Predicting Acute Mountain Sickness Using Regional Sea-Level Cerebral Blood Flow

Objective To investigate the role of sea-level cerebral blood flow(CBF)in predicting acute mountain sickness(AMS)using three-dimensional pseudo-continuous arterial spin labeling(3D-pCASL).Methods Forty-eight healthy volunteers reached an altitude of 3,650 m by air after undergoing a head magnetic resonance imaging(MRI)including 3D-pCASL at sea level.The CBF values of the bilateral anterior cerebral artery(ACA),middle cerebral artery(MCA),posterior cerebral artery(PCA),and posterior inferior cerebellar artery(PICA)territories and the laterality index(LI)of CBF were compared between the AMS and non-AMS groups.Statistical analyses were performed to determine the relationship between CBF and AMS,and the predictive performance was assessed using receiver operating characteristic(ROC)curves.Results The mean cortical CBF in women(81.65±2.69 mL/100 g/min)was higher than that in men(74.35±2.12 mL/100 g/min)(P<0.05).In men,the cortical CBF values in the bilateral ACA,PCA,PICA,and right MCA were higher in patients with AMS than in those without.Cortical CBF in the right PCA best predicted AMS(AUC=0.818).In women,the LI of CBF in the ACA was different between the AMS and non-AMS groups and predicted AMS with an AUC of 0.753.Conclusion Although the mechanism and prediction of AMS are quite complicated,higher cortical CBF at sea level,especially the CBF of the posterior circulatory system,may be used for prediction in male volunteers using non-invasive 3D-pCASL.

Hyperbaric oxygen therapy for cerebral blood flow and electroencephalogram in patients with acute cerebral infarction Choice for therapeutic occasion

BACKGROUND： Hyperbaric oxygen （HBO） therapy increases blood oxygen content, changes cerebral blood flow （CBF） and cerebral metabolism. Its therapeutic effects on cerebrovascular disease have been fully confirmed, but the occasion for HBO therapy is still unclear. OBJECTIVE： To observe the therapeutic effects of HBO therapy at different time on CBF and electroencephalogram （EEG） in patients with acute cerebral infarction （CI）. DESIGN： Randomized controlled trial. SETTING： Department of Neurology, Shidong Hospital, Yangpu District of Shanghai. PARTICIPANTS： Ninety-six inpatients with acute CI, admitted to Department of Neurology, Shidong Hospital, Yangpu District of Shanghai from January 2001 to December 2006, were involved in this experiment. The involved participants met the diagnosis criteria of acute CI and confirmed by skull CT or MRI. They all were patients with moderate CI （16- 30 points） according to neurologic deficit score formulated by Chinese Medical Association. Informed consents of detected items and therapeutic regimen were obtained from all the involved participants. They were randomized into two groups with 48 in each： early-stage treatment group and advanced-stage treatment group. Among the 48 patients in the early-stage treatment group, 21 male and 27 female, aged 53 -68 years, 22 patients were found with basal ganglia infarction, 10 with brain lobe infarction, 16 with multiple infarction, 27 accompanied with hypertension and 2 accompanied with diabetes meUitus. Among the 48 patients in the advanced-stage treatment group, 23 male and 25 female, aged 52 - 71 years, 25 patients were found with basal ganglia infarction, 10 with brain lobe infarction, 12 with multiple infarction, 1 with brain stem infarction, 28 accompanied with hypertension and 1 accompanied with diabetes mellitus. METHODS： After admission, patients of two groups received routine drug treatment. ① Patients in the early-stage treatment group and advanced-stage treatment group began to receive HBO therapy within one week of CI and 4 weeks after CI, respectively. The total course of treatment both was 2 weeks. EEG examination was carried out before and after therapy, and CBF was determined with ^133Xe inhalation.② Assessment criteria of curative effects： Basically cured： neurologic symptoms and body signs disappeared, could work and do housework; Markedly effective： score of neurologic deficit was decreased by over 21 points, could manage himself/herself partially; Effective： score of neurologic deficit was decreased by 8 to 12 points; Non-effective： Score was increased or decreased less than 8 points, neurologic deficit was worsened, even died. Total effective rate = （number of cured＋number of markedly effective＋number of effective）/ number of total cases ×100%. ③ t test and Chi-square test were used for comparing the difference of measurement data and enumeration data respectively, and Ridit analysis was used for comparing the difference of clinical curative effects. MAIN OUTCOME MEASURES： ① Comparison of EEG and CBF of patients from two groups before and after treatment. ②Comparison of post-treatment neurologic deficit of patients between two groups. RESULTS： All the involved 96 patients with CI participated in the final analysis. ① Clinical symptoms of patients from two groups after therapy were significantly improved as compared with those before therapy, and curative effects of early treatment group were better than those of advanced treatment group （ U = 1.99, P 〈 0.05 ） . ②After treatment, CBF in each region of brains, except for that in parietal lobe of patients in the advanced-stage treatment group, was significantly improved （P 〈 0.05 - 0.01）; The improvement of CBF of patients in the early-stage treatment group was more obvious than that in the early-stage treatment group （P 〈 0.05 - 0.01）. ③ The abnormal rate of EEF of patients from early-stage treatment group and advanced-stage treatment group before treatment was 94% and 96%, respectively. After treatment, improvement rate of EEG of patients in the early-stage treatment groulp was 95%, which was significantly different from that in the advanced-stage treatment group （82%, x^2=4.32, P 〈 0.05 ） CONCLUSION： HBO therapy both at early and advanced stages of CI （within 1 week and 4 weeks after CI attack） can improve CBF and EEG of patients with early CI, especially.

