Objective: To investigate the different effects on evacuation of hematoma, the severity of nerve injury, inflammatory reaction and oxidative stress response in the treatment of acute intracerebral hemorrhage by using ...Objective: To investigate the different effects on evacuation of hematoma, the severity of nerve injury, inflammatory reaction and oxidative stress response in the treatment of acute intracerebral hemorrhage by using minimally invasive puncture and drainage assisted with alteplase or urokinase. <br> Methods:A total of 114 patients with acute intracerebral hemorrhage treated with minimally invasive puncture and drainage in our hospital from May 2012 to October 2015 were retrospectively analyzed and divided into alteplase group and urokinase group, which received adjuvant therapy with alteplase and urokinase, respectively. Before and after treatment, CT was used for scanning, and the volume of hematoma and edema and the distance of midline shift were examined. After treatment, serum was collected for detecting the contents of molecular markers of nerve injury, inflammatory reaction and oxidative stress response. <br> Results:On the 3rd day after treatment, the volume of hematoma and edema and the distance of midline shift in minimally invasive group were significantly lower than those of craniotomy group, and incidence of intracranial infection was lower than that of craniotomy group. There was no significant difference of rebleeding incidence compared to craniotomy group. The serum contents of osteopontin, S100β, glial fibrillary acidic protein, neuron-specific enolase, myelin basic protein, neuropeptide Y, ischemia modified albumin, tumor necrosis factor alpha, interleukin-1β, interleukin-6, interleukin-8, soluble intercellular adhesion molecule-1, high-mobility group protein 1, malonaldehyde, advanced oxidation protein products and 8-hydroxy-2'-deoxyguanosine urine of patients from alteplase group were significantly lower than those of urokinase group. The content of total antioxidant capacity was obviously higher than that of urokinase group. <br> Conclusions: As for the effect on evacuation of hematoma and also the ameliorative effect on nerve injury, inflammatory reaction and oxidative stress response in treatment of acute intracerebral hemorrhage, minimally invasive puncture and drainage assisted with alteplase was superior to adjuvant therapy with urokinase.展开更多
Spontaneous intracerebral hemorrhage (ICH) accounts for one fifth of all strokes and is associated with an extremely high rate of morbidity and mortality. Affecting greater than 1 million people a year, ICH will leave...Spontaneous intracerebral hemorrhage (ICH) accounts for one fifth of all strokes and is associated with an extremely high rate of morbidity and mortality. Affecting greater than 1 million people a year, ICH will leave the majority of its’ patients significantly disabled or dead. An initially high systolic blood pressure upon presentation is associated with hematoma expansion, peri-hema- toma expansion, and increased mortality. The relationship between blood pressure, the degree of blood pressure control and hematoma expansion has yet to be defined, but the literature has ob- served a relationship between tightly controlled blood pressures and decreased hematoma expansion. There have been many proposed mechanisms to explain this effect. Larger initial hematomas may lend greater hydrostatic forces and this could result in greater total hematoma volume, and greater surrounding edema. Recent literature has suggested that blood pressure reductions in acute ICH may be tolerated because of reduced metabolism, and preserved autoreguation in the peri-hematoma region. The volume of the hematoma is a critical determinant of mortality and functional outcome after intracerebral hemorrhage, and early hematoma growth is an important cause of neurologic deterioration. An increase in volume of more than thirty-three percent is detectable on repeated computed tomography (CT) in thirty-eight percent of patients initially scanned within the first three hours of onset of symptoms;in two thirds of these cases this change is noticeable on CT within the first hour. This supports the hypothesis that early aggressive blood pressure optimization would decrease hematoma size and edema. This is further supported by the fact that patients with high blood pressure and acute intracerebral hemorrhage have worse outcomes than their counterparts. We hypothesize that prompt and aggressive, early blood pressure reduction in emergency department patients with acute spontaneous intracerebral hemorrhage will result in a reduction of early hematoma growth. The study institution is a large urban emergency department and tertiary care stoke center, with over 55,000 emergency department visits per year. This prospective cohort study compared the results and outcomes observed within the enrolled prospective study population, to the results and outcomes of a matched historical cohort population (future patients with intracranial hemorrhage that did not receive the ABC-ICH protocol). Methods and Material: A nicardipine infusion was administered to optimize blood pressure in all patients presenting with intracerebral hemorrhage with a target mean arterial pressure (MAP) of 80 - 110. Hematoma volume (primary outcome measure) was measured on cat scans at time of presentation and at twenty-four hours. The hematoma volume in the enrolled prospective study population was compared to those of a matched cohort (patients with intracranial hemorrhage that did not receive the ABC-ICH protocol following the conclusion of the study). Results: One hundred total patients were enrolled into the study. Fifty patients were enrolled prospectively in the study and matched to a similar group of fifty cohort patients. The difference in the mean change of hematoma volume at twenty-four hours was 7.29 ml (control) and 2.84 ml (study). The result was an absolute decrease in hematoma size of 4.45 ml in the group treated aggressively with nicardapine for blood pressure reduction within one hour of their initial presentation. Conclusions: These results support the previous research suggesting that aggressive blood pressure control in intracerebral hemorrhage reduces hematoma growth, however the clinical benefit of such a reduction will have to be evaluated in ongoing research.展开更多
