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1Prof. Dott.. Bondì Massimo . Phone and Fax: 06.9997048-Italy Email:[email protected] ADDRESS- Via Oliivetello,19 Trevignano Romano 00069-Italy BONDI’ MASSIMO Libero docente in Surgical Pathology and Clinical. University La Sapienza –Roma già Primario. General Surgeon. Pathologist.. MD.General Surgeon SYDNEY.Australia BONDI’ MANUELE. Natural Science Degree-Parma University (Italy) TITLE Appeared on the Gazz.Sanit.,Minerva medica,166,3,june,2007 And 12,2008. “Experimental demonstration of the Pathogenesis of the Coma, through the Unified Synaptic channel collapse. Physiological - Clinical and Quantum-electrodynamics considerations.” SUMMARY It is possible to obtain the Coma through the total aspiration of the cerebrospinal fluid. Physiological , Clinical and Quantum-electrodynamics considerations about the traumatic Coma. Ninty minutes for saving the Brain. KEY WORDS CONSCIOUSNESS, CEREBRAL CORTEX, VENTRICLES, CEREBRO-SPINAL FLUID, UNIFIED SYNAPTIC CHANNEL( USC), QUANTUM-ELECTRO-DYNAMICS (QED), PHOTONS. -------------------------------------------- 2Prof. Dott.. Bondì Massimo . Phone and Fax: 06.9997048-Italy Email:[email protected] ADDRESS- Via Oliivetello,19 Trevignano Romano 00069-Italy INTRODUCTION In 1998 Bondì-Bondì (1) describe for the first time an histological structure present in the cerebral cortex, named Unified Synaptic channel (USC). This histological structure (about 200 A* width) was identified as “Synaptic fissure” by Sherrington (2) Nobel 1952. This “fissure” however, according to Bondì, spreads among the miliards (150-200) of cortical-cerebral neurons, assuming the histomorphological particular features of a Channel. J.C.Eccles (3) Nobel 1963, gave the experimental demonstration of the intracellular electric registration of a stimulus-information of excitement-inhibition. Such a stimulus determines one exocytosisemission, which has come to be considered as the basic neuron unitary activity of the cerebral cortex. Every emission of 30-50 microvescicula releases several different neuro-transmitters, which from the presynapse arrives to the post-synapse, there causing, via the mechanismall or nothing- a new electric state called “Depolarisation”corresponding to an excitatory condition defined “Excitatory post-synaptic potential”(EPSP). Eccles later hypothesis defined the EPSP as the Intelligence Quantic Theory and could confirm the dualistic model of mixed transmission of the nervous impuls. QED in the central interneuronic synaptic level of the USC and classical physics at the level of nervous peripheric system. . Bondì proposed a model for the identification of consciousness based on QED activity and its application to the biochemical structure of the USC. Bondì perceives the latter as a channel running in loops all along the labyrinthic structure of the bi-emispheric cerebral cortex and constituting a “new” anatomical and histological structure on its own, along which the flow of molecular (and ionic) particles (such as neurotransmitters) determines a sort of constant low-noise effect. The model also tries to combine classical physics with quantic physics in studying the emersion and identification of consciousness represented as a “whole”. Quantum- electro-dynamics 3Prof. Dott.. Bondì Massimo . Phone and Fax: 06.9997048-Italy Email:[email protected] ADDRESS- Via Oliivetello,19 Trevignano Romano 00069-Italy (QED) applied to the Synaptic space (USC) may constitue the transmission vehicle of the global brain cortex (about 160.000Km.long). The extension of the USC is likely to produce the synchronic and synergic emergence of consciousness in a quantic model based on a finely regulated mechanism of projection of sensorial inputs (comprehending the stages of exocitosis and active transport), which can be assembled in quantic sources and then processed along the USC . We propose a model for the identification of consciousness based on QED activity and its application to the biochemical structure of the USC. In this context the emergence of the awareness of the ”SELF” would thus appear to be based upon a mechanism of an extremely small and shortly lived exchange of neuro-transmitters and other molecules , which according to their diffusion rate seem to sum up their effects to produce a “constant” flow of material.