Pulsed arterial spin labeling effectively and dynamically observes changes in cerebral blood flow after mild traumatic brain injury

Cerebral blood flow is strongly associated with brain function, and is the main symptom and diagnostic basis for a variety of encephalopathies. However, changes in cerebral blood flow after mild traumatic brain injury remain poorly understood. This study sought to observe changes in cerebral blood flow in different regions after mild traumatic brain injury using pulsed arterial spin labeling. Our results demonstrate maximal cerebral blood flow in gray matter and minimal in the white matter of patients with mild traumatic brain injury. At the acute and subacute stages, cerebral blood flow was reduced in the occipital lobe, parietal lobe, central region, subcutaneous region, and frontal lobe. Cerebral blood flow was restored at the chronic stage. At the acute, subacute, and chronic stages, changes in cerebral blood flow were not apparent in the insula. Cerebral blood flow in the temporal lobe and limbic lobe diminished at the acute and subacute stages, but was restored at the chronic stage. These findings suggest that pulsed arterial spin labeling can precisely measure cerebral blood flow in various brain regions, and may play a reference role in evaluating a patient＇s condition and judging prognosis after traumatic brain injury.

A New Method for Evaluating Regional Cerebral Blood Flow Changes:Laser Speckle Contrast Imaging in a C57BL/6J Mouse Model of Photothrombotic Ischemia

The present study aimed to improve the processing of data acquired from laser speckle contrast imaging（LSCI） to provide a standardization method to explore changes in regional cerebral blood flow（r CBF） and to determine the correlations among r CBF, cerebral ischemic lesion volume and microvascular density over time in a focal ischemic region. C57BL/6J mice were subjected to focal photothrombotic（PT） ischemia. r CBF was measured using LSCI at different time points before and after PT ischemia through an intact skull. Standardized r CBF（Sr CBF）, defined as the ratio of r CBF measured in the ipsilateral region of interest（ROI） to that in the corresponding contralateral region, was calculated to evaluate potential changes. In addition, the volume of the ischemic lesion and the microvascular density were determined using Nissl staining and immunofluorescence, respectively. The relationships among the ischemic lesion volume, microvascular density and Sr CBF were analyzed over time. The results showed that the cortical r CBF measured using LSCI following PT ischemia in the C57BL/6J mice gradually increased. Changes in the cerebral ischemic lesion volume were negatively correlated with Sr CBF in the ischemic region. Changes in the microvascular density were similar to those observed in Sr CBF. Our findings indicate that LSCI is a practical technique for observing changes in murine cortical r CBF without skull opening and for analyzing the relationships among the ischemic lesion volume, microvascular density and Sr CBF following focal cerebral ischemia. Preliminary results also suggest that the use of LSCI to observe the formation of collateral circulation is feasible.

