients) were compared. Brain perfusion parameters, neurological status, ischemic neuronal damage markers were examined. Results. In patients undergoing carotid endarterectomy an ischemic neuronal damage is provoked due to brain perfusion decrease as a result of common carotid artery clipping regardless of anesthesia method. Inhalational anesthesia was associated with relatively lower ischemic neuronal damage markers levels. Some patients form every group have developed serious post-surgical neurological complications (stroke, transient cerebral ischemic attack, neurological status deterioration). Post-surgical complications were registered in 10 (16.7%) patients from the first group, in 9 (15%) patients form the second group, in 3 (4.3%) patients from the third group. Citicoline was the most effective drug for associated neurological disorders treatment. Conclusion. Inhalational anesthesia with sevoflurane compared to intravenous anesthesia with propofol and regional anesthesia using deep cervical plexus block limits the neuronal damage and is associated with lower number of post-surgical neurological complications, which can be treated with citicoline.
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Zharova, Elena, Anastasia Bondarenko, Elena Vershinina, Olga Titova, and Natalia Talnishnih. "Rehabilitation of patients with facial nerve injuries after neurosurgical treatment." Vestnik of Saint Petersburg University. Medicine 15, no. 1 (2020): 37–48. http://dx.doi.org/10.21638/spbu11.2020.105.
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The facial nerve is most often, as compared with other cranial nerves, damaged due to surgical interventions. In the first place, as the cause of iatrogenic damage, is neurosurgical treatment for neoplasms of the ponto-cerebellar angle and temporal bone, brain injuries. The neuropathy of the facial nerve is the cause of neurological and cosmetic defects that have a serious traumatic effect on the patient. The psychological consequences of facial neuropathy are more important for the patient than physical damage. Paresis of mimic muscles cannot be hidden and often leads to social maladjustment, isolation and a marked reduction in the quality of life. Facial neuropathy, in most cases, is not a life-threatening condition, but it definitely changes the patient’s life. This article proposes an effective rehabilitation system, tested on 172 patients with facial nerve damage after neurosurgical treatment. The combined use of physiotherapy, massage, therapeutic gymnastics, including posture treatment with taping, during the early period of the disease, allows restoring nerve function and maintaining mimic muscles, as well as avoiding undesirable complications such as pathological synkinesis and corneal atrophy.
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Hamzagic, Nedim, Tomislav Nikolic, Biljana Popovska Jovicic, Petar Canovic, Sasa Jacovic, and Dejan Petrovic. "Acute Kidney Damage: Definition, Classification and Optimal Time of Hemodialysis." Serbian Journal of Experimental and Clinical Research 20, no. 3 (September 1, 2019): 267–75. http://dx.doi.org/10.1515/sjecr-2017-0050.
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Abstract Acute damage to the kidney is a serious complication in patients in intensive care units. The causes of acute kidney damage in these patients may be prerenal, renal and postrenal. Sepsis is the most common cause of the development of acute kidney damage in intensive care units. For the definition and classification of acute kidney damage in clinical practice, the RIFLE, AKIN and KDIGO classifications are used. There is a complex link between acute kidney damage and other organs. Acute kidney damage is induced by complex pathophysiological mechanisms that cause acute damage and functional disorders of the heart (acute heart failure, acute coronary syndrome and cardiac arrhythmias), brain (whole body cramps, ischaemic stroke and coma), lung (acute damage to the lung and acute respiratory distress syndrome) and liver (hypoxic hepatitis and acute hepatic insufficiency). New biomarkers, colour Doppler ultrasound diagnosis and kidney biopsy have significant roles in the diagnosis of acute kidney damage. Prevention of the development of acute kidney damage in intensive care units includes maintaining an adequate haemodynamic status in patients and avoiding nephrotoxic drugs and agents (radiocontrast agents). The complications of acute kidney damage (hyperkalaemia, metabolic acidosis, hypervolaemia and azotaemia) are treated with medications, intravenous solutions, and therapies for renal function replacement. Absolute indications for acute haemodialysis include resistant hyperkalaemia, severe metabolic acidosis, resistant hypervolaemia and complications of high azotaemia. In the absence of an absolute indication, dialysis is indicated for patients in intensive care units at stage 3 of the AKIN/KDIGO classification and in some patients with stage 2. Intermittent haemodialysis is applied for haemodynamically stable patients with severe hyperkalaemia and hypervolaemia. In patients who are haemodynamically unstable and have liver insufficiency or brain damage, continuous modalities of treatment for renal replacement are indicated.
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Romero, José Rafael, Viken L. Babikian, Douglas I. Katz, and Seth P. Finklestein. "Neuroprotection and Stroke Rehabilitation: Modulation and Enhancement of Recovery." Behavioural Neurology 17, no. 1 (2006): 17–24. http://dx.doi.org/10.1155/2006/137532.
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Recent advances in research are modifying our view of recovery after nervous system damage. New findings are changing previously held concepts and providing promising avenues for treatment of patients after stroke. This review discusses mechanisms of neuronal injury after brain ischemia and the attempts to study neuroprotection options based on such mechanisms. It also considers measures available at present to improve outcome after stroke and presents new areas of research, particularly stimulation techniques, neurogenesis and trophic factors to enhance recovery. In order to improve outcomes, medications that may be detrimental to recovery should be avoided, while symptomatic therapy of problems such as depression, pain syndromes and spasticity may contribute to better results. Continued surveillance and early treatment of complications associated with acute stroke, along with supportive care remain the mainstay of treatment for stroke patients in the recovery phase. Present research on limiting brain damage and improving recovery and plasticity enhance the prospects for better clinical treatments to improve recovery after stroke.
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Liang, Jia, Zhifeng Qi, Wenlan Liu, Peng Wang, Wenjuan Shi, Wen Dong, Xunming Ji, Yumin Luo, and Ke Jian Liu. "Normobaric Hyperoxia Slows Blood–Brain Barrier Damage and Expands the Therapeutic Time Window for Tissue-Type Plasminogen Activator Treatment in Cerebral Ischemia." Stroke 46, no. 5 (May 2015): 1344–51. http://dx.doi.org/10.1161/strokeaha.114.008599.
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Background and Purpose— Prolonged ischemia causes blood–brain barrier (BBB) damage and increases the incidence of neurovasculature complications secondary to reperfusion. Therefore, targeting ischemic BBB damage pathogenesis is critical to reducing neurovasculature complications and expanding the therapeutic time window of tissue-type plasminogen activator (tPA) thrombolysis. This study investigates whether increasing cerebral tissue P O 2 through normobaric hyperoxia (NBO) treatment will slow the progression of BBB damage and, thus, improve the outcome of delayed tPA treatment after cerebral ischemia. Methods— Rats were exposed to NBO (100% O 2 ) or normoxia (21% O 2 ) during 3-, 5-, or, 7-hour middle cerebral artery occlusion. Fifteen minutes before reperfusion, tPA was continuously infused to rats for 30 minutes. Neurological score, mortality rate, and BBB permeability were determined. Matrix metalloproteinase-9 was measured by gelatin zymography and tight junction proteins (occludin and cluadin-5) by Western blot in the isolated cerebral microvessels. Results— NBO slowed the progression of ischemic BBB damage pathogenesis, evidenced by reduced Evan blue leakage, smaller edema, and hemorrhagic volume in NBO-treated rats. NBO treatment reduced matrix metalloproteinase-9 induction and the loss of tight junction proteins in ischemic cerebral microvessels. NBO-afforded BBB protection was maintained during tPA reperfusion, resulting in improved neurological functions, significant reductions in brain edema, hemorrhagic volume, and mortality rate, even when tPA was given after prolonged ischemia (7 hours). Conclusions— Early NBO treatment slows ischemic BBB damage pathogenesis and significantly improves the outcome of delayed tPA treatment, providing new evidence supporting NBO as an effective adjunctive therapy to extend the time window of tPA thrombolysis for ischemic stroke.
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Krylov, V. V., V. A. Rak, A. S. Tokarev, M. V. Sinkin, I. S. Trifonov, O. L. Yevdokimova, V. N. Stepanov, E. N. Rozhnova, and G. V. Koinash. "Stereotactic Radiosurgery in the Complex Treatment of Patients With Epilepsy Associated With Various Structural Brain Lesions." Russian Sklifosovsky Journal "Emergency Medical Care" 10, no. 1 (April 20, 2021): 73–82. http://dx.doi.org/10.23934/2223-9022-2021-10-1-73-82.
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BACKGROUND Structural damage to the brain substance in adults is one of the most common causes of epilepsy. Currently, such patients are prescribed drug therapy and/or surgery. With this approach, epileptic symptoms can persist in a significant proportion of patients (up to 30%, depending on the disease).AIM OF STUDY To clarify the efficacy of stereotactic radiosurgery (STS) as part of the complex treatment of patients suffering from pharmacoresistant symptomatic epilepsy with hippocampal sclerosis, vascular malformations, and some benign tumors of the brain and its membranes.MATERIAl AND METHODS Examination and radiosurgical treatment were carried out in 45 patients with various brain diseases accompanied by symptomatic epilepsy, provided that the previous conservative or surgical treatment was insufficiently effective. During the observation period, the frequency of seizures was assessed and the presence and nature of postoperative complications were recorded.RESUlTS With a median follow-up of 30 months, good outcomes (class I–II according to J. Engel’s scale) were observed in 5 out of 8 patients with hippocampal sclerosis who underwent STS after amygdaloghippocamplobectomy; seizure frequency decreased in all patients. Complications of STS were noted in 2 patients and had a transient nature. In the group of patients with meningiomas, in 4 out of 8 patients, seizures completely stopped, in 3 patients the frequency of seizures decreased by more than 90%, in another 1 the frequency of seizures decreased by 60%. There were no complications of STS during the observation period. Inintracerebral tumors (diffuse astrocytoma), Engel Ia outcome was observed in both patients. In the group of patients with cavernous angiomas, there were good outcomes (class I–II according to J. Engel’s scale) in 17 patients (85%). Deterioration (Engel IVc outcome) was observed in 1 patient (5%), 2 patients (10%) had complications of STS. In the group of patients with arteriovenous malformations, good outcomes (classes I–II according to J. Engel’s scale) were found in all 7 patients. The complication after STS was revealed in 1 patient.CONClUSION The presented results confirm the high efficiency and low risk of side effects when using stereotactic radiosurgery in the complex treatment of patients with epilepsy associated with common structural brain lesions.
