Increased intracellular Ca2+ concentration in the hippocampal CA1 area during global ischemia and reperfusion in the rat: a possible cause of delayed neuronal death.

The crucial role of free cytosolic Ca2+ in ischemic neuronal damage has been studied in recent years. In the present report, changes in the intracellular Ca2+ concentration in the hippocampal CA1 area during transient global ischemia and reperfusion were measured using in vivo Ca2+ fluorometry with fura-2 in the four-vessel occlusion and reperfusion model in halothane-anesthetized rats. Marked changes were seen during 10-min global ischemia, with the intracellular Ca2+ concentration increasing gradually following application of the ischemic insult and rapidly about 2 min after the beginning of ischemia, and continuing to increase until reperfusion. On reperfusion, the intracellular Ca2+ concentration began to decrease and returned to the pre-ischemic level within 15 min. Induction of severe global ischemia was confirmed by the complete suppression of synaptic activity and the decrease in hippocampal temperature in the CA1 area. After seven days, CA1 pyramidal cell loss was observed histopathologically in the same rats which had undergone measurement of the intracellular Ca2+ concentration changes. In the present study, a temporal profile of the free cytosolic Ca2+ dynamics during ischemic and early post-ischemic period was determined in vivo. The results demonstrate that the intracellular Ca2+ concentration in the hippocampal CA1 area is transiently and markedly increased during a brief ischemia-inducing delayed neuronal death, implying that Ca2+ overload during cerebral ischemia is a possible cause of the delayed cell death of CA1 pyramidal neurons.

Relating EEG changes and I--thou feelings during nursing interview.

The present investigation describes correlations between subjective experiences and physiological responses of a nurse observed during a client-centered interview. Electroencephalograms (EEGs) were recorded during twelve interview sessions for the nurse, and also for a patient in six sessions simultaneously with the nurse. Heart rate (HR) was also measured in five different sessions for the nurse and patient separately. To investigate subjective experience, the nurse listen to the recorded dialogue of interview. She reviewed it focusing on a feeling of oneness with the patient. Alpha waves in EEGs appeared frequently during the interview and these periods were very well coincided with the time points when the nurse experienced a feeling of oneness with patient like I-thou relation described by Buber. Although alpha waves were very rarely recorded in the patient EEGs, it occasionally appeared at about the same time as that of the nurse. The nurse's HR was very stable during sessions as compared with that of the patient. The present study suggests the usefulness of physiological approaches using EEGs to investigate the deep interpersonal process occurring during nurse-patient interactions.

Changes of labile metabolites during anoxia in moderately hypo- and hyperthermic rats: correlation to membrane fluxes of K+.

The objective of this study was to assess the influence of temperature on the coupling among energy failure, depolarization, and ionic fluxes during anoxia. To that end, we induced anoxia by cardiac arrest in anesthetized rats maintained at a body temperature of either 34 degrees C or 40 degrees C, measured extracellular K+ concentration (K+e), and froze the neocortex through the exposed dura for measurements of phosphocreatine (PCr), creatine (Cr), ATP, ADP, and AMP, glucose, glycogen, pyruvate and lactate content after ischemic intervals of maximally 130 s. Free ADP (ADPf) concentrations were derived from the creatine kinase equilibrium. Hypothermia reduced the initial rate of rise in K+e, and delayed the terminal depolarization; however, both hypo- and hyperthermic animals showed massive loss of ion homeostasis at a K+e of 10-15 mM. The initial rate of rise in K+e did not correlate to changes in ATP, or ATP/ADPf ratio, suggesting that temperature changes per se may control the degree of activation of K+ conductances. The results clearly showed that, in both hyper- and hypothermic subjects, energy failure preceded the sudden activation of membrane conductances for ions. The results indicate that temperature primarily influences membrane permeability to ions like K+e (and Na+), and that cerebral energy state is secondarily affected. It is proposed that the higher rate of rise of K+e at high temperatures accelerates ATP hydrolysis primarily by enhancing metabolic rate in glial cells.

Ischemic penumbra in a model of reversible middle cerebral artery occlusion in the rat.

