Neuroprotective Effects Of Bilobalide Are Accompanied By A Reduction Of Ischemia-induced Glutamate Release In Vivo
brain-injury; cerebral-artery occlusion; extract egb-761; Ginkgo biloba; Ginkgo biloba; Glucose; inhibition; mice; Microdialysis; Microdialysis; Middle cerebral artery occlusion; Neurosciences & Neurology; phospholipid breakdown; sensorimotor; stroke; stroke
Neuroprotective properties of bilobalide, a specific constituent of Ginkgo extracts, were tested in a mouse model of stroke. After 24 h of middle cerebral artery occlusion (MCAO), bilobalide reduced infarct areas in the core region (striatum) by 40-50% when given at 10 mg/kg 1 h prior to MCAO. Neuroprotection was also observed at lower doses, or when the drug was given 1 h past stroke induction. Sensorimotor function in mice was improved by bilobalide as shown by corner and chimney tests. When brain metabolism in situ was monitored by microdialysis, MCAO caused a rapid disappearance of extracellular glucose in the striatum which returned to baseline levels after reperfusion. Extracellular levels of glutamate were increased by more than ten-fold in striatal tissue, and by four- to fivefold in hippocampal tissue (penumbra). Bilobalide did not affect glucose levels but strongly attenuated glutamate release in both core and penumbra regions. Bilobalide was equally active when given locally via the microdialysis probe and also reduced ischemia-induced glutamate release in vitro in brain slices. We conclude that bilobalide is a strong neuroprotectant in vivo at doses that can be used therapeutically in humans. The mechanism of action evidently involves reduction of glutamate release, thereby reducing excitotoxicity. (C) 2011 Elsevier B.V. All rights reserved.
Lang D; Kiewert C; Mdzinarishvili A; Schwarzkopf T M; Sumbria R; Hartmann J; Klein J
Brain Research
2011
2011-11
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1016/j.brainres.2011.10.005" target="_blank" rel="noreferrer noopener">10.1016/j.brainres.2011.10.005</a>
The relationship between psychiatric medication and course of hospital stay among intoxicated trauma patients
acute; brain-injury; chronic alcohol-abuse; comorbidity; cost; disorders; Emergency Medicine; ethanolism; general hospitals; hospitalization; inpatients; intoxication; Length of Stay; pneumonia; prevalence; Psychiatry; trauma
Introduction The purpose of this study was to determine whether trauma patients requiring psychiatric medication who were admitted with positive alcohol or drug screen require more pain medications or sedation resulting in longer length of stay. Methods Data were retrospectively collected from 1997 through 2003 on patients with positive alcohol or drug screen who also received psychiatric medication during their hospital stay in a trauma center. Patients were matched by age, injury severity score, and injury to controls who had negative alcohol and toxicology screens and no psychiatric medication. An additional group consisted of positive alcohol or drug-screen trauma patients without psychiatric medication during hospitalization. Each group had 25 patients. Results No significant differences between the three groups regarding comorbidities or pain-medication doses given per day were found. The patients with positive alcohol and with psychiatric medication were more likely to have respiratory complications such as pneumonia or respiratory failure requiring ventilator support (36 versus 4%, P=0.005), to develop other infections (8 versus 0%), or other complications (26 versus 4%, P=0.0007) compared with the controls. A significant difference in hospital length of stay between the group with positive toxicity and psychiatric medication and that with negative toxicity and psychiatric medication (mean: 12.8 and 5.5 days, respectively; P=0.01) was found. Conclusion Psychiatric medication and positive drug or alcohol screens are associated with longer length of stay and increased respiratory complications. Factors influencing these outcomes need more clarification and prospective studies.
