Quantitative Research Into The Deconditioning Of Hydrodynamic To Disorder Of Consciousness Carried Out Using Transcranial Doppler Ultrasonography & Photoplethysmography Obtained Via Finger-transmissive Absorption

Objective:To investigate the expression pattern and the mechanism of CASK in the hippocampus of epileptic rat modal. And in this study transcranial Doppler ultrasonography(TCD) and photoplethysmography(PPG) has been utilized, through the observation of peripheral and cerebrovascular hemodynamic changes of the disorder of consciousness(DOC) patients, measured on clinical behavior scale of Coma Recovery Score–Revised(CRS-R) to obesrve their diagnostic value in evaluation of DOC patients when they are in epilepsy.Methods:30 healthy adult male Sprague–Dawley rats were divided into 6 groups(n=5 per group) : control group and groups assessed at 1d, 3d, 7d, 14 d, and 30 days after kindling by lithium chloride-pilocarpine, then CASK expression were measured by immunohistochemistry, immunoflurescence and western blotting. 21 healthy adult male Sprague–Dawley rats were divided into 3 groups(n=7 per group) A modified lentivirus was used to knockdown CASK expression in rats. Subsequently, the behavior of these rats was observed in the first hour after kindling and the expression of N-methel-D-aspartate receptor subunit2b(NMDAR2b) which is the downstream of CASK complex was further examined post-seizure.TCD ultrasound was used to evaluate the flow velocity & waveform patterns of middle cerebral artery(MCA), while PPG infrared signals were utilized to assess the peripheral circulation as a mean of measuring cardiovascular activities. The research was carried out on a sample of 36 individuals, of which 16 met the DOC criteria and 21 were healthy individuals, causes of cerebral injury were following: 8 due to traumatic brain injury, 5 caused by hypoxic ischemic encephalopathy, 2 cases of hemorrhagic stroke and 1 case of alcoholic encephalopathy. Each person in the patients groups was assessed by the Coma Recovery Scale-Revised(CRS-R)。Results:CASK is expressed only in neurons not gliacyte, and the number of CASK positive-cell in experimental group is more than that in control group. CASK expression in the hippocampus was reduced to minimum at 1 d after kindling, and maintained at increased levels until 30days(except at 14 days)(p<0.05). After CASK knockdown,both seizure frequency and seizure class of the epilepsy in the SD rats were decreased. Before CASK knockdown, NMDAR2 b expression in the hippocampus increased at 24 hours and maintained at 3 days and decreased at 10 days following kindling.. After CASK knockdown, NMDAR2 b expression in the hippocampus was reduced at the same time point comparing with the previous intervention following kindling.Systolic velocity, end-diastolic velocity & mean velocity of middle cerebral artery in tested patients, as detected by TCD, were at levels of 75.56cm/s, 23.31cm/s and 38.88cm/s respectively, a decrease of 23%, 43% and 38% in relation to normal values. The values of pulsatility index(PI) of the middle cerebral artery(MCA) increased in patients groups comparing with normal. Through multiple linear correlation analysis, we found that the PI of the left MCA of TCD of the patients correlated with their motor subscore, included in their Coma Recovery Score–Revised(CRS-R)(Pearson’s product-moment correlation coefficient=-0.556,p= 0.025). The values of photoplethysmographic augmentation index(PAI) that were detected by PPG were at 0.093. An increase of 85% in relation to normal values. Finally, using multiple linear correlation analysis we found the correlation between the PAI of PPG and the mean velocity of the left MCA of the TCD(Pearson’s product-moment correlation coefficient=-0.377,p= 0.022)in all the groups.Conclusions:The expression of CASK in epilepsy is abnormal than in the controls, which is influencing the occurrence and development of epilepsy. CASK is linked to epilepsy via its action on synaptic NMDAR2 b, which may be the potential target of anti-epileptic drugs.The results of this study revealed a specific relationship between TCD PI and PPG PAI in the DOC patients. That relationship can potentially be exploited to enhance the capabilities in early assessment of the deconditioning of the DOC parients’ cardiovascular system & its influence on their cerebral vascular system. Ultimately, the dependency discovered can assist in predicting the tendency of the prognosis of the DOC patients in clinic especially when they are in epilepsy.