Objective.To explore the seasonal changes of hemorheology in patients with intracerebral hemorrhage in acute phase.Methods.The hemorheology indexes were detected in 100 acute cerebral hemorrhage patients and 30 normal...Objective.To explore the seasonal changes of hemorheology in patients with intracerebral hemorrhage in acute phase.Methods.The hemorheology indexes were detected in 100 acute cerebral hemorrhage patients and 30 normal persons.The observed group were divided into summer group,transition season group and winter group according to traditional solar terms,then the hemorheology indexes of different groups were compared.Results.Compared with control group,the whole blood viscosity increased with statistical significance(P<0.05).The whole blood viscosity of four cut blood rates and plasma viscosity were further compared in summer group,transition season group and winter group,and the indexes were the highest in winter group.Compared with transition season group,the erythrocyte aggregation index and erythrocyte transformation index acute intracerebral hemorrhage patients were decreased in winter group and summer group.The whole blood viscosity,plasma viscosity and erythrocyte sedimentation rate(ESR)compared in each group were increased with statistical significance.There were no significant statistical differences in hematocrit(HCT)among each groups(P>0.05).Conclusion.The hemorheology indexes in acute intracerebral hemorrhage patients are influenced by changes of different seasons and The blood of acute cerebral hemorrhage patients shows a concentrated tendency.The whole blood viscosity and plasma viscosity of acute cerebral hemorrhage patients were increased more obviously in winter group,which may be a pathophysiological basis of high incidence of acute cerebral hemorrhage in cold season and increase of severe cases.展开更多
Background: Hyperglycemia is always seen amongst acute intra-cerebral hemorrhage (ICH) and usually has been reported in literature and studied in relation to mortality and poor recovery. However, literature specific t...Background: Hyperglycemia is always seen amongst acute intra-cerebral hemorrhage (ICH) and usually has been reported in literature and studied in relation to mortality and poor recovery. However, literature specific to stroke-associated pneumonia (SAP) on this topic is very small. Further, how to differentiate the predictive value of hyperglycemia with and without abnormal HbA1C in such patients is still a matter of debate and no universal consensus. We evaluated hyperglycemia as a marker for SAP in patients with ICH to assess its usefulness as a potential predictor. Materials and methods: Clinical characteristics for a sample of 551 patients with acute ICH were collected from the Beijing Tiantan Hospital of Capital Medical University, Beijing, China. Possible associated risk factors of SAP were reviewed. Hyperglycemia and HbA1C on admission were the main hypothetic predictor, SAP occurring within the first 7 days is the primary outcome. Results: The cohort study includes 551 hospitalized patients. The prevalence of hyperglycemia was 52.5% and SAP occurred in 147 (26.7%). The incidence of SAP was higher in the group with hyperglycemia than those without hyperglycemia (37.7% versus 14.5%, p 6.5) (OR, 1.57;95%CI, 0.81 - 3.23) had not been shown to be associated with SAP. Conclusions: In this hospital-based cohort of patients presenting with acute intra-hemorrhage, hyperglycemia on admission was associated significantly with SAP. The association was stronger for hyperglycemia with normal HgbA1C than for hyperglycemia with high HgbA1C. Hyperglycemia with normal HgbA1C might be a more sensitive predictor of early acute complication, such as SAP.展开更多
The corticospinal tract （CST） is a major neuronal tract of motor function in the human brain （York, 1987; Davidoff, 1990; Jang, 2014）. Recovery of an injured CST is one of the motor recovery mechanisms in stroke p...The corticospinal tract （CST） is a major neuronal tract of motor function in the human brain （York, 1987; Davidoff, 1990; Jang, 2014）. Recovery of an injured CST is one of the motor recovery mechanisms in stroke patients （Hendricks et al., 2003; Jang et al., 2006, 2007; Swayne et al., 2008; Kwon et al., 2011, 2013; Kwon and Jang, 2012; Yeo and Jang, 2013; Rong et al., 2014）. Diffusion tensor tractography （DTT）, derived from diffusion tensor imaging （DTI）, and transcra- nial magnetic stimulation （TMS） have been widely used in demonstrating the recovery of an injured CST （Hendricks et al., 2003; Jang et al., 2006, 2007; Swayne et al., 2008; Pannek et al., 2009; Kwon et al., 2011, 2013; Kwon and Jang, 2012; Yeo and Jang, 2013; Rong et al., 2014）. DTT has the advan- tage of enabling visualization of the architecture and integ- rity of the CST at the subcortical level in three dimensions （Mori et al., 1999; Kunimatsu et al., 2004）.展开更多
