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Huo G, Lan Y, Feng Y, Gao X, Chen C. The Efficacy for Hypertensive Intracerebral Hemorrhage Between Neuroendoscopic Surgery and Conservative Treatment: A Retrospective Observational Study. Neurologist 2025; 30:109-115. [PMID: 39575625 DOI: 10.1097/nrl.0000000000000597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2025]
Abstract
OBJECTIVES This study aims to investigate the efficacy of neuroendoscopic surgery in the treatment of hypertensive intracerebral hemorrhage (HICH). METHODS A total of 193 patients diagnosed with HICH were divided into 2 groups in this study: the observation group (n=101) received neuroendoscopic surgery, whereas the control group (n=92) underwent conservative treatment. Then, the outcomes between these 2 groups were compared and assessed. RESULTS In the pretreatment phase, there were no significant differences in the levels of inflammation and neurological function scores between these 2 groups ( P >0.05). After 3 months of treatment, the observation group displayed significantly shorter median hospital stay, lower average hospital costs, and faster hematoma resorption time, along with reduced levels of tumor necrosis factor-alpha (TNF-α), C-reactive protein (CRP), interleukin (IL)-6 and IL-8, aquaporin-4 (AQP4), macrophage migration inhibitory factor (MIF), matrix metalloproteinase-9 (MMP-9), granulocyte macrophage colony stimulating factor (GM-CSF), Nerve Deficiency Scale (NDS), Graeb score, and national institute of health stroke scale (NIHSS) compared with the control group ( P <0.05). In addition, the observation group exhibited higher rate of hematoma clearance and better glasgow outcome scale (GOS) score compared with the control group ( P <0.05). The effective treatment rate in the observation group was notably superior to that in the control group (89.11% vs. 73.91%, P <0.05). CONCLUSIONS Neuroendoscopic surgery is an effective treatment for HICH, with alleviating the inflammatory response and enhancing the neurological function. The treatment shows promising outcomes and justifies extensive implementation.
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Affiliation(s)
- Guojin Huo
- Department of Neurosurgery, Yulin No. 1 Hospital, Yulin City, Shaanxi
| | - Yanping Lan
- Department of Neurosurgery, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan City, Ningxia, China
| | - Yi Feng
- Department of Neurosurgery, Yulin No. 1 Hospital, Yulin City, Shaanxi
| | - Xiang Gao
- Department of Neurosurgery, Yulin No. 1 Hospital, Yulin City, Shaanxi
| | - Chen Chen
- Department of Neurosurgery, Yulin No. 1 Hospital, Yulin City, Shaanxi
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Xiao Z, Mao X, Wang B, Yang Y, Niu J, Yang YM, Liu AH, Duan YH. Relationship between high levels of D-dimer and prognosis in patients with spontaneous supratentorial cerebral haemorrhage: A retrospective study and double validation. J Stroke Cerebrovasc Dis 2025; 34:108129. [PMID: 39528055 DOI: 10.1016/j.jstrokecerebrovasdis.2024.108129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2024] [Revised: 10/16/2024] [Accepted: 11/08/2024] [Indexed: 11/16/2024] Open
Abstract
OBJECTIVE The aim of this study was to investigate the correlation between D-Dimer and unfavorable outcome after surgery for spontaneous supratentorial intracerebral hemorrhage(SSICH) METHODS: A total of 557 patients with spontaneous supratentorial intracerebral hemorrhage underwent surgical treatment, which included craniotomy evacuation of hematoma and puncture and drainage. Based on the modified Rankin Scale (mRS) bifurcation, the patients were divided into two subgroups: favorable outcome (mRS score 0-2) and unfavorable outcome (mRS score 3-5). D-dimer levels were measured within 24 h of admission, monitored until discharge, and grouped by quartiles (Q1-Q4). We collected and calculated D-dimer levels at different periods of time: (1) at admission (pre-surgery); (2) average post-surgery level; (3) average level during hospitalization; and (4) peak level during hospitalization. Two methods were used for validation, the first using a traditional multifactorial Logsitic regression equation, and the second where we chose baseline clinical, laboratory, and other variables and constructed a prognostic model through multivariate logistic regression. RESULTS Statistical results showed statistically significant differences in age, Glasgow Coma Score (GCS) on admission, high levels of D-dimer, and bleeding. Predictive models developed on the basis of initial age, GCS, and D-Dimer showed good discriminatory power CONCLUSIONS: D-dimer is an independent risk factor for the development of poor postoperative prognosis in patients with SSTICH, and a prognostic model developed on the basis of D-Dimer predicts the development of poor postoperative prognosis in patients with SSTICH. The model needs to be validated in larger studies conducted at other institutions.
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Affiliation(s)
- ZhenKun Xiao
- Hengyang Key Laboratory of Hemorrhagic Cerebrovascular Disease, Department of Neurosurgery, the Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Xingyu Mao
- Hengyang Key Laboratory of Hemorrhagic Cerebrovascular Disease, Department of Neurosurgery, the Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Bing Wang
- Hengyang Key Laboratory of Hemorrhagic Cerebrovascular Disease, Department of Neurosurgery, the Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - YiBo Yang
- Hengyang Key Laboratory of Hemorrhagic Cerebrovascular Disease, Department of Neurosurgery, the Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Jie Niu
- Hengyang Key Laboratory of Hemorrhagic Cerebrovascular Disease, Department of Neurosurgery, the Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Yong-Mei Yang
- Department of Anatomy, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Ai-Hua Liu
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China; Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China.
| | - Yong-Hong Duan
- Hengyang Key Laboratory of Hemorrhagic Cerebrovascular Disease, Department of Neurosurgery, the Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China.
