Closed cranial window rodent model for investigating hemodynamic response to elevated intracranial pressure

Background:Elevated intracranial pressure(ICP)occurs in several physiological and pathological conditions,yet long-term sequellae are not common,which implies that blood flow is preserved above ischemic thresholds.Methods:This pilot study sought to confirm this hypothesis using a closed cranial window model in a rat in which ICP was elevated to 120 mmHg for 12 min,and superficial cortical perfusion was measured by laser Doppler flowmetry and laser speckle flowmetry.Results:Following a transient increase,cortical blood flow decreased to between 25%and 75%of baseline.These levels correspond to disrupted metabolism and decreased protein synthesis but did not exceed thresholds for electrical signaling or membrane integrity.This may partially explain how some episodes of elevated ICP remain benign.Conclusion:The closed cranial window model provides a platform for prospective study of physiologic responses to artificially elevated ICP during neurosurgery to promote hemostasis.

EFFECTS OF ACUPUNCTURE AT FENGCHI POINT (GB 20) ON CEREBRAL BLOOD FLOW

Blood velocity in the vertebral artery and the basilar artery was observed before and after acupuncture at Fengchi point (GB 20) in 97 patients by transcranial Doppler ultrasonic detecting. The results showed that the blood velocity in patients with either high or low blood flow had significant changes after acupuncture (P

Effects of electroacupuncture at Fengchi(GB20)on motor function and GFAP/NeuN expression around the ischemic tissue of the motor cortex in MCAO rats

Objective:To investigate the potential mechanism of electroacupuncture(EA)at bilateral Fengchi(GB20)in treating cerebral ischemia-reperfusion injury and to provide a scientific basis for future experimental research and clinical applications.Methods:Forty male specific-pathogen-free Sprague-Dawley rats were randomly divided into four groups:a normal group,a normal with EA group,a model group,and a model with EA group,with 10 rats in each group.The normal group received no intervention.The normal with EA group received EA at bilateral Fengchi(GB20).The model group underwent middle cerebral artery occlusion(MCAO)using the suture.The model with EA group underwent MCAO and received EA at bilateral Fengchi(GB20).Cerebral blood flow was monitored using a laser Doppler cerebral blood flow meter.Neurologic damage was assessed using the neurologic deficit score,and motor ability was observed using the CatWalk gait system.The expression of glial fibrillary acidic protein(GFAP)and neuronal nuclei(NeuN)protein,the neuron markers,was detected by Western blotting.The protein expression levels of GFAP and NeuN,as well as the number of positive cells in the motor cortex,were detected using immunofluorescence.Results:Compared to the normal group,the cerebral blood flow values in the model group and the model with EA group decreased by more than 50%during the modeling process(P<0.01)and returned to pre-modeling levels after reperfusion(P>0.05).The neurologic deficit score increased(P<0.05),the average motor velocity decreased(P<0.05),GFAP protein expression and the number of positive cells in the motor cortex increased(P<0.05),and the NeuN protein expression and the number of positive cells decreased(P<0.05)in the model group.Compared to the model group,the neurologic deficit score decreased(P<0.05),the average motor velocity accelerated(P<0.05),GFAP and NeuN protein expression and the number of positive cells in the motor cortex increased(P<0.01)in the model with EA group.Conclusion:EA at bilateral Fengchi(GB20)can reduce neuronal loss and increase GFAP and NeuN protein expression in the motor cortex of rats after ischemia-reperfusion,improve the motor function after ischemic stroke,and accelerate the recovery of balance and stability of the affected limbs.

