Accuracy of Brain Multimodal Monitoring to Detect Cerebral Hypoperfusion After Traumatic Brain Injury.

OBJECTIVE:: To examine the accuracy of brain multimodal monitoring-consisting of intracranial pressure, brain tissue PO2, and cerebral microdialysis-in detecting cerebral hypoperfusion in patients with severe traumatic brain injury. DESIGN:: Prospective single-center study. PATIENTS:: Patients with severe traumatic brain injury. SETTING:: Medico-surgical ICU, university hospital. INTERVENTION:: Intracranial pressure, brain tissue PO2, and cerebral microdialysis monitoring (right frontal lobe, apparently normal tissue) combined with cerebral blood flow measurements using perfusion CT. MEASUREMENTS AND MAIN RESULTS:: Cerebral blood flow was measured using perfusion CT in tissue area around intracranial monitoring (regional cerebral blood flow) and in bilateral supra-ventricular brain areas (global cerebral blood flow) and was matched to cerebral physiologic variables. The accuracy of intracranial monitoring to predict cerebral hypoperfusion (defined as an oligemic regional cerebral blood flow < 35 mL/100 g/min) was examined using area under the receiver-operating characteristic curves. Thirty perfusion CT scans (median, 27 hr [interquartile range, 20-45] after traumatic brain injury) were performed on 27 patients (age, 39 yr [24-54 yr]; Glasgow Coma Scale, 7 [6-8]; 24/27 [89%] with diffuse injury). Regional cerebral blood flow correlated significantly with global cerebral blood flow (Pearson r = 0.70, p < 0.01). Compared with normal regional cerebral blood flow (n = 16), low regional cerebral blood flow (n = 14) measurements had a higher proportion of samples with intracranial pressure more than 20 mm Hg (13% vs 30%), brain tissue PO2 less than 20 mm Hg (9% vs 20%), cerebral microdialysis glucose less than 1 mmol/L (22% vs 57%), and lactate/pyruvate ratio more than 40 (4% vs 14%; all p < 0.05). Compared with intracranial pressure monitoring alone (area under the receiver-operating characteristic curve, 0.74 [95% CI, 0.61-0.87]), monitoring intracranial pressure + brain tissue PO2 (area under the receiver-operating characteristic curve, 0.84 [0.74-0.93]) or intracranial pressure + brain tissue PO2+ cerebral microdialysis (area under the receiver-operating characteristic curve, 0.88 [0.79-0.96]) was significantly more accurate in predicting low regional cerebral blood flow (both p < 0.05). CONCLUSION:: Brain multimodal monitoring-including intracranial pressure, brain tissue PO2, and cerebral microdialysis-is more accurate than intracranial pressure monitoring alone in detecting cerebral hypoperfusion at the bedside in patients with severe traumatic brain injury and predominantly diffuse injury.

A new species of Probursata Bravo-Hollis, 1984 (Mogenea: Heteraxinidae: Heteraxininae) parasite of Oligoplites spp. (Osteichthyes: Carangidae) from the coast of the state of Rio de Janeiro, Brazil

Probursata brasiliensis n. sp., a gill filament parasite of carangid fishes, O. palometa (Cuvier), Oligoplites saurus (Bloch & Schneider), and O. saliens (Bloch), from the Brazilian coast, is described and illustrated. The new species differs from Probursata veraecrucis Bravo-Hollis, 1984, the type and only species of this genus by the presence of spines in the auricular expansions of the genital atrium, by the trifurcate supplementary process of the clamp's midsclerite, and by having a larger number of tests and clamps. This is the first record of the genus Probursata Bravo-Hollis, 1984, in the South Atlantic Ocean.

Higher arithmetic Chow groups

We give a new construction of higher arithmetic Chow groups for quasi-projective arithmetic varieties over a field. Our definition agrees with the higher arithmetic Chow groups defined by Goncharov for projective arithmetic varieties over a field. These groups are the analogue, in the Arakelov context, of the higher algebraic Chow groups defined by Bloch. The degree zero group agrees with the arithmetic Chow groups of Burgos. Our new construction is shown to be a contravariant functor and is endowed with a product structure, which is commutative and associative.