Lipid peroxidation mediated by oxygen radical is one of the main mechanisms underlying secondary brain injury. Among all vitamin E compounds, α-tocopherol shows the most prominent antioxidative effects. It plays an i...Lipid peroxidation mediated by oxygen radical is one of the main mechanisms underlying secondary brain injury. Among all vitamin E compounds, α-tocopherol shows the most prominent antioxidative effects. It plays an important role in cell aging and injury. However, there has been no report regarding the effects of α-tocopherol on changes in brain tissue morphology after intracerebral hemorrhage (ICH), cerebral edema, or the expression of Bax and Bcl-2 proteins. We use SD rats to carry out the related studies;based on the atlas of SD rats, the caudate nucleus was positioned using a stereotaxic apparatus, and 50 μl autologous tail artery blood was injected to caudate nucleus in the ICH and α-tocopherol groups to establish ICH model. Rats in the sham surgery group received the same volume of saline in the caudate nucleus. Rats in the α-tocopherol group received intraperitoneal injections of α-tocopherol at 600 mg/kg every day. Rats in the ICH group and sham surgery group received the same amount of saline at the same times as those in the α-tocopherol group. We observed some interesting results: comparisons of brain tissue sections of rats from different groups showed that brain tissue damage and functional neurological deficits among rats from the α-tocopherol group were less pronounced than in the ICH group. Wet weight/ dry weight measurement showed that rats from the α-tocopherol group exhibited less cerebral edema than those in the ICH group. Rats from the α-tocopherol group showed less Bax expression and more Bcl-2 expression than those in the ICH group.展开更多
BACKGROUND: The mechanism of intracerebral hemorrhage (ICH)-induced hemorrhagic brain injury is very complicated, involving the position-occupying effect of cephalophyma, ischemic factors, the toxic effect of hematoma...BACKGROUND: The mechanism of intracerebral hemorrhage (ICH)-induced hemorrhagic brain injury is very complicated, involving the position-occupying effect of cephalophyma, ischemic factors, the toxic effect of hematoma components, the destruction of blood-brain barrier, etc. The expression and effect of hemeoxygenase-1 (HO-1) in the cerebrovascular disease has been paid close attention. OBJECTIVE: To observe the expression of HO-1 and change of superoxide dismutase (SOD) in the peri-hematomal brain tissue of rats following ICH. DESIGN: Randomized controlled animal experiment. SETTING: Department of Neurology, Yijishan Hospital Affiliated to Wannan Medical College. MATERIALS: Forty healthy male SD rats, of clean grade, weighing from 250 to 300 g, were provided by Qinglongshan Animal Farm of Nanjing. The involved 40 rats were randomized into sham-operation group (n =5) and ICH group (n =35), and ICH group was divided into 7 subgroups with 5 rats in each: ICH 6, 12, 24, 48, 72, 100 and 168 hours groups. Rabbit anti-rat HO-1 immunohistochemial kit ( Boster Co., Ltd., Wuhan) and SOD kit (Jiancheng Bioengineering Institute, Nanjing)were used in this experiment. METHODS: This experiment was carried out in the Department of Neurology, Yijishan Hospital Affiliated to Wannan Medical College Between April and July 2005. In the ICH group: Autologous blood of rats was injected into the head of caudate nucleus to create ICH animal models. In the sham-operation group, the same amount of normal saline was injected into the head of caudate nucleus of rats. The brains of rats in each group were harvested at different time points. The hematoma-side brain tissue was cut open in the coronal plane taking hematomal region as center, and the posterior part was fixed with 100 g/L neutral formaldehyde. 100 mg brain tissue was taken from anterior part. The number of positive cells in HO-1 and SOD activity in peri-hematomal brain tissue at different time after ICH were detected by immunohistochemical method and xanthine oxidation method respectively. MAIN OUTCOME MEASURES: ① The expression of HO-1 in the peri-hematomal brain tissue of rats in two groups following ICH.② The expression of SOD activity in the peri-hematomal brain tissue of rats in two groups following ICH. RESULTS: ①The number of HO-1 positive cells in the peri-hematomal brain tissue of rats in two groups following ICH 6, 12, 24, 48, 72, 120 and 168 hours was (11.03±2.01),(16.47±2.98),(25.50±5.65),(51.57±7.05),(47.33±4.73),(26.57±5.12),(7.63±2.17) cells/high-fold visual field , respectively; The number of HO-1 positive cells in the ICH 12-120 hours groups was significantly higher than that of sham-operation group [(6.07±1.85)cells/high-fold visual field, P < 0.01]; The HO-1 positive cells were the most in the ICH 48 hours group and were still expressed a little in the ICH 168 hours group. ② The SOD in the brain tissue of rats at ICH 6, 12, 24, 48, 72, 120 and 168 hours was (404.46±8.14),(396.84±10.97),(387.74±5.32),(356.21±9.27),(307.95±10.15),(357.48±11.28) and (402.98±7.23) kNU/g, respectively; The SOD activity of ICH 12 to 120 hours groups was significantly lower than that of sham-operation group [(415.47±11.44) kNU/g,P < 0.01], and that of ICH 72 hours group was the lowest. There was no significant difference of SOD activity between ICH 168 hours group and sham-operation group (P > 0.05). CONCLUSION: Following ICH, the expression of HO-1 in peri-hematomal brain tissue of rats in two groups is obviously increased, but the antioxidant ability of brain tissue is decreased. The changes of both maybe play an important role in the formation of ICH-induced hemorrhagic brain injury.展开更多