Cerebral angiography and MR perfusion images in patients with ischemic cerebral vascular disease

OBJECTIVE: To evaluate the value of perfusion MR imaging and angiographic evidence of collateral circulation in symptomatic patients with ischemic cerebrovascular diseases (ICVD). METHODS: Cerebral angiography and perfusion MR were performed in 16 patients with symptoms of ICVD. Qualitative perfusion maps were calculated for regional cerebral blood volume (rCBV) and mean transit time (MTT). RESULTS: A total of 27 lesions were seen on the perfusion MR maps (6 infarcts and 21 ischemic lesions) and most of them (26/27) showed a prolonged MTT. MTT is sensitive to the presence of ischemic lesions, but not sufficient in distinguishing infarct from ischemia. All of the infarcts showed a decreased rCBV, while most of the ischemic lesions showed a normal or increased rCBV. When collateral circulation was identified on angiography, most ischemic lesions were not infarcts and had a normal or increased rCBV. The absence of angiographically identifiable cerebral collaterals may not always result in an infarct; 50% had decreased rCBV. Despite the absence of angiographic collaterals, the other half had normal or increased rCBV. CONCLUSION: Cerebral angiographic evidence of collateral circulation is important in identifying a favorable outcome in patients with ICVD. However, a lesion with a normal or increased rCBV suggests a sufficient collateral circulation even without angiographic collaterals. Perfusion images may be a potentially useful adjunctive tool in the prediction of the outcome of ICVD, particularly where no apparent collateral macrocirculation is seen on CA.

Effects of acupuncture combined with Brunnstrom staging on upper-limb motor function,cerebral arterial blood flow velocity,and brain function remodeling after stroke

Objective:To explore the effects of acupuncture combined with Brunnstrom staging on upper-limb motor function,cerebral arterial blood flow velocity,and brain function remodeling after stroke.Methods:A total of 77 patients after stroke were selected between January 2017 and December 2019 to perform a prospective study.All cases were divided into an observation group and a control group by the random number table method.Both groups were treated with conventional symptomatic treatment for stroke and functional exercise according to the Brunnstrom staging.The observation group was treated with additional acupuncture treatment based on the Brunnstrom staging therapy.The therapeutic efficacy was evaluated after six-week treatment.The traditional Chinese medicine(TCM)symptom scores of dizziness,headache,limb numbness,and language disorders before and after the treatment in the two groups were compared.According to the Fugl-Meyer motor function assessment(FMA),the upper-limb motor function before and after the treatment was compared.And the average systolic blood flow velocity of the anterior cerebral artery(ACA),middle cerebral artery(MCA),and posterior cerebral artery(PCA)in the two groups before and after the treatment were compared.According to the modified Edinburgh-Scandinavia stroke scale(MESSS),the nerve function before and after the treatment was compared.Results:The total effective rate of the observation group was 94.9%,significantly higher than 79.0%of the control group(P<0.05).After the treatment,the TCM symptom scores of dizziness,headache,limb numbness,and language disorders in both groups decreased,and the scores in the observation group were all significantly lower than those in the control group(P<0.05).The FMA score of upper limbs in both groups increased,and the score in the observation group was significantly higher than that in the control group(P<0.05).The average systolic blood flow velocities of the ACA,MCA and PCA in both groups increased,and were significantly higher in the observation group than in the control group(P<0.05).The MESSS score in both groups decreased,and the score in the observation group was significantly lower than that in the control group(P<0.05).Conclusion:Acupuncture combined with Brunnstrom staging is effective for patients after stroke.It can effectively improve the upper-limb motor function and cerebral artery blood flow velocity,promote brain function remodeling,and restore nerve function.

Effects of acupuncture plus language training on language function and cerebral blood flow in patients with motor aphasia after ischemic stroke