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Kraśniej-Dębkowska, Agnieszka, Maciej Śnieżyński, and Anna Członkowska. "Inflammatory process as an etiological and prognostic factor of stroke and the goal of potential treatment strategies." Pharmacotherapy in Psychiatry and Neurology 36, no. 4 (February 8, 2021): 297–311. http://dx.doi.org/10.33450/fpn.2020.12.003.
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Objective. Inflammation is the body’s natural defence mechanism against factors that damage its tissues. However, if it lasts chronically, it may adversely affect the body’s homeostasis. Inflammation is not only a long-known risk factor for the development of atherosclerosis and its complications, but also develops brain tissue damage in the course of ischemic stroke or intracerebral haemorrhage, leading to even greater damage. In addition, the immune system functions are impaired, which increases the risk of infection. Literature review. Drugs that can reduce the risk of stroke by inhibiting vascular damage and modifying the inflammatory process in the central nervous system, including counteracting the risk of infection, have become the subject of many experimental and clinical studies on strokes. Such drugs include canakinumab, human recombinant interleukin-1 receptor antagonist, colchicine, fingolimod, siponimod or natalizumab. Conclusions. Considering all available research results, the therapeutic pathway using anti-inflammatory drugs has a high potential; however, the complications associated with evoked immunosuppression in patients should be kept in mind. The paper presents a review of the literature on the role of the inflammatory process in the pathogenesis of stroke as well as related therapeutic options.
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Rodrigues, Joana, Dalila Rocha, Fátima Santos, and Anabela João. "NeonatalCitrobacter koseriMeningitis: Report of Four Cases." Case Reports in Pediatrics 2014 (2014): 1–4. http://dx.doi.org/10.1155/2014/195204.
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Citrobacter koseriis a rare cause of neonatal meningitis with predisposal for brain abscesses, and therefore responsible for high mortality and serious neurologic sequelae in this age group. We present the evolution and outcome of four cases ofC. koserimeningitis. One of them developed brain abscesses and another one died. The cases show the bacteria's propensity for serious brain damage, despite early and adequate treatment, and the high risk of long-term neurologic complications in survivors, which imposes a close follow-up.
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Vasilyeva, Y. B., A. E. Talypov, and S. S. Petrikov. "Clinical Features of Traumatic Brain Injury in Various Kinds of Brain Damage." Russian Sklifosovsky Journal "Emergency Medical Care" 8, no. 3 (November 6, 2019): 295–301. http://dx.doi.org/10.23934/2223-9022-2019-8-3-295-301.
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Various circumstances of the injury lead to various types of brain damage. The main types of destructive effects are countracoup effect and acceleration/deceleration. The high intensity injuring force creates conditions for occurrence of combinations of different types of damage leading to aggravation of pathological processes caused by trauma, complication of clinical picture, difficulties of diagnosis and treatment, prolongation of hospital stay, and requires an additional methods of research and treating the injured. Finding the genesis of symptoms observed upon neurologic examination, and especially the differential diagnosis between primary and secondary lesions of the brain stem are nessesary to choose the emergency care for victims with severe traumatic brain injury, as well as to forecast the outcomes of treatment. The dynamics of neurological symptoms (level of wakefulness, pupil size, eyeball mobility, muscle tone and limb movement disorders, pathological plantar reflexes) have significant differences in patients with various types of brain damage, which makes a regular assessment of neurological status extremely important in these patients.
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Barbara, C., E. Pozzati, G. Marucci, M. Joechler, L. Pisoni, E. Bellei, M. Leonardi, and L. Masetti. "Effects of Glubran Acrylic Glue on the Subarachnoid Surface in Swine." Rivista di Neuroradiologia 18, no. 5-6 (December 2005): 537–45. http://dx.doi.org/10.1177/197140090501800503.
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Glubran2 is a cyanoacrylate-based synthetic glue modified by addition of a second monomer. Among its many advantages over traditional cyanoacrylate products, Glubran2 has a much lower thermal polymerization temperature than that of cyanoacrylates used for cutaneous application. For many years, the new glue has been widely used in neuroradiology endovascular treatments. Our study aimed to assess the use of Glubran2 to treat possible complications arising during the embolization of aneurysms or vascular malformations like AVM or fistulae. A complication encountered in some of these cases is rupture of the vessel wall by the microguide or perforation of the aneurysmal sac by the coils used for embolization. This complication could be overcome by injecting Glubran2 into the rupture point but this would put the glue directly in contact with the subarachnoid space and possibly reach adjacent brain tissue. The aim of this experimental study was to place the glue in direct contact with brain tissue to ascertain its immediate compatibility and tolerability in vivo and any ensuing tissue damage. Three swine underwent neurosurgical procedures and survived for different times after which they were slaughtered and their brains explanted and sent for macroscopic and microscopic investigation by the Pathological Anatomy Service. As a whole, Glubran2 was well tolerated in vivo and did not cause major damage in direct contact with brain tissue.
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Jung, WooSang, SeungWon Kwon, SeongUk Park, SangKwan Moon, JungMi Park, ChangNam Ko, and KiHo Cho. "Electroacupuncture for Decorticate Rigidity of the Upper Limbs in a Patient with Anoxic Brain Damage." Case Reports in Medicine 2013 (2013): 1–4. http://dx.doi.org/10.1155/2013/524603.
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Decorticate rigidity is a type of abnormal posturing that can make it difficult to move a patient and to change the patient’s position to prevent a decubitus ulcer. This condition poses a latent risk of bed sores. To prevent those complications, we used electroacupuncutre for decorticate rigidity of the upper limbs in a patient with anoxic brain damage. A 51-year-old man complained of rigidity of both of the upper and lower extremities due to anoxic brain damage. His rigidity was exhibited as flexed arms and extended legs, which are the typical positions in decorticate rigidity. Prior to electroacupuncture, his decorticate rigidity was treated with dantrolene sodium and baclofen. However, his rigidity had not improved. This patient received total 41 sessions of electroacupuncture. The patient’s Modified Ashworth’s Scale changed from 4 at baseline to 2 after the treatment, indicating an improvement in the rigidity of the upper limbs. Preston’s Hypertonicity Scale and passive ROM of the elbow joints also improved. We report the observed effects of electroacupuncture for decorticate rigidity of the upper limbs in a patient with anoxic brain damage. Further controlled studies are needed to determine whether electroacupuncture is a useful alternative treatment for decorticate rigidity in patients with anoxic brain damage.
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Kim, Donghyun, Kyeong-A. Kim, Jeong-Hyeon Kim, Eun-Hye Kim, and Ok-Nam Bae. "Methylglyoxal-Induced Dysfunction in Brain Endothelial Cells via the Suppression of Akt/HIF-1α Pathway and Activation of Mitophagy Associated with Increased Reactive Oxygen Species." Antioxidants 9, no. 9 (September 3, 2020): 820. http://dx.doi.org/10.3390/antiox9090820.
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Methylglyoxal (MG) is a dicarbonyl compound, the level of which is increased in the blood of diabetes patients. MG is reported to be involved in the development of cerebrovascular complications in diabetes, but the exact mechanisms need to be elucidated. Here, we investigated the possible roles of oxidative stress and mitophagy in MG-induced functional damage in brain endothelial cells (ECs). Treatment of MG significantly altered metabolic stress as observed by the oxygen-consumption rate and barrier-integrity as found in impaired trans-endothelial electrical resistance in brain ECs. The accumulation of MG adducts and the disturbance of the glyoxalase system, which are major detoxification enzymes of MG, occurred concurrently. Reactive oxygen species (ROS)-triggered oxidative damage was observed with increased mitochondrial ROS production and the suppressed Akt/hypoxia-inducible factor 1 alpha (HIF-1α) pathway. Along with the disturbance of mitochondrial bioenergetic function, parkin-1-mediated mitophagy was increased by MG. Treatment of N-acetyl cysteine significantly reversed mitochondrial damage and mitophagy. Notably, MG induced dysregulation of tight junction proteins including occludin, claudin-5, and zonula occluden-1 in brain ECs. Here, we propose that diabetic metabolite MG-associated oxidative stress may contribute to mitochondrial damage and autophagy in brain ECs, resulting in the dysregulation of tight junction proteins and the impairment of permeability.
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Szewczak, Krzysztof, Magdalena Niespialowska, Beata Jakubowska-Solarska, Magdalena Chalabis, and Jacek Gawlowicz. "Prospective of ischemic stroke biomarkers." Current Issues in Pharmacy and Medical Sciences 30, no. 2 (June 27, 2017): 69–74. http://dx.doi.org/10.1515/cipms-2017-0014.