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Wang J, Wang J. Asiaticoside protected brain injury in hypertensive intracerebral hemorrhage via activation of the PI3K/AKT pathway. J Biochem Mol Toxicol 2024; 38:e23843. [PMID: 39253885 DOI: 10.1002/jbt.23843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 08/06/2024] [Accepted: 08/29/2024] [Indexed: 09/11/2024]
Abstract
Hypertensive intracerebral hemorrhage (HICH) is a destructive disease with high mortality, incidence, and disability. Asiaticoside (AC) is a triterpenoid derivative that has demonstrated to exert a protective effect on neuron and blood vessel. To investigate the function and potential mechanism of AC on HICH. Human brain microvascular endothelial cells (hBMECs) were treated with 20 U/mL thrombin for 24 h to establish the HICH model in vitro, and AC with the concentration of 1, 2 and 4 µM were used to incubate hBMECs. The effect and potential mechanism of AC on HICH were investigated by using cell counting kit-8, flow cytometry, tube forming assays, vascular permeability experiments and western blot assays. In vivo, rats were injected with 20 µL hemoglobin with a concentration of 150 mg/mL, and then intragastrically administrated with 1.25, 2.5 and 5 mg/kg AC. Behavioral tests, brain water content measurement, hematoxylin-eosin (HE) staining, terminal deoxynucleotidyl transferase deoxyuridine triphosphate (dUTP) nick end labeling assays, and western blot were used to assess the effect and potential mechanism of AC on HICH. AC (at 2 and 4 µM) improved the proliferation, apoptosis, angiogenesis and vascular permeability in thrombin-induced hBMECs (p < 0.05). Besides, AC (2.5 and 5 mg/kg) ameliorated behavioral scores, brain water content, pathological lesion, apoptosis and the expression of vascular permeability-related proteins in rats with HICH (p < 0.05). In addition, AC elevated the expression of PI3K/AKT pathway after HICH both in cell and animal models (p < 0.05). Application of LY294002, an inhibitor of PI3K/AKT pathway, reversed the ameliorative effect of AC on the proliferation, apoptosis, angiogenesis and vascular permeability in thrombin-induced hBMECs (p < 0.05). AC reduced brain damage by increasing the expression of the PI3K/AKT pathway after HICH.
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Affiliation(s)
- Jicun Wang
- Department of Neurology, The Hospital of Shunyi District Beijing, Beijing, China
| | - Jianxin Wang
- Department of Neurosurgery, Henan Provincial People's Hospital, Henan Provincial Cerebrovascular Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou, China
- Department of Neurosurgery, The Hospital of Shunyi District Beijing, Beijing, China
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Xiao ZK, Duan YH, Mao XY, Liang RC, Zhou M, Yang YM. Traditional craniotomy versus current minimally invasive surgery for spontaneous supratentorial intracerebral haemorrhage: A propensity-matched analysis. World J Radiol 2024; 16:317-328. [PMID: 39239245 PMCID: PMC11372547 DOI: 10.4329/wjr.v16.i8.317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 07/15/2024] [Accepted: 07/23/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND Minimally invasive surgery (MIS) and craniotomy (CI) are the current treatments for spontaneous supratentorial cerebral haemorrhage (SSTICH). AIM To compare the efficacy and safety of MIS and CI for the treatment of SSTICH. METHODS Clinical and imaging data of 557 consecutive patients with SSTICH who underwent MIS or CI between January 2017 and December 2022 were retrospectively analysed. The patients were divided into two subgroups: The MIS group and CI group. Propensity score matching was performed to minimise case selection bias. The primary outcome was a dichotomous prognostic (favourable or unfavourable) outcome based on the modified Rankin Scale (mRS) score at 3 months; an mRS score of 0-2 was considered favourable. RESULTS In both conventional statistical and binary logistic regression analyses, the MIS group had a better outcome. The outcome of propensity score matching was unexpected (odds ratio: 0.582; 95%CI: 0.281-1.204; P = 0.144), which indicated that, after excluding the interference of each confounder, different surgical modalities were more effective, and there was no significant difference in their prognosis. CONCLUSION Deciding between MIS and CI should be made based on the individual patient, considering the hematoma size, degree of midline shift, cerebral swelling, and preoperative Glasgow Coma Scale score.
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Affiliation(s)
- Zhen-Kun Xiao
- Hengyang Key Laboratory of Hemorrhagic Cerebrovascular Disease, Department of Neurosurgery, Hengyang Medical School, University of South China, Hengyang 421000, Hunan Province, China
| | - Yong-Hong Duan
- Hengyang Key Laboratory of Hemorrhagic Cerebrovascular Disease, Department of Neurosurgery, Hengyang Medical School, University of South China, Hengyang 421000, Hunan Province, China
| | - Xin-Yu Mao
- Hengyang Key Laboratory of Hemorrhagic Cerebrovascular Disease, Department of Neurosurgery, Hengyang Medical School, University of South China, Hengyang 421000, Hunan Province, China
| | - Ri-Chu Liang
- Hengyang Key Laboratory of Hemorrhagic Cerebrovascular Disease, Department of Neurosurgery, Hengyang Medical School, University of South China, Hengyang 421000, Hunan Province, China
| | - Min Zhou
- Hengyang Key Laboratory of Hemorrhagic Cerebrovascular Disease, Department of Neurosurgery, Hengyang Medical School, University of South China, Hengyang 421000, Hunan Province, China
| | - Yong-Mei Yang
- Department of Anatomy, Hengyang Medical School, University of South China, Hengyang 421000, Hunan Province, China
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Sun Z, Liu J, Dong S, Duan X, Xue F, Miao X. Prognostic predictive value of intracranial pressure and cerebral oxygen metabolism monitoring in patients with spontaneous intracerebral hemorrhage. Acta Neurol Belg 2023; 123:1815-1821. [PMID: 36029437 PMCID: PMC10505100 DOI: 10.1007/s13760-022-02037-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 07/14/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Our study aimed to investigate the predictive value of intracranial pressure (ICP) and cerebral oxygen metabolism monitoring in the postoperative prognosis of patients with spontaneous intracerebral hemorrhage (SICH). METHODS The clinical data of 55 patients with SICH treated by neurosurgery were analyzed retrospectively. These patients were divided into two groups based on postoperative Glasgow Outcome Scale (GOS) scores, i.e., the poor prognosis group (GOS I-III) and the good prognosis group (GOS IV and V). Next, the ICP and cerebral oxygen metabolism indexes, such as brain temperature (BT), cerebral perfusion pressure (CPP), internal jugular venous oxygen saturation (SjvO2), and arterial partial pressure of carbon dioxide (PaCO2), were recorded after the operation. Further, the prognostic differences between the two groups were compared, and the predictive values were evaluated using the receiver operating characteristic curve (ROC) and area under the curve (AUC). RESULTS The results showed that the average ICP and BT in the good prognosis group were lower than those in the poor prognosis group. However, the CPP and SjvO2 in the good prognosis group were higher than those in the poor prognosis group. Moreover, the incidence of low PaCO2 in the poor prognosis group was higher than that in the good prognosis group. CONCLUSIONS Our results demonstrated that the average ICP, BT, CPP, SjvO2, and arterial PaCO2 may reflect the changes in brain function and cerebral blood flow, which are significantly correlated with the prognosis of patients. Further, our findings indicated that the combined postoperative ICP levels with cerebral oxygen metabolism indexes could guide clinical treatments and predict prognosis.