BACKGROUND ： Experimental animal models of intracerebral hemorrhag （ICH） are greatly needed, so the process of establishment should be ideal in hematoma formation and easy to operate. OBJECTIVE ： To construct mode...BACKGROUND ： Experimental animal models of intracerebral hemorrhag （ICH） are greatly needed, so the process of establishment should be ideal in hematoma formation and easy to operate. OBJECTIVE ： To construct model of ICH in rats with double injection of autologous blood taken from the cut tail cut and double withdrawal of the needle （shortened as two-step injection model）, and compare with those induced by single and double injections. DESIGN ： A randomized controlled tria SETTING： Department of Neurology, General Hospital of Military Area Command of Chinese PLA. MATERIALS： Thirty male Wistar rats of 10 to 12 months, weighing （400±25） g, provided by the Experimental Center of Medical Animals, General Hospital of Shenyang Military Area Command of Chinese PLA, were divided randomly into 3 groups with 10 rats in each group： two-step injection group, single injection group, double injection group. METHODS ： The experiment was carried out in the Department of Neurology, General Hospital of Military Area Command of Chinese PLA from March to June in 2004. Autologous blood ICH model in rats were established as follows： In the two-step injection group, 50 μL unclotted autologous blood was taken from the rat tail cut, then injected with microsyringe into the caudate nucleus, 10 μL injected at first, paused for 2 minutes, and then the rest 40 μL injected slowly and continuously within 2 minutes. After the injection, the needle was kept immovable for about 4 minutes, withdrawn 2.0 mm, again kept immovable for about 4 minute, and then removed wholly at a slow speed. In the single injection group, 50 μL unclotted tail blood was injected slowly and continuously all within 2 minutes and the needle was slowly removed;（4） In the double injection group, 10 mL blood was injected at first, paused for 2 minutes, the rest 40 μL injected evenly within 2 minutes, and then the needle was withdrawn slowly and uninterruptedly. Neurologic findings were scored in accordance with Longa＇s five-point scale （0-4 scores, the higher the score, the severer the neurological dysfunction）. The rats were killed to remove and sections were prepared, the morphological features of hematomas were grossly observed, the maximal diameter and size of hematomas in each slice were measured with the imaging analytical system, and the volume was calculated. Meanwhile, the conveniences of the techniques were compared. MAIN OUTCOME MEASURES： The morphological features and volume of hematomas, neurologic deficit score （NDS）, and the convenience of the techniques were compared. RESULTS： All the 30 rats were involved in the analysis of results without deletion. （1） Results of the morphological observation of volume of hematoma： In the two-step injection group, hematomas located in the right caudate nucleus area regularly in circular or analogously circular shape in each slice. The formation rate of hematomas in the single injection group and double injection group were lower than those in the two-step injection group [60% （6/10）, 80% （8/10）, 100% （10/10）, P〈 0.01, 0.05]. The volume of hematomas in the single injection group and double injection group were smaller than those in the two-step injection group [（28.5±14.8）, （33.4±7.4）, （41.6±3.9） mm3, P〈 0.01, 0.05]. （2） NDS results： The NDS scores in the single injection group and double injection group were smaller than that in the two-step injection group （0.90±0.83, 1.30±0.78, 1.90±0.57, P〈 0.05）. （3）Comparison of the convenience of the techniques： The double injection method allowed generating reproducible hematomas in rats with shortcomings that it needed autologous arterial blood from femoral artery, and precision instruments such as microinfusion pump. The two-step injection injected fresh unclotting blood taken directly from the tail cut with microsyringe into the rat brain, and it has the advantages of easy operation, no influence on the activity of thrombase, shorter duration for model establishment, and higher rate of hematoma formation, which could generate ideal and economical models of ICH. The two-step injection induced hemotoma regularly in circular or analogously circular shape in each slice, but those induced by single and double injections were mostly in strip or fusiform shapes and extending along the needle tracks or into the ventricle or subarachnoid space. CONCLUSION ： The autologous blood ICH model induced by the two-step injection method is a reproducible and reliable one in regular shape, which is better than those induced by double and single injections.展开更多
Objective:to investigate the expression of yeast silencing information regulator 2(Sirt2)in the secondary injury of intracerebral hemorrhage(ICH).Methods:twelve Sprague Dawley(SD)rats were randomly divided into a sham...Objective:to investigate the expression of yeast silencing information regulator 2(Sirt2)in the secondary injury of intracerebral hemorrhage(ICH).Methods:twelve Sprague Dawley(SD)rats were randomly divided into a sham group and an ICH group,with six rats in each group.A rat model of ICH was established by injecting collagenase type IV into the right striatum of the rats.The expression of Sirt2 was measured by Western blot and immunohistochemistry after ICH.Result:the behavioral score of the ICH rats was the lowest at 48 h after the operation;therefore the rats at 48 h after surgery were selected as the model rats.The expression of Sirt2 was significantly higher in the striatal tissue of the ICH rats compared with the sham group(P<0.05).Conclusion:the expression of Sirt2 around hematoma in ICH rats decreases,and Sirt2 is expected to become a new target for ICH treatment.展开更多
目的系统评价急性缺血性卒中静脉溶栓后症状性颅内出血预测模型的特征,为静脉溶栓临床决策提供参考。方法检索中国知网、万方数据知识服务平台、维普资讯、PubMed、Embase、Web of Science和The Cochrane Library数据库,收集急性缺血性...目的系统评价急性缺血性卒中静脉溶栓后症状性颅内出血预测模型的特征,为静脉溶栓临床决策提供参考。方法检索中国知网、万方数据知识服务平台、维普资讯、PubMed、Embase、Web of Science和The Cochrane Library数据库,收集急性缺血性卒中静脉溶栓后症状性颅内出血预测模型相关研究信息,检索时限为建库至2022年12月18日。由2位研究员独立筛选文献、提取资料并评价偏倚风险后对纳入模型的基本特征和方法论进行系统评价。结果纳入20项研究,共30个预测模型。纳入模型ROC曲线的AUC值范围为0.42~0.94。24个(80%)预测模型的整体预测性能较好,模型对不同结局的定义和算法的区分度有明显差异。最常见的预测因子包括NIHSS评分、年龄、梗死的影像学征象或评分、血糖、收缩压和抗血小板药物。结论急性缺血性卒中静脉溶栓后症状性颅内出血预测模型呈现出建模算法多样化、模型性能更佳化、预测因素多元化等特点,但总体偏倚风险较高,未来研究还需要进一步校准模型。此外,应更加关注模型的更新与外部验证,提高其外推性及临床效用,从而发挥模型更大的临床价值。展开更多