(fig. 1-2-3)(already published) In the 1997 this model was presented to the International Symposium on the “Consciousness” – Belgrado- (4) (5). The pathogenesis of the Coma that is a symptom and not a diagnosis, becomes definitily comprehensible. In fact every time a collection or lump(hematoma,,abcess, tumor ) compresses the cerebral parenchyma, there is a compression of the cortex (about one cm.in thickness) against the cranial non-stretch bone. In this way all the extension-width of USC is reduced or completely disappeared, determining the consciousness loss, that is the Coma, that begins in the precise moment in which the collection reaches the critical limit of the closure (collapse) of the USC. OBJECT OF THE RESEARCH The described model must and can be experimentally proved. The research object is precisely the experimental demonstration of the Coma pathogenesis, never before described. The experimental constitution of a liquid collection ,compressing the cortex, is very difficult; therefore we decided to act contrary, foreseeing to obtain the same result, that is the Coma. 4Prof. Dott.. Bondì Massimo . Phone and Fax: 06.9997048-Italy Email:[email protected] ADDRESS- Via Oliivetello,19 Trevignano Romano 00069-Italy It is well known that the cerebral parenchyma is maintained by a cellular-fibrous network (astroglia,macroglia,mesoglia), that gives itself a soft-firm consistency. This consistency becomes however hard-elastic, for the presence of the ventricles, that plenty of liquor (cerebrospinal fluid), incompressible as all the liquids, contributes to gives the described hard-elastic consistency, necessary for the good functioning of the interneuronic network (USC) and capillary circulation. With the complete emptying of the cerebrospinal fluid contents, it is possible to obtain the sudden and simultaneous collapse of the USC. That means the consciousness loss, i.e. the “Coma” outbreak. MATERIAL AND METHOD The animal sacrifice is not necessary. 1)Animal : big,medium size After a carefull trichotomy of the dorsal-lumbar-sacral region the animal is immobilized. The trichotomy is essential for locating the intervertebral space. 2)Disinfection of the skin. 3)Superficial anesthesia of the animal with etherization causing relaxation for introducing the needle. 4)Introduction of an aspirating needle, like for epidural anesthesia, in the 2nd-3rd intervertebral subaracnoidal space and interposition of a tubule between the needle and a syringe (50 cc.). 4)The animal will be waked up with generous doses of Oxigen 5)As soon as the animal will be awake (presence of the conjunctivalcorneal reflex ) and conscious, all the cerebrospinal liquid will be aspirated until the negative pressure of the syringe. The fluid will stay in the syringe. 6)Aspiration times: rapid= 3 minutes Slow= 5 minutes 7) Disappearance of the reflexes and measuring of the outbreak of consciousness loss corresponding to the total aspiration of the 5Prof. Dott.. Bondì Massimo . Phone and Fax: 06.9997048-Italy Email:[email protected] ADDRESS- Via Oliivetello,19 Trevignano Romano 00069-Italy cerebrospinal fluid. The animal even if stimulated is acinetic and unconscious. 8)The animal is left without consciousness (Coma) for some minutes(3-4) . 9)Slow reintroduction of the fluid before aspirated and measuring of the minutes for the reappearance of consciousness and reflexes. 10)Extraction of the needle RESULT The experiment ( total aspiration of the c.s. fluid from the intervertebral lumbar subaracnoidal space) determines the outbreak of the Coma, caused by the collapse of the USC. This “collapse” is comprehensible, considering the total, sudden and simultaneous emptying of c.s. fluid up to obtain the negative pressure in the syringe. The containers of the c.s. fluid that are the walls of the ventricles cavities falling in, and the cerebral Cortex, site of the course of the USC, loses its hard-elastic consistency because it is no more supported by the pressure that the c.s.fluid acts on the ventricles walls and therefore all the Cortex collapses itself. The USC loses its vacuousness (200 A° ) and its QED ionic included is reabsorbed through the neuronal membranes. The totality of the cortical neurons suddenly and simultaneously is blocked (exocitosys and active transport are interrupted ), the Consciousness disappeares and so the “Coma” appears . The reintroduction of the previously aspirated c.s,fluid determines the reappeared vacuousness (200 A*) of the USC, due to new extension of the cortex (about 1 cm.), and so the “Coma” disappeared. 6Prof. Dott.. Bondì Massimo . Phone and Fax: 06.9997048-Italy Email:[email protected] ADDRESS- Via Oliivetello,19 Trevignano Romano 00069-Italy DISCUSSION Having described the formation and identification of the consciousness appearing like the stream of a river, already understood by William James (6) ,that runs as an ionic-corpusclemolecolar flow through the enormous extension of the USC (160.000 kms.), due to the gyruses of the cerebral cortex(about 1 cm.of thickness), we must affirm that the consciousness is mainly optical, and therefore photonical (about 70-80%) . The remaining 20-25% is represented by the auditory consciousness and for 3-5% by the olfactory,gustatory , thermotactic-tactile and painfull consciousness. It may be interesting to point out synthetically the transformation in image of the photonic component of consciousness. The Creator or the Case, two faces of the same medal, identifiable with the unknown of the” Human Thought”, with the “FIAT LUX” has foreseen in the evolution course an organ capable to observe the Universe Creation. In which way? The Light crosses the pupil, that is the opening in the center of the iris and hits at the speed of 300.000 Km/s. the “retina” membrane at the interior of the ocular globule , that with its nine strata slows down , adsorbs and transforms such a speed-wave, in the dramatically smaller speed of 10 Km/s. By diminishing the speed, the mass increases and the photonic wave assumes the corpuscle form that can move in this way along the fibres of the optical nerve (about 1.250.000), which originates from the 8th stratus of the Retina The nervous fibers have not the histological structure capable to receive the transmission of a wave, that in fact does not need any conductor for its transmission, but needs only the space. The same happens in the transmission of the electrical energy that arrives in our houses with a wire conductor and radio and Tv waves that do not need any conductor wire. The atomic corpuscles put, differently of the waves, one to the other along the nervous fibers, capable to receive this movement due to the neuro-cellular electric potential membrane’s difference. Terminal 7Prof. Dott.. Bondì Massimo . Phone and Fax: 06.9997048-Italy Email:[email protected] ADDRESS- Via Oliivetello,19 Trevignano Romano 00069-Italy station of the cosmic travel of the initial photonic wave is the corticocerebral occipital centre. The optical nerve(about 10 cm. of length in the human brain) after the chiasm decussation , gives off the photonic message transformed in image and colour (after have been registered in the neuronal cells) in the USC, acquiring the QED form. This cosmiccerebral travel is obviously valid also for the sound waves(auditory organ,temporal lobe, about 15-20 %) and for about 3-4% for the gustatory,olfactory, thermotactile and painfull pertaining to the sensorium In this way the system, wave-corpuscle-wave, becomes a restricted necessity. The nervous optical fibers are only the axons of the retinal gangliar cells. Before arriving at the gangliar cells the messages coming from the photo-sensible elements, cones stratus, receive a great quantity of sophisticated analysis of information. Briefly the proteic molecule that linking to the phosphodiesterasis enzyme makes active the Rhodopsine, equivalent to “retinal porpora”, is the “trasducine” which realizes the trasduction between the impact of the photon and the electrical answer of the photoreceptor. Retinal also combines with opsins in the retinal cones to form the three pigments responsible for colour vision. The difference of electric potential that can be measured between outside and inside of the cellular membrane increases during the lighting, so an enormous number of simultaneous photoluminescences is obtained. All the animal visual systems are based on the photoluminescence of the”retinal” hit from the Light. Every “Quantum” of the Light decreasing the speed and adsorbed by a molecule of “Rhodopsine”becomes isomeric for the retinal chromophories. (R.Hubbard, A.Kropf) (7). In such case it is evident that the evolution produced a highly efficient system for carrying out the adsorbed and decreased light in the biochemical language. This language has been developed in three phases: Quantistic(with wave function), electricionic-corpuscle (Optical nerve),QED in the USC. It is so comprehensible as, pervaded by the wave-corpuscle photonic-, coming from the sun radiation, all the biological subjects having a visual field, together with the other sense-organs, have been able to identify themselves , everyone in the peculiar environment, that for the human 8Prof. Dott.. Bondì Massimo . Phone and Fax: 06.9997048-Italy Email:[email protected] ADDRESS- Via Oliivetello,19 Trevignano Romano 00069-Italy subjects signified in the evolution course,( millions years ), the formation and the identification of the Consciousness of the “SELF ” CONCLUSIONS The histological existence of an interneuronic synaptic structure in the cerebral-cortex tissue(USC) where a ionic-corpusclemolecolar flow represented by the reactive activity of the sensorial and motors centers ( and of the human language, with the 3 centers: Broca,Werniche,Kussmaul) , can be identified with the consciousness formation that can be interpreted as a sort of constant,continous and simultaneous low-noise effect. When the cortex receives sufficient afferent impulses, it is said to be aroused or activated. That is, a critical number of cortical neurons is brought into the proper patterns of activity to produce a state of consciousness and alertness. Thus, the great afferent systems are important for promoting cortical activity and, hence,wakefulness. However, at relatively low levels of stimulation