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Affiliation(s)
- Zhen Sun
- Shaanxi Provincial People’s Hospital, Xi’an, 710086 Shaanxi China
| | - Jing Liu
- Zhujiang Hospital of Southern Medical University, Guangzhou, 510280 Guangdong China
| | - Shengpu Dong
- Shaanxi Provincial People’s Hospital, Xi’an, 710086 Shaanxi China
| | - Xianglong Duan
- Shaanxi Provincial People’s Hospital, Xi’an, 710086 Shaanxi China
| | - Fei Xue
- Shaanxi Provincial People’s Hospital, Xi’an, 710086 Shaanxi China
| | - Xingyu Miao
- Shaanxi Provincial People’s Hospital, Xi’an, 710086 Shaanxi China
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Wang J, Zhou L, Chen Y, Zhou H, Tan Y, Zhong W, Zhou Z. Prediction of short-term prognosis of patients with hypertensive intracerebral hemorrhage by radiomic-clinical nomogram. Front Neurol 2023; 14:1053846. [PMID: 36816560 PMCID: PMC9935706 DOI: 10.3389/fneur.2023.1053846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 01/10/2023] [Indexed: 02/05/2023] Open
Abstract
Hypertensive intracerebral hemorrhage (HICH) is the most common type of spontaneous intracerebral hemorrhage in China which is associated with high mortality and disability. We sought to develop and validate a noncontrast computed tomography (NCCT)-based nomogram model to achieve short-term prognostic prediction for patients with HICH. We retrospectively studied 292 patients with HICH from two medical centers, and they were divided into training (n = 151), validation (n = 66), and testing cohorts (n = 75). Based on radiomics, univariate and multivariate, and logistic regression analyses, four models (black hole sign, clinical, radiomics score, and combined models) were established to predict the prognosis of patients with HICH 30 days after the onset. The results suggested that the combined model had the best predictive performance with the area under the receiver operating characteristic curve (AUC) of 0.821, 0.816, and 0.815 in the training, validation, and testing cohorts, respectively. In addition, a radiomics-clinical (R-C) nomogram was visualized. A calibration curve analysis showed that the R-C nomogram had satisfactory calibration in the three cohorts. A decision curve analysis demonstrated that the R-C nomogram was clinically valuable. Our results suggest that the R-C nomogram can accurately and reliably predict the short-term prognosis of patients with HICH and provide a useful evaluation for making individualized treatment plans.
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Affiliation(s)
- Jing Wang
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lu Zhou
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China,Department of Radiology, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuanyuan Chen
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hongli Zhou
- Department of Radiology, Nanchong Central Hospital, Nanchong, Sichuan, China
| | - Yuanxin Tan
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Weijia Zhong
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China,*Correspondence: Weijia Zhong ✉ ; ✉
| | - Zhiming Zhou
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China,Zhiming Zhou ✉
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Xu HZ, Guo J, Wang C, Liu X, Song ZQ, Chen RF, Qiu B, Wang Q, Huang Y. A Novel Stereotactic Aspiration Technique for Intracerebral Hemorrhage. World Neurosurg 2023; 170:e28-e36. [PMID: 36270590 DOI: 10.1016/j.wneu.2022.10.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Minimally invasive surgery is effective and recommended for treatment of intracerebral hemorrhage; however, neurosurgeons in grass-root hospitals in underdeveloped countries lack effective and precise minimally invasive surgery techniques. The aim of this study was to present a technique of computed tomography angiography-based three-dimensional-printed navigation mold-guided stereotactic aspiration and demonstrate its clinical application using a hard needle in a series of patients. METHODS The novel stereotactic aspiration technique was performed in 18 patients with spontaneous intracerebral hemorrhage at our center, and clinical outcomes were reported. We compared the volume of hematoma measured by 3 different methods: ABC/2 formula, manual segmentation with OsiriX, and manual segmentation with 3D Slicer. RESULTS The surgery was completed safely within an average operative time of 15.11 minutes, achieving the goal of <15 mL residual clot volume or >70% clot removal in all patients. No intracranial rebleeding or infection was observed postoperatively. At the end of the 6-month follow-up, 61.11% (11/18) of patients achieved a modified Rankin Scale score <3. There was overall better agreement of hematoma measurement using segmentation with 3D Slicer rather than ABC/2 measurement or hematoma measurement using segmentation with OsiriX. CONCLUSIONS Our novel method of stereotactic aspiration benefited patients in this study with good percent clot removal, few surgery-related complications, and a favorable prognosis. Manual segmentation with 3D Slicer could be used to provide the neurosurgeon with dependable information about hematoma volume. This cheap and convenient technique may be applied in grass-root hospitals in underdeveloped countries. Assessment in multicenter prospective clinical trials is needed.
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Affiliation(s)
- Heng-Zhou Xu
- Department of Neurosurgery, Civil Aviation General Hospital, Beijing, China
| | - Jing Guo
- Department of Neurology, Civil Aviation General Hospital, Beijing, China
| | - Ce Wang
- Department of Neurosurgery, Civil Aviation General Hospital, Beijing, China
| | - Xiao Liu
- Department of Neurosurgery, Civil Aviation General Hospital, Beijing, China
| | - Zhi-Qiang Song
- Department of Neurosurgery, Civil Aviation General Hospital, Beijing, China
| | - Rui-Feng Chen
- Department of Neurosurgery, Civil Aviation General Hospital, Beijing, China
| | - Bing Qiu
- Civil Aviation Medicine Institute, Civil Aviation Medical Center of CAAC, Beijing, China
| | - Qing Wang
- Civil Aviation Aircrew Medical Assessment, Civil Aviation Medical Center, Beijing, China
| | - Yong Huang
- Department of Neurosurgery, Civil Aviation General Hospital, Beijing, China.