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Abstract Methods currently used in brain vascular disorder diagnostics are neither fast enough nor clear-out; thus, there exists a necessity of finding new types of testing which could enlarge and complete the actual panel of diagnostics or be an alternative to current methods. The discovery of sensitive and specific biomarkers of ischemic brain stroke will improve the effects of treatment and will help to assess the progress or complications of the disease. The relevant diagnosis of ischemic stroke (IS) within the first 4.5 hours after the initial symptoms allows for the initiation of treatment with recombinant tissue plasminogen activators which limits the magnitude of negative changes in the brain and which enhance the final effectiveness of therapy. The potential biomarkers which are under investigation are substances involved in the processes of coagulation and fibrinolysis, and are of molecules released from damaged vascular endothelial cells and from nerves and cardiac tissue. The analyzed substances are typical of oxidative stress, apoptosis, excitotoxicity and damage of the blood brain barrier.
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Fontaine, Réjean, and Trevor Young. "Unilateral ECT: Advantages and Efficacy in the Treatment of Depression." Canadian Journal of Psychiatry 30, no. 2 (March 1985): 142–47. http://dx.doi.org/10.1177/070674378503000210.
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Electroconvulsive therapy is an efficacious treatment for some acute or drug resistant psychiatric disorders. However, there is some concern with memory impairment and brain damage and in order to decrease these complications, some changes to the technical aspect of electroconvulsive therapy were implemented during the last few decades. One of the major changes is the use of unilateral electrical stimulation on the non-dominant hemisphere which leads to less memory impairment and faster recovery time of cognitive functions. However, for optimal efficacy several variables have to be understood and integrated: electrodes placement, interelectrodes distance, waveform stimuli.
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Novak, Vera, Federico Gomez, Alexandre Campos Dias, Daniela A. Pimentel, and Freddy J. Alfaro. "Diabetes-Related Cognitive Decline, a Global Health Issue, and New Treatments Approaches." International Journal of Privacy and Health Information Management 5, no. 2 (July 2017): 58–70. http://dx.doi.org/10.4018/ijphim.2017070104.
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The epidemic of type 2 diabetes (T2DM) is spreading around the globe and challenging the unprecedented success of health sciences in increasing longevity. T2DM has been linked to accelerated brain aging, functional decline in older adults and dementia. Brain insulin resistance and glycemic variability are potential mechanisms underlying T2DM-related brain damage and cognitive decline. Intranasal insulin therapy has emerged as a potential new treatment for T2DM-related cognitive impairment. Wearable technologies now allow better monitoring of behaviors and glycemic levels over several days and deliver real time feedback that can be used to improve self-management and lead to new prevention strategies and therapies for T2DM complications.
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Xu, Chengyang, Ang Zheng, Tianyi He, and Zhipeng Cao. "Brain–Heart Axis and Biomarkers of Cardiac Damage and Dysfunction after Stroke: A Systematic Review and Meta-Analysis." International Journal of Molecular Sciences 21, no. 7 (March 28, 2020): 2347. http://dx.doi.org/10.3390/ijms21072347.
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Background: Cardiac complications after a stroke are the second leading cause of death worldwide, affecting the treatment and outcomes of stroke patients. Cardiac biomarkers such as cardiac troponin (cTn), brain natriuretic peptide (BNP), and N-terminal pro-brain natriuretic peptide (NT-proBNP) have been frequently reported in patients undergoing a stroke. The aim of the present study is to meta-analyze the relationship between changes in such cardiac biomarkers and stroke and to present a systematic review of the previous literature, so as to explore the brain–heart axis. Methods: We searched four online databases pertinent to the literature, including PubMed, Embase, the Cochrane Library, and the Web of Science. Then, we performed a meta-analysis to investigate changes in cTn, BNP, and NT-proBNP associated with different types of stroke. Results and Conclusions: A significant increase in cTnI concentration was found in patients exhibiting a brain hemorrhage. BNP increased in cases of brain infarction, while the NT-proBNP concentration was significantly elevated in patients suffering an acute ischemic stroke and brain hemorrhage, indicating cardiac damage and dysfunction after a stroke. Our analysis suggests that several potential mechanisms may be involved in the brain–heart axis. Finally, clinicians should pay careful attention to monitoring cardiac function in the treatment of cerebrovascular diseases in order to provide a timely and more accurate treatment.
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Crossman, A. R., C. E. Clarke, S. Boyce, R. G. Robertson, and M. A. Sambrook. "MPTP-Induced Parkinsonism in the Monkey: Neurochemical Pathology, Complications of Treatment and Pathophysiological Mechanisms." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 14, S3 (August 1987): 428–35. http://dx.doi.org/10.1017/s0317167100037859.
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ABSTRACT:MPTP induces parkinsonism in monkeys by destruction of the substantia nigra, pars compacta. It can also damage ventral tegmental dopamine neurones and the noradrenergic locus coeruleus, both of which may be affected in Parkinson's disease. Motor symptoms in MPTP-treated monkeys respond readily to levodopa or dopamine agonist therapy. Administration of levodopa over 4-8 weeks leads to the emergence of “peak- dose” dyskinesia. Such abnormal movements are not seen following challenge doses of levodopa in animals not on long-term therapy. Radioligand studies reveal a 40-180% increase in D2 receptor binding in the striatum of parkinsonian monkeys. 2-deoxyglucose studies of regional brain metabolism indicate that MPTP-induced parkinsonism is characterised by abnormally increased activity of medial pallidal neurones which project to the thalamus and pedunculopontine nucleus and reduced activity of subthalamic nucleus neurones.
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Samarghandian, Saeed, Mohsen Azimi-Nezhad, Fariborz Samini, and Tahereh Farkhondeh. "Chrysin treatment improves diabetes and its complications in liver, brain, and pancreas in streptozotocin-induced diabetic rats." Canadian Journal of Physiology and Pharmacology 94, no. 4 (April 2016): 388–93. http://dx.doi.org/10.1139/cjpp-2014-0412.
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Chrysin (CH) is a natural flavonoid with pharmacological influences. The purpose of the current study was the assessment of possible protective effects of CH against oxidative damage in the serum, liver, brain, and pancreas of streptozotocin (STZ)- induced diabetic rats. In the present study, the rats were divided into the following groups of 8 animals each: control, untreated diabetic, 3 CH (20, 40, 80 mg/kg/day)-treated diabetic groups. To find out the modulations of cellular antioxidant defense systems, malondialdehyde (MDA) level and antioxidant enzymes including glutathione-S-transferase (GST), superoxide dismutase (SOD), and catalase (CAT) activities were determined in the serum, liver, brain, and pancreas. STZ caused an elevation of glucose, MDA, TG, TC, LDL-C and with reduction of HDL-C, total protein, SOD, CAT, and GST in the serum, liver, brain, and pancreas (p < 0.01). The findings showed that the significant elevation in the glucose, MDA, TG, TC, LDL-C and reduction of HDL-C, total protein, SOD, CAT, and GST were ameliorated in the CH-treated diabetic groups versus to the untreated groups, in a dose dependent manner (p < 0.05). The current study offers that CH may be recovered diabetes and its complications by modification of oxidative stress.
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Coroian, Flavia, Claire Jourdan, Jérome Froger, Claire Anquetil, Olivier Choquet, Bertand Coulet, and Isabelle Laffont. "Percutaneous Needle Tenotomy for the Treatment of Muscle and Tendon Contractures in Adults With Brain Damage: Results and Complications." Archives of Physical Medicine and Rehabilitation 98, no. 5 (May 2017): 915–22. http://dx.doi.org/10.1016/j.apmr.2016.11.014.
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Abe, Yuriko, Mamoru Ayusawa, Kengo Kawamura, Ryuta Yonezawa, Masataka Kato, Akiko Komori, Ryutaro Kohira, and Ichiro Morioka. "A combination therapy for Kawasaki disease with severe complications: a case report." Open Medicine 15, no. 1 (December 26, 2019): 8–13. http://dx.doi.org/10.1515/med-2020-0002.
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AbstractKawasaki disease (KD) is a form of acute multisystem vasculitis that presents with various complications, including coronary artery aneurysm. Heart failure and brain damage are rare, but life-threatening complications are associated with KD. Here, we describe a 4-year-old girl who developed intravenous immunoglobulin-resistant KD with both left ventricular failure and acute encephalopathy. On day 8 of the illness, the low left ventricular ejection fraction, mitral regurgitation, and low blood pressure, which required continuous administration of dobutamine, were observed during the treatments for KD, including intravenous immunoglobulin. She also appeared unconscious, where the electroencephalogram showed slow waves of activity in all regions of the brain. The cardiac performance improved after she received plasma exchange for three days. However, her unconsciousness with slow waves of activity on electroencephalogram and fever continued after the plasma exchange. Therefore, she was treated with methylprednisolone pulse, followed by prednisolone, as well as intravenous immunoglobulin. Finally, she recovered without any cardiac or neurological sequelae not only at the time she was discharged, but also throughout the follow-up period. The combination therapy using plasma exchange and methylprednisolone pulse may be a treatment option for severe KD with left ventricular failure and acute encephalopathy complications.
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Cárdenas-Rodríguez, Noemí, Cindy Bandala, América Vanoye-Carlo, Iván Ignacio-Mejía, Saúl Gómez-Manzo, Estefani Yaquelin Hernández-Cruz, José Pedraza-Chaverri, Liliana Carmona-Aparicio, and Beatriz Hernández-Ochoa. "Use of Antioxidants for the Neuro-Therapeutic Management of COVID-19." Antioxidants 10, no. 6 (June 17, 2021): 971. http://dx.doi.org/10.3390/antiox10060971.