Electroacupuncture induces acute changes in cerebral cortical mi RNA profile, improves cerebral blood flow and alleviates neurological deficits in a rat model of stroke

Electroacupuncture has been shown to improve cerebral blood flow in animal models of stroke. However, it is unclear whether electroacupuncture alters mi RNA expression in the cortex. In this study, we examined changes in the cerebral cortical mi RNA profile, cerebral blood flow and neurological function induced by electroacupuncture in a rat model of stroke. Electroacupuncture was performed at Renzhong（GV26） and Neiguan（PC6）, with a frequency of 2 Hz, continuous wave, current intensity of 3.0 m A, and stimulation time of 1 minute. Electroacupuncture increased cerebral blood flow and alleviated neurological impairment in the rats. mi RNA microarray profiling revealed that the vascular endothelial growth factor signaling pathway, which links cell proliferation with stroke, was most significantly affected by electroacupuncture. Electroacupuncture induced changes in expression of rno-mi R-206-3p, rno-mi R-3473, rno-mi R-6216 and rno-mi R-494-3p, and these changes were confirmed by quantitative real-time polymerase chain reaction. Our findings suggest that changes in cell proliferation-associated mi RNA expression induced by electroacupuncture might be associated with the improved cerebral blood supply and functional recovery following stroke.

Blood flow restriction in human skeletal muscle during rest periods after high-load resistance training down-regulates miR-206 and induces Pax7

Backgroud:Blood flow re striction(BFR) with low-intensity re sistance training has been shown to result in hypertrophy of skeletal muscle.In this study,we tested the hypothesis that BFR during the rest periods between acute,high-intensity resistance exercise sessions(70% of 1 repetition maximum,7 sets with 10 repetitions) enhances the effects of the resistance training.Methods:A total of 7 healthy young men performed squats,and between sets BFR was carried out on one leg while the other leg served as a control.Because BFR was applied during rest periods,even severe occlusion pressure(approximately 230 mmHg),which almost completely blocked blood flow,was well-tolerated by the participants.Five muscle-specific microRNAs were measured from the biopsy samples,which were taken 2 h after the acute training.Results:Doppler data showed that the pattern of blood flow recovery changed significantly between the first and last BFR.microRNA-206 levels significantly decreased in the BFR leg compared to the control.The mRNA levels of RAC-β serine/threonine-protein kinase v22,nuclear re spiratory factor 1,vascular endothelial growth factor,lupus Ku autoantigen protein p70 genes(p <0.05),and paired box 7(p <0.01) increased in the BFR leg.The protein levels of paired box 7,nuclear respiratory factor 1,and peroxisome proliferator-activated receptor y coactivator 1α did not differ between the BFR leg and the control leg.Conclusion:BFR,during the rest periods of high-load resistance training,could lead to mRNA elevation of those proteins that regulate angiogenesis,mitochondrial biogenesis,and muscle hypertrophy and repair.However,BFR also can cause DNA damage,judging from the increase in mRNA levels of lupus Ku autoantigen protein p70.