Objective:To observe the effects of acupuncture at the Governor Vessel acupoints plus language training on the language function and cerebral blood flow in patients with motor aphasia after ischemic stroke.Methods:Eighty-six patients were randomized into a control group and an observation group,with 43 cases in each group.Conventional symptomatic treatment was offered to both groups.Besides,the control group received language training,while the observation group received language training plus additional acupuncture at the Governor Vessel acupoints.Before and after treatment,the aphasia battery of Chinese(ABC)and Chinese functional communication profile(CFCP)were tested,and the mean velocity(Vm)and resistance index(Rl)of the left middle cerebral artery(MCA)were detected.Results:The total effective rate was higher in the observation group than in the control group(P<0.05).After treatment,the observation group gained higher scores in oral expression,comprehension,repeating,naming objects,reading,and writing,as well as the general score of ABC(all P<0.Q5)f higher than those in the control group(all P<0.05).The CFCP score increased in both groups after intervention,showing significant intra-group differences(both P<0.05),and the CFCP score was higher in the observation group than in the control group(P<0.05).After treatment,Vm of the left side MCA in creased in the con trol group(P<0.05),while no significant change was observed in Rl(P>0.05);in the observation group,Vm of the left side MCA increased and Rl decreased signfiicantly compared with the baseline(both P<0.05),and were markedly different from those in the control group(both P<0.05).Conclusion:Acupuncture at the Governor Vessel acupoints plus language training can produce valid efficacy in treating motor aphasia after ischemic stroke;it can notably improve the language function,everyday oral communication ability,and in crease cere bral perfusion of the patients.

Neuroprotective effect of Naomaitong extract following focal cerebral ischemia induced by middle cerebral artery occlusion in rats

OBJECTIVE: To examine the neuroprotective effect of extract from Naomaitong following focal cerebral ischemia reperfusion induced by occlusion of middle cerebral artery(MCA), and to determine the biochemical alterations in urine using proton nuclear magnetic resonance spectroscopy and principal component analysis.METHODS: Wistar rats were randomly assigned tothree groups: sham-operated group, MCA focal cerebral ischemia reperfusion model group, and active extract of Naomaitong treatment group. The model was established by an improved MCA occlusion(MCAO) method. Sham-operated rats received the same surgical procedure, but without occlusion. The Naomaitong treatment group were treated with active extract from Naomaitong at a dose of3.0 g·kg-·1d-1. Brain tissues and urine samples were collected from all groups for histopathological assessment and proton nuclear magnetic resonance spectroscopy-based metabonomics, respectively.RESULTS: Hematoxylin-eosin and triphenyl tetrazolium chloride staining of brain tissues showed a significant decrease in cerebral infarction area in the Naomaitong group. In model rats, metabonomic analyses showed increased urinary levels of glutamate, taurine, trimetlylamine oxide, betaine, and glycine, and reduced levels of creatinine and creatine.Naomaitong regulated the metabolic changes by acting on multiple metabolic pathways, including glycine metabolism, glutaminolysis, transmethylation metabolism and creatinine metabolism.CONCLUSION: These data demonstrate that extract from Naomaitong is neuroprotective against focal cerebral ischemia induced by MCAO, and can alleviate biochemical changes in urinary metabolism. Metabonomics may be a useful approach for assessing the biochemical mechanisms underlying the neuroprotective actions of extract from Naomaitong.

Therapeutic efficacy of acupuncture plus Tuina for spastic cerebral palsy and discussion of its mechanism

Objective To discuss the effects of acupuncture plus Tuina(Chinese therapeutic massage)in intervening the mental development,motor function,cerebral hemodynamics,and muscle tone in kids with spastic cerebral palsy(CP).Methods A retrospective analysis was conducted on 87 kids with spastic CP.They were divided into a control group and an observation group based on their original treatment plan.Kids in the control group received symptomatic treatment,motor development therapy,and Tuina treatment.The observation group was additionally given acupuncture treatment.One month was taken as a treatment course.After six courses,the efficacy,change in muscle tone,mental development,gross motor function,fine motor function,and the systolic velocity(Vs),mean velocity(Vm),and pulsatility index(PI)of the anterior cerebral artery(ACA),middle cerebral artery(MCA),and posterior cerebral artery(PCA)were compared between the two groups.Results After treatment,the muscle tone score dropped in both groups(P<0.05)and was significantly lower in the observation group than in the control group(P<0.05).The observation group achieved more significant efficacy than the control group(P<0.05).After the intervention,the mental development index(MDI),psychomotor development index(PDI),gross motor function measure(GMFM)score,and fine motor function measure(FMFM)score all increased in both groups(P<0.05)and were notably higher in the observation group than in the control group(P<0.05).After treatment,the Vs and Vm of the ACA,MCA,and PCA were markedly higher in the observation group than in the control group(P<0.05),and the observation group was significantly lower than the control group comparing the PI of the ACA,MCA,and PCA(P<0.05).Conclusion Based on the symptomatic treatment and motor development therapy,Tuina and acupuncture treatment can effectively treat spastic CP children,manifesting as reducing muscle tone,boosting mental development,and improving motor function and cerebral hemodynamics.