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Li Z, Khan S, Liu Y, Wei R, Yong VW, Xue M. Therapeutic strategies for intracerebral hemorrhage. Front Neurol 2022; 13:1032343. [PMID: 36408517 PMCID: PMC9672341 DOI: 10.3389/fneur.2022.1032343] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/17/2022] [Indexed: 09/03/2023] Open
Abstract
Stroke is the second highest cause of death globally, with an increasing incidence in developing countries. Intracerebral hemorrhage (ICH) accounts for 10-15% of all strokes. ICH is associated with poor neurological outcomes and high mortality due to the combination of primary and secondary injury. Fortunately, experimental therapies are available that may improve functional outcomes in patients with ICH. These therapies targeting secondary brain injury have attracted substantial attention in their translational potential. Here, we summarize recent advances in therapeutic strategies and directions for ICH and discuss the barriers and issues that need to be overcome to improve ICH prognosis.
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Affiliation(s)
- Zhe Li
- Department of Cerebrovascular Diseases, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Academy of Medical Science, Zhengzhou University, Zhengzhou, China
- Henan Medical Key Laboratory of Translational Cerebrovascular Diseases, Zhengzhou, China
| | - Suliman Khan
- Department of Cerebrovascular Diseases, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Academy of Medical Science, Zhengzhou University, Zhengzhou, China
- Henan Medical Key Laboratory of Translational Cerebrovascular Diseases, Zhengzhou, China
| | - Yang Liu
- Department of Cerebrovascular Diseases, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Academy of Medical Science, Zhengzhou University, Zhengzhou, China
- Henan Medical Key Laboratory of Translational Cerebrovascular Diseases, Zhengzhou, China
| | - Ruixue Wei
- Department of Cerebrovascular Diseases, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Academy of Medical Science, Zhengzhou University, Zhengzhou, China
- Henan Medical Key Laboratory of Translational Cerebrovascular Diseases, Zhengzhou, China
| | - V. Wee Yong
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Mengzhou Xue
- Department of Cerebrovascular Diseases, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Academy of Medical Science, Zhengzhou University, Zhengzhou, China
- Henan Medical Key Laboratory of Translational Cerebrovascular Diseases, Zhengzhou, China
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Li W, Wu LX, Huang BS, Yang LJ, Huang JQ, Li ZS, Jiao J, Cheng T, Li D, Xiong Y. A pilot study: Gut microbiota, metabolism and inflammation in hypertensive intracerebral hemorrhage. J Appl Microbiol 2022; 133:972-986. [PMID: 35560738 DOI: 10.1111/jam.15622] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 05/05/2022] [Accepted: 05/10/2022] [Indexed: 11/28/2022]
Abstract
AIMS In recent years, the incidence rate of hypertensive intracerebral hemorrhage (HICH) has been increasing, accompanied by high mortality and morbidity, which has brought a heavy burden to the social economy. However, the pathogenesis of HICH is still unclear. This study intends to explore the mechanism of gut microbiota metabolism and inflammation in the process of HICH to provide a theoretical basis for the diagnosis and treatment of HICH. METHODS AND RESULTS HE staining showed that the brain tissues of model group had obvious edema injury, which indicated that the HICH model was successfully constructed. ELISA analysis showed that IL-1β and TNF-α levels in blood and brain tissues were significantly increased, and IL-10 level was significantly decreased in blood. IHC analysis showed that microglia and macrophages were activated in the model group. 16S rRNA sequence showed that the diversity of gut microbiota in HICH patients decreased. And the microbiota belonged to Firmicutes, Proteobacteria and Verrucomicrobia changed significantly. LC-MS/MS analysis showed that the metabolic phenotype of HICH patients changed. And the 3,7-Dimethyluric acid and 7-Methylxanthine related metabolic pathways of caffeine metabolism pathways were down-regulated in patients with HICH. Bacteroides was negatively correlated with the IL-1β and TNF-α level. Blautia was negatively correlated with the IL-1β and TNF-α level, and positively correlated with the IL-10 level. Akkermansia was negatively correlated with the 3,7-Dimethyluric acid and 7-Methylxanthine. CONCLUSION Our study suggested that HICH accompanied by the increased inflammation in peripheral blood and brain, decreased gut microbiota diversity, altered gut metabolic phenotype, and down-regulation of caffeine metabolism pathway. SIGNIFICANCE AND IMPACT OF THE STUDY Our study reported that HICH accompanied by the increased inflammation, decreased gut microbiota diversity, and altered gut metabolic phenotype. Due to the number of patients, this work was a pilot study.