It has become increasingly clear that a stroke lesion usually consists of a densely ischemic focus and of perifocal areas with better upheld flow rates. At least in rats and cats, some of these perifocal ("penumbral") areas subsequently become recruited in the infarction process. The mechanisms may involve an aberrant cellular calcium metabolism and enhanced production of free radicals. In general, though, the metabolic perturbation in the penumbra requires better characterization. The objective of this article was to define flow distribution in a rat model of reversible middle cerebral artery (MCA) occlusion, so as to allow delineation of the metabolic aberrations responsible for the subsequent infarction. We modified the intraluminal filament occlusion model recently developed by Koizumi et al. (1986), and described in more detail by Nagasawa and Kogure (1989), adopting it for use in both spontaneously breathing and artificially ventilated rats. Successful occlusion of the MCA (achieved in about 9/10 rats) was judged by unilateral EEG depression in ventilated rats, and neurological deficits, such as circling, in spontaneously breathing ones. CBF in the ipsilateral hemisphere was reduced to nearly constant values after 20, 60, and 120 min of occlusion, flow rates in the focus being about 10% and in the perifocal ipsilateral areas about 15-20% of control (contralateral side). When the filament was left in place (permanent occlusion) 2,3,5-triphenyl tetrazolium chloride (TTC) staining and histopathology after 24 h showed a massive infarct on the occluded side, extending from caudoputamen and overlaying cortex to the occipital striate cortex. Animals recirculated after 60 min of MCA occlusion, and allowed to survive 7 days for histopathology, showed infarction of the caudoputamen (lateral part or whole nucleus) in 5/6 animals and selective neuronal necrosis in one animal. The neocortex showed either infarcts, selective neuronal necrosis, or no damage. There was some overlap between neocortical areas which were infarcted and those which were salvaged by reperfusion. In general, though, both the CBF data and the recovery studies with a histopathological endpoint define large parts of the neocortex as perifocal (penumbral) areas which lend themselves to studies of metabolic events leading to infarction.

Health workers' attitudes toward euthanasia in Japan.

Despite impressive life-saving medical advancements, diseases for which there are no cure still exist. In the past doctors and health workers in Japan often preferred not to disclose the diagnosis of an incurable disease--particularly cancer--to patients. A 1980 study revealed that only 17% of the Japanese doctors questioned actually had the experience of informing their patients they had cancer, while reportedly in the US 98% of doctors inform patients they have cancer. This attitude in Japan, however, is changing. And with this change such issues as care of the terminally ill after being informed about their diagnosis, human rights problems and other issues have arisen. In fact, euthanasia, although highly criticized when first introduced, is now being increasingly preferred to medical treatment that prolongs life in the presence of severe pain associated with an incurable disease. After reading a 1982 survey that revealed that 84% of the Japanese people interviewed would prefer to die with dignity rather than prolong life with a machine, four researchers decided to examine terminal care more fully, this time from the viewpoint of the medical staff. Below, their study results.

Phosphorylase alpha and labile metabolites during anoxia: correlation to membrane fluxes of K+ and Ca2+.

The objective of the present study was to explore mechanisms responsible for activation of ion conductances in the initial phases of brain ischemia, particularly for the early release of K+ that precedes massive cell depolarization, and rapid downhill fluxes of K+, Na+, Cl-, and Ca2+. As it has been speculated that a K+ conductance can be activated either by an increase in the free cytosolic calcium concentration (Ca2+i) or by a fall in ATP concentration, the question arises whether the early increase in extracellular K+ concentration (K+e) is preceded by a rise in Ca2+i and/or a fall in ATP content. In the present experiments, ischemia was induced in rats by cardiac arrest, the time courses of the rise in K+e and cellular depolarization were determined by microelectrodes, and the tissue was frozen in situ through the exposed dura for measurements of levels of labile metabolites. including adenine nucleotides and cyclic AMP (cAMP), after ischemic periods of 15, 30, 60, and 120 s. Conversion of phosphorylase b to a was assessed, because it depends, among other things, on changes in Ca2+i. The K+e value rose within a few seconds following induction of ischemia, but massive depolarization (which is accompanied by influx of calcium) did not occur until after approximately 65 s. Activation of phosphorylase was observed already after 15 s and before glycogenolysis had begun. At that time, 3',5'-cAMP concentrations were unchanged, and total 5'-AMP concentrations were only moderately increased. The results demonstrate that a K+ conductance is activated at a time when the overall ATP concentration remains at 95% of control values.(ABSTRACT TRUNCATED AT 250 WORDS)

The effect of mild hyperthermia and hypothermia on brain damage following 5, 10, and 15 minutes of forebrain ischemia.

