Further investigations into the speed of cerebral swelling following blunt cranial trauma

An anesthetized sheep model of traumatic brain injury (TBI) has been developed to assess early changes in intracranial pressure (ICP) following closed head injury. Immediately after TBI, a transient (<10 min) hypertensive response occurred, followed by significant and prolonged systemic hypotension. ICP demonstrated a biphasic response, being seven times baseline values of 8 ± 2 mm Hg 10 min after injury, decreasing to 25 ± 2 mm Hg by 30 min, and then increasing to values exceeding 30 mm Hg by 4 h postinjury. ICP was always significantly higher than baseline values, which combined with hypotension, reduced cerebral perfusion pressure to less than 60% of normal. This early and sustained increase in ICP after craniocerebral trauma acutely alters cerebral perfusion pressure and brain oxygenation and provides a potential pathophysiological explanation for immediate clinical manifestations in humans following significant TBI.     

Brain Fluid Content Related to Body Position and Postmortem Interval – An Animal Model

Adult male Sprague Dawley rats were euthanized and placed in a horizontal or vertical (head‐down) position at room temperature, after which brain fluid content was measured by a moisture analysis technique at variable time points. No significant difference in brain fluid content was observed between horizontal and vertical postmortem positions. A significant increase in brain fluid content was demonstrated 3, 6, and 24 h after death, with maximal fluid content observed at 24 h. Specifically, the brain fluid content of control animals was 77.79 ± 0.36%, increasing to 80.05 ± 0.22% at 24 h (p < 0.0001). This study has demonstrated no significant differences in brain fluid content related to postmortem position, suggesting that a head‐down position is not associated with increased brain fluid content or swelling. However, significant temporal increases in brain fluid content after death, most likely related to cerebral liquefaction, occur.     

Hyperosmolarity Induces Armanni‐Ebstein‐like Renal Tubular Epithelial Swelling and Cytoplasmic Vacuolization

Armanni–Ebstein lesions have been considered pathognomonic for diabetes mellitus and appear as markedly swollen renal tubular epithelial cells with cytoplasmic clearing and glycogen accumulation. However, the extent to which hyperosmolarity contributes to the Armanni–Ebstein phenotype is unclear. Ten sheep were injected intravenously with 20% mannitol at 11 mOsm/kg, and subsequent histological evaluation of the kidneys showed variable degrees of osmotic nephrosis and cytoplasmic clearing of renal tubular epithelial cells similar to that seen with Armanni–Ebstein lesions. However, although morphological changes similar to Armanni–Ebstein lesions could be produced, no intracytoplasmic glycogen was demonstrated with periodic Acid–Schiff (PAS) stain. This suggests that while hyperosmolarity may contribute to the development of an Armanni–Ebstein phenotype, glycogen accumulation may result from the more complex metabolic effects of glucose on renal tubular epithelial cells. Thus, when Armanni/Ebstein‐like vacuolizations are seen at autopsy, a confirmatory PAS stain is recommended because of the potential effect of hyperosmolar states.     

Federal Circuit affirms Nilssen's 15 patents unenforceable for inequitable conduct

The US Federal Circuit affirmed the District Court finding thatit did not abuse its discretion in holding 15 of Nilssen's patentsunenforceable due to his intentional withholding of materialinformation during patent prosecution from the US Patent Office(‘USPTO’).     

Citizenship and Democracy: A Journey to Europe's Past

The relationship between citizenship and democracy is poorly understood, and the two notions are often used synonymously. Governing is obviously the central issue, but whereas citizenship seems to require self-limitation by calling on civic virtues, democracy is actually enlarging citizens' power. The Polish and Dutch Republics from the seventeenth and eighteenth century present an interesting mirror image of how citizenship and democracy relate to each other in political practice.     

Constructing Authoritative Answers to a Latent Crisis? Strategies of Puzzling,Powering and Framing in Dutch Climate Adaptation Practices Compared

While adaptation tends to be approached as an issue for policy analysis, framing and powering strongly interact with policy analysis (puzzling) and are at least as important for adequate outcomes in such an ambiguous context. The present contribution compares and analyzes two Dutch adaptation strategies in the Central Netherlands: (1) realizing a flood bypass channel near the town of Kampen and (2) exploring possibilities to raise the water level of Lake IJssel, enhancing the country’s freshwater storage capacity. The article concludes that in both trajectories there is an important role for policy analysis (puzzling) but the cases differ strongly in the way actors frame the intervention, their corresponding powering strategies and the policy outcomes.     

Dutch 'Multiculturalism' Beyond the Pillarisation Myth

This article is about the state of multiculturalist politics in the Netherlands. It assesses the popular claim that a paradigmatic change has occurred in the Netherlands due to events such as 9/11 and the murders of Pim Fortuyn and Theo van Gogh. The article argues that although changes are significant, both in discourse and in practice, they must be viewed as part of a process of rethinking the relation between newcomers and the state that goes back as far as the end of the 1980s. Long-standing claims about the exemplary form of multiculturalism in the Netherlands were always ambiguous at least, or even hard to sustain. The article criticises the persistent idea that Dutch accommodating integration policies since the end of the 1970s are an extension of the historical tradition of 'pillarisation'. Only by going beyond this myth can we understand why recent changes are much less of a break with the past, and why multiculturalism was never accepted or practised as fully as has often been suggested in more stereotypical depictions of Dutch integration policy.     

The Forensic Implications of Amphetamine Intoxication in Cases of Inflicted Blunt Craniocerebral Trauma

The effects of D‐amphetamine on outcome after blunt craniocerebral trauma are characterized and the potential legal implications discussed. Traumatic brain injury (TBI) was induced under general anesthesia in adult, male Sprague Dawley rats using the impact acceleration model. At 10 min prior to injury, D‐amphetamine (5 mg/kg) or saline vehicle was administered subcutaneously; animals were subsequently assessed over a 7‐day period post‐trauma for motor outcome using a rotarod device. D‐amphetamine treated animals performed significantly better (p < 0.001; ANOVA) than vehicle treated controls on their motor assessment, suggesting that D‐amphetamine exposure prior to injury either is neuroprotective or enhances motor performance. It is possible, therefore, that an individual who has taken amphetamines may function at a better motor level after head trauma than one who has not been exposed to the drug. Future interpretations of the potential effects of amphetamines on TBI should include this possibility.     

Alcohol intoxication may exacerbate the effects of blunt cranial trauma through changes in brain free magnesium levels

Moderate to high levels of alcohol decrease brain intracellular free magnesium concentration, a factor known to be critical in brain injury. Phosphorus magnetic resonance spectroscopy was used to examine changes to brain free magnesium concentration after blunt cranial trauma in alcohol-intoxicated rats. Rats exposed acutely or chronically to alcohol sufficient to increase blood alcohol levels to between 150 and 350 mg/dL demonstrated a brain free magnesium level that was 20-50% less than in nonintoxicated animals (p < 0.01). After injury, brain free magnesium levels declined more rapidly and to a greater extent in alcohol-affected animals than in nonintoxicated control animals (p < 0.001). As both preinjury depletion of magnesium and degree of magnesium decline after brain injury have been associated with poor recovery, these findings suggest that moderate to severe alcohol intoxication may predispose the brain to a worse outcome by reducing brain free magnesium levels, both before and after injury.