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Affiliation(s)
- Wei Li
- Department of Neurosurgery, The First Hospital of Changsha, Changsha, Hunan, China
| | - Li-Xiang Wu
- Department of Physiology, school of Basic Medical Sciences, Central South University, Changsha, Hunan, China
| | - Bai-Sheng Huang
- Department of Physiology, school of Basic Medical Sciences, Central South University, Changsha, Hunan, China
| | - Li-Jian Yang
- Department of Neurosurgery, The First Hospital of Changsha, Changsha, Hunan, China
| | - Jun-Qiang Huang
- Department of Neurosurgery, The First Hospital of Changsha, Changsha, Hunan, China
| | - Zeng-Shi Li
- Department of Neurosurgery, The First Hospital of Changsha, Changsha, Hunan, China
| | - Jia Jiao
- Department of Neurosurgery, The First Hospital of Changsha, Changsha, Hunan, China
| | - Tianxiang Cheng
- Department of Neurosurgery, the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Ding Li
- Department of Interventional vascular surgery, Hunan Provincial People's Hospital, Changsha, Hunan, China
| | - Yuanyuan Xiong
- Department of Neurosurgery, the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
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Ren S, Han S, Wang L, Huang Y, Wu J, Wu G. Minimally Invasive Surgery for ICH Evacuation Combined With Deferoxamine Treatment Increased Perihematomal Claudin-5 and ZO-1 Expression Levels and Decreased BBB Permeability in Rabbits. Front Neurol 2022; 13:835494. [PMID: 35309557 PMCID: PMC8927815 DOI: 10.3389/fneur.2022.835494] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveTo investigate the role of minimally invasive surgery (MIS) in intracerebral hemorrhage (ICH) evacuation combined with deferoxamine (DFX) treatment on perihematomal tight junction protein (claudin-5 and ZO-1) expression levels and blood-brain barrier (BBB) permeability in rabbits.MethodsWe randomly assigned 65 male rabbits (weight: 1.9–2.6 kg) to a normal control group (NC group, 13 rabbits), hemorrhage model group (HM group, 13), DFX treatment group (DFX group, 13 rabbits), MIS group (MIS group, 13 rabbits), or MIS combined with DFX treatment group (MIS + DFX group, 13 rabbits). ICH was established in all of the groups except the NC group. MIS was performed to evacuate the hematoma 6 h after the ICH model was created in the MIS and MIS + DFX groups. The DFX and MIS + DFX groups were treated with DFX (100 mg/kg, dissolved in 2 mL of 0.9% saline solution, administered intramuscularly) at 2 h, and then every 12 h for 7 d. The same dose of 0.9% saline solution was administered to the NC, HM, and MIS groups at the same time points. Sixty-five rabbits were divided into 5 groups, and 13 rabbits in each group. Neurological deficit (i.e., Purdy's score) was recorded in all rabbits before euthanasia (N total = 65). In each group, 2 rabbits were used for iron concentration measurement (N total = 10), 2 rabbits were used for brain water content measurement (N total = 10), 3 rabbits were used for BBB permeability measurement (N total = 15), 3 rabbits were used for claudin-5, ZO-1 expression detection by Western Blotting (N total = 15), and 3 rabbits were used for claudin-5, ZO-1 mRNA detection by real-time PCR (N total = 15). On day 7, the rabbits were sacrificed and the perihematomal brain tissue was harvested to test the iron concentration, brain water content (BWC), tight junction proteins (claudin-5 and ZO-1) expression, and BBB permeability.ResultsPurdy's score, iron concentration, and BWC were lower in the MIS and MIS + DFX groups compared to the HM and DFX groups. The MIS + DFX group showed a significant decrease in these indicators. The use of MIS to evacuate the hematoma led to increased expression levels of claudin-5 and ZO-1, as well as decreased BBB permeability. The MIS + DFX group exhibited a remarkable increase in claudin-5 and ZO-1 expression levels and a significant decrease in BBB permeability.ConclusionsMIS combined with DFX treatment could increase the expression levels of perihematomal tight junction proteins (claudin-5 and ZO-1) expression, reduce BBB permeability, and improve the neurological function. MIS combined with DFX treatment may also prevent secondary brain damage following ICH.
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Affiliation(s)
- Siying Ren
- Department of Emergency, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
- *Correspondence: Siying Ren
| | - Shanshan Han
- Graduate School of Guizhou Medical University, Guiyang, China
| | - Likun Wang
- Department of Emergency, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Yuanxin Huang
- Department of Emergency, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Jing Wu
- Graduate School of Guizhou Medical University, Guiyang, China
| | - Guofeng Wu
- Department of Emergency, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
- Guofeng Wu
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11
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Hong Y, Wang XH, Xiong YT, Li J, Liu CF. Association Between Admission Serum Phosphate Level and All-Cause Mortality Among Patients with Spontaneous Intracerebral Hemorrhage. Risk Manag Healthc Policy 2021; 14:3739-3746. [PMID: 34526830 PMCID: PMC8435619 DOI: 10.2147/rmhp.s317615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 09/01/2021] [Indexed: 02/04/2023] Open
Abstract
Background Hypophosphatemia was reported to frequently occur in patients with nontraumatic intracranial hemorrhage (ICH); however, the correlation between hypophosphatemia and outcomes of ICH remains unclear. This study aimed to examine the association between admission serum phosphate and all-cause mortality among patients with mild–moderate spontaneous ICH (sICH). Methods A total of 851 patients with sICH were enrolled. Serum phosphate was acquired within 24 hours on admission, and participants were divided according to phosphate quartiles. The primary outcome was all-cause mortality within 90 days, and univariate and multivariate models were employed to estimate the mortality risk. Results There were significant differences among sICH patients with different phosphate quartiles in terms of age, diastolic blood pressure (DBP), activated partial thromboplastin time (APTT), platelet count, and incidence of respiratory failure events on admission (P < 0.05). Log rank test showed a significant difference in the mortality risk among sICH patients with each phosphate quartile. Univariate Cox regression analysis revealed that age, smoking, DBP, APTT, NIH stroke scale (NIHSS) score, hematoma volume and serum phosphate might be associated with the 90-day all-cause mortality in patients with sICH (P < 0.05). Multivariable Cox regression analysis showed that the crude mortality was 4.3-fold greater in sICH patients with serum phosphate Q1 than those with Q4 (P < 0.001), and remained 3.18-fold higher after adjusting for age, smoking, DBP, APTT, NIHSS score, hematoma volume and early withdrawal of life-sustaining therapy (P = 0.011). Representative operating curve (ROC) analysis showed that admission serum phosphate was predictable for all-cause mortality within 90 days in patients with sICH (area under the ROC = 0.628, P < 0.001). Conclusion Low admission serum phosphate is strongly associated with a high risk of mortality in patients with mild–moderate sICH, and hypophosphatemia may be a prognostic marker for all-cause mortality in patients with mild–moderate sICH.
