Glossary

Apoptosis – Cell death: “Catastrophic neurodegeneration in stroke and epilepsy” Neurodegeneration is a collaboration between necrosis and apoptosis. Neurons can be murdered by any number of assailants: three common culprits are poisons, strangulation (choking off oxygen in ischemia), and abusive overwork resulting in a type of "nervous breakdown" after exhaustion (such as in status epilepticus). In such situations, both necrosis and apoptosis may occur.” (Marlangue C, et al. Apoptotic features of selective neuronal death in ischemia, epilepsy and toxicity. Trends Neurosci 1996;19:109-114). “When a clot blocks your artery at the start of a stroke, the damage is swift. Every second, 32,000 neurons -- brain cells -- die; that's 1.9 million in a minute. In that same minute, your brain loses 14 billion synapses, the vital intersections between neurons. Also lost in that minute are 7.5 miles of myelinated fibers through which thoughts pass.” (See Saver J.L., Time Is Brain-Quantified. Stroke. 37(1):263-266, Jan 2006.)

Barthel – A stroke scale for assessing the quality of a patient’s daily activities.

BA – basilar artery

CBC –Complete Blood Count a broad screening test to check for such disorders as anemia, infection, and many other diseases. It is actually a panel of tests that examines different parts of the blood.

CCA – Common Carotid Artery

CT – Computed Tomography is an imaging method using x-rays to rapidly differentiate an ischemic stroke from a hemorrhagic stroke due to a bleed into a cerebral space. It produces a volume of data which can be manipulated, through a process known as windowing, in order to demonstrate various bodily structures based on their ability to block the X-ray/Röntgen beam.

CTA - Computed tomography angiography (CTA) provides noninvasive three-dimensional views of cerebral blood vessels and is sensitive for identifying aneurysms. First, a contrast dye is injected into a vein to make the blood vessels stand out against the surrounding tissue. Then a rotating device passes beams of X-rays through the head and neck to create cross-sectional images. The computer then assembles these into a three-dimensional picture of how blood flows in the brain's arteries and veins.

EKG – Electro Cardio Gram or German electrokardiogramma is the recording of the electrical activity of the heart over time via skin electrodes (see Einthoven 1912).

FDA – Food and Drug Administration, USA

GPIIb-IIIa – Platelet Glycoprotein GPIIb-IIIa Complex is a platelet membrane glycoprotein complex important for platelet adhesion and aggregation. It is an integrin complex containing integrin alphaiib and integrin beta3 which recognizes the arginine-glycine-aspartic acid (rgd) sequence present on several adhesive proteins and as such, it is a receptor for fibrinogen. Fibrinogen links then bind activated platelets together. (See Chirkov YY et al, Reversal of human platelet aggregation by low concentrations of nitroglycerin in vitro in normal subjects. Am J Cardiol. 1992;70:802–806)

ICA = Internal carotid artery

INR - International normalized ratio measures the time it takes for blood to clot and compares it to an average. The INR value measures the extrinsic pathway of coagulation (prothrombin time or PT to a normal (control) sample) and is useful in monitoring the impact of anticoagulant (“blood thinning”) medicines.

Ischemia - blood supply to part of the brain is decreased, leading to dysfunction of the brain tissue in that area served by the vessel. (See Broughton B., Apoptotic Mechanisms After Cerebral Ischemia, Stroke, 2009 Jan 29. “Conclusions—Although the ischemic penumbra is under threat of infarction, it is potentially salvageable and thus represents an opportunity for therapeutic intervention”)

LEC – Local Ethics Committee

M1 – The long horizontal segment of the MCA (sphenoidal segment viewed in the coronal plane). Frequent location of thromboembolic occlusion.

M2 – Sylvian segment of the MCA (also known as the insular segment) that is a frequent location of thromboembolic occlusion.

MABP – Mean arterial blood pressure

MCA – middle cerebral artery

mRS – modified Rankin Scale, a neurological assessment of the symptoms of stroke

See http://www.strokeassociation.org/

NIH – National Institutes of Health in the USA

NIHSS – National Institutes of Health Stroke Scale - A programmed documentation completed during a neurological examination of a stroke victim to identify and assess neurological deficits. The result is a score on a measurement scale that quantifies these neurological deficits.

Nitrites – In smooth muscle cells in the walls of arteries, these compounds provide a source for NO upon scissioning by photons of UV light.

NO – Nitric oxide, a signaling molecule is a biologically generated gas composed of one atom of nitrogen and one atom of oxygen (bonding only for seconds at most). NO is now known to play important functional roles in a variety of physiological systems. Within the vasculature, NO induces vasodilation, inhibits platelet aggregation, prevents neutrophil/platelet adhesion to endothelial cells, inhibits smooth muscle cell proliferation and migration, regulates programmed cell death (apoptosis) and maintains endothelial cell barrier function. NO generated by neurons acts as a neurotransmitter, whereas NO generated by macrophages in response to invading microbes acts as an antimicrobial agent.

OPUS - Optical Photonic Ultraviolet Scission

P1 – Posterior cerebral artery (PCA) is another frequent location of thromboembolic occlusion. The P1 segment supplies blood to the thalmus and midbrain.

