No / Archaeological work in advance of construction at a site on the edge of York, UK, yielded human remains of prehistoric to Romano-British date. Amongst these was a mandible and cranium, the intra-cranial space of which contained shrunken but macroscopically recognizable remains of a brain. Although the distinctive surface morphology of the organ is preserved, little recognizable brain histology survives. Though rare, the survival of brain tissue in otherwise skeletalised human remains from wet burial environments is not unique. A survey of the literature shows that similar brain masses have been previously reported in diverse circumstances. We argue for a greater awareness of these brain masses and for more attention to be paid to their detection and identification in order to improve the reporting rate and to allow a more comprehensive study of this rare archaeological survival.

The neurological wake-up test, NWT, is a clinical monitoring tool that can be used to evaluate the level of consciousness in patients with traumatic brain injury (TBI) and subarachnoid haemorrhage (SAH) during neurocritical care (NCC). Since patients with severe TBI or SAH are often treated with mechanical ventilation and sedation, the NWT requires that the continuous sedation is interrupted. However, interruption of continuous sedation may induce a stress response and the use of the NWT in NCC is controversial. The effects of the NWT on intracranial pressure (ICP) and cerebral perfusion pressure (CPP) were evaluated in 21 patients with TBI or SAH. Compared to baseline when the patients were sedated with continuous propofol sedation, the NWT resulted in increased ICP and CPP (p<0.05). Next, the effects of the NWT on the stress hormones adrenocorticotrophic hormone (ACTH), cortisol, epinephrine and norepinephrine were evaluated in 24 patients. Compared to baseline, the NWT caused a mild stress response resulting in increased levels of all evaluated stress hormones (p<0.05). To compare the use of routine NCC monitoring tools, the choice of sedation and analgesia and the frequency of NWT in Scandinavian NCC units, a questionnaire was used. The results showed that all 16 Scandinavian NCC units routinely use ICP and CPP monitoring and propofol and midazolam were primary choices for patient sedation in an equal number of NCC units. In 2009, the NWT was not routinely used in eight NCC units whereas others used the test up to six times daily. Finally, intracerebral microdialysis (MD), brain tissue oxygenation (PbtiO2) and jugular bulb oxygenation (SjvO2) were used in 17 TBI patients to evaluate the effect of the NWT procedure on focal neurochemistry and cerebral oxygenation. The NWT did not negatively alter interstitial markers of energy metabolism or cerebral oxygenation. In conclusion, the NWT induced a mild stress response in patients with TBI or SAH that did not result in a detectable, significant secondary insult to the injured brain. These results suggest that the NWT may safely be used as a clinical monitoring tool in the NCC of severe TBI and SAH in a majority of patients.