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Affiliation(s)
- Yu Hong
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215004, People's Republic of China.,Department of Neurology, Affiliated Yixing People's Hospital of Jiangsu University, Yixing, Jiangsu, 214200, People's Republic of China
| | - Xian-Hui Wang
- Department of Neurology, Taicang First People's Hospital, Taicang, Jiangsu, 215400, People's Republic of China
| | - Yi-Tong Xiong
- Department of Neurology, Affiliated Yixing People's Hospital of Jiangsu University, Yixing, Jiangsu, 214200, People's Republic of China
| | - Jie Li
- Department of Neurology, Affiliated Yixing People's Hospital of Jiangsu University, Yixing, Jiangsu, 214200, People's Republic of China
| | - Chun-Feng Liu
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215004, People's Republic of China
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12
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The rule of brain hematoma pressure gradient and its influence on hypertensive cerebral hemorrhage operation. Sci Rep 2021; 11:4599. [PMID: 33633221 PMCID: PMC7907243 DOI: 10.1038/s41598-021-84108-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 02/09/2021] [Indexed: 11/10/2022] Open
Abstract
To comparatively study the size of and variation in the ‘brain-haematoma’ pressure gradient for different surgical methods for hypertensive intracerebral haemorrhage (HICH) and analyse the gradient’s influence on surgical procedures and effects of the haemorrhage. Seventy-two patients with HICH treated from 1/2019 to 12/2019 were randomly divided into two groups, namely, the keyhole endoscopy and large trauma craniotomy groups, according to different operative methods. Intraoperative changes in intracranial pressure (ICP) were monitored to calculate intraoperative alterations in the ‘brain-haematoma’ pressure gradient. Intraoperative characteristics (operative time, bleeding volume, volume of blood transfusion, and haematoma clearance rate) and postoperative characteristics (oedema, postoperative activities of daily living (ADL) scores, mortality rate and rebleeding rate) were compared between the two groups. In the keyhole endoscopy group, ICP decreased slowly; the ‘brain-haematoma’ pressure gradient was large, averaging 251.1 ± 20.6 mmH2O, and slowly decreased. The mean operative time was 83.6 ± 4.3 min, the mean bleeding volume was 181.2 ± 13.6 ml, no blood transfusions were given, the average postoperative haematoma clearance rate was 95.6%, the rate of severe oedema was 10.9%, and the average postoperative ADL score was 85.2%. In the large trauma craniotomy group, ICP rapidly decreased after craniotomy. When the haematoma was removed, the ‘brain-haematoma’ pressure gradient was small, averaging 132.3 ± 10.5 mmH2O, and slowly decreased. The mean operative time was 232 ± 26.1 min, the mean bleeding volume was 412.6 ± 35.2 ml, the average volume of blood transfusion was 281.3 ± 13.6 ml, and the average postoperative haematoma clearance rate was 82.3%; moreover, the rate of severe oedema was 72.1%, and the average postoperative ADL score was 39.0%. These differences were statistically significant (P < 0.05). Neither the death rate (P > 0.05, 2.7% VS 2.8%) nor rebleeding rate (P > 0.05, 2.7% VS 2.8%) showed any obvious changes. The magnitude and variation in the ‘brain-haematoma’ pressure gradient for different surgical methods significantly influence surgical procedures and effects of HICH. During keyhole endoscopy surgery, this gradient was relatively large and slowly decreased; the haematoma was therefore easier to remove. Advantages of this approach include a high haematoma clearance rate, decreased bleeding volume, decreased operative time, reduced trauma, decreased postoperative brain oedema and improved postoperative recovery of neurological function. Chinese Clinical Trial Register: ChiCTR1900020655 registration in 12/01/02,019 registration in 28/02/02,020 Number: NCOMMS-20–08,091.
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13
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Wang X, Hong Y, Wu L, Duan X, Hu Y, Sun Y, Wei Y, Dong Z, Wu C, Yu D, Xu J. Deletion of MicroRNA-144/451 Cluster Aggravated Brain Injury in Intracerebral Hemorrhage Mice by Targeting 14-3-3ζ. Front Neurol 2021; 11:551411. [PMID: 33510702 PMCID: PMC7835478 DOI: 10.3389/fneur.2020.551411] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 11/26/2020] [Indexed: 12/18/2022] Open
Abstract
This study aims at evaluating the importance and its underlying mechanism of the cluster of microRNA-144/451 (miR-144/451) in the models with intracerebral hemorrhage (ICH). A model of collagenase-induced mice with ICH and a model of mice with simple miR-144/451 gene knockout (KO) were used in this study. Neurodeficits and the water content of the brain of the mice in each group were detected 3 days after collagenase injection. The secretion of proinflammatory cytokines, such as tumor necrosis factor α (TNF-α) and interleukin 1β (IL-1β), as well as certain biomarkers of oxidative stress, was determined in this study. The results revealed that the expression of miR-451 significantly decreased in the mice with ICH, whereas miR-144 showed no significant changes. KO of the cluster of miR-144/451 exacerbated the neurological deficits and brain edema in the mice with ICH. Further analyses demonstrated that the KO of the cluster of miR-144/451 significantly promoted the secretion of TNF-α and IL-1β and the oxidative stress in the perihematomal region of the mice with ICH. In addition, the miR-144/451's depletion inhibited the regulatory axis' activities of miR-451-14-3-3ζ-FoxO3 in the mice with ICH. In conclusion, these data demonstrated that miR-144/451 might protect the mice with ICH against neuroinflammation and oxidative stress by targeting the pathway of miR-451-14-3-3ζ-FoxO3.