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Coronavirus Disease 2019 (COVID-19), caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), is an emergent infectious disease that has caused millions of deaths throughout the world. COVID-19 infection’s main symptoms are fever, cough, fatigue, and neurological manifestations such as headache, myalgias, anosmia, ageusia, impaired consciousness, seizures, and even neuromuscular junctions’ disorders. In addition, it is known that this disease causes a series of systemic complications such as adverse respiratory distress syndrome, cardiac injury, acute kidney injury, and liver dysfunction. Due to the neurological symptoms associated with COVID-19, damage in the central nervous system has been suggested as well as the neuroinvasive potential of SARS-CoV-2. It is known that CoV infections are associated with an inflammation process related to the imbalance of the antioxidant system; cellular changes caused by oxidative stress contribute to brain tissue damage. Although anti-COVID-19 vaccines are under development, there is no specific treatment for COVID-19 and its clinical manifestations and complications; only supportive treatments with immunomodulators, anti-vascular endothelial growth factors, modulating drugs, statins, or nutritional supplements have been used. In the present work, we analyzed the potential of antioxidants as adjuvants for the treatment of COVID-19 and specifically their possible role in preventing or decreasing the neurological manifestations and neurological complications present in the disease.
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Lukyanchikov, V. A., and E. V. Udodov. "Tactics of surgical treatment of acute brain ischemia caused by atherosclerotic damage of the brachiocephalic arteries." Russian journal of neurosurgery 22, no. 3 (September 28, 2020): 31–41. http://dx.doi.org/10.17650/1683-3295-2020-22-3-31-41.
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The study objective is to test tactics of surgical treatment of patients with brachiocephalic artery pathology in the acute stage of ischemic stroke.Materials and methods. In the period between 01.07.2014 and 31.12.2017 at the Neurosurgery Division of the N.V. Sklifosovsky Research Institute of Emergency Medicine and the Neurosurgery Division of the N.A. Semashko Republican Clinical Hospital (Simferopol), 125 surgeries were performed in patients with occlusion and stenosis of the precerebral arteries in the acute stage of ischemic stroke. Carotid endarterectomy was performed in 69 cases, among them 54 were performed by eversion technique, 15 traditionally, in 4 cases sympathectomy of the internal carotid artery (ICA) was performed, in 4 – endarterectomy from the external carotid artery, in 3 – redirection of the ICA, in 2 – ICA prosthesis, in 9 – thrombointimectomy. Extracranial-intracranial bypass anastomosis was performed in patients with acute ICA thrombosis (n = 16) and symptomatic ICA occlusion (n = 22).Results. Good and moderate results (4–5 points per the Glasgow Outcome Scale) were achieved in 119 (95.2 %) observations. Level of consciousness impairment, evaluations per the NIHSS, Rankin, Rivermead scales, brain ischemia volume, presence of brain hypoperfusion prior to surgery, timetable of surgical intervention, postoperative characteristics of the volumetric blood flow and brain reperfusion characteristics significantly affected treatment results. Total rate of complications and deaths was 4.8 %. In 3 cases, death was caused by myocardial infarction, malignant hyperperfusion with hemorrhagic transformation of the ischemic lesion and repeat stroke.Conclusion. Surgical treatment of patients with transient ischemic attacks, acute small or completed stroke should be performed as soon as possible: this tactic decreases the risk of repeat ischemic attacks and improves functional outcomes of treatment. In case of crescendo of a transient ischemic attack or progressing stroke, surgical treatment should be postponed and performed 24 hours after stabilization of the patient’s neurological status.
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dos Santos Rubio, EllianneJacira, Eelke M. Bos, Ruben Dammers, Maarten J. Koudstaal, and Anton G. Dumans. "Two-Stage Cranioplasty: Tissue Expansion Directly over the Craniectomy Defect Prior to Cranioplasty." Craniomaxillofacial Trauma & Reconstruction 9, no. 4 (December 2016): 355–60. http://dx.doi.org/10.1055/s-0035-1549011.
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Performing a skull reconstruction for a long-term existing large cranium defect usually needs either skin enhancement or skin flaps and cranioplasty. This procedure can be accompanied with aesthetic and functional complications. The presented case describes a 27-year-old man in need of a cranial reconstruction following decompressive craniectomy as treatment for severe traumatic brain injury. Autologous cranioplasty after decompressive craniectomy failed due to bone flap infection. Because of cognitive behavioral problems, a protective helmet needed to be worn in awaiting cranioplasty. The final titanium cranioplasty was placed subsequent to scalp expansion. The expansion was realized by placing a temporary and custom-made polymethylmethacrylate (PMMA) plate over the defect with a tissue expander on top of it, using the existing scar and skull defect. Our reported technique avoids additional skin flap creation and accompanied complications such as additional scalp and bone damage. In cognitive damaged patients who need to wear a helmet constantly, this simple method provides, concurrently, protection of the brain and tissue expansion. We demonstrate a successful novel technical manner to provide scalp enhancement by positioning a temporary PMMA graft over the skull defect and placing the tissue expander on top of it.
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Solanki, Nilay D., Shailesh K. Bhavsar, and Dharmang T. Pandya. "Role of phytotherapy in diabetic neuropathy and neurodegeneration: from pathogenesis to treatment." Journal of Phytopharmacology 7, no. 2 (April 10, 2018): 152–61. http://dx.doi.org/10.31254/phyto.2018.7209.
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Diabetes mellitus is a metabolic disorder associated with structural and functional alterations of various organ systems. The tissue injury is attributed primarily to chronic hyperglycemia. Diabetic complications are associated with microvascular and macrovascular damage to the major organs of the body, here in this topic role of herbals for complications of Nervous system in diabetes is discussed as a new therapeutic horizon. Peripheral neuropathy along with the small and large blood vessel disease can explain most of the diabetesrelated organ failure, over the last two decades that the deleterious effects of chronic hyperglycemia extend beyond neuropathy and angiopathy. Examples of such diabetic complications include opacification of the lens and central nervous system [CNS] dysfunction. In contrast to the high prevalence rate of renal failure in diabetic patients, except for retinal disease, the chronic diabetic complications of the CNS are subtle and often unrecognized. Whereas the CNS effects of acute alterations in blood glucose level are well known, the effect of chronic hyperglycemia on brain metabolism and cognitive function is not widely appreciated. All the conventional therapies for the diabetic neuropathy with neurodegeneration do have disadvantage from the point of view of efficacy and side effects. Since last few decades Herbals getting more attraction towards neuroprotection in CNS complications of diabetes, further more studies are going on herbals for neuroprotection in diabetes. In the treatment of diabetic neuropathy [DN] herbals and phytoconstituents were proved better option, because excellent efficacy and cost effectiveness compared to conventional treatment
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Baptista, Marina G. P., Cintia G. M. Ferreira, Yuri M. L. Albuquerque, Carolline G. D’assunção, Rebeca C. Alves, Valéria Wanderley-Teixeira, and Álvaro A. C. Teixeira. "Histomorphometric and immunohistochemical evaluation of the frontal cerebral cortex in diabetic rats after treatment with melatonin." Pesquisa Veterinária Brasileira 40, no. 12 (December 2020): 1077–87. http://dx.doi.org/10.1590/1678-5150-pvb-6421.
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ABSTRACT: The central nervous system is vulnerable to complications caused by diabetes. These complications lead to increased oxidative stress in the brain, resulting in damage to the cerebral cortex, among other regions. Insulin and hypoglycemic agents are still the most widely used treatments. However, current research with an experimental model of diabetes suggests the use of antioxidants, such as melatonin. Thus, we tested the hypothesis that exogenous melatonin may decrease or prevent the effects of diabetes in the frontal cortex of the rat brain. Fifty albino rats were allocated into five groups: GC = rats without diabetes induction, GD = diabetic rats induced by streptozotocin, GDM = streptozotocin-induced and melatonin-treated diabetic rats, GDI = diabetic rats induced by streptozotocin and treated with insulin, GDMI = diabetic rats induced by streptozotocin and treated with melatonin and insulin simultaneously. Diabetes was induced by intraperitoneal administration of streptozotocin (60mg/kg). Insulin (5U/day) was administered subcutaneously and melatonin (10mg/kg) by drinking water; both treatments last days after. We analyzed animals’ weight, the cytokines IL-6 and TNF-α, apoptosis, glycogen, and did morphometry and histopathology of the frontal cortex were analyzed. The results showed that the cerebral cortex of the diabetic animals presented axonal degeneration, reduced number of neurons in the cortex, reduced glycogen, increased IL-6 and TNF-α expression, high apoptotic index, and reduced animal weight and the brain. Treatment with melatonin associated or not with insulin prevented such effects. Thus, we conclude that melatonin associated with insulin may be an alternative for avoiding the impact of diabetes in the brain’s frontal cortex.
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Cordaro, Marika, Angela Trovato Salinaro, Rosalba Siracusa, Ramona D’Amico, Daniela Impellizzeri, Maria Scuto, Maria Laura Ontario, et al. "Hidrox® Roles in Neuroprotection: Biochemical Links between Traumatic Brain Injury and Alzheimer’s Disease." Antioxidants 10, no. 5 (May 20, 2021): 818. http://dx.doi.org/10.3390/antiox10050818.
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Traumatic brain injuries (TBI) are a serious public-health problem. Furthermore, subsequent TBI events can compromise TBI patients’ quality of life. TBI is linked to a number of long- and short-term complications such as cerebral atrophy and risk of developing dementia and Alzheimer’s Disease (AD). Following direct TBI damage, oxidative stress and the inflammatory response lead to tissue injury-associated neurodegenerative processes that are characteristic of TBI-induced secondary damage. Hidrox® showed positive effects in preclinical models of toxic oxidative stress and neuroinflammation; thus, the aim of this study was to evaluate the effect of Hidrox® administration on TBI-induced secondary injury and on the propagation of the AD-like neuropathology. Hidrox® treatment reduced histological damage after controlled cortical impact. Form a molecular point of view, hydroxytyrosol is able to preserve the cellular redox balance and protein homeostasis by activating the Nrf2 pathway and increasing the expression of phase II detoxifying enzymes such as HO-1, SOD, Catalase, and GSH, thus counteracting the neurodegenerative damage. Additionally, Hidrox® showed anti-inflammatory effects by reducing the activation of the NFkB pathway and related cytokines overexpression. From a behavioral point of view, Hidrox® treatment ameliorated the cognitive dysfunction and memory impairment induced by TBI. Additionally, Hidrox® was associated with a significant increased number of hippocampal neurons in the CA3 region, which were reduced post-TBI. In particular, Hidrox® decreased AD-like phenotypic markers such as ß-amyloid accumulation and APP and p-Tau overexpression. These findings indicate that Hidrox® could be a valuable treatment for TBI-induced secondary injury and AD-like pathological features.