Effects of electroacupuncture pretreatment on motor function and cerebral blood flow in MCAO model rats

Objective:To observe the effects of electroacupuncture(EA)pretreatment on motor function,cerebral blood flow,cerebral infarction volume,and vascular endothelial growth factor(VEGF)level in middle cerebral artery occlusion(MCAO)model rats.Methods:Twenty-four male Sprague-Dawley rats were randomly divided into a normal group,a model group,and an EA group,with eight rats in each group.The middle cerebral artery ischemia-reperfusion model was established by the suture-occluded method in the model group and the EA group,while not in the normal group.The EA group was pretreated with EA at bilateral Fengchi(GB20)before model preparation,once a day for 30 min each time for a total of 7 d.The changes in the CatWalk gait parameters,modified Bederson neurological deficit score,cerebral blood flow,cerebral infarction volume after ischemia,and VEGF level in the brain tissue of rats in each group were observed.Results:Compared with the normal group,the modified Bederson neurological deficit score in the model group and the EA group increased after modeling(P<0.05),and the CatWalk gait parameters(one-leg stance duration,gait cadence,and gait cycle)were all changed(P<0.05).Compared with the model group,the modified Bederson neurological deficit score in the EA group decreased(P<0.05),and the CatWalk gait parameters improved(P<0.05).Immediately after ischemia,the cerebral blood flow in the normal group was greater than that in the model group and the EA group(P<0.05);after reperfusion,the cerebral blood flow in the EA group was greater than that in the model group(P<0.05).Compared with the normal group,the cerebral infarction volume in the model group and the EA group increased(P<0.05).Compared with the model group,the cerebral infarction volume in the EA group decreased(P<0.05).The expression level of VEGF-positive cells in the rat brain tissue in the model group was higher than that in the normal group(P<0.05),and was higher in the EA group than in the model group(P<0.05).Conclusion:EA pretreatment improves the limb motor function in MCAO model rats,alleviates the symptoms of neurological deficits,promotes the recovery of cerebral blood flow,reduces the cerebral infarction area after MCAO modeling,and increases the VEGF expression in the brain tissue.

Effects of electroacupuncture on angiogenesis and cortical VEGF and BDNF expression in rats with focal cerebral ischemia

