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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
141

Nutrição e excitabilidade cortical: efeitos de potenciação da atividade elétrica associada à depressão alastrante

SOUZA, Thays Kallyne Marinho de 31 January 2011 (has links)
Made available in DSpace on 2014-06-12T22:58:44Z (GMT). No. of bitstreams: 2 arquivo3155_1.pdf: 1119611 bytes, checksum: e64813b9f4c123b0ef51176f3966b96e (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) Previous issue date: 2011 / Conselho Nacional de Desenvolvimento Científico e Tecnológico / O fenômeno da depressão alastrante cortical (DAC) é influenciado por alterações da excitabilidade do cérebro, e tem sido utilizado como modelo para o estudo dessa excitabilidade. Após a ocorrência da DAC, tem sido encontrado um aumento na atividade elétrica neural e sináptica. Isto poderia sugerir uma relação entre a DAC e o fenômeno neural conhecido como LTP (do inglês Long-term potentiation ). A LTP corresponde a um aumento persistente na atividade sináptica (plasticidade neuronal) que tem sido associado com aprendizagem e memória (IZQUIERDO, 2008). O objetivo foi investigar em ratos adultos (90-120 dias) nutridos e desnutridos se a presença da DAC potencia a atividade elétrica espontânea e evocada do córtex cerebral. Ratos Wistar machos, nutridos (N- amamentados em ninhadas de 6 filhotes; n=10), desnutridos no aleitamento (D - amamentados em ninhadas de 12 filhotes; n=10) e com restrição alimentar na vida adulta (RA - receberam 70% da dieta consumida por animais nutridos; n=7), foram anestesiados e submetidos ao registro &#8213;basal&#8214; da atividade elétrica cortical espontânea (ECoG), na região parietal direita, em dois pontos denominados &#8213;anterior&#8214; (a) e &#8213;posterior&#8214; (p), durante 2h. Após este período, a DAC passou a ser deflagrada, a cada 20min, com KCl a 2% e o ECoG, bem como a variação lenta de voltagem que acompanha a DAC, foram registrados por mais 2h. Em cada hora do registro, amostras de aproximadamente 10 minutos dos registros em papel foram digitalizadas e analisadas por meio de um algoritmo específico e as amplitudes do ECoG foram convertidas em unidades relativas. Em comparação com os valores basais, as amplitudes no período com DAC aumentaram significantemente (p<0,05) no ponto a, nos três grupos (aumentos de 13% a 23%). No ponto p, o aumento da amplitude (de 22%) foi significante apenas no grupo D. Um quarto grupo, no qual não se provocou a DAC, apresentou amplitudes semelhantes durante as 4 horas do registro. A resposta cortical evocada por estimulação elétrica trans-calosa também apresentou um aumento de 20 e 40% (nos grupos N e D, respectivamente), após a DAC, em relação aos valores basais. Os resultados: (1) reforçam a hipótese de que no rato a DAC potencia a atividade elétrica cortical espontânea e evocada &#8213;in vivo , sugerindo efeito semelhante à LTP; (2) indicam a existência de diferenças regionais no tecido cortical, quanto a esse efeito; (3) sugerem que essa potenciação é modulada pelo estado nutricional
142

Suplementação com L-glutamina em ratos lactentes nutridos e desnutridos: efeitos sobre o fenômeno da depressão alastrante cortical após o desmame