Improvement of regional cerebral blood flow after oral intake of ranched-chain amino acids in patients with cirrhosis

AIM： To evaluate the effect of oral intake of branchedchain amino acids （BCAA） on brain perfusion in patients with liver cirrhosis. METHODS： Single photon emission computed tomography scans were performed in 43 patients with cirrhosis and in 15 age-matched healthy subjects. Twenty-nine out of forty-three patients were randomly treated with either BCAA granules or placebo, and single photon emission computed tomography was performed before and after the treatment. We measured the regional cerebral blood flow values using a threedimensional stereotaxic region of interest template. RESULTS： Cirrhotic patients had regions of significant hypoperfusion in the bilateral central （right P = 0.039, P〈0.05; left P = 0.006 P〈0.01）, parietal （right P = 0.028, P〈0.05; left P = 0.009, P〈0.01）, angular （right P = 0.039, P〈0.05; left P = 0.008, P〈0.01）, and left pericallosal segments （P = 0.038 P〈0.05） as compared with healthy subjects. A significant increase in cerebral perfusion was observed 70 min after the oral intake of BCAA in the angular （right P = 0.012, P〈0.05; left P = 0.049, P〈0.05）, temporal （right P = 0.012, P〈0.05; left P=0.038, P〈0.05）, pericallosal segments （right P = 0.025, P〈0.05; left P = 0.049, P〈0.05） and left precentral （P = 0.044, P〈0.05）, parietal （P = 0.040, P〈0.05） and thalamus （P = 0.033, P〈0.05）. No significant change in perfusion was observed in the placebo group. CONCLUSION： Administration of BCAA rapidly improves cerebral perfusion.

REAL-TIME MONITORING OF MITOCHONDRIAL FUNCTION AND CEREBRAL BLOOD FLOW FOLLOWING FOCAL ISCHEMIA IN RATS

Focal ischemia due to reduction of cerebral blood flow(CBF),creates 2 zones of damage:the core area,which suffers severe damage,and penumbra area,which surrounds the core and suffers intermediate levels of injury.Objectives:A novel method is introduced,which evaluates mitochondrial function in the core and in the penumbra,during focal cerebral ischemia.Methods:Wistar rats underwent focal cerebral ischemia by middle cerebral artery occlusion(MCAO)for 60 minutes,followed by 60 minutes of reperfusion.Mitochondrial function was assessed by a unique Multi-Site—Multi-Parametric(MSMP)monitoring system,which measures mitochondrial NADH using fluorometric technique,and CBF using Laser Doppler Flowmetry(LDF).Results:At the onset of occlusion,CBF dropped and NADH increased significantly only in the right hemisphere.CBF levels were significantly lower and NADH significantly higher in the core than in the penumbra.After reperfusion,CBF and NADH recovered correspondingly to the intensity of ischemia.Conclusion:Application of the MSMP system can add significant information for the understanding of the cerebral metabolic state under ischemic conditions,with an emphasis on mitochondrial function.

Abnormal volumetric brain morphometry and cerebral blood flow in adolescents with depression

BACKGROUND Prior research has demonstrated that the brains of adolescents with depression exhibit distinct structural alterations.However,preliminary studies have documented the pathophysiological changes in certain brain regions,such as the cerebellum,highlighting a need for further research to support the current understanding of this disease.AIM To study brain changes in depressed adolescents.METHODS This study enrolled 34 adolescents with depression and 34 age-,sex-,and education-level-matched healthy control(HC)individuals.Structural and functional alterations were identified when comparing the brains of these two participant groups through voxel-based morphometry and cerebral blood flow(CBF)analysis,respectively.Associations between identified brain alterations and the severity of depressive symptoms were explored through Pearson correlation analyses.RESULTS The cerebellum,superior frontal gyrus,cingulate gyrus,pallidum,middle frontal gyrus,angular gyrus,thalamus,precentral gyrus,inferior temporal gyrus,superior temporal gyrus,inferior frontal gyrus,and supplementary motor areas of adolescents with depression showed an increase in brain volume compared to HC individuals.These patients with depression further presented with a pronounced drop in CBF in the left pallidum(group=98,and peak t=-4.4324),together with increased CBF in the right percental gyrus(PerCG)(group=90,and peak t=4.5382).In addition,17-item Hamilton Depression Rating Scale scores were significantly correlated with the increased volume in the opercular portion of the left inferior frontal gyrus(r=-0.5231,P<0.01).CONCLUSION The right PerCG showed structural and CBF changes,indicating that research on this part of the brain could offer insight into the pathophysiological causes of impaired cognition.