Understanding the ageing process is of increasing importance to an ageing society and one aspect of this is investigating what role the brain has in this process. Cognitive ability declines as we age and it is one of the most distressing aspects of getting older. Brain tissue deterioration is a significant contributor to lower cognitive ability in late life but the underlying biological mechanisms in the brain are not yet fully understood. One reason for this is the difficulty in obtaining accurate measures of potential ageing-related brain biomarkers. The chapters in this thesis explore the difficulties of quantifying brain changes in the ageing brain from Magnetic Resonance Imaging (MRI), and how the changes identified are related to cognition in later life. The data was acquired as part of the second wave of the longitudinal Lothian Birth Cohort 1936 study in which 866 people aged 73 years, returned for cognitive and medical assessment. At this stage of the study 702 underwent MR imaging resulting in 627 complete datasets across all testing. The entire data, a randomly chosen subset of 150 and 416 freely available data were used to investigate global and regional measurement methods in older brains and how the resultant measurements related to cognitive performance. Furthermore the presence of early life cognitive data in the form of a general intelligence test sat at age 11, served as an indicator of cognitive ability prior to the potential influence of the ageing process. The chapters concerning global measures at first establish, that a measure of intracranial volume (ICV) serves as both a way of correcting for individual differences in brain size between participants and as a proxy premorbid measure of brain size. The analysis, utilising freely available cross-sectional MRI data (http://www.oasis-brains.org) revealed that ICV differed very little between 18-28 year olds and 84-96 year olds where as total brain tissue volume (TBV) differed by 14.1% between the two groups, which was more than twice the standard deviation across the entire age range (18-96 years). Second a validated, reliable method for measuring ICV was investigated using 150 people randomly chosen from the LBC1936 study. Automated and semi-automated methods were validated against reference measurements the results of which showed that common ageing features make automated and semi-automated methods that do not have an additional manual editing step, ineffective at producing accurate ICV measurements. This analysis also highlighted the need to employ additional spatial overlap assessment to volumetric comparison of measurement methods to reduce the effect of false-positives and false-negatives skewing apparent discrepancies between methods. Using the information gained here ICV and TBV from the entire LBC1936 cohort were analysed in a structural equation model, alongside cognitive ability measures at both age 11 and age 73. We found that TBV was a stronger predictor of later life cognitive ability, after accounting for early life ability, but that a modest association remained between ICV and late life cognition. This suggests that early life factors pay a role in how well we age, though the relationship is complex. The regional measures chapters look at two brain regions commonly associated with ageing, the hippocampus and the frontal lobes. Measuring either of these brain regions in large samples of healthy older adults is challenging for many reasons. The hippocampus is small and as with all brain regions shows greater variation in older age, this makes employing automated methods that have the advantage of being fast and reproducible difficult. Following the results of our systematic review of automated methods for measuring the hippocampus, the two most commonly used and available automated methods were validated against reference standard measurements. The results indicated that although automated methods present an attractive alternative to laborious manual measurements they still require manual editing to produce accurate measurements in older adults. The modified strategy employed across the LBC1936 was to use an automated method and then manually edit the output; these segmentations were used to investigate the potential of multimodal image analysis in clarifying associations between the hippocampus and cognitive ability in old age. The analysis focused on associations between longitudinal relaxation time (T1), magnetization transfer ratio (MTR), fractional anisotropy (FA) and mean diffusivity (MD) in the hippocampus and general factors of fluid intelligence, cognitive processing speed and memory. The findings show that multi-modal MRI assessments were more sensitive than volumetric measurements at detecting associations with cognitive measures. The difficulty with producing a relevant frontal lobe measure was made apparent when the result of a large systematic review looking at the manual protocols used revealed 19 methods and 15 different landmarks had been employed. This resulted in an analysis that took the 5 most common boundaries reported and applied them to 10 randomly selected participants from the LBC1936. The results showed significant differences between the resultant volumes, with the smallest measurement when using the genu as the posterior marker representing only 35% of the measurement acquired using the central sulcus. The results from the studies presented in this thesis strongly highlight the need to develop age specific methods when using brain MRI to study ageing. Furthermore the implications of using unstandardised protocols, making assumptions about a methods performance based on validation in younger samples and the need to account for early life factors in this area of research have been made clearer. Studies building on these findings will be beneficial in elucidating the role of the brain in ageing.

Microbeam radiotherapy (MRT), an experimental high-dose rate concept with spatial fractionation at the micrometre range, has shown a high therapeutic potential as well as good preservation of normal tissue function in pre-clinical studies. We investigated the suitability of MRT as a simultaneously integrated boost (SIB) in conventional whole-brain irradiation (WBRT). A 174 Gy MRT SIB was administered with an array of quasi-parallel, 50 m wide microbeams spaced at a centre-to-centre distance of 400 m either on the first or last day of a 5 4 Gy radiotherapy schedule in healthy adult C57 BL/6J mice and in F98 glioma cell cultures. The animals were observed for signs of intracranial pressure and focal neurologic signs. Colony counts were conducted in F98 glioma cell cultures. No signs of acute adverse effects were observed in any of the irradiated animals within 3 days after the last irradiation fraction. The tumoricidal effect on F98 cell in vitro was higher when the MRT boost was delivered on the first day of the irradiation course, as opposed to the last day. Therefore, the MRT SIB should be integrated into a clinical radiotherapy schedule as early as possible.

No description available.