LIMA, Denise Sandrelly Cavalcanti de 31 January 2009 (has links)
Made available in DSpace on 2014-06-12T22:59:51Z (GMT). No. of bitstreams: 2 arquivo3884_1.pdf: 972393 bytes, checksum: b6a9eb05522515e024ec6c5fa9b28d34 (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) Previous issue date: 2009 / O aminoácido glutamina (Gln) atua como precursor dos neurotransmissores glutamato e ácido gama-amino-butírico (GABA). Portanto, supõe-se que a sua suplementação dietética possa exercer influência sobre a excitabilidade cerebral. Esta dissertação originou o artigo intitulado L-glutamine supplementation during the lactation period facilitates cortical spreading depression in well-nourished and early-malnourished rats, atualmente submetido para publicação, e que está apresentado às páginas 25 &#150; 48. O objetivo foi caracterizar em ratos recém-desmamados, bem-nutridos (N) e desnutridos (D), os efeitos da suplementação enteral com Gln durante o período de desenvolvimento do cérebro sobre a depressão alastrante cortical (DAC). Ratos Wistar machos, nas condições N e D, receberam Gln (500mg/Kg/dia) por gavagem do 7º ao 27º dia de vida pós-natal. Dos 30 aos 40 dias de vida, foram submetidos ao registro da DAC durante 4 horas, em dois pontos da superfície cortical parietal do hemisfério direito. A velocidade de propagação foi calculada a partir do tempo requerido para uma onda da DAC atravessar a distância inter-eletrodos. Nas duas condições nutricionais, os ratos suplementados com Gln apresentaram velocidades de propagação da DAC mais elevadas (p<0,05; N-Gln = 4.22 ± 0.23; D-Gln = 4.51 ± 0.27 mm/min), quando comparados a um grupo controle tratado com o veículo (água) usado para dissolver a Gln (N-V = 3.77 ± 0.21; D-V = 4.15 ± 0.18 mm/min). Este último grupo, não diferiu de um outro grupo controle &#147;ingênuo&#148; (I), que não foi submetido ao procedimento de gavagem (N-I = 3.71 ± 0.16; D-I = 4.10 ± 0.11 mm/min). Um quarto grupo, tratado com um aminoácido &#147;placebo&#148; (glicina; Gly), também apresentou velocidade de propagação que não diferiu do controle tratado com água (N-Gly = 3.59 ± 0.24; D-Gly = 4.15 ± 0.18 mm/min). A suplementação com Gln não alterou os pesos corporais e encefálicos dos animais em nenhuma das condições nutricionais estudadas. Os resultados indicam que a suplementação com Gln durante o período de desenvolvimento do cérebro facilita a propagação da DAC e que este efeito não é alterado pela desnutrição. Supõe-se que a Gln exerce um papel sobre a excitabilidade cerebral, provavelmente resultante da modulação da síntese de neurotransmissores
143

Rôle des facteurs de transcription Dmrt3 et Dmrt5 au cours du développement du cortex cérébral chez la souris / Study of the role of transcription factors Dmrt3 and Dmrt5 during the cerebral cortex development in mouse