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Affiliation(s)
- Xiaohong Wang
- School of Medicine, Yangzhou University, Yangzhou, China.,Jiangsu Key Laboratory of Experimental & Translational Non-coding RNA ResearchNoncoding RNA Center, Yangzhou University, Yangzhou, China.,Jiangsu Co-innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou University, Yangzhou, China
| | - Yin Hong
- National Center for Clinical Research of Nervous System Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Lei Wu
- School of Medicine, Yangzhou University, Yangzhou, China.,Jiangsu Key Laboratory of Experimental & Translational Non-coding RNA ResearchNoncoding RNA Center, Yangzhou University, Yangzhou, China
| | - Xiaochun Duan
- Department of Neurosurgery, Affiliated Hospital of Yangzhou University, Yangzhou, China
| | - Yue Hu
- Department of Neurology, Zhangjiagang City First People's Hospital, Zhangjiagang, China
| | - Yongan Sun
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Yanqiu Wei
- School of Medicine, Yangzhou University, Yangzhou, China
| | - Zhen Dong
- School of Medicine, Yangzhou University, Yangzhou, China
| | - Chenghao Wu
- School of Medicine, Yangzhou University, Yangzhou, China.,Jiangsu Key Laboratory of Experimental & Translational Non-coding RNA ResearchNoncoding RNA Center, Yangzhou University, Yangzhou, China
| | - Duonan Yu
- School of Medicine, Yangzhou University, Yangzhou, China.,Jiangsu Key Laboratory of Experimental & Translational Non-coding RNA ResearchNoncoding RNA Center, Yangzhou University, Yangzhou, China.,Jiangsu Co-innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou University, Yangzhou, China
| | - Jun Xu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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14
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Fahlström A, Nittby Redebrandt H, Zeberg H, Bartek J, Bartley A, Tobieson L, Erkki M, Hessington A, Troberg E, Mirza S, Tsitsopoulos PP, Marklund N. A grading scale for surgically treated patients with spontaneous supratentorial intracerebral hemorrhage: the Surgical Swedish ICH Score. J Neurosurg 2020; 133:800-807. [PMID: 31443074 DOI: 10.3171/2019.5.jns19622] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 05/16/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors aimed to develop the first clinical grading scale for patients with surgically treated spontaneous supratentorial intracerebral hemorrhage (ICH). METHODS A nationwide multicenter study including 401 ICH patients surgically treated by craniotomy and evacuation of a spontaneous supratentorial ICH was conducted between January 1, 2011, and December 31, 2015. All neurosurgical centers in Sweden were included. All medical records and neuroimaging studies were retrospectively reviewed. Independent predictors of 30-day mortality were identified by logistic regression. A risk stratification scale (the Surgical Swedish ICH [SwICH] Score) was developed using weighting of independent predictors based on strength of association. RESULTS Factors independently associated with 30-day mortality were Glasgow Coma Scale (GCS) score (p = 0.00015), ICH volume ≥ 50 mL (p = 0.031), patient age ≥ 75 years (p = 0.0056), prior myocardial infarction (MI) (p = 0.00081), and type 2 diabetes (p = 0.0093). The Surgical SwICH Score was the sum of individual points assigned as follows: GCS score 15-13 (0 points), 12-5 (1 point), 4-3 (2 points); age ≥ 75 years (1 point); ICH volume ≥ 50 mL (1 point); type 2 diabetes (1 point); prior MI (1 point). Each increase in the Surgical SwICH Score was associated with a progressively increased 30-day mortality (p = 0.0002). No patient with a Surgical SwICH Score of 0 died, whereas the 30-day mortality rates for patients with Surgical SwICH Scores of 1, 2, 3, and 4 were 5%, 12%, 31%, and 58%, respectively. CONCLUSIONS The Surgical SwICH Score is a predictor of 30-day mortality in patients treated surgically for spontaneous supratentorial ICH. External validation is needed to assess the predictive value as well as the generalizability of the Surgical SwICH Score.
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Affiliation(s)
- Andreas Fahlström
- 1Department of Neuroscience, Neurosurgery, Uppsala University, Uppsala University Hospital, Uppsala
| | | | - Hugo Zeberg
- 3Department of Neuroscience, Karolinska Institutet
| | - Jiri Bartek
- 4Department of Medicine and Clinical Neuroscience, Neurosurgery, Karolinska Institutet, Karolinska University Hospital, Stockholm
- 5Department of Neurosurgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Andreas Bartley
- 6Department of Clinical Neuroscience, Neurosurgery, University of Gothenburg, Sahlgrenska Academy, Sahlgrenska University Hospital, Gothenburg
| | - Lovisa Tobieson
- 7Department of Clinical and Experimental Medicine, Neurosurgery, Linköping University, Linköping University Hospital, Linköping
| | - Maria Erkki
- 8Department of Clinical Neuroscience, Neurosurgery, Umeå University, Umeå University Hospital, Umeå, Sweden; and
| | - Amel Hessington
- 1Department of Neuroscience, Neurosurgery, Uppsala University, Uppsala University Hospital, Uppsala
| | - Ebba Troberg
- 2Department of Clinical Sciences Lund, Neurosurgery, Lund University, Skane University Hospital, Lund
| | - Sadia Mirza
- 4Department of Medicine and Clinical Neuroscience, Neurosurgery, Karolinska Institutet, Karolinska University Hospital, Stockholm
| | - Parmenion P Tsitsopoulos
- 1Department of Neuroscience, Neurosurgery, Uppsala University, Uppsala University Hospital, Uppsala
| | - Niklas Marklund
- 1Department of Neuroscience, Neurosurgery, Uppsala University, Uppsala University Hospital, Uppsala
- 2Department of Clinical Sciences Lund, Neurosurgery, Lund University, Skane University Hospital, Lund
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15
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Hvas CL, Lauridsen SV, Pedersen ES, Gyldenholm T, Hvas AM. Ex vivo effect of hemostatic therapy in subarachnoid and intracerebral hemorrhage. Thromb Res 2020; 189:42-47. [DOI: 10.1016/j.thromres.2020.02.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 01/25/2020] [Accepted: 02/14/2020] [Indexed: 11/30/2022]
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16
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Che XR, Wang YJ, Zheng HY. Prognostic value of intracranial pressure monitoring for the management of hypertensive intracerebral hemorrhage following minimally invasive surgery. World J Emerg Med 2020; 11:169-173. [PMID: 32351650 DOI: 10.5847/wjem.j.1920-8642.2020.03.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The incidence of hypertensive intracerebral hemorrhage (HICH) has been increasing during the recent years in low- and middle-income countries. With high mortality and morbidity rates, it brings huge burden to the families. It lacks evidence regarding the application of intracranial pressure (ICP) monitoring in HICH. In the current study, the authors aimed to evaluate whether ICP monitoring could make any difference on the prognosis of HICH patients after minimally invasive surgery. METHODS A retrospective review of 116 HICH patients admitted to the Second Affiliated Hospital of Zhejiang University School of Medicine, between 2014 and 2016, was performed. The effects of ICP monitoring on 6-month mortality and favorable outcomes were evaluated by univariate and logistic regression analysis. RESULTS ICP monitors were inserted into 50 patients. Patients with ICP monitoring had a significantly better outcome (P<0.05). The average in-hospital duration in patients with ICP monitoring was shorter than that in the patients without ICP monitoring (16.68 days vs. 20.47 days, P<0.05). Mortality rates between ICP monitoring and no ICP monitoring did not differ significantly (16.0% vs. 15.1%, P=0.901). On univariate analysis, age, Glasgow Coma Scale (GCS) on admission and presence of ICP monitor were independent predictors of 6-month favorable outcomes. CONCLUSION ICP monitoring is associated with a better 6-month functional outcome compared with no ICP monitoring. Future study is still needed to confirm our results and elucidate which subgroup of HICH patients will benefit most from the minimally invasive surgical intervention and ICP monitoring.