A combination of theoretical, numerical, and experimental methods were utilized to determine that shock waves can form in brain tissue from smooth boundary conditions. The conditions that lead to the formation of shock waves were determined. The implication of this finding was that the high gradients of stress and strain that could occur at the shock wave front could contribute to mechanism of brain injury in blast loading conditions. The approach consisted of three major steps. In the first step, a viscoelastic constitutive model of bovine brain tissue under finite step-and-hold uniaxial compression with 10 1/s ramp rate and 20 s hold time has been developed. The assumption of quasi-linear viscoelasticity (QLV) was validated for strain levels of up to 35%. A generalized Rivlin model was used for the isochoric part of the deformation and it was shown that at least three terms (C_10, C_01 and C_11) are needed to accurately capture the material behavior. Furthermore, for the volumetric deformation, a linear bulk modulus model was used and the extent of material incompressibility was studied. The hyperelastic material parameters were determined through extracting and fitting to two isochronous curves (0.06 s and 14 s) approximating the instantaneous and steady-state elastic responses. Viscoelastic relaxation was characterized at five decay rates (100, 10, 1, 0.1, 0 1/s) and the results in compression and their extrapolation to tension were compared against previous models. In the next step, a framework for understanding the propagation of stress waves in brain tissue under blast loading was developed. It was shown that tissue nonlinearity and rate dependence are key parameters in predicting the mechanical behavior under such loadings, as they determine whether traveling waves could become steeper and eventually evolve into shock discontinuities. To investigate this phenomenon, the QLV material model developed based on finite compression results mentioned above was extended to blast loading rates, by utilizing the stress data published on finite torsion of brain tissue at high rates (up to 700 1/s). It was shown that development of shock waves is possible inside the head in response to compressive pressure waves from blast explosions. Furthermore, it was argued that injury to the nervous tissue at the microstructural level could be attributed to the high stress and strain gradients with high temporal rates generated at the shock front and this was proposed as a mechanism of injury in brain tissue. In the final step, the phenomenon of shock wave formation and propagation in brain tissue was further studied by developing a one-dimensional model of brain tissue using the Discontinuous Galerkin finite element method. This model is capable of capturing high-gradient waves with higher accuracy than commercial finite element software. The deformation of brain tissue was investigated under displacement input and pressure input boundary conditions relevant to blast over-pressure reported in the literature. It was shown that a continuous wave can become a shock wave as it propagates in the tissue when the initial changes in acceleration are beyond a certain limit. The high spatial gradients of stress and strain at the shock front cause large relative motions at the cellular scale at high temporal rates even when the maximum strains and stresses are relatively low. This gradient-induced local deformation occurs away from the boundary and can therefore contribute to the diffuse nature of blast-induced injuries.   / Mechanical Engineering

For years, the modelling of the brain tissue has been widely investigated. Indeed, a biomechanical model of the brain would find applications in fields like image-guided neurosurgery or safety system design (helmets, car manufacturing, security fences design,...). In the present thesis, we propose an original, fractional calculus-based, constitutive equation of the brain tissue. Different types of experiments (unconfined compression, relaxation and cyclic tests) were carried out in order to characterize the mechanical behaviour of the brain tissue. The use of the digital image correlation enabled us, for the first time to our best knowledge, to prove the incompressibility of the brain tissue, a widespread assumption. The constitutive model was calibrated and validated using these experiments. The agreement between the model and the experimental results is very satisfactory. The model reproduces with only a few percent error the stress-strain curves for the compression tests at three different loading rates covering two orders of magnitude as well as the behaviour in the relaxation and cyclic tests. La modélisation du tissu cérébral fait l'objet de nombreuses recherches depuis quelques années. En effet, un modèle biomécanique du cerveau trouverait des applications dans le domaine de la neurochirurgie guidée par l'image et chez les fabricants de système de sécurité (casques, automobiles, barrières de sécurité,...). Dans cette thèse, nous proposons un modèle d'équation constitutive original pour le tissu cérébral basé sur l'utilisation des dérivées d'ordre réel arbitraire (aussi connues sous le terme de dérivées fractionnaires). Divers types d'essais (compression, relaxation et essais cycliques) ont également été réalisés afin de caractériser le comportement mécanique du tissu cérébral. L'utilisation de la corrélation d'images numériques a permis, pour la première fois à notre connaissance, de démontrer expérimentalement son incompressibilité, justifiant ainsi une hypothèse couramment rencontrée. La loi constitutive développée a été calibrée et validée à partir de ces essais. L'accord entre le modèle et les résultats expérimentaux est très satisfaisant en ce qui concerne le comportement en compression à trois vitesse de déformation différentes s'étalant sur deux ordres de grandeur. Il en va de même pour les comportements en relaxation et lors des essais cycliques.