this is not enough, and the ascending Reticular activating system of the brain stem, which has its upper end in the posterior hypothalamus, and lower thalamus, becomes important. The RETICULAR system has a generalized influence upon the cortex. The pathways from its upper extremity of the cortex are not well understood, but impulses are presumably related through the thalamic nuclei and through the internal capsule. The Reticular system is thus to maintain wakfulness at levels of visceral and somatic stimulation which would not ordinarily activate the cortex. The sleep produced by lesions of the reticular system is not usually completely irreversible. It may be that cortical sleep, which seems most important in man, is supplemented by subcortical sleep and the same form of consciousness, if not awareness, is possible in the absence of the cortex. From the practical point of view, it is important that extensive hypothalamic and thalamic lesions may produce somnolence or pathologic sleep in patients. The same is true with large lesions extending through the central reticular formation of the midbrain and pons. All in all, the clinical 9Prof. Dott.. Bondì Massimo . Phone and Fax: 06.9997048-Italy Email:[email protected] ADDRESS- Via Oliivetello,19 Trevignano Romano 00069-Italy support the premise that subcortical, as well as cortical mechanisms, are important for changes in the states of consciousness. (F.H. Netter) (9) The total empting of the c. s. fluid can experimentally prove the outbreak of the “coma” that contrary disappears with the reactivation of the consciousness, as soon as the c.s. fluid is reinjected, so reestablished the physiological conditions of substain of the cerebral-cortex stratus, essential for the ionic movement present in the USC. The pathogenesis of the symptom “coma” has so a precise point of reference in the “USC Collapse, ” that must be clinically taken into consideration. Except for the “Pharmacological Coma” that has a pathogenesis hydrophobic-hydrochemical (Hameroff) (8), every Traumatic hemorrhagic compressing Coma, must be taken care of a precox surgical decompression(extradural and subaracnoidal space drenage.ventriculostomy,and if necessary evacuative craniotomy). This decompression must be very early (to save the brain in the first 90 minutes) without loss of precious time in the casualty ward of the peripheral Hospital, from which in a second time the patient is transferred to central Hospital in absence of the neuro-surgeon. In this way the patient receives the hematic leakage that determines infiltration of cortico-cerebral tissue. Thus the degenerative process starts, that after 3 hours determines a deeper and deeper “coma” up to become irreversible (so said brain death). It is a brain death that is caused for lack of organisation. It should be hoped that as for the Angioplasty and for the cerebral apoplectic stroke there could be the continuous presence in Hospitals of Teams ready to operate suitably (Door-to-balloon of Americans ) so opening a temporal reduced window also for the many numerous cranial traumatisms , that contrary are often abandoned to the sad destiny of a brain death frequently avoidable. The patients in “vegetative coma” should be about 1500 according to a recent statistic in Italy. An urgent operation performed in useful time is only a question of organisation. It is absurd to perform only a cardio-respiratory reanimation,without a valid cerebral reanimation. It should be like to perform a blood transfusion in a haemorrhagic patient without operating on the haemorrhagic cause. 10Prof. Dott.. Bondì Massimo . Phone and Fax: 06.9997048-Italy Email:[email protected] ADDRESS- Via Oliivetello,19 Trevignano Romano 00069-Italy The huge increase of the comatose patients is a very important problem to be solved. REFERENCES \) Bondì M.-Bondì M..: Riv.Biol.-Biology Forum. “The role of synaptic junctions in the identification of human consciousness”(1998),91,329-33 2) Sherrington C.S.:” Man on his nature” Cambridge University ,press. London,(1952) 3)Beck F.-Eccles J.C.;”Quantum aspects of brain activity and the role of consciousness”,Proc.Nat.Acad.Sci.,11357-11361,(1989) 4)Bondì M-Bondì M. : “………interpretation of the pathogenesis of the human coma”,ECPD brain consciousness international symposium,2223 September 1997,pag.201-204,Belgrade,Jugoslave 5)Bondì M-.Bondì’ M.: “Quantum electrodynamics(QED) and unified synaptic channel (USC) in the identification of consciousness” Neuroquantology,riv. on line ,June( 2005),www. Neuroquantology.com 6)James W. : “The principle of Psycology”, Harvard Univ., press.reprint.,USA ,(1981) 7) Hubbard R.-Kropf A.: Isomeri molecolari nella Visione”,Le Scienze,Quaderni,29,4,3-12.(1986) 8)Hameroff S.R.-Watt R.C.:”Information in processing microtubules” J.Theor.Biol. 98, 549-561,(1982) 9)Netter F.H.:” Nervous system”, (1968) Edit. CIBA