Saulnier, Amandine 27 February 2015 (has links)
Le cortex cérébral est composé d’un grand nombre de types de neurones organisés radialement en couches cellulaires et tangentiellement en aires corticales fonctionnellement distinctes. Son développement est régulé par des signaux fonctionnant comme morphogènes sécrétés par des centres organisateurs situés à la périphérie du télencéphale dorsal. Ces morphogènes contrôlent l’expression dans les progéniteurs corticaux de gènes codant pour des facteurs de transcription qui régulent la prolifération, la différenciation et la spécification des progéniteurs corticaux. Les cascades de gènes impliquées dans la mise en place du cortex cérébral dans lesquelles ces signaux et facteurs de transcription interviennent restent cependant actuellement mal connues.<p>Les gènes Dmrt3 et Dmrt5 appartiennent à une famille de gènes fortement conservée évolutivement codant pour des facteurs de transcription à doigt de zinc connus pour leur rôle dans le développement sexuel. Des résultats obtenus dans le laboratoire ayant montré que Dmrt5 joue un rôle crucial dans la neurogenèse au niveau du système olfactif chez le xénope, j’ai voulu savoir, dans un premier temps, si la fonction de Dmrt5 dans la neurogenèse était une fonction ancestrale. Pour répondre à cette question, j’ai recherché des gènes Dmrts chez une espèce de Cnidaire, Nematostella vectensis, et ai étudié leur expression au cours du développement. L’un d’entre-eux, NvDmrtB, est fortement exprimé dans le système nerveux et s’est avéré être requis pour la différenciation des cellules nerveuses chez N. vectensis, suggérant que les gènes Dmrts avaient déjà un rôle dans la neurogenèse dans l’ancêtre commun des Bilatériens et des Cnidaires.<p>Par ailleurs, d’autres travaux ont montré que chez la souris les gènes Dmrt5 et Dmrt3 sont exprimés dans le cerveau en développement au niveau du télencéphale dorsal. Afin d’approcher leur fonction dans le développement cortical, j’ai analysé leur expression au cours du développement embryonnaire, caractérisé les anomalies de développement du cortex cérébral des souris knockout Dmrt5-/- et Dmrt3-/- ainsi que des souris double knockout Dmrt3-/-;Dmrt5-/- et étudié leur régulation. Mes résultats ont montré que Dmrt3 et Dmrt5 sont coexprimés dans les progéniteurs corticaux en gradient avec un maximum d’expression du côté caudo-médian. J’ai également observé que l’absence de Dmrt5 induit une réduction de la taille des vésicules télencéphaliques et que les structures de la partie caudo-médiane du cortex telles que le plexus choroïde et l’hippocampe sont altérées ainsi que les aires visuelle et somato-sensorielle. Au niveau moléculaire, mes résultats ont montré que Dmrt5 est requis pour l’expression de différents gènes codant pour les signaux Wnt et Bmp sécrétés au niveau de la région caudo-médiane des vésicules télencéphaliques, et qu’il contrôle négativement Pax6 et positivement Emx2, des déterminants respectivement de l’identité rostro-latérale et caudo-médiane du cortex cérébral. Bien que la taille des vésicules télencéphaliques n’apparaisse pas affectée chez les souris Dmrt3-/-, l’expression de différents composants de la voie Wnt et celle d'Emx2 et Pax6 est légèrement altérée, comme chez les souris Dmrt5-/-. Chez les souris double knock-out Dmrt3-/-;Dmrt5-/-, une réduction de la taille du cortex et des altérations de l’expression des gènes similaires et plus sévères que celle des souris Dmrt5-/- ont été observées. Nous avons également mis en évidence que l’expression de Dmrt3 est réduite chez les souris Dmrt5-/- et que inversement celle de Dmrt5 est légèrement augmentée chez les souris Dmrt3-/-. Enfin, nous avons observé que l’expression de ces deux gènes est dépendante du facteur de transcription Gli3 et que seul l’expression de Dmrt3 requiert les facteurs de transcription Pax6 et Emx2.<p>Ensemble, nos résultats indiquent que les facteurs de transcription Dmrt5 et Dmrt3 contrôlent le développement de la partie caudo-médiane du cortex, Dmrt5 agissant en amont de Dmrt3. Ils suggèrent également que ces facteurs y joueraient des rôles partiellement redondants en régulant l’expression de cibles communes tels les gènes Wnt3a et Pax6.! / Doctorat en sciences, Spécialisation biologie moléculaire / info:eu-repo/semantics/nonPublished
144

Cortical thickness estimation of the proximal femur from multi-view, dual-energy X-ray absorptiometry

Tsaousis, Nikolaos January 2015 (has links)
Hip fracture is the leading cause of acute orthopaedic hospital admission amongst the elderly, with around a third of patients not surviving one-year post-fracture. Current risk assessment tools ignore cortical bone thinning, a focal structural defect characterizing hip fragility. Cortical thickness can be measured using computed tomography, but this is expensive and involves a significant radiation dose. Dual-energy X-ray absorptiometry (DXA) is the preferred imaging modality for assessing fracture risk, and is used routinely in clinical practice. This thesis proposes two novel methods which measure the cortical thickness of the proximal femur from multi-view DXA scans. First, a data-driven algorithm is designed, implemented and evaluated. It relies on a femoral B-spline template which can be deformed to fit an individual?s scans. In a series of experiments on the trochanteric regions of 120 proximal femurs, the algorithm?s performance limits were established using twenty views in the range 0? ? 171?: estimation errors were 0.00 ? 0.50 mm. In a clinically viable protocol using four views in the range ?20? to 40?, measurement errors were ?0.05 ? 0.54 mm. The second algorithm accomplishes the same task by deforming statistical shape and thickness models, both trained using Principal Component Analysis (PCA). Three training cohorts are used to investigate (a) the estimation efficacy as a function of the diversity in the training set and (b) the possibility of improving performance by building tailored models for different populations. In a series of cross-validation experiments involving 120 femurs, minimum estimation errors were 0.00 ? 0.59 mm and ?0.01 ? 0.61 mm for the twenty- and four-view experiments respectively, when fitting the tailored models. Statistical significance tests reveal that the template algorithm is more precise than the statistical, and that both are superior to a blind estimator which naively assumes the population mean, but only in regions of thicker cortex. It is concluded that cortical thickness measured from DXA is unlikely to assist fracture prediction in the femoral neck and trochanters, but might have applicability in the sub-trochanteric region.
145