Muakkassa F F; Marley R A; Dolinak J; Salvator A E; Workman M C
European Journal of Emergency Medicine
2008
2008-02
Journal Article
<a href="http://doi.org/10.1097/MEJ.0b013e3280b17ea0" target="_blank" rel="noreferrer noopener">10.1097/MEJ.0b013e3280b17ea0</a>
Predictors of New Findings on Repeat Head CT Scan in Blunt Trauma Patients with an Initially Negative Head CT Scan
benefit; brain-injury; follow-up; intracranial injury; management; moderate; patients; serial computed-tomography; Surgery; utility
BACKGROUND: Our goal was to determine the need for a repeat head CT scan when the initial CT was negative. STUDY DESIGN: Data were collected from January 1, 2002 to December 31, 2008. There were 281 patients admitted to the trauma center with an initial negative head CT, who had a repeat CT during the same hospitalization. Repeat CTs were categorized into negative/negative (NNG) and negative/positive (NPG) groups. RESULTS: There were 281 patients who underwent a repeat head CT for changes in neurologic status, persistent symptoms, follow-up, decreased mental status, or suspected bleed. Of these, 241 patients remained negative (NNG) and new abnormal findings were noted in 40 patients (NPG). There were no differences in sex (NNG, 63% males vs NPG, 75% females; p = 0.14) or average age (NNG, 51.6 +/- 22.5 years vs NPG, 45.2 +/- 24.6 years; p = 0.07). There was no difference in positive toxicology (NNG, 29% vs NPG, 30%; p = 0.94) or mechanism of injury (NNG, 51% motor vehicle crash [MVC] vs NPG, 62% MVC; p = 0.18). There was a significant difference in Injury Severity Score (ISS) (NNG, 10.7 +/- 8.1 vs NPG, 17.9 +/- 11.0; p = 0.0002) and initial Glasgow Coma Scale (GCS) (NNG, 12.7 +/- 3.5 vs NPG, 10.9 +/- 4.2; p = 0.006). Patients with an ISS > 15 and who were intubated were associated with an increased odds of having a positive repeat CT scan (odds ratio [OR] 2.6; 95% CI 1.2, 5.5 and OR 3.5; 95% CI, 1.7, 7.3, respectively). CONCLUSIONS: Patients with a high ISS score and/or those who are intubated have significantly higher odds of having a positive repeat head CT when repeated for follow-up or when clinically warranted. (J Am Coll Surg 2012;214:965-972. (C) 2012 by the American College of Surgeons)
Muakkassa F F; Marley R A; Paranjape C; Horattas E; Salvator A; Muakkassa K
Journal of the American College of Surgeons
2012
2012-06
Journal Article
<a href="http://doi.org/10.1016/j.jamcollsurg.2012.02.004" target="_blank" rel="noreferrer noopener">10.1016/j.jamcollsurg.2012.02.004</a>
Effect of Hospital Length of Stay on Functional Independence Measure Score in Trauma Patients
after-discharge; alcohol; anemia; association; brain-injury; Function; injury severity score; intensive-care-unit; Length of Stay; life; outcomes; Patient Outcome Assessment; Recovery of; Rehabilitation; Rehabilitation; Sport Sciences; survival
Objective: The purpose of this study was to determine whether prolonged hospital length of stay (HLOS) and rehabilitation facility length of stay (RLOS) lead to poor functional outcomes, defined as a Functional Independence Measure (FIM) score of less than 76 (LFIM) at rehabilitation facility (RF) discharge. Design: This study analyzed retrospective data collected between 2002 and 2009 on 326 patients in a trauma center and affiliated RF. Factors predicting LFIM at RF discharge were determined using multivariate logistic regression, chi(2) tests, and t tests. Results: Significant multivariate predictors of LFIM included age (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.02-1.07; P < 0.0001), spinal cord injury (OR, 7.22; 95% CI, 2.73-19.02; P = 0.000), female sex (OR, 2.34; 95% CI, 1.17-4.65; P = 0.01), and RF admission FIM (OR, 0.93; 95% CI, 0.91Y0.95; P < 0.001). An increased risk of LFIM (OR, 2.21; 95% CI, 1.41Y3.45; P = 0.001) was observed with an increased ratio of HLOS/RLOS after adjusting for injury severity score. Conclusion: An increased ratio of HLOS/RLOS increases the risk of LFIM more than 2-fold after adjusting for injury severity score, spinal cord injury, and FIM upon RF admission. Delays in transfer to an RF negatively affect patient functional outcomes. Studies to identify factors affecting delays in transfer from hospitals to RF should be conducted.
Muakkassa F F; Marley R A; Billue K L; Marley M; Horattas S; Yetmar Z; Salvator A; Hayek A
American Journal of Physical Medicine & Rehabilitation
2016
2016-08
Journal Article
<a href="http://doi.org/10.1097/phm.0000000000000453" target="_blank" rel="noreferrer noopener">10.1097/phm.0000000000000453</a>