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Affiliation(s)
- Xiao-Ru Che
- Department of Cardiology, Zhejiang Province People's Hospital, Hangzhou, China.,Department of Cardiology, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Yong-Jie Wang
- Department of Neurosurgery, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Hai-Yan Zheng
- Department of Cardiology, Zhejiang Province People's Hospital, Hangzhou, China.,Department of Neurosurgery, the Fouth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu, China
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17
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Wang S, Cui Y, Xu J, Gao H. miR-140-5p Attenuates Neuroinflammation and Brain Injury in Rats Following Intracerebral Hemorrhage by Targeting TLR4. Inflammation 2020; 42:1869-1877. [PMID: 31376096 DOI: 10.1007/s10753-019-01049-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The Toll-like receptor 4 (TLR4)-mediated neuroinflammation plays a key role in inducing secondary brain injury after intracerebral hemorrhage (ICH). However, how TLR4 is regulated during this pathological process is not well understood. In the present study, by taking advantage of a rat ICH model, we show that miR-140-5p is reversely correlated with TLR4 expression in the peri-hematomal striatum following ICH. In vitro, miR-140-5p directly targets TLR4 and suppresses its expression in a rat neuronal PC12 cell line. Moreover, an intracerebral ventricular injection of miR-140-5p mimics improves neurological function and reduces apoptotic cell death and limits the production of inflammatory cytokines following ICH, indicating that miR-140-5p attenuates brain injury and neuroinflammation in vivo. Furthermore, miR-140-5p suppresses TLR4 expression and inhibits the downstream MyD88/TRIF inflammatory pathway and NF-κB activity following ICH, suggesting that the inhibition of TLR4-mediated neuroinflammation at least in part accounts for the neuroprotective role of miR-140-5 against ICH-induced brain injury in rats. Collectively, these results identify miR-140-5 as a negative regulator of TLR4 and downstream inflammatory pathway following ICH, implicating that miR-140-5 might represent as a potential therapeutic target for alleviating ICH-induced brain injury.
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Affiliation(s)
- Shunda Wang
- Department of Rehabilitation Medicine, Shaanxi Provincial People's Hospital, Xi'an, 710068, Shaanxi, China
| | - Yujie Cui
- Rheumatology Department, The Fifth Affiliated Hospital Sun Yat-sen University, Zhuhai, 519000, China
| | - Jiaqi Xu
- Burn and Plastic Surgery, The Fifth Affiliated Hospital Sun Yat-sen University, Zhuhai, 519000, China
| | - Heng Gao
- Department Emergency Medicine, Shaanxi Provincial People's Hospital, No. 256 Friendship West Road, Xi'an, 710068, Shaanxi, China.
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18
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Hu L, Zhang H, Wang B, Ao Q, He Z. MicroRNA-152 attenuates neuroinflammation in intracerebral hemorrhage by inhibiting thioredoxin interacting protein (TXNIP)-mediated NLRP3 inflammasome activation. Int Immunopharmacol 2020; 80:106141. [PMID: 31982825 DOI: 10.1016/j.intimp.2019.106141] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 11/30/2019] [Accepted: 12/19/2019] [Indexed: 12/22/2022]
Abstract
Neuroinflammation significantly contributes to brain injury and neurological deterioration following intracerebral hemorrhage (ICH). MicroRNA-152(miR-152) was reported to be downregulated in ICH patients and to possess anti-inflammatory properties in other diseases. In this study, we aimed to explore the role of miR-152 in ICH, and the underlying mechanisms, using a collagenase-induced rat ICH model and hemin-exposure as a cell model. We first confirmed that miR-152 was consistently downregulated in both models. Overexpression of miR-152 in microglial BV2 cells reduced hemin-induced inflammatory response and reactive oxygen species (ROS) generation, thus protecting co-cultured neuronal HT22 cells. Moreover, overexpression of miR-152 by intracerebroventricular lentivirus injection in ICH rats significantly alleviated neurodecifits, brain edema, and hematoma. These changes were associated with a marked reduction in ICH-induced neuronal death, as detected by co-staining of NeuN and TUNEL, and ICH-induced neuroinflammation, as revealed by inflammatory cytokine levels as well as by the number of Iba1 positive-stained cells in the perihematomal region. Mechanistically, miR-152 significantly inhibited ICH-induced TXNIP expression, and its overexpression blocked the interaction between TXNIP and NOD-like receptor pyrin domain containing 3(NLRP3), thus inhibiting NLRP3-driven inflammasome activation to attenuate neuroinflammation in vivo and in vitro. Moreover, the results of si-TXNIP transfection further confirmed that TXNIP inhibition was involved in the reduction of NLRP3 inflammasome activation by the overexpression of miR-152. Collectively, the present study demonstrates that miR-152 confers protection against ICH-induced neuroinflammation and brain injury by inhibiting TXNIP-mediated NLRP3 inflammasome activation, indicating a potential strategy for ICH treatment.
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Affiliation(s)
- Liuting Hu
- Department of Neurology, The First Affiliated Hospital of China Medical University, Shenyang 110000, People's Republic of China
| | - Heyu Zhang
- Department of Neurology, The First Affiliated Hospital Sun Yat-sen University, Guangzhou 510080, People's Republic of China
| | - Bingyang Wang
- Department of Neurology, The First Affiliated Hospital of China Medical University, Shenyang 110000, People's Republic of China
| | - Qiang Ao
- Department of Tissue Engineering, China Medical University, Shenyang 110122, People's Republic of China
| | - Zhiyi He
- Department of Neurology, The First Affiliated Hospital of China Medical University, Shenyang 110000, People's Republic of China.
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Ju DT, Lin BJ, Chen YA, Chung TT, Liu WH, Tang CT, Hueng DY, