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      Pial Microvascular Responses to Transient Bilateral Common Carotid Artery Occlusion: Effects of Hypertonic Glycerol

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          Objective: The aim of the study was to assess the rat pial microvessel alterations due to transient bilateral common carotid artery occlusion (BCCAO) and to investigate the mechanism of 10% hypertonic glycerol neuroprotection. Our suggestion was that 10% glycerol solution infusion could dilate pial arterioles through nitric oxide release and/or stimulation of ATP-sensitive potassium (K<sub>ATP</sub>) channels. Therefore, we studied the effects of hypertonic glycerol after inhibition of nitric oxide synthase, with N<sup>G</sup>-nitro- L-arginine-methyl ester or N<sup>G</sup>-nitro- L-arginine, or K<sub>ATP</sub> channels with glibenclamide. Methods: Pial microcirculation of male Wistar rats was visualized by a fluorescent microscopy technique through an open cranial window, using fluorescein isothiocyanate bound to dextran (molecular weight 70 kDa). BCCAO was induced for 30 min and reperfusion lasted 60 min. The arterioles were classified according to the Strahler ordering scheme. Permeability increase was quantified by normalized grey levels (NGL). Leucocytes were stained with rhodamine 6G. Perfused capillary length and capillary red blood cell (RBC) velocity were measured by computer-assisted methods. Results: The arterioles were assigned 5 orders of branchings, from order 1 (diameter 16.0 ± 2.5 µm) to order 5 (62.0 ± 5.0 µm). BCCAO caused inhomogenous changes in diameter of arterioles and leakage of fluorescent dextran, that was further enhanced by reperfusion (0.45 ± 0.05 NGL, p < 0.01). Adhesion of leukocytes to venules was marked and capillary perfusion was reduced by 39.2 ± 6.0% of baseline as well as capillary RBC velocity. 10% glycerol solution caused an increase in diameter of all arterioles within 25 ± 2 min of administration (by 20 ± 5% in order 4, 25 ± 4% in order 3 and 18 ± 3% in order 2; p < 0.01). Leakage (0.19 ± 0.03 NGL, p < 0.01), leukocyte adhesion (2.0 ± 1.0/100 µm of venular length, p < 0.01) and capillary occlusion (reduction by 13.0 ± 5.5% of baseline) were prevented compared with controls. Capillary RBC velocity increased compared with controls. N<sup>G</sup>-nitro- L-arginine-methyl ester or N<sup>G</sup>-nitro- L-arginine infused prior to glycerol caused vasoconstriction and reduced the protective effects of hypertonic glycerol on permeability increase. The number of adherent leukocytes and perfused capillary length decreased, while capillary RBC velocity was higher than baseline. Glibenclamide prior to 10% glycerol solution blunted glycerol-induced vasodilatation, but did not affect protection by hypertonic glycerol on blood-brain barrier disruption, leukocyte adhesion and capillary perfusion, preserving high capillary RBC velocity. Papaverine (20 mg/kg body weight) induced an increase in arteriolar diameter, enhancing interstitial edema; adhesion of leukocytes was marked as well as capillary occlusion, while capillary RBC velocity increased. Conclusions: 10% glycerol solution was able to prevent microvascular alterations due to BCCAO protecting cerebral tissue. The effects appear to be due to hyperosmolality causing stimulation of K<sub>ATP</sub> channels, increase in vessel wall shear stress and release of nitric oxide.

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          Use of hypertonic saline solutions in treatment of cerebral edema and intracranial hypertension.