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Sahukari, Ravi, Jyothi Punabaka, Shanmugam Bhasha, Venkata S. Ganjikunta, Shanmugam K. Ramudu, and Sathyavelu R. Kesireddy. "Plant Compounds for the Treatment of Diabetes, a Metabolic Disorder: NF-κB as a Therapeutic Target." Current Pharmaceutical Design 26, no. 39 (November 10, 2020): 4955–69. http://dx.doi.org/10.2174/1381612826666200730221035.
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Background: The prevalence of diabetes in the world population hás reached 8.8 % and is expected to rise to 10.4% by 2040. Hence, there is an urgent need for the discovery of drugs against therapeutic targets to sojourn its prevalence. Previous studies proved that NF-κB serves as a central agent in the development of diabetic complications. Objectives: This review intended to list the natural plant compounds that would act as inhibitors of NF-κB signalling in different organs under the diabetic condition with their possible mechanism of action. Methods: Information on NF-κB, diabetes, natural products, and relation in between them, was gathered from scientific literature databases such as Pubmed, Medline, Google scholar, Science Direct, Springer, Wiley online library. Results and Conclusion: NF-κB plays a crucial role in the development of diabetic complications because of its link in the expression of genes that are responsible for organs damage such as kidney, brain, eye, liver, heart, muscle, endothelium, adipose tissue and pancreas by inflammation, apoptosis and oxidative stress. Activation of PPAR-α, SIRT3/1, and FXR through many cascades by plant compounds such as terpenoids, iridoids, flavonoids, alkaloids, phenols, tannins, carbohydrates, and phytocannabinoids recovers diabetic complications. These compounds also exhibit the prevention of NF-κB translocation into the nucleus by inhibiting NF-κB activators, such as VEGFR, RAGE and TLR4 receptors, which in turn, prevent the activation of many genes involved in tissue damage. Current knowledge on the treatment of diabetes by targeting NF-κB is limited, so future studies would enlighten accordingly.
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Alekseeva, T. M., O. A. Portik, and M. P. Topuzova. "Posthypoxic encephalopathy in patients after cardiac surgery: etiological, pathogenetic, and clinical aspects (a literature review)." Neurology, Neuropsychiatry, Psychosomatics 10, no. 3 (November 9, 2018): 121–28. http://dx.doi.org/10.14412/2074-2711-2018-3-121-128.
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Post-hypoxic encephalopathy is a brain damage manifested by neurological, neuropsychiatric, and mental disorders, which is caused by a reduction in cerebral blood flow and by a resultant effect of an episode of hypoxia of various etiology and duration. This complication is most characteristic of patients who have undergone cardiac surgery in view of the high prevalence and severity of clinical manifestations, worse quality of life, the longer length of hospital stay, and the higher cost of treatment and rehabilitation. To determine the individual management tactics for such patients, combining both successful surgical treatment, by reducing perioperative stress, and prevention of cerebral complications, it is necessary to analyze the patterns of their development. The role of pathophysiological risk factors, including preoperative, perioperative and postoperative ones, for posthypoxic encephalopathy, is considered. Its preoperative risk factors include age, gender, concomitant diseases, education level, and cognitive functions before surgery, cardiac morphofunctional changes, and depressive disorders. There are surgery-related (type and duration of anesthesia, operating-suite temperatures, and hyperglycemia) and postoperative (pain syndrome after surgical intervention, sleep disorders, and the environment) risk factors. Emphasis is placed on the technical characteristics of on-pump operations, among which there are cerebral hypoperfusion, microembolism, non-pulsatile flow, and duration of extracorporeal circulation. Classifications of cerebral complications are presented. Different types of brain dysfunction are analyzed to assess their incidence rates, clinical features, and dynamics in the postoperative period.
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Schnabel, Renate B., Gert Hasenfuß, Sylvia Buchmann, Kai G. Kahl, Stefanie Aeschbacher, Stefan Osswald, and Christiane E. Angermann. "Heart and brain interactions." Herz 46, no. 2 (February 5, 2021): 138–49. http://dx.doi.org/10.1007/s00059-021-05022-5.
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AbstractCardiovascular diseases (CVD) and mental health disorders (MHD; e.g. depression, anxiety and cognitive dysfunction) are highly prevalent and are associated with significant morbidity and mortality and impaired quality of life. Currently, possible interactions between pathophysiological mechanisms in MHD and CVD are rarely considered during the diagnostic work-up, prognostic assessment and treatment planning in patients with CVD, and research addressing bidirectional disease mechanisms in a systematic fashion is scarce. Besides some overarching pathogenetic principles shared by CVD and MHD, there are specific syndromes in which pre-existing neurological or psychiatric illness predisposes and contributes to CVD development (as in Takotsubo syndrome), or in which the distorted interplay between innate immune and central nervous systems and/or pre-existing CVD leads to secondary MHD and brain damage (as in peripartum cardiomyopathy or atrial fibrillation). Clinical manifestations and phenotypes of cardio-psycho-neurological diseases depend on the individual somatic, psychosocial, and genetic risk profile as well as on personal resilience, and differ in many respects between men and women. In this article, we provide arguments on why, in such conditions, multidisciplinary collaborations should be established to allow for more comprehensive understanding of the pathophysiology as well as appropriate and targeted diagnosis and treatment. In addition, we summarize current knowledge on the complex interactions between the cardiovascular and central nervous systems in Takotsubo syndrome and peripartum cardiomyopathy, and on the neurological and psychiatric complications of atrial fibrillation.
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Kumar, Suneel, Thomas Theis, Monica Tschang, Vini Nagaraj, and Francois Berthiaume. "Reactive Oxygen Species and Pressure Ulcer Formation after Traumatic Injury to Spinal Cord and Brain." Antioxidants 10, no. 7 (June 24, 2021): 1013. http://dx.doi.org/10.3390/antiox10071013.
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Traumatic injuries to the nervous system, including the brain and spinal cord, lead to neurological dysfunction depending upon the severity of the injury. Due to the loss of motor (immobility) and sensory function (lack of sensation), spinal cord injury (SCI) and brain injury (TBI) patients may be bed-ridden and immobile for a very long-time. These conditions lead to secondary complications such as bladder/bowel dysfunction, the formation of pressure ulcers (PUs), bacterial infections, etc. PUs are chronic wounds that fail to heal or heal very slowly, may require multiple treatment modalities, and pose a risk to develop further complications, such as sepsis and amputation. This review discusses the role of oxidative stress and reactive oxygen species (ROS) in the formation of PUs in patients with TBI and SCI. Decades of research suggest that ROS may be key players in mediating the formation of PUs. ROS levels are increased due to the accumulation of activated macrophages and neutrophils. Excessive ROS production from these cells overwhelms intrinsic antioxidant mechanisms. While short-term and moderate increases in ROS regulate signal transduction of various bioactive molecules; long-term and excessively elevated ROS can cause secondary tissue damage and further debilitating complications. This review discusses the role of ROS in PU development after SCI and TBI. We also review the completed and ongoing clinical trials in the management of PUs after SCI and TBI using different technologies and treatments, including antioxidants.
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Hasan, Md Tanvir, Daniel Lewis, and Mohammed Siddiqui. "Brain abscess – A rare complication of endovascular treatment for acute ischemic stroke." Surgical Neurology International 11 (October 2, 2020): 319. http://dx.doi.org/10.25259/sni_481_2020.
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Background: Brain abscess is a neurosurgical emergency, which can arise through direct bacterial seeding or hematogenous spread. Rarely, brain abscess formation has been reported following ischemic stroke. An increasingly utilized therapy for stroke is mechanical thrombectomy, and within this report, we present a case of brain abscess formation following this procedure. Case Description: A 78-year-old female presented to our center with a right total anterior circulation stroke (TACS) secondary to terminal internal carotid artery occlusion. An emergent mechanical thrombectomy was performed and the patient’s initial postoperative recovery was good. In the 3rd week after the procedure, however, the patient became more confused and following the onset of fever, an MRI brain was performed, which demonstrated an extensive multiloculated right-sided brain abscess. Burr hole drainage of the abscess was subsequently undertaken and pus samples obtained grew Proteus mirabilis, presumed secondary to a urinary tract infection, and the patient was started on prolonged antibiotic therapy. To date, the infection has been eradicated and the patient survives albeit with persistent neurological deficits. Conclusion: To the best of our knowledge, this is the first reported UK case of brain abscess following mechanical thrombectomy for stroke. Endovascular interventions can lead to increased incidence of ischemia-reperfusion injury in stroke with increased blood–brain barrier damage and risk of microbial seeding. This case highlights the need for rigorous asepsis and proactive treatment of systemic infections in the acute phase following endovascular treatment and consideration of brain abscess in all patients who present with new-onset confusion and unexplained fever following stroke.
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Sukhotskaya, A. A., V. G. Bairov, L. B. Mitrofanova, D. V. Ryzhkova, I. L. Nikitina, and S. A. Amidhonova. "SURGICAL TREATMENT OF ATIPICAL FORMS OF CONGENITAL HYPERINSULINISM." Russian Journal of Pediatric Surgery 24, no. 2 (May 12, 2020): 83–88. http://dx.doi.org/10.18821/1560-9510-2020-24-2-83-88.