Human endogenous retroviruses (HERVs) constitute about 8% of the human genome. There are around 4000 pol-containing retroviral integrations in the human genome, which makes it impractical to measure each of them separately. Therefore we developed a set of degenerate real time PCRs to detect major groups bearing sequence similarities to gammaretroviruses, one of the largest groups of human endogenous retrovirus, and betaretroviruses, some of which have integrated into the human genome most recently and which remain the most intact. It was found that, although both gammaretroviral and betaretroviral RNAs were broadly expressed in various healthy tissues including reproductive tissues and brain, a differential expression pattern was observed. My work further revealed that HERVE and HERVW, two gammaretroviral sequences, were ubiquitously and highly expressed in pathologic and normal female reproductive tissues with tissue specific patterns. Expression of HERVE was higher in endometriotic tissue than in normal endometrium. HERVE and HERVW RNAs were higher in normal ovarian tissue than in ovarian cancer. Besides these tissue- and neoplasia-related differences, there were wide differences in HERV expression among individuals. Next, a selective pattern of HERVW upregulation was demonstrated in SK-N-DZ, a neuroblastoma cell line, upon re-oxygenation after a period of hypoxia or with 5-azacytidine, a demethylating agent. Furthermore, broad and high expressions of gammaretrovirus-like transcripts in different brain areas analyzed were identified. The expression levels were variable among different donors. In conclusion a ubiquitous HERV expression was observed in tissues and cell lines, with various patterns. At this stage the data are not sufficient to conclude whether HERV has any physiological or pathological roles in humans. However, their differential expression patterns are compatible with functional roles of HERV in humans.

No description available.

Outcome after traumatic brain injury (TBI) depends on the extent of primary cell death and on the development of secondary brain injury. The general aim of this thesis was to find strategies and quality systems to minimize the extent of secondary insults in neurointensive care (NIC). An established standardized management protocol system, multimodality monitoring and computerized data collection, and analysis systems were used. The Uppsala TBI register was established for regular monitoring of NIC quality indexes. For 2008-2010 the proportion of patients improving during NIC was 60-80%, whereas 10% deteriorated. The percentage of ‘talk and die’ cases was < 1%. The occurrences of secondary insults were less than 5% of good monitoring time (GMT) for intracranial pressure (ICP) > 25 mmHg, cerebral perfusion pressure (CPP) < 50 mmHg and systolic blood pressure < 100 mmHg. Favorable outcome was achieved by 64% of adults. Nurse checklists of secondary insult occurrence were introduced. Evaluation of the use of nursing checklists showed that the nurses documented their assessments in 84-85% of the shifts and duration of monitoring time at insult level was significantly longer when secondary insults were reported regarding ICP, CPP and temperature. The use of nurse checklist was found to be feasible and accurate.  A clinical tool to avoid secondary insults related to nursing interventions was developed. Secondary brain insults occurred in about 10% of nursing interventions. There were substantial variations between patients. The risk ratios of developing an ICP insult were 4.7 when baseline ICP ≥ 15 mmHg, 2.9 when ICP amplitude ≥ 6 mmHg and 1.7 when pressure autoregulation ≥ 0.3. Hyperthermia, which is a known frequent secondary insult, was studied. Hyperthermia was most common on Day 7 after admission and 90% of the TBI patients had hyperthermia during the first 10 days at the NIC unit. The effects of hyperthermia on intracranial dynamics (ICP, brain energy metabolism and BtipO2) were small but individual differences were observed. Hyperthermia increased ICP slightly more when temperature increased in the groups with low compliance and impaired pressure autoregulation. Ischemic pattern was never observed in the microdialysis samples. The treatment of hyperthermia may be individualized and guided by multimodality monitoring.