The present study examines the effects of mild hypothermia and hyperthermia on the density and distribution of ischemic brain damage, and compares these effects to those induced by variations in the duration of ischemia. Body temperatures were maintained at 35 degrees C, 37 degrees C, and 39 degrees C, before, during, and after ischemia, and brain temperatures were held at similar values with a technique that in preliminary experiments proved to avoid intracerebral temperature gradients or overheating of surface structures. In all animals, brain damage was assessed by histopathological analysis of perfusion-fixed brains after six to seven days of recovery. Our results confirm previous findings showing that a decrease in temperature of only 2 degrees C significantly reduces damage to several selectively vulnerable neuronal populations. The results also showed that an increase in temperature of 2 degrees C significantly enhances brain damage. In general, a rise in temperature had effects similar to an increased duration of the ischemia. In some areas, such as the CA1-subiculum sectors of the hippocampus, temperature and ischemic duration altered damage in a gradual manner, but in others, such as the caudoputamen, there was a steplike change from virtually no to virtually complete damage. In some areas, the effects of hypothermia and hyperthermia appeared symmetrical around the normal temperature of 37 degrees C. Hyperthermia had some seemingly "specific" effects, however, notably the tendency to induce pannecrosis ("infarction") in the neocortex and caudoputamen, and to cause damage to the substantia nigra pars reticulata. The results underscore the potentially devastating effects of fever in patients with cerebrovascular disease.

Preservation of brain temperature during ischemia in rats.

Our objectives were to study the loss of heat from ischemic brain and to devise a method of maintaining brain temperature. Reversible forebrain ischemia was induced by carotid clamping and exsanguination in 30 anesthetized and artificially ventilated rats. Rectal, skull, and brain temperatures were measured, confirming previous findings that brain temperature falls by 4-5 degrees C during 15 minutes of ischemia unless measures are taken to maintain head temperature by external heating. Temperature gradients developed within the ischemic brain, superficial tissues being cooler than deep ones. These temperature gradients were reversed when skull temperature was maintained at core body (rectal) temperature by external heating. With rectal and skull temperatures maintained at 38 degrees, 37 degrees, 35 degrees, or 33 degrees C, brain temperatures nonetheless decreased by approximately 1 degree C during ischemia. This decrease in brain temperature could be prevented by placing the rat in a Plexiglas box with circulating air at temperatures close to that of the body core and a relative humidity of approximately 100%. We also found that, unless special precautions are taken, a temperature gradient develops between the brain and body core during recirculation.

The influence of mild body and brain hypothermia on ischemic brain damage.

The influence of brain and body temperature on ischemic brain damage, notably on the density and distribution of selective neuronal vulnerability, was studied in SPF-Wistar rats subjected to 15 min of forebrain ischemia induced by bilateral occlusion of the common carotid arteries combined with arterial hypotension (50 mm Hg) in a room air environment. In one group of animals, the body temperature was maintained at 37 degrees C but no attempt was made to prevent heat losses from the ischemic brain; i.e., the head was not heated during ischemia. Under those conditions the temperature of the caudoputamen and at a subcutaneous site over the skull bone spontaneously fell to approximately 32 degrees C. In four other groups, both the rectal and the subcutaneous skull temperatures were maintained at 38, 37, 35, and 33 degrees C during the ischemia. Our results confirm those recently reported when brain temperature was varied during 20 min of ischemia, with body temperature kept constant. Thus, the histopathological outcome of the brain damage, as assessed after 7 days of recovery, was strongly temperature dependent. Whereas ischemia at 37-38 degrees C consistently caused neuronal necrosis in the hippocampus, neocortex, and caudoputamen, spontaneous cooling of the brain during ischemia at a rectal temperature of 37 degrees C significantly reduced the ischemic damage. Intentional lowering of temperature to 35 degrees C markedly reduced and to 33 degrees C virtually prevented neuronal necrosis in some but not all of the regions studied. While damage to the caudoputamen was extremely temperature sensitive, that affecting the CA1 sector of the hippocampus, and particularly the lateral reticular nucleus of the thalamus, was less so. Our results suggest that whatever biochemical events are responsible for selective neuronal vulnerability, they are temperature sensitive; however, since there are differences in sensitivity between different parts of the brain, more than one mechanism may be involved.