Mitofusin 1 and Mitofusin 2 Function in the Context of Brain Development

Hamze, Carmen January 2011 (has links)
Mitofusin 1 and 2 are outer-mitochondrial membrane proteins that have been shown to be involved in fusion. Mitofusin 2 has also been associated with apoptosis and development. When Mfn1 and Mfn2 were each conditionally knocked out from the cerebellum, Purkinje cells in Mfn2 deficient cerebellum during development had undergone neurodegeneration. Mutations in Mfn2 have also been associated with the Charcot Marie Tooth Type 2A (CMT2A). We want to asses the effect Mfn2 and Mfn1 might have on the development of other regions of the brain such as the telencephalon. We generated Mfn1 and Mfn2 conditional knockouts in the telencephalon by crossing them with Foxg1 Cre - a cre expressed in the telencephalon. We found that Mfn1 deficient mice have lost their corpus callosum at the midline, but survive over 6 months with a decrease in progenitor cells postnatally. Mfn2 deficient mice die between P9 and P12 with a decrease in progenitor cells postnatally and a decrease in number of neurons in the cortex. Therefore, our results suggest that Mfn1 and Mfn2 play a significant role in the development of the telencephalon.
146

A 3D Framework for the Musculoskeletal Segmentation of Magnetic Resonance Images

Moghadas Tabatabaei Zavareh, Seyed Mehdi January 2015 (has links)
In this thesis a new framework is proposed for obtaining the spongy bone, cortical bone, muscle and adipose tissue from MRI data. The method focuses on the accurate extraction of the edges of the target tissues, which is the main drawback of previous works. In this framework six new methods, as listed in section 1.3, are utilized together for improving the result of the segmentation by detecting the relational position of the tissues, acquiring the best possible contribution from the operator in terms of time and efficiency, forward and backward transfer of the segmented tissues at the seed slice and using the newly proposed Deformable Kernel Fuzzy-C Mean (DKFCM) method for improving the result of segmentation on the edges. This method first limits the searching area for the voxels of the target tissue from the whole data to a small strip around the edges of the target tissue. Then, it applies a very accurate segmentation on the searching area, using a deformable kernel, which is capable of adapting itself with the shape of the edge. Comparing the results of this work with some popular MRI segmentation methods like active contour, watershed, FCM and also some heuristic methods, which are proposed in literature for segmenting the MRI to four tissues, demonstrates the superiority of the proposed method especially on the edges.
147

Sensibilidade somestésica como fator participante do desenvolvimento neural: análise eletrofisiológica em ratos precocemente desnutridos