Effects of unilateral motor cortex lesion on ipsilesional hand's reach and grasp performance in monkeys: relationship with recovery in the contralesional hand.

Manual dexterity, a prerogative of primates, is under the control of the corticospinal (CS) tract. Because 90-95% of CS axons decussate, it is assumed that this control is exerted essentially on the contralateral hand. Consistently, unilateral lesion of the hand representation in the motor cortex is followed by a complete loss of dexterity of the contralesional hand. During the months following lesion, spontaneous recovery of manual dexterity takes place to a highly variable extent across subjects, although largely incomplete. In the present study, we tested the hypothesis that after a significant postlesion period, manual performance in the ipsilesional hand is correlated with the extent of functional recovery in the contralesional hand. To this aim, ten adult macaque monkeys were subjected to permanent unilateral motor cortex lesion. Monkeys' manual performance was assessed for each hand during several months postlesion, using our standard behavioral test (modified Brinkman board task) that provides a quantitative measure of reach and grasp ability. The ipsilesional hand's performance was found to be significantly enhanced over the long term (100-300 days postlesion) in six of ten monkeys, with the six exhibiting the best, though incomplete, recovery of the contralesional hand. There was a statistically significant correlation (r = 0.932; P < 0.001) between performance in the ipsilesional hand after significant postlesion period and the extent of recovery of the contralesional hand. This observation is interpreted in terms of different possible mechanisms of recovery, dependent on the recruitment of motor areas in the lesioned and/or intact hemispheres.

Lentiviral gene transfer to the nonhuman primate brain.

Lentiviral vectors infect quiescent cells and allow for the delivery of genes to discrete brain regions. The present study assessed whether stable lentiviral gene transduction can be achieved in the monkey nigrostriatal system. Three young adult Rhesus monkeys received injections of a lentiviral vector encoding for the marker gene beta galatosidase (beta Gal). On one side of the brain, each monkey received multiple lentivirus injections into the caudate and putamen. On the opposite side, each animal received a single injection aimed at the substantia nigra. The first two monkeys were sacrificed 1 month postinjection, while the third monkey was sacrificed 3 months postinjection. Robust incorporation of the beta Gal gene was seen in the striatum of all three monkeys. Stereological counts revealed that 930,218; 1,192,359; and 1,501,217 cells in the striatum were beta Gal positive in monkeys 1 (n = 2) and 3 (n = 1) months later, respectively. Only the third monkey had an injection placed directly into the substantia nigra and 187,308 beta Gal-positive cells were identified in this animal. The injections induced only minor perivascular cuffing and there was no apparent inflammatory response resulting from the lentivirus injections. Double label experiments revealed that between 80 and 87% of the beta Gal-positive cells were neurons. These data indicate that robust transduction of striatal and nigral cells can occur in the nonhuman primate brain for up to 3 months. Studies are now ongoing testing the ability of lentivirus encoding for dopaminergic trophic factors to augment the nigrostriatal system in nonhuman primate models of Parkinson's disease.

Neotropical Monogenoidea. 23. Two new species of Gyrodactylus (Gyrodactylidae) from a Cichlid and an Erythrinid fish of Southeastern Brazil

Two new species of Gyrodactylus Nordmann, 1832 (Platyhelminthes, Monogenoidea) are described from fishes collected from southeastern Brazil. Gyrodactylus geophagensis n. sp. was collected from the body surface of the "cará", Geophagus brasiliensis (Quoy and Gaimard, 1824) (Cichlidae), from the Rio da Guarda, state of Rio de Janeiro; its major diagnostic features are the morphology of the anchor with a short, truncate superficial root and the shape of the hooks - with a long, delicate shaft. Gyrodactylus trairae n. sp. parasitizes the body surface of the "traíra", Hoplias aff. malabaricus (Bloch, 1794) (Erythrinidae), from the rio Guandu, state of Rio de Janeiro and can be easily differentiated from other species of the genus by having a thin, dorsal bridge, connecting the superficial bar with the spathulated shield. These are the first species of Gyrodactylus formally reported from Brazil. Presently, 26 species of Gyrodactylidae are known from freshwater fishes in the neotropical region; a list of these species is provided.