Plasma levels of leukotriene C4, B4, slow reacting substance of anaphylaxis in chronological phases of cerebrovascular disease.

In this study we report and compare plasma leukotriene (LT) levels in seventeen (17) patients with cerebral infarction, five (5) patients with cerebral hemorrhage and twelve (12) age-matched healthy volunteers. Plasma samples were collected at intervals of 1-7 days, 8-14 days, 15-30 days and 31 days- after cerebrovascular accident. Plasma immunoreactive LTC4, LTB4 and SRS-A (Slow Reacting Substance of Anaphylaxis or total peptido-LT's) levels were measured for each sample. Immunoreactive LTC4 (and SRS-A) levels were elevated in patients with cerebral infarction whilst LTB4 levels were raised in the patients with cerebral hemorrhage. In particular, cerebral infarcted patients exhibited significantly elevated levels in phases 1-7 days and after 15 days when compared with the age-matched healthy volunteers. In patients with cerebral hemorrhage, significant increases in LTB4 were measured in days 1-7 only. These results suggest a clinical relationship between the plasma levels of LT's and cerebrovascular disease.

Brain eicosanoid levels in spontaneously hypertensive rats after ischemia with reperfusion: leukotriene C4 as a possible cause of cerebral edema.

The relation of brain eicosanoids to progression of cerebral edema was studied in stroke-resistant spontaneously hypertensive rats subjected to incomplete global brain ischemia induced by bilateral occlusion of the common carotid arteries. Thromboxane B2 and 6-keto prostaglandin F1 alpha levels were significantly elevated 5 minutes after reperfusion but returned to control levels by 30 minutes. In contrast, leukotriene C4 levels increased 2 hours after bilateral common carotid artery occlusion and peaked 30 minutes after reperfusion, with higher levels persisting until 60 minutes after reperfusion. Cerebral ischemia was accompanied by cerebral edema early after reperfusion. The edema correlated with increased leukotriene C4 levels. That the increased brain water content was causally related to an increase in leukotriene C4 was supported by results obtained following administration of the 5-lipoxygenase inhibitors ONO-LP-016 and AA-861. Both inhibitors suppressed the increased leukotriene C4 and brain water contents after reperfusion. Our results indicate that leukotriene C4 is closely associated with an induction of ischemic cerebral edema.

[Involvement of arachidonic acid cascade in brain edema and cerebral energy metabolism after reperfusion].

The involvements of arachidonic acid metabolites in the development of ischemic brain edema and cerebral energy metabolism were investigated on the experimental ischemia and reperfusion model. The level of arachidonic acid in brain tissue increases especially on the ischemic insult, which is rapidly converted to prostaglandins and leukotrienes after the reperfusion. The drugs which modify the arachidonic acid metabolism were administrated to clarify the effect on ischemic brain edema and cerebral energy metabolism. Male stroke resistant spontaneously hypertensive rats (SHRSR) were subjected to incomplete ischemia for two hours by occlusion of both common carotid arteries with vascular clips, and reperfused for two hours. The drugs used are dexamethasone, indomethacin, trapidil and OKY-046. Indomethacin inhibits cyclooxygenase. Dexamethasone inhibits phospholipases by the production of lipocortin. OKY-046 inhibits thromboxane A2 synthetase. Trapidil inhibits thromboxane A2 synthetase and increases the level of 6-keto-PGF1 alpha. These drugs were administered 18 hours before, just after clipping on (1/2) and off (1/2). Brain water content, cerebral ATP and lactic acid levels were examined. In the saline treated group, the cerebral water content was increased after the reperfusion and reached its maximal level after two hours of the reperfusion. The development of brain edema was prevented by the administration of dexamethasone or trapidil, but not by indomethacin and OKY-046. Administration of trapidil or dexamethasone was found to prevent the decrease in ATP and the increase of lactic acid. In the indomethacin administrated group, only the increase of lactic acid was prevented. 6-keto-PGF1 alpha was high in the trapidil administrated group and low in the indomethacin administrated group.(ABSTRACT TRUNCATED AT 250 WORDS)

[Protective effect of thromboxane A2 synthetase inhibitor (trapidil) on acutely-induced cerebral ischemia].