Objective To observe the effect of electroacupuncture(EA)of“concurrent treatment of the brain and heart”on angiogenesis and cortical vascular endothelial growth factor(VEGF)and brain-derived neurotrophic factor(BDNF)in rats with focal cerebral ischemia,and to explore the mechanism of EA in cerebral ischemia treatment.Methods A total of 108 Sprague-Dawley rats,27 rats were randomly selected as the sham-operation group,and the rest rats received the right middle cerebral artery occlusion operation for model preparation firstly,and then were divided into a model group,a traditional acupoint group,and a concurrent treatment of the brain and heart group,with 27 rats in each group.In the sham-operation group,only the carotid artery was isolated.EA at Shuigou(CV26),Quchi(LI11),Hegu(LI4),and Zusanli(ST36)in the traditional acupoint group,and EA at Fengfu(GV16),Baihui(GV20),Xinshu(BL15),and Neiguan(PC6)in the concurrent treatment of the brain and heart group were performed 4 h after the operation,once a day,for 14 consecutive days.Rats in the sham-operation group and the model group were identically fixed without any treatment.Before and after treatment,the modified neurological severity score(mNSS),regional cerebral blood flow(rCBF),and CD34 positive expression by immunohistochemistry were measured.The positive protein expression levels of VEGF and BDNF were detected by immunofluorescence,and the mRNA expression levels of VEGF and BDNF were detected by quantitative reverse transcription-polymerase chain reaction(qRT-PCR).Results Compared with the sham-operation group,the mNSS,rCBF,and ischemic side cortical micro-vessel density(MVD)decreased,and the protein and mRNA expression levels of VEGF and BDNF increased in the model group(P<0.01).Compared with the model group,the mNSS of the two EA groups decreased,and the mNSS of the concurrent treatment of the brain and heart group was lower than that of the traditional acupoint group on the 14th day(P<0.05).Compared with the model group,the rCBF in the two EA groups increased,and the rCBF reached the highest on the 14th day(P<0.05 or P<0.01),and the rCBF in the concurrent treatment of the brain and heart group was higher than that in the traditional acupoint group(P<0.05);the MVD of the two EA groups was higher than that of the model group,and the MVD of the concurrent treatment of the brain and heart group was higher than that of the traditional acupoint group on the 7th and 14th days(P<0.05 or P<0.01).Compared with the model group,the protein and mRNA expression levels of VEGF and BDNF in the two EA groups increased(P<0.01).The VEGF expression level was the highest on the 7th day in the concurrent treatment of the brain and heart group(P<0.05),and the BDNF expression level was higher on the 7th and 14th days than on the 3rd day(P<0.05).The mRNA expression levels of VEGF and BDNF in both EA groups reached the highest on the 7th day(P<0.05 or P<0.01).Conclusion EA therapy can up-regulate the VEGF and BDNF expression levels and increase the rCBF in the cortex of rats with focal cerebral ischemia,which may be one mechanism of EA in the cerebral ischemia treatment.The therapeutic effect is accumulated with the effective time,and the concurrent treatment of the brain and heart group is superior to the traditional acupoint group in promoting angiogenesis.

Waggle needling Yanglingquan(GB34) enhances cerebral blood flow and ameliorates condition of spastic paresis in rats with middle cerebral artery occlusion induced by surgical nylon suture

OBJECTIVE:To evaluate the therapeutic efficacy and the influence on cerebral blood supply of waggle needling Yanglingquan(GB34) on spastic paresis(SP) rats after middle cerebral artery occlusion(MCAO) induced and investigate its mechanism of relieving neurobehavior deficiency.METHODS:SP rat model was produced by permanent MCAO.Rats were divided into five groups:blank control group(Control),sham operation group(Sham),model group(Model),waggle needling group(WN) and perpendicular needling group(PN).SP rats were treated with acupuncture from day 3 after MCAO,once a day for 6 d.The modified neurological severity score(m NSS) and modified Ashworth scale(MAS) were conducted on days 0,1,3,5,7 and 9.Cerebral blood flow(CBF) in ischemic cortex was measured by laser speckle imaging 5 min pre ischemia,5 min post ischemia,and after intervention on day 9.All rats were sacrificed at day 9 and the protein and m RNA expressions of γ2 subunit of the γ-aminobutyric acid receptor A(GABAAγ2) and K+-Cl-cotransporter 2(KCC2) in the ischemic cortex and lumber enlargement was measured by Western blotting and real-time quantitative polymerase chain reaction.RESULTS:Both Control and Sham groups showed no changes in m NSS and MAS scores and in the regional CBF.Compared with Model group,both WN and PN treatments significantly ameliorated neurological deficit(P < 0.01),decreased muscle tone(P < 0.05),and enhanced CBF(P < 0.001) in SP rats;moreover,WN showed superior effects than PN(P < 0.001).In line with the improvement in neurobehavior,acupuncture interventions up-regulated the expressions of GABAAγ2 and KCC2 in the ischemic cortex as well as lumber enlargement(P < 0.01) in SP rats,and those changes were more obvious in WN(P < 0.05).CONCLUSIONS:Acupuncture at Yanglingquan(GB34) enhanced cerebral blood flow and ameliorated SP in permanent MCAO rats,while waggle needling was superior to regular perpendicular needling.Waggle needling Yanglingquan(GB34) would be a potential complementary therapy for SP.