文摘Objective: To investigate the different effects on evacuation of hematoma, the severity of nerve injury, inflammatory reaction and oxidative stress response in the treatment of acute intracerebral hemorrhage by using minimally invasive puncture and drainage assisted with alteplase or urokinase. <br> Methods:A total of 114 patients with acute intracerebral hemorrhage treated with minimally invasive puncture and drainage in our hospital from May 2012 to October 2015 were retrospectively analyzed and divided into alteplase group and urokinase group, which received adjuvant therapy with alteplase and urokinase, respectively. Before and after treatment, CT was used for scanning, and the volume of hematoma and edema and the distance of midline shift were examined. After treatment, serum was collected for detecting the contents of molecular markers of nerve injury, inflammatory reaction and oxidative stress response. <br> Results:On the 3rd day after treatment, the volume of hematoma and edema and the distance of midline shift in minimally invasive group were significantly lower than those of craniotomy group, and incidence of intracranial infection was lower than that of craniotomy group. There was no significant difference of rebleeding incidence compared to craniotomy group. The serum contents of osteopontin, S100β, glial fibrillary acidic protein, neuron-specific enolase, myelin basic protein, neuropeptide Y, ischemia modified albumin, tumor necrosis factor alpha, interleukin-1β, interleukin-6, interleukin-8, soluble intercellular adhesion molecule-1, high-mobility group protein 1, malonaldehyde, advanced oxidation protein products and 8-hydroxy-2'-deoxyguanosine urine of patients from alteplase group were significantly lower than those of urokinase group. The content of total antioxidant capacity was obviously higher than that of urokinase group. <br> Conclusions: As for the effect on evacuation of hematoma and also the ameliorative effect on nerve injury, inflammatory reaction and oxidative stress response in treatment of acute intracerebral hemorrhage, minimally invasive puncture and drainage assisted with alteplase was superior to adjuvant therapy with urokinase.
文摘Spontaneous intracerebral hemorrhage (ICH) accounts for one fifth of all strokes and is associated with an extremely high rate of morbidity and mortality. Affecting greater than 1 million people a year, ICH will leave the majority of its’ patients significantly disabled or dead. An initially high systolic blood pressure upon presentation is associated with hematoma expansion, peri-hema- toma expansion, and increased mortality. The relationship between blood pressure, the degree of blood pressure control and hematoma expansion has yet to be defined, but the literature has ob- served a relationship between tightly controlled blood pressures and decreased hematoma expansion. There have been many proposed mechanisms to explain this effect. Larger initial hematomas may lend greater hydrostatic forces and this could result in greater total hematoma volume, and greater surrounding edema. Recent literature has suggested that blood pressure reductions in acute ICH may be tolerated because of reduced metabolism, and preserved autoreguation in the peri-hematoma region. The volume of the hematoma is a critical determinant of mortality and functional outcome after intracerebral hemorrhage, and early hematoma growth is an important cause of neurologic deterioration. An increase in volume of more than thirty-three percent is detectable on repeated computed tomography (CT) in thirty-eight percent of patients initially scanned within the first three hours of onset of symptoms;in two thirds of these cases this change is noticeable on CT within the first hour. This supports the hypothesis that early aggressive blood pressure optimization would decrease hematoma size and edema. This is further supported by the fact that patients with high blood pressure and acute intracerebral hemorrhage have worse outcomes than their counterparts. We hypothesize that prompt and aggressive, early blood pressure reduction in emergency department patients with acute spontaneous intracerebral hemorrhage will result in a reduction of early hematoma growth. The study institution is a large urban emergency department and tertiary care stoke center, with over 55,000 emergency department visits per year. This prospective cohort study compared the results and outcomes observed within the enrolled prospective study population, to the results and outcomes of a matched historical cohort population (future patients with intracranial hemorrhage that did not receive the ABC-ICH protocol). Methods and Material: A nicardipine infusion was administered to optimize blood pressure in all patients presenting with intracerebral hemorrhage with a target mean arterial pressure (MAP) of 80 - 110. Hematoma volume (primary outcome measure) was measured on cat scans at time of presentation and at twenty-four hours. The hematoma volume in the enrolled prospective study population was compared to those of a matched cohort (patients with intracranial hemorrhage that did not receive the ABC-ICH protocol following the conclusion of the study). Results: One hundred total patients were enrolled into the study. Fifty patients were enrolled prospectively in the study and matched to a similar group of fifty cohort patients. The difference in the mean change of hematoma volume at twenty-four hours was 7.29 ml (control) and 2.84 ml (study). The result was an absolute decrease in hematoma size of 4.45 ml in the group treated aggressively with nicardapine for blood pressure reduction within one hour of their initial presentation. Conclusions: These results support the previous research suggesting that aggressive blood pressure control in intracerebral hemorrhage reduces hematoma growth, however the clinical benefit of such a reduction will have to be evaluated in ongoing research.