The experimental study presented was undertaken to evaluate the role of thromboxane A2 contributing to aggravating cerebral ischemia, and to examine the effect of a thromboxane A2 synthetase inhibitor, trapidil on cerebral ischemia. Cerebral ischemia model was induced in 16 week old spontaneously hypertensive rats (SHR) by bilateral common carotid artery ligation (BLCL). Two doses of trapidil 15 mg/kg was intraperitoneally administered one dose 2 hr before and one dose 15 min after BLCL in SHR. While control animals only underwent BLCL. Brain tissue metabolites such as ATP, lactate and pyruvate, brain water content and plasma thromboxane B2 and 6 Keto PGF1 alpha were determined 3 hr after BLCL. Scanning electron microscopic observations were also recorded. ATP concentrations were 1.36 +/- 0.23 n moles/mg wet tissue in the trapidil treated group, 0.61 +/- 0.26 n moles/mg wet tissue in the control group, the difference between the treated and the control being significant (P less than 0.001). Lactate concentrations were 4.70 +/- 1.20 n moles/mg wet tissue in the treated group, 12.17 +/- 8.53 n moles/mg wet tissue in the control group, the difference between the treated and the control being significant (P less than 0.02). Pyruvate concentrations were 0.59 +/- 0.11 n moles/mg wet tissue in the treated group, 0.43 +/- 0.16 n moles/mg wet tissue in the control, the difference was also significant (P less than 0.05). Average water content was 78.87 +/- 0.59% in the treated group, 79.82 +/- 0.33% in the control.(ABSTRACT TRUNCATED AT 250 WORDS)

[Effects of S-adenosyl-L-methionine on experimental cerebral ischemia].

Effects of S-adenosyl-L-methionine (SAMe) on experimental cerebral ischemia were investigated using two different ischemic models. Cerebral energy metabolites (ATP, lactate, c-AMP) and brain water content were measured. It is reported that SAMe accelerates synthesis of phosphatidyl choline and increases erythrocyte membrane fluidity. Complete ischemia was produced by heart excision using wistar kyoto rats. SAMe (100 mg/kg, I.P.) was administered twice at one hour and immediately before inducing ischemia. The brain of rats were irradiated by microwave to stop the enzyme activity exactly 60 seconds after inducing ischemia and brain energy metabolites were measured. Recirculation model was produced by one hour recirculation following two hours ischemia induced by clipping of bilateral common carotid arteries using stroke-prone spontaneously hypertensive rats. SAMe (100 mg/kg, I.V.) was administered twice one hour after clipping and ten minutes after recirculation. The brain metabolites and water content were measured one hour after recirculation. In the complete ischemia, ATP and c-AMP levels were statistically high in the SAMe treated group compared to the untreated group (vehicle). But there was no statistical difference in lactate between the treated group and the untreated group. In the recirculation model, lactate elevation was suppressed in the SAMe treated group compared to the vehicle group with statistical difference, but there was no difference in ATP and c-AMP. Also, there was no difference in water content between the treated and the untreated group. SAMe protected energy failure in ischemia and accelerated recovery from ischemia. It is indicated that this agent is beneficial for treatment of cerebral ischemia in the acute stage.

Characteristics of urinary incontinence in bedridden geriatric patients.

Urinary incontinence was studied in 11 elderly patients who were bedridden for more than a year in a home for the aged. The time when voiding occurred, the amount of urine at each voiding, the frequency and the interval between urinations were recorded for two periods of 3 days. Diurnal rhythm of water excretion disappeared or was reversed in most of the subjects. The amount of urine voided at one time varied considerably from time to time in the same subjects ranging from less than 50 to more than 200 ml, and this was observed during both the day and night. The average frequency of incontinent voiding was seven to eight times per day. Suggestions are made to apply the present results in the care of urinary incontenence in the aged.