TENÓRIO, Angélica da Silva 31 January 2009 (has links)
Made available in DSpace on 2014-06-12T23:01:26Z (GMT). No. of bitstreams: 2 arquivo3937_1.pdf: 3652700 bytes, checksum: 7fa1f289cc1616b1a2abc77bd19b9fda (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) Previous issue date: 2009 / A condição nutricional, bem como a interação organismo-ambiente são fatores que influenciam o desenvolvimento do sistema nervoso. Mecanismos de plasticidade neural ocorrem diante de modificações nessas variáveis, podendo resultar em conseqüências funcionais. No rato, a privação da aferência sensorial representado pelas vibrissas pode induzir alterações morfológicas na correspondente área de representação cortical, modificando suas propriedades funcionais. No presente trabalho investigou-se a influência da remoção precoce unilateral das vibrissas sobre as características da Depressão Alastrante Cortical (DAC) analisada em ratos após o desmame e na idade adulta, sob condições favoráveis e desfavoráveis de lactação (respectivamente, grupos bem-nutrido e desnutrido; ninhadas formadas por 6 e 12 filhotes). Os animais foram submetidos à remoção unilateral das vibrissas no 2º. ou 3º. dia de vida e os registros eletrofisiológicos da DAC foram realizados em dois pontos da superfície cortical de ambos os hemisférios cerebrais, aos 30-40 dias (animais jovens) ou aos 90-120 dias (animais adultos). Os pesos corporais e encefálicos foram reduzidos, enquanto que a velocidade de propagação da DAC aumentou nos animais desnutridos, quando comparados aos animais bem-nutridos. A remoção das vibrissas esteve associada a uma redução nos pesos corporais e encefálicos nos animais jovens, mas não nos adultos. Os ratos submetidos à privação sensorial apresentaram velocidades da DAC mais altas no hemisfério contralateral à remoção das vibrissas, quando comparadas com o hemisfério ipsilateral, no entanto, aqueles que foram submetidos à desnutrição apresentaram uma redução significativa da velocidade da DAC no hemisfério ipsilateral à remoção das vibrissas, quando comparados com os hemisférios correspondentes dos desnutridos que permaneceram com as vibrissas intactas. Nos animais controles (mantidos com as vibrissas intactas), nenhuma diferença inter-hemisférica foi encontrada. Os resultados sugerem que (1) a privação sensorial originada nas vibrissas durante o desenvolvimento cerebral facilita a propagação da DAC e (2) a desnutrição pode influenciar esse efeito, o qual (3) parece ser permanente, uma vez que persistiu até a idade adulta
148

L-Arginina facilita a depressão alastrante cortical, de forma dependente da dose, em ratos nutridos e precocemente desnutridos

MAIA, Luciana Maria Silva de Seixas 31 January 2008 (has links)
Made available in DSpace on 2014-06-12T23:01:55Z (GMT). No. of bitstreams: 2 arquivo4016_1.pdf: 919373 bytes, checksum: 6d569bd31b577ccce5874c17f74906e2 (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) Previous issue date: 2008 / A L-Arginina atua como precursor do óxido nítrico, que possui várias funções no sistema nervoso, e cuja síntese pode ser modulada pela ingestão de L-Arginina. Em trabalho anterior deste laboratório (Frazão, 2004), demonstrou-se que a administração de 300mg/kg/dia de L-Arginina durante o aleitamento facilita, em animais bem nutridos adultos (90-120 dias), a propagação do fenômeno da depressão alastrante cortical (DAC). Neste trabalho, ratos lactentes, nutridos e desnutridos, foram tratados por gavagem (do 7º ao 28º dia de vida), com L-Arginina, em três doses (150, 300 e 450mg/kg/dia). Aos 30-40 dias, estudou-se o impacto desse tratamento sobre o peso corporal e encefálico, bem como sobre a propagação da DAC. Em comparação com dois grupos controles (um, tratado por gavagem com água e outro, sem tratamento ingênuo ), a administração de L-Arginina, nos animais bem nutridos, aumentou a velocidade de propagação da DAC, e este efeito variou positivamente com as três doses empregadas. Nos desnutridos, a velocidade da DAC aumentou apenas no grupo tratado com a dose mais alta (450mg/Kg/dia). Os dados indicam que a administração de L-Arginina durante o período de desenvolvimento facilita a propagação da DAC, de forma dependente da dose e também do estado nutricional precoce. Sugere-se que, nesse efeito, esteja envolvida a modulação da síntese de óxido nítrico conseqüente à administração de L-Arginina
149