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Introduction. 30-60% of all patients with congenital hyperinsulinism have a delayed psychomotor development, and 15-25% of them have a severe organic brain damage, including epilepsy. The timely diagnostics and intensive care can prevent severe neurological complications. If the conservative therapy is not effective, then the surgical treatment is a need. Objective: To demonstrate features of surgical correction of atypical forms of congenital hyperinsulinism. Material and methods. 11 children with atypical forms of congenital hyperinsulinism were operated on in the department of pediatric surgery in the V.A. Almazov National Medical Center in 2017-03.2019. Results. 2 children demonstrated a complete relief of hyperinsulinism in 9 months (1.5 years) of follow-up; one patient had a significant improvement of his psycho-motor development. Conclusion. Some children with presumably focal forms of hyperinsulinism, by PET-CT findings, may have histologically atypical forms. In the atypical lesion of the pancreas, an intraoperative biopsy dramatically changes the planned volume of pancreatectomy up to almost total removal of the gland.
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Nesargi, Saudamini, Alexander Nitsch, and Martin Wolf. "The utility of cerebral oxygenation monitoring in premature neonates." Journal of Medical Science 89, no. 4 (December 30, 2020): e485. http://dx.doi.org/10.20883/medical.e485.
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Near-infrared spectroscopy allows the measurement of cerebral oxygenation in preterm infants. This study aimed to demonstrate several highly relevant clinical situations in preterm infants in which the standard set of monitoring parameters without near-infrared spectroscopy is not sufficient to detect possible adverse situations, possibly resulting in severe complications, i.e. adverse neurological outcomes. The examples include situations of low blood pressure, persistent open ductus arteriosus, malfunctioning autoregulation of the brain oxygenation, and periods of irregular breathing. Without near-infrared spectroscopy, it is impossible to determine whether such a situation imposes any risk for the brain, whereas the measurement of cerebral oxygenation as an additional source of information enables the clinician to recognise these conditions and modify treatment or use countermeasures to protect the patient from brain damage and ensuing lifelong disabilities.
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Zhang, Wenchao, Paul R. Krafft, Tianlong Wang, John H. Zhang, Li Li, and Jiping Tang. "Pathophysiology of Ganglioside GM1 in Ischemic Stroke: Ganglioside GM1: A Critical Review." Cell Transplantation 28, no. 6 (January 22, 2019): 657–61. http://dx.doi.org/10.1177/0963689718822782.
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Ganglioside GM1 is a member of the ganglioside family which has been used in many countries and is thought of as a promising alternative treatment for preventing several neurological diseases, including cerebral ischemic injury. The therapeutic effects of GM1 have been proved both in neonates and in adults following ischemic brain damage; however, its clinical efficacy in patients with ischemic stroke is still uncertain. This review examines the recent knowledge of the neuroprotective properties of GM1 in ischemic stroke, collected in the past two decades. We conclude that GM1 may have potential for stroke treatment, although we need to be cautious in respect of its complications.
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Zinkevičiūtė Žarskienė, Giedrė, Diana Bilskienė, and Andrius Macas. "Differencial Diagnosis of Hypovolemia and Cushing‘s Response in Traumatic Brain Injury Patients, Using Hemodynamic Assessment Methods, to Prevent Secondary Brain Damage." Sveikatos mokslai 25, no. 2 (April 20, 2015): 83–86. http://dx.doi.org/10.5200/sm-hs.2015.035.
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Traumatic brain injury is the leading cause of death and further cause of disability and a major public health problem. Although the severity of the injury depends directly on the primary brain injury, secondary brain injury deteriorates the outcomes. The main causes of secondary ischemic injury include hypotension (systolic blood pressure 90mmHg) and hypoxaemia (PaO260mmHg), which are directly associated with increase of morbidity and mortality due to severe traumatic brain injury. Hypoxia and hypotension during decompresive craniotomy are independently associated with significant increaeses in vegetative state development and higher frequency of disability. Intraoperative period, including immediate anaesthesia during urgent craniotomy, is a critical moment for these patients. Their intraoperative hypotension can be caused by various factors, such as blood loss due other traumatic injuries, direct pulmonary or heart disorders, sympathetic tone lesions (spinal cord injury and neurogenic shock), potent anesthetic medicaments action or current hypovolemia and inadequate infusion therapy. How to solve this situation? Usually we choose a larger infusion therapy and vasoactive drugs. Is it realy a best solution for the patient? Severe brain trauma and related complications are the most common morbidity and mortality causes in young and middle-aged people. The initial injury we can not influence, but to avoid the major secondary brain injury risks, especially such as hypotension and hypoxia, are required. Only quick and accurate diagnosis, secondary risk factors prevention and immediate treatment may improve the outcomes.
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Shanko, Y. G., S. I. Krivenko, V. V. Goncharov, V. V. Novitskaya, A. S. Zamaro, A. L. Tanin, M. A. Nekhai, et al. "MESENCHYMAL STEM CELLS IN THE COMPLEX TREATMENT OF TRAUMATIC BRAIN INJURY." Medical Science of Ukraine (MSU) 17, no. 1 (March 30, 2021): 11–23. http://dx.doi.org/10.32345/2664-4738.1.2021.02.
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Relevance. The problem of effective prevention and treatment of traumatic brain injuries (TBI) of various etiologies has not been resolved in all countries of the world. Primary brain damage from trauma initiates secondary damage to the nervous tissue. As a result, the interaction of brain neural networks is disrupted and the control of somatic and visceral functions of the body is weakened. The article is based on our own clinical observations and comparison of results with literature data and provides a discussion of the prospects for the use of cell technologies in the prevention of fatal disorders of vital functions control in traumatic brain injuries.
Objective. To evaluate the effectiveness of intranasal perineural implantation of mesenchymal stem cells (MSCs) in the complex therapy of patients with TBI.
Materials and methods. The technique intranasal perineural administration of MSCs was used in complex therapy of 15 patients with severe TBI. The patients were 19÷69 years old, 13 men and two women. A cell suspension was isolated from the adipose tissue of the patient's abdominal wall and centrifuged for 10 min at 1500 rpm. The cell pellet was washed in phosphate buffered saline and DMEM. Cells were cultured in plastic culture flasks in a humidified atmosphere with 5% CO2 content. The cell mass was trypsinized according to standard technique and resuspended in physiological saline on the day of implantation. Dynamics of culture growth, pluripotency, phenotyping of MSCs were monitored. MSCs were injected under general anesthesia into the submucosa of the nasal cavity 3-4 times with an interval of 3-7 days, depending on the growth rate of MSCs, in a single dose from 12.0×106 to 35.0×106 cells.
Results. The use of allogeneic and predominantly autologous MSCs of adipose tissue in the complex treatment of patients with severe TBI by intranasal perineural delivery to the area of traumatic brain injury does not cause complications and is a safe technique. 8 patients with severe TBI showed from 4 to 7 points according to the Glasgow Outcome Scale Extended, with an average of 5.4±1.1 points after 6 months. The main result is that complex therapy, including intranasal implantation of MSCs in acute and subacute periods of severe TBI, contributes to the survival of patients and restoration of neurological – including cognitive – functions control.
Conclusions. The effectiveness of intranasal perineural implantation of MSCs in the complex therapy of patients with TBI has been demonstrated. The mechanisms of the beneficial effects of perineural implantation of MSCs in patients with TBI require further research.
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Fedorenko, E. V., P. E. Lutsenko, V. A. Arkhangelsky, E. M. Kazakova, T. A. Shelkovnikova, and W. Yu Usov. "USE OF MIDDLE-FIELD MRIWITH SPECIFIC SEQUENCIES COMPENSATING THE MOVEMENT ARTEFACTS FOR BRAIN STUDIES IN PATIENTS WITH HIV INFECTION." Diagnostic radiology and radiotherapy, no. 3 (November 21, 2018): 43–49. http://dx.doi.org/10.22328/2079-5343-2018-9-3-43-49.
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Nowadays of great importance is not only the issue of early diagnosis of HIV infection, but of early detection and effective treatment of AIDS complications. The annual increase in the incidence of HIV infection amounts to 4%. Unfortunately, a great number of patients ask for hospital care when their disease has the stage of secondary complications. Such situation requires a fast and affordable diagnostics together with verification of the nature of the affection. Purpose. To evaluate the diagnosis effectiveness of the secondary infectious cerebral affection in patients with HIV infection using the method of non-contrast MRI including the usage of the specially developed software. One hundred thirty three patients were recruited for the study, the main group of 108 persons (as old as 36,8±8,3), all referred to the brain MRI with suggestion of neurologic complications of HIV. The control group comprised 25 patients of the same age with focal damage of vascular nature. In everybody the MRI has been carried out using open middle-field scanner (Az-360, by AZ plc company, Moscow) with field induction 0,4 T, supplied with wireless four-channel quadratur coil for head studies, without contrast enhancement, but using in everybody the specially designed protocols for compensation of movement artifacts. All patients were re-examined in 2, 4 and 6 weeks. MRI images both in first admission and in follow-up studies were reported first qualitatively by type of contour of pathologic focus, by presence of multiple pattern of focal damage, by ultrastructure of foci, extent of perifocal oedema, interhaemispheric dislocation; also the dimensions of lateral ventriculi, of external subarachnoidal spaces and thickness of cortex in various regions were measured. Focal cerebral damage verified later as toxoplasmosis was revealed in the main group in 80% (86 of 108) of patients. False-negative and false-positive conclusions of MRI studies were not revealed also in prospective follow-up studies. Of these in 69 (80,2%) the pathologic foci were multiple and did localize periventricularly in particular in putamen, nucleus caudatus, equally frequent for both haemispherae, single foci were detected in thalami, concomitant with tendency to extensive cortical dystrophy. The putamen region was involved more frequently as compared to other basal ganglii (р=0,003). No significant differences were revealed between various cortical regions as regard to frequency of detection of pathologic foci. Four weeks period was detected as being the most effective time for the dynamic control in the course of treatment. Conclusion. Middle-field MRI of the brain with compensation of movement artifacts is a proper technique for both the diagnosis and follow-up control of treatment of cerebral toxoplasmosis in patients with HIV infection.
