“…A potential limitation to this complex experimental design comparing the effects of a single ‘hit’, PAE, to a double ‘hit’, i.e., PAE + Stroke, is that we did not include animals in this study which were subject to a sham stroke surgery which would have included the insertion of a needle intracerebrally in an anesthetized animal. The surgical insertion of a needle into the brain, equivalent to a stab-injury model for traumatic brain injury, 44 possibly constitutes a second hit by itself. To address the possibility that surgery procedure itself could elicit a systemic inflammatory response, a separate cohort of adult male and female rats that were either stroke naïve (6 females, 5 males) or exposed to sham surgery (6 females, 5 males), i.e., anesthesia followed by needle insertion into the brain to the same stereotaxic coordinates as above were assessed.…”