文摘Objective.To explore the seasonal changes of hemorheology in patients with intracerebral hemorrhage in acute phase.Methods.The hemorheology indexes were detected in 100 acute cerebral hemorrhage patients and 30 normal persons.The observed group were divided into summer group,transition season group and winter group according to traditional solar terms,then the hemorheology indexes of different groups were compared.Results.Compared with control group,the whole blood viscosity increased with statistical significance(P<0.05).The whole blood viscosity of four cut blood rates and plasma viscosity were further compared in summer group,transition season group and winter group,and the indexes were the highest in winter group.Compared with transition season group,the erythrocyte aggregation index and erythrocyte transformation index acute intracerebral hemorrhage patients were decreased in winter group and summer group.The whole blood viscosity,plasma viscosity and erythrocyte sedimentation rate(ESR)compared in each group were increased with statistical significance.There were no significant statistical differences in hematocrit(HCT)among each groups(P>0.05).Conclusion.The hemorheology indexes in acute intracerebral hemorrhage patients are influenced by changes of different seasons and The blood of acute cerebral hemorrhage patients shows a concentrated tendency.The whole blood viscosity and plasma viscosity of acute cerebral hemorrhage patients were increased more obviously in winter group,which may be a pathophysiological basis of high incidence of acute cerebral hemorrhage in cold season and increase of severe cases.
文摘Background: Hyperglycemia is always seen amongst acute intra-cerebral hemorrhage (ICH) and usually has been reported in literature and studied in relation to mortality and poor recovery. However, literature specific to stroke-associated pneumonia (SAP) on this topic is very small. Further, how to differentiate the predictive value of hyperglycemia with and without abnormal HbA1C in such patients is still a matter of debate and no universal consensus. We evaluated hyperglycemia as a marker for SAP in patients with ICH to assess its usefulness as a potential predictor. Materials and methods: Clinical characteristics for a sample of 551 patients with acute ICH were collected from the Beijing Tiantan Hospital of Capital Medical University, Beijing, China. Possible associated risk factors of SAP were reviewed. Hyperglycemia and HbA1C on admission were the main hypothetic predictor, SAP occurring within the first 7 days is the primary outcome. Results: The cohort study includes 551 hospitalized patients. The prevalence of hyperglycemia was 52.5% and SAP occurred in 147 (26.7%). The incidence of SAP was higher in the group with hyperglycemia than those without hyperglycemia (37.7% versus 14.5%, p 6.5) (OR, 1.57;95%CI, 0.81 - 3.23) had not been shown to be associated with SAP. Conclusions: In this hospital-based cohort of patients presenting with acute intra-hemorrhage, hyperglycemia on admission was associated significantly with SAP. The association was stronger for hyperglycemia with normal HgbA1C than for hyperglycemia with high HgbA1C. Hyperglycemia with normal HgbA1C might be a more sensitive predictor of early acute complication, such as SAP.
基金supported by the DIGIST R&D Program of the Ministry of Science,ICT and Future Planning(15-BD-0401)
文摘The corticospinal tract （CST） is a major neuronal tract of motor function in the human brain （York, 1987; Davidoff, 1990; Jang, 2014）. Recovery of an injured CST is one of the motor recovery mechanisms in stroke patients （Hendricks et al., 2003; Jang et al., 2006, 2007; Swayne et al., 2008; Kwon et al., 2011, 2013; Kwon and Jang, 2012; Yeo and Jang, 2013; Rong et al., 2014）. Diffusion tensor tractography （DTT）, derived from diffusion tensor imaging （DTI）, and transcra- nial magnetic stimulation （TMS） have been widely used in demonstrating the recovery of an injured CST （Hendricks et al., 2003; Jang et al., 2006, 2007; Swayne et al., 2008; Pannek et al., 2009; Kwon et al., 2011, 2013; Kwon and Jang, 2012; Yeo and Jang, 2013; Rong et al., 2014）. DTT has the advan- tage of enabling visualization of the architecture and integ- rity of the CST at the subcortical level in three dimensions （Mori et al., 1999; Kunimatsu et al., 2004）.
文摘Lipid peroxidation mediated by oxygen radical is one of the main mechanisms underlying secondary brain injury. Among all vitamin E compounds, α-tocopherol shows the most prominent antioxidative effects. It plays an important role in cell aging and injury. However, there has been no report regarding the effects of α-tocopherol on changes in brain tissue morphology after intracerebral hemorrhage (ICH), cerebral edema, or the expression of Bax and Bcl-2 proteins. We use SD rats to carry out the related studies;based on the atlas of SD rats, the caudate nucleus was positioned using a stereotaxic apparatus, and 50 μl autologous tail artery blood was injected to caudate nucleus in the ICH and α-tocopherol groups to establish ICH model. Rats in the sham surgery group received the same volume of saline in the caudate nucleus. Rats in the α-tocopherol group received intraperitoneal injections of α-tocopherol at 600 mg/kg every day. Rats in the ICH group and sham surgery group received the same amount of saline at the same times as those in the α-tocopherol group. We observed some interesting results: comparisons of brain tissue sections of rats from different groups showed that brain tissue damage and functional neurological deficits among rats from the α-tocopherol group were less pronounced than in the ICH group. Wet weight/ dry weight measurement showed that rats from the α-tocopherol group exhibited less cerebral edema than those in the ICH group. Rats from the α-tocopherol group showed less Bax expression and more Bcl-2 expression than those in the ICH group.
文摘Intra-cerebral hem-orrhage(ICH)refers tospontaneous intra-cerebral parenchyma bleeding.A series of patho-logical alterations woulddevelop in patients withICH,including,besideshematoma occupyingeffect,secondary cerebral edema and reductionof cerebral blood flow in
文摘BACKGROUND: The mechanism of intracerebral hemorrhage (ICH)-induced hemorrhagic brain injury is very complicated, involving the position-occupying effect of cephalophyma, ischemic factors, the toxic effect of hematoma components, the destruction of blood-brain barrier, etc. The expression and effect of hemeoxygenase-1 (HO-1) in the cerebrovascular disease has been paid close attention. OBJECTIVE: To observe the expression of HO-1 and change of superoxide dismutase (SOD) in the peri-hematomal brain tissue of rats following ICH. DESIGN: Randomized controlled animal experiment. SETTING: Department of Neurology, Yijishan Hospital Affiliated to Wannan Medical College. MATERIALS: Forty healthy male SD rats, of clean grade, weighing from 250 to 300 g, were provided by Qinglongshan Animal Farm of Nanjing. The involved 40 rats were randomized into sham-operation group (n =5) and ICH group (n =35), and ICH group was divided into 7 subgroups with 5 rats in each: ICH 6, 12, 24, 48, 72, 100 and 168 hours groups. Rabbit anti-rat HO-1 immunohistochemial kit ( Boster Co., Ltd., Wuhan) and SOD kit (Jiancheng Bioengineering Institute, Nanjing)were used in this experiment. METHODS: This experiment was carried out in the Department of Neurology, Yijishan Hospital Affiliated to Wannan Medical College Between April and July 2005. In the ICH group: Autologous blood of rats was injected into the head of caudate nucleus to create ICH animal models. In the sham-operation group, the same amount of normal saline was injected into the head of caudate nucleus of rats. The brains of rats in each group were harvested at different time points. The hematoma-side brain tissue was cut open in the coronal plane taking hematomal region as center, and the posterior part was fixed with 100 g/L neutral formaldehyde. 100 mg brain tissue was taken from anterior part. The number of positive cells in HO-1 and SOD activity in peri-hematomal brain tissue at different time after ICH were detected by immunohistochemical method and xanthine oxidation method respectively. MAIN OUTCOME MEASURES: ① The expression of HO-1 in the peri-hematomal brain tissue of rats in two groups following ICH.② The expression of SOD activity in the peri-hematomal brain tissue of rats in two groups following ICH. RESULTS: ①The number of HO-1 positive cells in the peri-hematomal brain tissue of rats in two groups following ICH 6, 12, 24, 48, 72, 120 and 168 hours was (11.03±2.01),(16.47±2.98),(25.50±5.65),(51.57±7.05),(47.33±4.73),(26.57±5.12),(7.63±2.17) cells/high-fold visual field , respectively; The number of HO-1 positive cells in the ICH 12-120 hours groups was significantly higher than that of sham-operation group [(6.07±1.85)cells/high-fold visual field, P < 0.01]; The HO-1 positive cells were the most in the ICH 48 hours group and were still expressed a little in the ICH 168 hours group. ② The SOD in the brain tissue of rats at ICH 6, 12, 24, 48, 72, 120 and 168 hours was (404.46±8.14),(396.84±10.97),(387.74±5.32),(356.21±9.27),(307.95±10.15),(357.48±11.28) and (402.98±7.23) kNU/g, respectively; The SOD activity of ICH 12 to 120 hours groups was significantly lower than that of sham-operation group [(415.47±11.44) kNU/g,P < 0.01], and that of ICH 72 hours group was the lowest. There was no significant difference of SOD activity between ICH 168 hours group and sham-operation group (P > 0.05). CONCLUSION: Following ICH, the expression of HO-1 in peri-hematomal brain tissue of rats in two groups is obviously increased, but the antioxidant ability of brain tissue is decreased. The changes of both maybe play an important role in the formation of ICH-induced hemorrhagic brain injury.