          To review the literature on the use of hypertonic saline (HS) in treating cerebral edema and intracranial hypertension. Review of scientific and clinical literature retrieved from a computerized MEDLINE search from January 1965 through November 1999. Pertinent literature is referenced, including clinical and laboratory investigations, to demonstrate principles and efficacy of treatment with HS in patients with intracranial space-occupying pathology. The literature was reviewed to summarize the mechanisms of action, efficacy, adverse effects, systemic effects, and comparisons with standard treatments in both clinical and laboratory settings. HS has an osmotic effect on the brain because of its high tonicity and ability to effectively remain outside the bloodbrain barrier. Numerous animal studies have suggested that fluid resuscitation with HS bolus after hemorrhagic shock prevents the intracranial pressure (ICP) increase that follows resuscitation with standard fluids. There may be a minimal benefit in restoring cerebral blood flow, which is thought to be mitigated through local effects of HS on cerebral microvasculature. In animal models with cerebral injury, the maximum benefit is observed in animals with focal injury associated with vasogenic edema (cryogenic injury). The ICP reduction is seen for < or =2 hrs and may be maintained for longer periods by using a continuous infusion of HS. The ICP reduction is thought to be caused by a reduction in water content in areas of the brain with intact blood-brain barrier such as the nonlesioned hemisphere and cerebellum. Most comparisons with mannitol suggest almost equal efficacy in reducing ICP, but there is a suggestion that mannitol may have a longer duration of action. Human studies published to date reporting on the use of HS in treating cerebral edema and elevated ICP include case reports, case series, and small controlled trials. Results from studies directly comparing HS with standard treatment in regard to safety and efficacy are inconclusive. However, the low frequency of side effects and a definite reduction of ICP observed with use of HS in these studies are very promising. Systemic effects include transient volume expansion, natriuresis, hemodilution, immunomodulation, and improved pulmonary gas exchange. Adverse effects include electrolyte abnormalities, cardiac failure, bleeding diathesis, and phlebitis. Although unproven, a potential for central pontine myelinolysis and rebound intracranial hypertension exists with uncontrolled administration. HS demonstrates a favorable effect on both systemic hemodynamics and intracranial pressure in both laboratory and clinical settings. Preliminary evidence supports the need for controlled clinical trials evaluating its use as resuscitative fluid in brain-injured patients with hemorrhagic shock, as therapy for intracranial hypertension resistant to standard therapy, as firstline therapy for intracranial hypertension in certain intracranial pathologies, as small volume fluid resuscitation during spinal shock, and as maintenance intravenous fluid in neurocritical care units.
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            Spatial heterogeneity of the nonlinear dynamics in the FMRI BOLD response.

             Z Saad,  P Bandettini,  R Birn (2001)
            Recent studies of blood oxygenation level dependent (BOLD) signal responses averaged over a region of interest have demonstrated that the response is nonlinear with respect to stimulus duration. Specifically, shorter duration stimuli produce signal changes larger than expected from a linear system. The focus of this study is to characterize the spatial heterogeneity of this nonlinear effect. A series of MR images of the visual and motor cortexes were acquired during visual stimulation and finger tapping, respectively, at five different stimulus durations (SD). The nonlinearity was assessed by fitting ideal linear responses to the responses at each SD. This amplitude, which is constant for different SD in a linear system, was normalized by the amplitude of the response to a blocked design, thus describing the amount by which the stimulus is larger than predicted from a linear extrapolation of the response to the long duration stimulus. The amplitude of the BOLD response showed a nonlinear behavior that varied considerably and consistently over space, ranging from almost linear to 10 times larger than a linear prediction at short SD. In the motor cortex different nonlinear behavior was found in the primary and supplementary motor cortexes.
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              Geometric Characteristics of Arterial Network of Rat Pial Microcirculation

              Objective: The aim of the study was to assess the geometric characteristics of rat pial microcirculation and describe the vessel bifurcation patterns by ‘connectivity matrix’. Methods: Male Wistar rats were used to visualize pial microcirculation by a fluorescent microscopy technique through an open cranial window, using fluorescein isothiocyanate bound to dextran (molecular weight 70 kDa). The arteriolar network was mapped by stop-frame images. Diameters and lengths of arterioles were measured with a computer-assisted method. Pial arterioles were classified according to a centripetal ordering scheme (Strahler method modified according to diameter) from the smallest order 1 to the largest order 5 arterioles in the preparation. A distinction between arteriolar segments and elements was used to express the series-parallel features of the pial arteriolar networks. A connectivity matrix was used to describe the connection of blood vessels from one order to another. Results: The arterioles were assigned 5 orders of branching by Strahler’s ordering scheme, from order 1 (diameter: 16.0 ± 2.5 µm) to order 5 (62 ± 5.0 µm). Order 1 arterioles gave origin to capillaries, assigned order 0. The diameter, length and branching of the 5 arteriolar orders grew as a geometric sequence with the order number in accordance with Horton’s law. The segments/elements ratio was the highest in order 4 and 3 arterioles, indicating the greatest asymmetry of ramifications. Finally, the branching vessels in the networks were described in details by the connectivity matrix. Fractal dimensions of arteriolar length and diameter were 1.75 and 1.78, respectively. Conclusions: The geometric characteristics of rat pial microcirculation indicate that distribution of vessels is fractal. The connectivity matrix allowed us to describe the number of daughter vessels spreading from parent vessels. This ordering scheme may be useful to describe vessel function, according to diameter, length and branching.

                Author and article information

                J Vasc Res
                Journal of Vascular Research
                S. Karger AG
                February 2008
                12 October 2007
                : 45
                : 2
                : 89-102
                aDepartment of Physiology and Biochemistry, University of Pisa, Pisa, and bDepartment of Neuroscience, Federico II University Medical School, Naples, Italy
                109818 J Vasc Res 2008;45:89–102
                © 2007 S. Karger AG, Basel

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                Page count
                Figures: 9, Tables: 7, References: 44, Pages: 14
                Research Paper


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