Photolysis - Chemical changes resulting from the absorption of light that change properties of materials, particularly polymers. The chemical changes can include bond scission (especially of the molecular backbone), color formation, cross-linking, and chemical rearrangements. Irradiation of S-nitrosothiol with light (lambda = 355 nm & followed by absorption spectroscopy) results in homolytic decomposition of NacySNO and GSNO to generate radicals (GS and NacyS ) and NO. (See Rotta J C G; et al, Nitric oxide release from the S-nitrosothiol zinc phthalocyanine complex by flash photolysis. Brazilian journal of medical and biological research = Revista brasileira de pesquisas médicas e biológicas / Sociedade Brasileira de Biofísica ... [et al.] 2003;36(5):587-94.)

PROACT II - Prolyse in Acute Cerebral Thromboembolism II, a Phase II randomized, controlled, multicenter, open-label clinical trial with blinded follow-up. Furlan A., et al, Cerebrovascular Center, Department of Neurology, Cleveland Clinic Foundation, Intra-arterial (IA) prourokinase for acute ischemic stroke. The PROACT II study: a randomized controlled trial. Prolyse in Acute Cerebral Thromboembolism (JAMA, 1999 Dec ;282(21):2003-11.)

PTA – Percutaneous Transluminal Angioplasty

PTT – Partial Thromboplastin Time or how long it takes blood to clot

Pulsed UV – Projecting coherent ultraviolet light (laser) at high rates of repetition (kHz) allows for efficient average power output from a laser

Q-switch - A technique by which a laser can be made to produce a pulsed output beam where the peak is a very high energy

r-tPA - A form of recombinant tissue plasminogen activator that is made in the laboratory. It helps dissolve blood clots by breaking apart the fibrin content of a clot and is used to treat heart attacks, strokes, and clots in the lungs. Also called Activase, Alteplase, and recombinant tissue plasminogen activator.

Rankin - A clinician-reported measure of global disability, widely applied for evaluating stroke patient outcomes and as an end point in randomized clinical trials. The modified Rankin scale (mRS) consists of six grades of stroke severity. It is a descriptive categorization of functional recovery of cerebrovascular disease patients (>60 years) at the time of discharge or transfer from the index hospitalization.

RBC –red blood cell

S-Nitrosothiol – Biological metabolites of nitric oxide. These complexes contained within smooth muscle cells are putatively the source of NO for the Opus process. The decomposition of S-nitrosothiols by photolysis is well understood. UV-visible light causes a homolytic cleavage of the sulfur-nitrogen bond, resulting in the release of zNO and a thiyl radical. (See THE JOURNAL OF BIOLOGICAL CHEMISTRY Vol. 271, No. 31, Issue of August 2, pp. 18596–18603, 1996, © 1996 by The American Society for Biochemistry and Molecular Biology, Inc. Mechanism of Nitric Oxide Release from S-Nitrosothiols* Ravinder Jit Singh, et al, From the Biophysics Research Institute, Medical College of Wisconsin, Milwaukee, Wisconsin)

SAH – sub arachnoid hemorrhage

SMC –smooth muscle cell

Scission - an action or process of cutting, dividing, or splitting: the state of being cut, divided, or split

TCD - Transcranial doppler (TCD) is a noninvasive ultrasound procedure for the assessment of blood flow through the cerebral vessels. A small, hand-held probe placed against the skull bounces sound waves off different parts of the brain. Frequency shifts in the reflected sound allow a computer to measure blood-flow velocity

TIMI/TICI – TIMI or thrombolysis in myocardial infarction score classifying the degree of vessel occlusion based on angiography and TICI or thrombolysis in cerebral infarction score based on imaging by MRA (Magnetic resonance angiography). Both scores are indicative of stroke therapy success based on the "re-canalization hypothesis," i.e., that reopening of occluded vessels improves clinical outcome in acute ischemic stroke through regional reperfusion and salvage of threatened tissues.

Triple-H therapy - Hypervolemia, hypertension, and hemodilution therapy is the standard of care for management of aneurysmal subarachnoid hemorrhage. Cerebral vasospasm is a recognized but poorly understood complication for many patients who have aneurysmal subarachnoid hemorrhage and can lead to delayed ischemic neurological deficit (stroke). Morbidity and mortality rates for vasospasm are high despite improvements in management. Since the middle of the 1970s, much has been written about the treatment of cerebral vasospasm. Hypervolemia, hypertension, and hemodilution (triple-H) therapy in an intensive-care setting has been shown in some studies to improve outcome and is an accepted means of treatment, although a randomized controlled trial has never been undertaken.

Thromboembolic – Blocking of a blood vessel by a blood clot dislodged from its site of origin. When the blockage occupies more than 75% of cross sectional area of the lumen of an artery, blood flow to the tissue supplied is reduced enough to cause symptoms because of decreased oxygen (hypoxia) and accumulation of metabolic products. More than 90% of obstruction can result in anoxia, the complete deprivation of oxygen, and infarction, a mode of cell death.

UV – Ultraviolet light of wavelengths 10 – 411 nm. The Opus process releases maximum amount of SMC nitric oxide at 355 nm wavelength.

Vasospasm - A condition in which blood vessels spasm, leading to vasoconstriction. This can lead to tissue ischemia and death (necrosis). Cerebral vasospasm may arise in the context of subarachonoid hemorrhage. Symptomatic vasospasm or delayed cerebral ischemia is a major contributor to post-operative stroke and death especially after aneurysmal subarachnoid hemorrhage. Vasospasm typically appears 4 to 10 days after subarachnoid hemorrhage.