文摘BACKGROUND ： Experimental animal models of intracerebral hemorrhag （ICH） are greatly needed, so the process of establishment should be ideal in hematoma formation and easy to operate. OBJECTIVE ： To construct model of ICH in rats with double injection of autologous blood taken from the cut tail cut and double withdrawal of the needle （shortened as two-step injection model）, and compare with those induced by single and double injections. DESIGN ： A randomized controlled tria SETTING： Department of Neurology, General Hospital of Military Area Command of Chinese PLA. MATERIALS： Thirty male Wistar rats of 10 to 12 months, weighing （400±25） g, provided by the Experimental Center of Medical Animals, General Hospital of Shenyang Military Area Command of Chinese PLA, were divided randomly into 3 groups with 10 rats in each group： two-step injection group, single injection group, double injection group. METHODS ： The experiment was carried out in the Department of Neurology, General Hospital of Military Area Command of Chinese PLA from March to June in 2004. Autologous blood ICH model in rats were established as follows： In the two-step injection group, 50 μL unclotted autologous blood was taken from the rat tail cut, then injected with microsyringe into the caudate nucleus, 10 μL injected at first, paused for 2 minutes, and then the rest 40 μL injected slowly and continuously within 2 minutes. After the injection, the needle was kept immovable for about 4 minutes, withdrawn 2.0 mm, again kept immovable for about 4 minute, and then removed wholly at a slow speed. In the single injection group, 50 μL unclotted tail blood was injected slowly and continuously all within 2 minutes and the needle was slowly removed;（4） In the double injection group, 10 mL blood was injected at first, paused for 2 minutes, the rest 40 μL injected evenly within 2 minutes, and then the needle was withdrawn slowly and uninterruptedly. Neurologic findings were scored in accordance with Longa＇s five-point scale （0-4 scores, the higher the score, the severer the neurological dysfunction）. The rats were killed to remove and sections were prepared, the morphological features of hematomas were grossly observed, the maximal diameter and size of hematomas in each slice were measured with the imaging analytical system, and the volume was calculated. Meanwhile, the conveniences of the techniques were compared. MAIN OUTCOME MEASURES： The morphological features and volume of hematomas, neurologic deficit score （NDS）, and the convenience of the techniques were compared. RESULTS： All the 30 rats were involved in the analysis of results without deletion. （1） Results of the morphological observation of volume of hematoma： In the two-step injection group, hematomas located in the right caudate nucleus area regularly in circular or analogously circular shape in each slice. The formation rate of hematomas in the single injection group and double injection group were lower than those in the two-step injection group [60% （6/10）, 80% （8/10）, 100% （10/10）, P〈 0.01, 0.05]. The volume of hematomas in the single injection group and double injection group were smaller than those in the two-step injection group [（28.5±14.8）, （33.4±7.4）, （41.6±3.9） mm3, P〈 0.01, 0.05]. （2） NDS results： The NDS scores in the single injection group and double injection group were smaller than that in the two-step injection group （0.90±0.83, 1.30±0.78, 1.90±0.57, P〈 0.05）. （3）Comparison of the convenience of the techniques： The double injection method allowed generating reproducible hematomas in rats with shortcomings that it needed autologous arterial blood from femoral artery, and precision instruments such as microinfusion pump. The two-step injection injected fresh unclotting blood taken directly from the tail cut with microsyringe into the rat brain, and it has the advantages of easy operation, no influence on the activity of thrombase, shorter duration for model establishment, and higher rate of hematoma formation, which could generate ideal and economical models of ICH. The two-step injection induced hemotoma regularly in circular or analogously circular shape in each slice, but those induced by single and double injections were mostly in strip or fusiform shapes and extending along the needle tracks or into the ventricle or subarachnoid space. CONCLUSION ： The autologous blood ICH model induced by the two-step injection method is a reproducible and reliable one in regular shape, which is better than those induced by double and single injections.
基金supported by the funds from Doctorate Program Funding of Hebei Normal University,Hebei Province,China(Grant No.198693)General Project of the National Natural Science Foundation of China(Project No.81873180).
文摘Objective:to investigate the expression of yeast silencing information regulator 2(Sirt2)in the secondary injury of intracerebral hemorrhage(ICH).Methods:twelve Sprague Dawley(SD)rats were randomly divided into a sham group and an ICH group,with six rats in each group.A rat model of ICH was established by injecting collagenase type IV into the right striatum of the rats.The expression of Sirt2 was measured by Western blot and immunohistochemistry after ICH.Result:the behavioral score of the ICH rats was the lowest at 48 h after the operation;therefore the rats at 48 h after surgery were selected as the model rats.The expression of Sirt2 was significantly higher in the striatal tissue of the ICH rats compared with the sham group(P<0.05).Conclusion:the expression of Sirt2 around hematoma in ICH rats decreases,and Sirt2 is expected to become a new target for ICH treatment.
文摘目的系统评价急性缺血性卒中静脉溶栓后症状性颅内出血预测模型的特征,为静脉溶栓临床决策提供参考。方法检索中国知网、万方数据知识服务平台、维普资讯、PubMed、Embase、Web of Science和The Cochrane Library数据库,收集急性缺血性卒中静脉溶栓后症状性颅内出血预测模型相关研究信息,检索时限为建库至2022年12月18日。由2位研究员独立筛选文献、提取资料并评价偏倚风险后对纳入模型的基本特征和方法论进行系统评价。结果纳入20项研究,共30个预测模型。纳入模型ROC曲线的AUC值范围为0.42~0.94。24个(80%)预测模型的整体预测性能较好,模型对不同结局的定义和算法的区分度有明显差异。最常见的预测因子包括NIHSS评分、年龄、梗死的影像学征象或评分、血糖、收缩压和抗血小板药物。结论急性缺血性卒中静脉溶栓后症状性颅内出血预测模型呈现出建模算法多样化、模型性能更佳化、预测因素多元化等特点,但总体偏倚风险较高,未来研究还需要进一步校准模型。此外,应更加关注模型的更新与外部验证,提高其外推性及临床效用,从而发挥模型更大的临床价值。
