Investigation of the Relationship between MBP Gene Polymorphisms and Delayed Encephalopathy after Acute Carbon Monoxide Poisoning

Background Increasing evidence reveals that delayed encephalopathy after acute carbon monoxide poisoning (DEACMP) results from the combined effects of environmental and genetic factors. The main pathological feature of DEACMP was generalized demyelination of cerebral white matter. Myelin basic protein (MBP) levels in cerebrospinal fluid (CSF) and serum samples from DEACMP patients were elevated.Objectives This study investigated the association of MBP single nucleotide polymorphisms(SNPs) (rs470555, rs470724, rs4890785, rs595997, rs76452994, and rs921336) with DEACMP. Methods We genotyped 416 DEACMP patients and 785 age, educational level, and sex-matched ACMP patients for rs470555, rs470724, rs4890785, rs595997, rs76452994, and rs921336 SNPs using the Agena MassArray. Results There were no significant differences in the allele frequency distribution, four genetic models, and genotype distributions between the DEACMP and ACMP groups for rs470555, rs470724, rs4890785, and rs595997. However, significant differences were observed for rs76452994 and rs921336.Conclusions This study revealed that the MBP polymorphisms, rs470555, rs470724, rs4890785, and rs595997, were not associated with DEACMP. Based on the codominant, dominant, and overdominant genetic inheritability patterns, the MBP rs76452994 and rs921366 polymorphisms were associated with DEACMP. Furthermore, the G allele of rs76452994 and T allele of rs921336 could lead to higher DEACMP risk.

The Effect of Adding Transcranial Direct Current Stimulation to Hyperbaric Oxygen Therapy in Patients With Delayed Encephalopathy After Carbon Monoxide Poisoning: A Randomised Controlled Trial

Objective: To investigate the effect of transcranial direct current stimulation (tDCS) combined with hyperbaric oxygen therapy (HBOT) in patients with delayed encephalopathy after carbon monoxide poisoning (DEACMP).Design: A parallel-group, open-label randomised controlled study.Setting: Hyperbaric Oxygen Therapy Room of the Second Hospital of Hebei Medical University.Subjects: A total of 40 patients were recruited for the current study. Patients were randomly divided into a treatment group and a control group (20 cases/group).Interventions: Control group: conventional, individualised rehabilitation therapy. Treatment group: conventional, individualised rehabilitation therapy and tDCS.Main Measures: cognitive function of patients, the Barthel Index (BI).Results: After treatment, significantly higher MMSE and BI scores, as well as a greater reduction in P300 latency and an increase in P300 amplitude, were observed in the treatment group compared to the control group (MMSE: 13 ± 7 vs. 9 ± 5; P300 latency: 342 ± 29 vs. 363 ± 17 ms; P300 amplitude: 7.0 ± 3.3 vs. 5.1 ± 2.7 μV; all P < 0.05). In both groups, however, MMSE and BI scores, in addition to P300 amplitude, were significantly improved; in contrast, there was a decrease in P300 latency in both groups after treatment compared to before treatment (all P < 0.05).Conclusion: Combined with HBOT, tDCS can help improve cognitive function and ADL in patients with DEACMP. This combination therapy might be a helpful method to enhance the recovery of patients with DEACMP.

BMSC-derived Exosomes Protect Against Delayed Encephalopathy after Acute Carbon Monoxide Poisoning in Rats via Blockade of Notch Signaling

Objective: Our aim was to probe the therapeutic effect by which (BMSC-ex) protect against (DEACMP) in rat models in vivo. Methods: BMSC-ex were successfully characterized and proven to pass the blood brain barrier and migrate to the injured brain area. Rats were randomly divided into six groups and the cognitive function of mice was evaluated by the morris water maze. The severity of pathological changes was evaluated by HE staining and LFB staining. The expression of cytokines was detected by ELISA. Immunohistochemical staining and western blot analysis were utilized to detect the protein expression of Foxp3、CD4、MBP、Notch1 and Hess1 in brain tissue.Results: We found that BMSC-ex significantly reduced inflammation, increased the levels of (Tregs), relieved demyelination, and ameliorated the cognitive impairment in DEACMP rats. Furthermore, inhibiting the Notch pathway led to a partial reversal of the effect of BMSC-ex in mice.Conclusions: BMSC-ex relieved the severity of demyelination in the DEACMP rat models by regulating Tregs subsets and the expression of Notch signaling. Hence BMSC-ex play a protected role in DEACMP by upregulating Tregs and the regulatory components of Notch signaling and this may provide a new clinical strategy for the treatment of DEACMP patients.