Regulation of CGRP gene expression and effects on light aversive behavior

Raddant, Ann Christine 01 December 2013 (has links)
Migraine is a debilitating neurological disorder, which affects over 10% of the general population. In addition to headache, migraine includes a host of associated symptoms, such as nausea and hypersensitivity to light, noise, and touch. While great strides have been made in migraine treatment in recent decades, the basic biological and pathophysiological mechanisms underlying migraine are still not well understood. Pain signals travel via a polysynaptic pathway from the periphery to the cortex, where conscious perception of pain occurs. This multi-neuron pathway produces a message that can be modified at any step of its transit. One peptide that may modify this pathway is calcitonin gene-related peptide (CGRP). CGRP is a potent vasodilator and neuromodulator, and mounting evidence suggests CGRP may play a causative role in migraine. CGRP levels are increased during migraine, but can be reduced upon successful treatment with drugs in the triptan class. Importantly, injection of CGRP into migraine patients can elicit a delayed, migraine-like headache. Finally, CGRP receptor antagonists are clinically effective in providing relief to migraine patients. In addition to CGRP, the CGRP gene (CALCA) expresses another peptide that may also be relevant to migraine. Procalcitonin (proCT) is a recognized biomarker for sepsis, but emerging evidence suggests it may have actions similar to CGRP in migraine. First, proCT has biological activity at the CGRP receptor. Second, proCT is reported to be increased during migraine. We hypothesized that regulation of CGRP and proCT may be altered in migraineurs, and that migraineurs may also be sensitized to the effects of these peptides. To study the role of these peptides in migraine pathways, a number of methods have been employed. Studies exploring regulation of gene expression were performed in cultured trigeminal ganglia, as well as primary cultures of trigeminal and cortical glia. These studies show that the Calca gene can be regulated by a number of stimuli, including hypoxia and reactive oxygen species. These insults have the ability to induce CALCA gene and peptide expression to varying degrees on different cell types. In addition to in vitro experiments on Calca gene regulation, the in vivo effects of CGRP on mouse behavior were also investigated. Animals were genetically sensitized to CGRP via overexpression of the rate-limiting CGRP receptor subunit. In these animals, injection of CGRP is sufficient to induce light aversion, which is used to model photophobia. Physiological and biochemical triggers of migraine were tested using this behavioral paradigm. While stress and mast cell degranulation are sufficient to induce light aversion, the role of CGRP in these events remains unclear, as both CGRP sensitized and control animals displayed a light aversion phenotype. Together, these studies show the dynamic regulation of the Calca gene in migraine pathways as well as highlight some of the challenges of modeling a complex disease in an animal model.
150

Tiny but mighty: mesenchymal stem cell-derived extracellular vesicles as a therapeutic in a monkey model of cortical injury

Go, Veronica 17 February 2021 (has links)
Cortical injury, such as that following stroke, is one of the leading causes of long-term disabilities world-wide. While some neuroprotective agents given within hours of stroke can reduce damage, there are currently no neurorestorative therapeutics that can enhance long-term recovery. To address this, we tested Mesenchymal Stem Cell (MSC) derived Extracellular Vesicles (EVs) as a treatment for cortical injury in rhesus monkeys (Macaca mulatta). Monkeys treated with EVs 24 hours after injury and again at 14 days after injury recovered more completely and more rapidly than monkeys given a vehicle control. However, the cellular changes associated with enhanced recovery remained unknown. In this dissertation, it was hypothesized that EVs modulated cells within the brain to enhance recovery after cortical injury. To explore this hypothesis, three specific aims were tested. Aim 1: To determine the effects of EVs on microglial reactivity. Since EVs in this study were derived from MSCs, it was hypothesized that they would have an immunomodulatory effect. Using immunohistochemistry, image analyses, and 3-D reconstruction, we showed that microglia shifted from reactive, damaging phenotypes towards homeostatic, surveilling functions in EV-treated monkeys. These effects correlated with reduced time to recovery, suggesting that reduced microglial reactivity enhanced recovery. Aim 2: To assess the effects of EVs on myelination. Because MSCs have regenerative effects, it was hypothesized that these MSC-derived EVs would improve neurorestoration. Using immunohistochemistry, qRT-PCR, Spectral Confocal Reflectance microscopy, and ELISA, we assessed myelination after cortical injury with and without EV treatment. EVs limited oligodendrocyte damage and increased densities of mature oligodendrocytes to enhance myelin maintenance. These effects correlated with improved recovery, suggesting the importance of myelination in recovery after cortical injury. Aim 3: To assess the neuroprotective role of EVs on infarct volumes. While it was hypothesized that EVs would reduce the densities of inflammatory cells (astrocytes, macrophages/microglia, T-cells), hemosiderin accumulation, and infarct volume, we found that EVs did not alter these endpoints. Collectively, our results suggest that EVs modulated microglia and oligodendrocytes to promote neurorestoration. Overall, these findings demonstrate the therapeutic potential of EVs for neurorestoration after cortical injury.

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