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Ellard, John. "Chelmsford and its aftermath." Psychiatric Bulletin 15, no. 11 (November 1991): 686–88. http://dx.doi.org/10.1192/pb.15.11.686.
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In mid-1963, Dr Harry Richard Bailey admitted a patient to Chelmsford, a small private hospital in a north-western suburb of Sydney. Between then and April 1979 he, and subsequently a handful of associates, treated a large number of patients with deep sedation, often combined with ECT. The patients' diagnoses included schizophrenia, bipolar disorder, alcoholism, and drug addiction; nothing suggests that the diagnosis and the treatment had any particular connection. Records exist for some 1,100 patients, 24 of whom died as a consequence of the treatment; 16 of them were under the age of 50. Others suffered brain damage, convulsions, delirium, pneumonia, hallucinations, cardiac irregularities, abscesses, urinary tract infections, fractures, and other complications.
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Pandey, Haushila Prasad, Vaibhav Mishra, and Dr Akanksha. "New Remedies from Natural Products in Brain Stroke." Journal of Universal College of Medical Sciences 4, no. 2 (January 25, 2018): 35–39. http://dx.doi.org/10.3126/jucms.v4i2.19090.
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Acute ischemic stroke is the third leading cause of death and the most frequent cause of permanent disability. Despite advances in the understanding of the pathophysiology of cerebral ischemia, therapeutic options remain limited. Only recombinant tissue-plasminogen activator (rt-PA) for thrombolysis is currently approved for use in the treatment of stroke. However, its use is limited by its short therapeutic window (three hours), complications derived essentially from the risk of haemorrhage, and the potential damage from reperfusion/ischemic injury. Two important pathophysiological mechanisms involved during ischemic stroke are oxidative stress and inflammation3. On the basis of pre existing literatures, brain tissue is not well equipped with antioxidant defenses. So for a future candidate drug that may able to cure the stroke it must have anti oxidant and anti inflammatory properties. This review will discuss the molecular and biochemical aspects of oxidative stress and inflammation in ischemic stroke that targets neuro-inflammation through natural products.Journal of Universal College of Medical Sciences (2016) Vol.04 No.02 Issue 14, page: 35-39
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Ong, Wei-Yi, Mei-Lin Go, De-Yun Wang, Irwin Kee-Mun Cheah, and Barry Halliwell. "Effects of Antimalarial Drugs on Neuroinflammation-Potential Use for Treatment of COVID-19-Related Neurologic Complications." Molecular Neurobiology 58, no. 1 (September 8, 2020): 106–17. http://dx.doi.org/10.1007/s12035-020-02093-z.
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AbstractThe SARS-CoV-2 virus that is the cause of coronavirus disease 2019 (COVID-19) affects not only peripheral organs such as the lungs and blood vessels, but also the central nervous system (CNS)—as seen by effects on smell, taste, seizures, stroke, neuropathological findings and possibly, loss of control of respiration resulting in silent hypoxemia. COVID-19 induces an inflammatory response and, in severe cases, a cytokine storm that can damage the CNS. Antimalarials have unique properties that distinguish them from other anti-inflammatory drugs. (A) They are very lipophilic, which enhances their ability to cross the blood-brain barrier (BBB). Hence, they have the potential to act not only in the periphery but also in the CNS, and could be a useful addition to our limited armamentarium against the SARS-CoV-2 virus. (B) They are non-selective inhibitors of phospholipase A2 isoforms, including cytosolic phospholipase A2 (cPLA2). The latter is not only activated by cytokines but itself generates arachidonic acid, which is metabolized by cyclooxygenase (COX) to pro-inflammatory eicosanoids. Free radicals are produced in this process, which can lead to oxidative damage to the CNS. There are at least 4 ways that antimalarials could be useful in combating COVID-19. (1) They inhibit PLA2. (2) They are basic molecules capable of affecting the pH of lysosomes and inhibiting the activity of lysosomal enzymes. (3) They may affect the expression and Fe2+/H+ symporter activity of iron transporters such as divalent metal transporter 1 (DMT1), hence reducing iron accumulation in tissues and iron-catalysed free radical formation. (4) They could affect viral replication. The latter may be related to their effect on inhibition of PLA2 isoforms. Inhibition of cPLA2 impairs an early step of coronavirus replication in cell culture. In addition, a secretory PLA2 (sPLA2) isoform, PLA2G2D, has been shown to be essential for the lethality of SARS-CoV in mice. It is important to take note of what ongoing clinical trials on chloroquine and hydroxychloroquine can eventually tell us about the use of antimalarials and other anti-inflammatory agents, not only for the treatment of COVID-19, but also for neurovascular disorders such as stroke and vascular dementia.
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Masood, Momina, Tahira Nazir, Marriam Nawaz, Awais Mehmood, Junaid Rashid, Hyuk-Yoon Kwon, Toqeer Mahmood, and Amir Hussain. "A Novel Deep Learning Method for Recognition and Classification of Brain Tumors from MRI Images." Diagnostics 11, no. 5 (April 21, 2021): 744. http://dx.doi.org/10.3390/diagnostics11050744.
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A brain tumor is an abnormal growth in brain cells that causes damage to various blood vessels and nerves in the human body. An earlier and accurate diagnosis of the brain tumor is of foremost important to avoid future complications. Precise segmentation of brain tumors provides a basis for surgical planning and treatment to doctors. Manual detection using MRI images is computationally complex in cases where the survival of the patient is dependent on timely treatment, and the performance relies on domain expertise. Therefore, computerized detection of tumors is still a challenging task due to significant variations in their location and structure, i.e., irregular shapes and ambiguous boundaries. In this study, we propose a custom Mask Region-based Convolution neural network (Mask RCNN) with a densenet-41 backbone architecture that is trained via transfer learning for precise classification and segmentation of brain tumors. Our method is evaluated on two different benchmark datasets using various quantitative measures. Comparative results show that the custom Mask-RCNN can more precisely detect tumor locations using bounding boxes and return segmentation masks to provide exact tumor regions. Our proposed model achieved an accuracy of 96.3% and 98.34% for segmentation and classification respectively, demonstrating enhanced robustness compared to state-of-the-art approaches.
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Vilela, Luciano Rezende, Lindisley Ferreira Gomides, Bruna Araújo David, Maísa Mota Antunes, Ariane Barros Diniz, Fabrício de Araújo Moreira, and Gustavo Batista Menezes. "Cannabidiol Rescues Acute Hepatic Toxicity and Seizure Induced by Cocaine." Mediators of Inflammation 2015 (2015): 1–12. http://dx.doi.org/10.1155/2015/523418.
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Cocaine is a commonly abused illicit drug that causes significant morbidity and mortality. The most severe and common complications are seizures, ischemic strokes, myocardial infarction, and acute liver injury. Here, we demonstrated that acute cocaine intoxication promoted seizure along with acute liver damage in mice, with intense inflammatory infiltrate. Considering the protective role of the endocannabinoid system against cell toxicity, we hypothesized that treatment with an anandamide hydrolysis inhibitor, URB597, or with a phytocannabinoid, cannabidiol (CBD), protects against cocaine toxicity. URB597 (1.0 mg/kg) abolished cocaine-induced seizure, yet it did not protect against acute liver injury. Using confocal liver intravital microscopy, we observed that CBD (30 mg/kg) reduced acute liver inflammation and damage induced by cocaine and prevented associated seizure. Additionally, we showed that previous liver damage induced by another hepatotoxic drug (acetaminophen) increased seizure and lethality induced by cocaine intoxication, linking hepatotoxicity to seizure dynamics. These findings suggest that activation of cannabinoid system may have protective actions on both liver and brain induced by cocaine, minimizing inflammatory injury promoted by cocaine, supporting its further clinical application in the treatment of cocaine abuse.
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Zhuang, Hongqing, Xin Wang, Zhiyong Yuan, Enmin Wang, and Junjie Wang. "Management of brain metastases in tyrosine kinase inhibitor-treated epidermal growth factor receptor-mutant non-small-cell lung cancer from the perspective of long-term radiation brain damage: A multi-institutional retrospective analysis." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): e13587-e13587. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.e13587.
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e13587 Background: To investigate the relationship between the timing of SRS intervention and the complications of cerebral radiation necrosis(CRN) and its impact on the cognitive function and quality of life(QOL) in patients with brain metastases of lung adenocarcinoma who received TKI treatment. Methods: A total of 361 targets from 257 patients with brain oligo-metastases of lung adenocarcinoma who received Cyberknife treatment between 2010 and 2017 were collected from three Cyberknife centers. The difference in brain necrosis between patients with or without TKI application was statistically counted. Logistic regression analysis was used to analyze the effect of applying TKI on the occurrence of CRN in patients, and the effect of SRS before and after TKI resistance on CRN. The effects of CRN on the cognitive function and quality of life of surviving patients were analyzed. Results: The rate of CRN in the TKI group was significantly higher than that in the non-TKI group. The incidence of brain necrosis in patients undergoing SRS after drug resistance was significantly higher than that in patients undergoing SRS before drug resistance. Regression analysis showed that combination of TKI with SRS, and SRS after TKI resistance were important influencing factors for CRN. The follow-up results of currently surviving patients showed that the occurrence of brain necrosis seriously affected the cognitive function and QOL of patients. Conclusions: Long-term radiation-induced brain damage needs to be seriously monitored in lung adenocarcinoma patients with brain metastasis undergoing combination of radiotherapy and TKI. Clinicians need to pay attention to this problem and make reasonable recommendations for radiotherapy and TKI treatment.
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Polkovnikov, О. Yu, A. М. Materukhin, V. S. Kosyanchuk, and N. О. Polkovnikova. "Infectious complications of aneurysmal subarachnoid hemorrhage." Endovascular Neuroradiology 32, no. 2 (November 17, 2020): 28–34. http://dx.doi.org/10.26683/2304-9359-2020-2(32)-28-34.
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Objective ‒ to assess the incidence of infectious complications in patients with aneurysmal subarachnoid hemorrhage (SAH); to determine the effect of the complicated course of aneurysmal SAH on the incidence of nosocomial infection.Materials and methods. The results of treatment of 250 patients in the acute period of aneurysmal SAH were analyzed, among them 124 observations (49.6 %) were identified, in which a complicated course of aneurysmal SAH was stated. In 185 cases, endovascular coiling was used to occlude the ruptured aneurysm, and in 65 cases the aneurysm was clipped. A group of patients who underwent infectious complications in the acute period of aneurysmal SAH was identified. The latter included: pneumonia, urinary tract infections, ventriculitis and meningitis.Results. The median age was 48.95 years (range 14 to 74 years). By gender, the majority were women ‒ 144 (57.6 %). Infectious complications were diagnosed in 52 (20.8 %) patients. Pneumonia was noted in 48 (19.2 %) cases. Urinary tract infections were observed in 36 (14.4 %) patients, in 7 (2.8 %) cases, infection of the nervous system (meningitis in 3 cases and ventriculitis in 4 cases). In the group of infectious complications, there were more observations referred to the group of complicated course of aneurysmal SAH ‒ 49 (92.3 %). Patients with severe SAH according to the WFNS, Hunt-Hess scales and the Fisher radiological scale prevailed. The average value was: WFNS ‒ 3.1 and Hunt‒Hess ‒ 3.7, according to the Fisher scale ‒ 3.5. Mortality in the group of infectious complications was 38.5 % (20 cases).Conclusions. Infectious complications occur with a frequency of 20.8 % and are a factor that worsens functional outcome and increases mortality in patients with aneurysmal SAH. Primary brain damage after rupture of an aneurysm, which determines the severity of SAH and the complicated course of the disease, is a predictor of the development of infectious complications.
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Zhang, Lei, Zahid Hussain, and Zhuanqin Ren. "Recent Advances in Rational Diagnosis and Treatment of Normal Pressure Hydrocephalus: A Critical Appraisal on Novel Diagnostic, Therapy Monitoring and Treatment Modalities." Current Drug Targets 20, no. 10 (July 12, 2019): 1041–57. http://dx.doi.org/10.2174/1389450120666190214121342.
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Background:Normal pressure hydrocephalus (NPH) is a critical brain disorder in which excess Cerebrospinal Fluid (CSF) is accumulated in the brain’s ventricles causing damage or disruption of the brain tissues. Amongst various signs and symptoms, difficulty in walking, slurred speech, impaired decision making and critical thinking, and loss of bladder and bowl control are considered the hallmark features of NPH.Objective:The current review was aimed to present a comprehensive overview and critical appraisal of majorly employed neuroimaging techniques for rational diagnosis and effective monitoring of the effectiveness of the employed therapeutic intervention for NPH. Moreover, a critical overview of recent developments and utilization of pharmacological agents for the treatment of hydrocephalus has also been appraised.Results:Considering the complications associated with the shunt-based surgical operations, consistent monitoring of shunting via neuroimaging techniques hold greater clinical significance. Despite having extensive applicability of MRI and CT scan, these conventional neuroimaging techniques are associated with misdiagnosis or several health risks to patients. Recent advances in MRI (i.e., Sagittal-MRI, coronal-MRI, Time-SLIP (time-spatial-labeling-inversion-pulse), PC-MRI and diffusion-tensor-imaging (DTI)) have shown promising applicability in the diagnosis of NPH. Having associated with several adverse effects with surgical interventions, non-invasive approaches (pharmacological agents) have earned greater interest of scientists, medical professional, and healthcare providers. Amongst pharmacological agents, diuretics, isosorbide, osmotic agents, carbonic anhydrase inhibitors, glucocorticoids, NSAIDs, digoxin, and gold-198 have been employed for the management of NPH and prevention of secondary sensory/intellectual complications.Conclusion:Employment of rational diagnostic tool and therapeutic modalities avoids misleading diagnosis and sophisticated management of hydrocephalus by efficient reduction of Cerebrospinal Fluid (CSF) production, reduction of fibrotic and inflammatory cascades secondary to meningitis and hemorrhage, and protection of brain from further deterioration.
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Voytsekhovsky, D. V., D. V. Svistov, I. S. Zheleznyak, M. V. Lytkin, A. V. Savello, K. N. Babichev, S. A. Landik, et al. "Ischemic complications of operations on intracranial aneurysms and their relationship with the dynamics of cognitive functions." Bulletin of the Russian Military Medical Academy 21, no. 2 (December 15, 2019): 32–36. http://dx.doi.org/10.17816/brmma25915.
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Surgical treatment remains the only way to primary prevention of intracranial hemorrhage in patients with cerebral aneurysms. The implementation of such interventions is associated with the risk of the development of secondary cerebral circulation disorders. The effect of ischemic damage to cerebral structures on the state of mental functions and the quality of life of patients is currently not well understood. The interrelation of the formation of foci of cerebral infarction according to magnetic resonance imaging and the dynamics of the state of cognitive functions of patients undergoing surgery for unruptured cerebral aneurysms is considered. It has been established that «fresh» foci of ischemic damage are formed in a third of patients. Among patients operated on with intravascular access, brain infarction zones are formed in half of the patients. Endovascular interventions under balloon assistance are associated with a high risk of asymptomatic ischemic complications. When comparing the results of neuropsychological examination in patients with diagnosed foci of cerebral infarction and the group where the ischemic complications were absent, no significant differences were found. According to the neuropsychological examination, the results before and after the operation did not differ significantly in patients with infarction foci. Thus, after surgery for unruptured aneurysms, local foci of cerebral infarction are often detected. In most cases, these changes are not associated with the deterioration of the higher mental functions of patients and are asymptomatic.
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Roger, Claire, and Benjamin Louart. "Beta-Lactams Toxicity in the Intensive Care Unit: An Underestimated Collateral Damage?" Microorganisms 9, no. 7 (July 14, 2021): 1505. http://dx.doi.org/10.3390/microorganisms9071505.
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Beta-lactams are the most commonly prescribed antimicrobials in intensive care unit (ICU) settings and remain one of the safest antimicrobials prescribed. However, the misdiagnosis of beta-lactam-related adverse events may alter ICU patient management and impact clinical outcomes. To describe the clinical manifestations, risk factors and beta-lactam-induced neurological and renal adverse effects in the ICU setting, we performed a comprehensive literature review via an electronic search on PubMed up to April 2021 to provide updated clinical data. Beta-lactam neurotoxicity occurs in 10–15% of ICU patients and may be responsible for a large panel of clinical manifestations, ranging from confusion, encephalopathy and hallucinations to myoclonus, convulsions and non-convulsive status epilepticus. Renal impairment, underlying brain abnormalities and advanced age have been recognized as the main risk factors for neurotoxicity. In ICU patients, trough concentrations above 22 mg/L for cefepime, 64 mg/L for meropenem, 125 mg/L for flucloxacillin and 360 mg/L for piperacillin (used without tazobactam) are associated with neurotoxicity in 50% of patients. Even though renal complications (especially severe complications, such as acute interstitial nephritis, renal damage associated with drug induced hemolytic anemia and renal obstruction by crystallization) remain rare, there is compelling evidence of increased nephrotoxicity using well-known nephrotoxic drugs such as vancomycin combined with beta-lactams. Treatment mainly relies on the discontinuation of the offending drug but in the near future, antimicrobial optimal dosing regimens should be defined, not only based on pharmacokinetics/pharmacodynamic (PK/PD) targets associated with clinical and microbiological efficacy, but also on PK/toxicodynamic targets. The use of dosing software may help to achieve these goals.
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Dobrynina, L. A., M. R. Zabitova, L. A. Kalashnikova, E. V. Gnedovskaya, and M. A. Piradov. "Hypertension and Cerebral Microangiopathy (Cerebral Small Vessel Disease): Genetic and Epigenetic Aspects of Their Relationship." Acta Naturae 10, no. 2 (June 15, 2018): 4–15. http://dx.doi.org/10.32607/20758251-2018-10-2-4-15.
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Hypertension (HT) and its cerebral complications are extremely vexing medical and social problems. Despite the obvious association between hypertension and the clinical and neuroimaging features of cerebral microangiopathy (CMA) (also known as cerebral small vessel disease), the causal links between them remain ambiguous. Besides, antihypertensive therapy as the only way to manage these patients does not always prevent brain damage. Knowledge about the key factors and mechanisms involved in HT and CMA development is important for predicting the risk of cerebral complications and developing new approaches to their prevention and treatment. At present, genome-wide association studies and other approaches are used to investigate the common hereditary mechanisms of HT and CMA development, which will explain a large number of CMA cases not associated with hypertension, lack of a correlation between HT severity and the degree of cerebral injury, and failure of antihypertensive therapy to prevent CMA progression. Epigenetic markers likely play a modulating role in the development of these diseases.