Monogeneans of leatherjackets, Oligoplites spp. (Osteichthyes: Carangidae), with the description of a new species of Metacamopia (Monogenea: Allodiscocotylidae) from the coast of the State of Rio de Janeiro, Brazil

Metacamopia oligoplites n. sp., a gill filament parasite of carangid fishes of three species of Oligoplites Gill, O. palometa (Cuvier), O. saurus (Bloch & Schneider), and O. saliens (Bloch), from the coast of the State of Rio de Janeiro, Brazil, is described and illustrated. Metacamopia oligoplites n. sp. differs from M. indica by: the shape of the body; the pre-, para-, and post-germarial testes; vaginas lacking sclerotized structures; well-developed seminal receptacles; muscular sleeves around the constriction between the vaginas and the seminal receptacles; and the haptor highly asymmetric, with a large, heel-like area; and differs from M. chorinemi by: the esophagus lacking diverticles; a larger number of testes (26-55) and not just, approximately 10; and the vaginas lacking sclerotized structures of any kind. This is the first record of Metacamopia in the South Atlantic Ocean. The generic diagnosis of Metacamopia is emended. Hargicola oligoplites is reported for the first time in the South Atlantic Ocean. Oligoplites palometa and O. saliens are new host records for Hargicola oligoplites.

Ultrastructure of spermatogenesis and sperm development in Saccocoelioides godoyi Kohn & Froes, 1986 (Digenea, Haploporidae)

Ultrastructural observations of spermatogenesis and sperm development of Saccocoelioides godoyi, an intestinal parasite of Leporinus friderici (Bloch, 1794) are described. The irregular-shaped spermatogonia form a peripheral layer, and show a prominent nucleus. Spermatocytes are larger than spermatogonia, and in the early stage present synaptonemal complex. Spermatids show nuclei smaller than the spermatocytes. Spermiogenesis is characterized by outgrowth of the zone of differentiation, presenting basal bodies, separated by an intercentriolar body. At the end of this process, the spermatozoa are released into the residual cytoplasmic mass. The spermatozoa of S. godoyi are elongate, similar to the pattern described for other Digenea, showing nuclei, mitochondria and two axonemes with the 9+1 configuration. The peripheral cortical microtubules on the dorsal and ventral faces are laterally interrupted.

MP2RAGE, a self bias-field corrected sequence for improved segmentation and T-1-mapping at high field

The large spatial inhomogeneity in transmit B, field (B-1(+)) observable in human MR images at hi h static magnetic fields (B-0) severely impairs image quality. To overcome this effect in brain T-1-weighted images the, MPRAGE sequence was modified to generate two different images at different inversion times MP2RAGE By combining the two images in a novel fashion, it was possible to create T-1-weigthed images where the result image was free of proton density contrast, T-2* contrast, reception bias field, and, to first order transmit field inhomogeneity. MP2RAGE sequence parameters were optimized using Bloch equations to maximize contrast-to-noise ratio per unit of time between brain tissues and minimize the effect of B-1(+) variations through space. Images of high anatomical quality and excellent brain tissue differentiation suitable for applications such as segmentation and voxel-based morphometry were obtained at 3 and 7 T. From such T-1-weighted images, acquired within 12 min, high-resolution 3D T-1 maps were routinely calculated at 7 T with sub-millimeter voxel resolution (0.65-0.85 mm isotropic). T-1 maps were validated in phantom experiments. In humans, the T, values obtained at 7 T were 1.15 +/- 0.06 s for white matter (WM) and 1.92 +/- 0.16 s for grey matter (GM), in good agreement with literature values obtained at lower spatial resolution. At 3 T, where whole-brain acquisitions with 1 mm isotropic voxels were acquired in 8 min the T-1 values obtained (0.81 +/- 0.03 S for WM and 1.35 +/- 0.05 for GM) were once again found to be in very good agreement with values in the literature. (C) 2009 Elsevier Inc. All rights reserved.