CLINICAL OBSERVATION ABOUT THE EFFECT OF BLOOD-LETTING OF JING-POINTS ON CEREBRAL BLOOD FLOW IN STROKE PATIENTS AT THE EARLY STAGE AND EXPERIMENTAL STUDY ON ITS MECHANISMS IN THE RABBIT

In this paper, the authors sum their research results about the effect of blood-letting of Jing (Well)-point on cerebral blood flow both in stroke patients and in experimental cerebral ischemia, cerebral hematoma and hypertension rabbits. In 30 cases of stroke (cerebral hemorrhage and cerebral infarction) patients, blood flow state of the anterior cerebral artery (ACA), middle cerebral artery (MCA) and the posterior cerebral artery (PCA), and the blood flow velocity of the bilateral vertebral artery (VA) and the basil artery (BA) are determined before and after pricking blood of the Twelve Jing-points. In experimental cerebral ischemia (by occlusion of the common carotid artery) rabbits, cerebral hematoma model rabbits and intravenous injection of noradrenaline induced hypertension rabbits, rheoencephalogram (REC) is detected before and after blood letting of the twelve "Jing"-points. In these 30 stroke patients, ultrasound Doppler examination’s results show that in 22 cases (73.33%) whose blood flow velocity decreases, after blood-letting of the 12 Jing-points, it increases significantly (P<0.01); in the rest 8 cases ( 26.67%) whose blood flow velocity speeds up, after treatment, it decreases evidently (P<0.01), showing a good dual-directional regulative effect of blood-letting therapy. In experimental cerebral ischemia rabbits, cerebral hematoma rabbits and hypertension rabbits whose REG lowers in the amplitude apparently (P<0.01), after blood letting stimulation of the 12 Jing-points, it increases at different degrees. Three patterns of stimulation as blood letting stimulation, pain stimulation and Jing-point stimulation, also the 3 factors of blood-letting therapy, may contribute to their effect on improvement of the cerebral blood flow. Somatic afferent nerve, sympathetic nerve of the vascular wall, central cholinergic nerve (M receptors) and adrenergic nerve (α receptors) participate in the effect of blood letting on cerebral blood flow.

Optimal velocity encoding during measurement of cerebral blood flow volume using phase-contrast magnetic resonance angiography

This study investigated the effect of velocity encoding on measurement of brain blood flow and blood volume of inflow and outflow using phase-contrast magnetic resonance angiography. A single two-dimensional phase-contrast magnetic resonance angiography slice was applied perpendicular to the internal carotid artery and the vertebral artery at C2 level. For each subject, the velocity encoding was set from 30 to 90 cm/s with an interval of 10 cm/s for a total of seven settings. Various velocity encodings greatly affected blood flow volume, maximal blood flow velocity and mean blood flow velocity in the internal carotid artery, but did not significantly affect vertebral arteries and jugular veins. When velocity encoding was 60-80 cm/s, the inflow blood volume was 655 _＋ 118 mL/min, and the outflow volume was 506 _＋ 186 mL/min. The ratio of outflow/inflow was steady at 0.78-0.83, and there was no aliasing in any of the images. These findings suggest that velocity encodings of 60 80 cm/s should be selected during measurement of cerebral blood flow volume using phase-contrast magnetic resonance angiography.

Blood-brain barrier and cerebral blood flow: Age differences in hemorrhagic stroke

Neonatal stroke is similar to the stroke that occurs in adults and produces a significant morbidity and long-term neurologic and cognitive deficits.There are important differences in the factors,clinical events and outcomes associated with the stroke in infants and adults.However,mechanisms underlying age differences in the stroke development remain largely unknown.Therefore,treatment guidelines for neonatal stroke must extrapolate from the adult data that is often not suitable for children.The new information about differences between neonatal and adult stroke is essential for identification of significant areas for future treatment and effective prevention of neonatal stroke.Here,we studied the development of stress-induced hemorrhagic stroke and possible mechanisms underlying these processes in newborn and adult rats.Using histological methods and magnetic resonance imaging,we found age differences in the type of intracranial hemorrhages.Newborn rats demonstrated small superficial bleedings in the cortex while adult rats had more severe deep bleedings in the cerebellum.Using Doppler optical coherent tomography,we found higher stress-reactivity of the sagittal sinus to deleterious effects of stress in newborn vs.adult rats suggesting that the cerebral veins are more vulnerable to negative stress factors in neonatal vs.adult brain in rats.However,adult but not newborn rats demonstrated the stroke-induced breakdown of blood brain barrier(BBB)permeability.The one of possible mechanisms underlying the higher resistance to stress-related stroke injures of cerebral vessels in newborn rats compared with adult animals is the greater expression of two main tight junction proteins of BBB(occludin and claudin-5)in neonatal vs.mature brain in rats.

Characterization of cerebral blood flow dynamics with multiscale entropy

Based on the laser speckle contrast imaging(LSCI)and the multiscale entropy(MSE),we study in this work the blood flow dynamics at the levels of cerebral veins and the surrounding network of microcerebral vessels.We discuss how the phenylephrine-related acute peripheral bypertension is refected in the cerebral circulation and show that the observed changes are scale dependent,and they are signifcantly more pronounced in microcerebral vessels,while the macrocerebral dynamics does not demonstrate authentic inter-group distinctions.We also consider the permeability of blood-brain barrier(BBB)and study its opening caused by sound exposure.We show that alterations associated with the BBB opening can be revealed by the analysis of blood flow at the level of macrocerebral vessels.

Sufficiently Elevated Core Body Temperature May Be Necessary to Maintain Cerebral Blood Flow Response throughout the Morning

In comparison to a carbohydrate-rich breakfast, a nutritionally balanced breakfast reportedly leads to a higher core body temperature because of diet-induced thermogenesis (DIT) and also results in higher task performance. This study aimed to examine the relationships among the core body temperature, blood glucose level, cerebral blood flow, and cognitive performance when the core body temperature is raised to a similar extent as in DIT in the morning. This crossover study included 18 male participants who performed four sets of cognitive tests in the morning with four different foot baths and glucose intake conditions. In elevated body temperature (EBT) conditions, the core body temperature was increased by a foot bath at 42&#730;C or 39&#730;C, while in low body temperature (LBT) conditions, it was maintained at 35&#730;C by a foot bath;the participants received no glucose or two intakes of 20-g glucose for each thermal condition. In addition to the core body temperature measurement, the cerebral blood flow in the dorsolateral prefrontal cortex (DLPFC) was measured using near-infrared spectroscopy. Three blood collections were performed to measure the changes in blood glucose levels. The results revealed that in the EBT conditions, the core body temperature remained 0.3&#730;C - 0.5&#730;C higher than that at wake-up time, while the glucose intake conditions increased blood glucose levels which remained higher than those during fasting. No significant between-treatment difference was observed in the results of cognitive tests. However, the blood flow in the DLPFC increased during the second test period in the EBT/glucose and LBT/glucose conditions, whereas during the fourth test period, it increased solely in the EBT/glucose condition. Thus, in addition to the blood glucose level, an elevated core body temperature within the physiological range may be needed for long-term maintenance of the cerebral blood flow response.