The efficacy of Rhodiola Rosea based on DTI image Segmentation Algorithm for patients with delayed Encephalopathy caused by CO poisoning

Objectives: By using DTI image segmentation algorithm investigate the effect of large plants Rhodiola injection on myocardial injury in patients with acute severe CO poisoning (ACOP), and to explore the clinical and CT delayed encephalopathy after ACOP. Methods: Seventy-two ACOP patients were randomly divided into control and observation group, 36 cases in each group from December 2015 – December 2017. The control group received hyperbaric oxygen, mannitol, dexamethasone, citicoline injection, gangliosides, dracone; observation group were large strain Rhodiola injection treatment group based on the once daily for two weeks of continuous treatment. The head CT, head MRI results were analyzed retrospectively. Results: (1) hsCRP and ET-1 in the observation group were significantly lower than those in the control group, and VEGF was significantly higher than that in the control group (P<0.01). No, NOS, and iNOS were significantly lower than those of the control group (P<0.01); (2) CT images of 16 cases showed bilateral symmetrical fusion lesions with blurred edges, low density, and oval center around the ventricle; (3) MRI showed that the lesion was located in the cerebral cortex, white matter lateral ventricle and/or basal ganglia in 12 cases. Conclusion: Rhodiola can reduce myocardial vascular endothelial cell injury, improve cardiac function, and protect the damaged myocardium. Meanwhile, after acute CO poisoning delayed encephalopathy early for CT and MRI examination facilitate analysis and prognosis of the disease. doi: https://doi.org/10.12669/pjms.37.6-WIT.4830 How to cite this:Gao Y, Cui H, Ren W, Han B. The efficacy of Rhodiola Rosea based on DTI image Segmentation Algorithm for patients with delayed Encephalopathy caused by CO poisoning. Pak J Med Sci. 2021;37(6):1558-1563. doi: https://doi.org/10.12669/pjms.37.6-WIT.4830 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Predictive Value of Gray-Matter–White-Matter Ratio on Brain Computed Tomography for Delayed Encephalopathy after Acute Carbon Monoxide Poisoning: A Retrospective Cohort Study

Background. This study is aimed at determining the predictive value of the gray-matter–white-matter ratio (GWR) on brain computed tomography for delayed encephalopathy after acute carbon monoxide (CO) poisoning (DEACMP). Methods. This retrospective cohort study reviewed 352 patients with acute CO poisoning and who underwent the brain computed tomography test. These patients were admitted to Cangzhou Central Hospital from May 2010 to May 2020. The patients were divided into the DEACMP ( n = 16 ) and non-DEACMP ( n = 336 ) groups. Pearson’s correlation coefficients were computed for correlation analysis. The predictive value of GWR for DEACMP was evaluated by using logistic regression analysis and receiver operator characteristic curves. Results. The morbidity of DEACMP was 4.5% (16/352). The GWR-basal ganglia, GWR-cerebrum, and GWR-average in the DEACMP group were lower than those in the non-DEACMP group. Correlation analysis indicated that GWR-basal ganglia ( r = 0.276 ; P < 0.001 ), GWR-cerebrum ( r = 0.163 ; P = 0.002 ), and GWR-average ( r = 0.20 0; P < 0.001 ) were correlated with DEACMP. Multivariate logistic regression analysis revealed that reduced GWR-basal ganglia, GWR-cerebrum, and GWR-average were independent risk factors ( P < 0.001 ; P = 0.008 ; P = 0.001 ; respectively). Compared with GWR-cerebrum and GWR-average, GWR-basal ganglia had a higher area under the curve of 0.881 (95% confidence interval: 0.783–0.983) with sensitivity and specificity of 93.8% and 68.7%, respectively. The cut-off value of GWR-basal ganglia was 1.055. Conclusion. GWR, especially GWR-basal ganglia, is an early useful predictor for DEACMP.