EFFECT OF ELECTROACUPUNCTURE ON CEREBRAL BLOOD FLOW, VIP AND ET IN RATS WITH VASCULAR DEMENTIA

Objective: To investigate the relationship between electroacupuncture (EA)-induced improvement of regional cerebral blood flow and the alternations of vasoactive intestinal peptide (VIP) and endothelin (ET) in rats with experimental vascular dementia (VD). Methods: 40 Wistar rats were evenly randomized into sham-operation, model, medication (Nimotone) and EA groups. Vascular dementia model was established by repeated cerebral ischemia-reperfusion which was induced by occlusion and reopen of the bilateral common carotid arteries. EA (2～200 Hz, 2～3 mA) was applied to "Baihui"(GV 20), "Dazhui"(GV 14) and "Zusanli"(ST 36) for 30 min, once daily and continuously for 15 days. The regional cerebral blood flow (rCBF) in parietal lobe and hippocampus was determined with method of hydrogen clearance; a step-down avoidance test was adopted to observe the rats’ behavior change; and plasma VIP and ET contents were assayed by radioimmunoassay. Results: In comparison with sham-operation group, the correct rate of step-down avoidance test, rCBF in parietal lobe and hippocampus and plasma VIP level in VD model group lowered significantly (P<0.01) and plasma ET increased considerably (P<0.01). However, compared with model group, the correct rate of step-down avoidance test, rCBF values and plasma VIP in EA group raised obviously while plasma ET declined significantly. No significant differences were found between EA and medication groups in the 4 indexes. Conclusion: EA can raise rCBF in the parietal lobe and hippocampus, elevate plasma VIP level and reduce plasma ET in rats with VD.

The effects of decompressive craniectomy on cerebral blood flow volume and brain metabolism in different aged patients with severe traumatic brain injury

Objective To explore effects of decompressive craniectomy on cerebral blood flow volume and brain metabolism in different aged patients with severe traumatic brain injury. Methods 71 cases were divided into three groups according age: group A( 【 30 years) ,group B ( 30 ～ 50 years) 。

Clinical Efficacy of Modified Erchen Decoction on Cervical Spondylotic Vertebral Arteriopathy with Stagnation and Blockade of Phlegm-dampness Syndrome and Effects on Cerebral Blood Flow Parameters

OBJECTIVE: To observe the effect of Modified Erchen Decoction on cervical spondylotic vertebral arteriopathy with stagnation and blockade of phlegm-dampness syndrome and effects on cerebral blood flow parameters. METHODS: A total of 80 cervical spondylotic vertebral arteriopathy(CSA) patients with stagnation and blockade of phlegmdampness syndrome admitted to our hospital from October 2016 to April 2017 were selected and randomly divided into observation group and control group, with 40 cases in each group. The observation group was treated with Modified Erchen Decoction and the control group was given conventional treatment with Western medicine. After 4 weeks of treatment, the main clinical symptoms and signs(vertigo, neck and shoulder pain, headache, psychological and social adjustment, daily life and work) and cerebral blood flow parameters [the peak values of intracranial vertebral-basal artery diastolic blood flow velocity(Vd) and systolic blood flow velocity(Vp)] were compared between the 2 groups. The total clinical effective rate and adverse reactions during treatment were also compared. RESULTS: After treatment, the total effective rate of the observation group was 90.0%, which was significantly higher than that of the control group(77.5%). The difference between the two groups was statistically significant(P < 0.05). After treatment, The scores of vertigo, neck and shoulder pain, headache, psychology and society adaptation, daily life and work were significantly increased(P < 0.05), and the above scores of the observation group were increased more obviously. The difference between the groups was statistically significant(P < 0.05). After treatment, the levels of Vd and Vp were significantly increased(P < 0.05), and the increase of the above indexes was more obvious in the observation group. The difference between the 2 groups was statistically significant(P < 0.05). There were no significant abnormalities in blood routine, urine routine, liver function and renal function. There was no significant difference in the incidence of adverse reactions between the 2 groups.(P > 0.05). CONCLUSION: The treatment of vertebral artery type cervical spondylopathy with stagnation and blockade of phlegm-dampness syndrome by Modified Erchen Decoction can effectively relieve the main clinical symptoms and signs, improve cerebral blood flow parameters, and improve the peak values of vertebral-basal artery diastolic blood flow velocity(Vd) and systolic blood flow velocity(Vp), which is safe and effective, and helps to promote the recovery of cervical function.

CEREBRAL BLOOD FLOW AND METABOLISM EVALUATION IN COMATOSE PATIENTS BY DYNAMIC SPECT

Thirty patients in coma state underwent dynamic SPECT with 133Xe, a validated technique for the quantitation of CBF by SPECT, using a new brain dedicated tomograph: CERTO-96. CMRO2 was computed by multiplying the mean CBF by AVDO2 according to the Fick’s principle. The mean values of CBF, AVDO2 and CMRO2 in patients with good outcome were significantly different from those with worse outcome. On the basis of the best "discriminant threshold", CBF and AVDO2 demonstrated an intermediate accuracy in separating the two groups, while CMRO2 showed a satisfactory accuracy.

Role of the Peripheral Sympathetic Innervations in Controlling Cerebral Blood Flow after the Transection of Bilateral Superior Cervical Sympathetic Ganglia Two Weeks Later

Background: Cerebral blood vessels are mainly supplied by sympathetic nerves arising from the superior cervical ganglia and cerebral blood volume may be influenced by bilateral superior cervical ganglionectomy (SCG). Various stages of cerebral blood volume changes depended on the time following bilateral excision of SCG. In this study, we emphasize the subacute effect (two weeks) on the local cerebral blood flow (LCBF). Material and Methods: Sprague-Dawley rats weighing 250 ~ 400 gm (n = 20) were selected into two groups. Under the ambient temperature 20oC, the first group animals (n = 10) received sham operation and the other group animals (n = 10) underwent bilateral SCG. The LCBF and O2 delivery of 14 brain struc-tures were measured for each animal by the use of 14C-iodoantipyrine technique two weeks after the opera-tion. Results: The average of LCBF was decreased from 150 ml/100 gm/min to 129 ml/100 gm/min after bi-lateral SCG. Only the LCBF at basal ganglia was increased from 108 ml/min/100 g in the sham-operated group to 118 ml/min/100g in the SCG group. A mean of 14% reduction of LCBF was estimated. In 14 brain structures, the delivery amount of O2 was all decreased, except in basal ganglia. However, these changes of LCBF and the delivery amount of O2 at these 14 brain structures did not reach the significant differences. Conclusions: The present results show that chronic effect (two weeks) of bilateral SCG on LCBF was not only in a decrease of the LCBF, but also a decrease of local cerebral O2 delivery. However, the changes didn’t show the significant differences.

Cerebral Blood Flow Measurement in the Assessment of Post-Traumatic Cerebral Contusions

Brain trauma (BT) is extremely common in the Western society, and has been identified as the main cause of death and disability in the under-40 age group. Many aspects of the pathophysiological mechanisms involved and the effect of changes in cerebral metabolism are unclear. The aim of this study was to establish the rela- tionship between anatomical changes and deranged cerebral perfusion in patients with cerebral contusions, using Computed Tomography (CT) and Single Proton Emission Computed Tomography (SPECT). Twenty- two (22) patients who had suffered BT were recruited. All patients underwent SPECT and CT head scans on the same day. 18 were men. Patient average age was 45.6. Patients were assessed using the Glasgow scale (average 10.6). Cause of trauma included traffic accidents (9 patients) and falls (13 patients). A 4-slice spiral CT scan was performed. For each contusion, areas of bleeding, edema, and healthy perilesional tissue were distinguished. SPECT was performed with 20 mCi of 99 mTcECD using a dual-head gamma camera (128 × 128 matrix). CT scan revealed a single lesion in 12 patients, and more than one lesion in 10. The biggest le- sions found on CT were located in the frontal region in 13 patients;temporal region in 4;and parietal region in 1;four patients had poorly defined lesions. A total absence of perfusion was visible in 18 patients in the hemorrhagic area and in 14 patients in the edema, In 7 cases SPECT showed hypoperfusion that did not cor- respond to any morphological changes on the CT scan. Quantitative of fused lesions appearing on both CT scan and SPECT revealed severe perfusion defects in the hemorrhagic area (17.8%) and in the edema (29.4%). In our study, regional cerebral blood flow add relevant information on encephalic damage in pa- tients with BT.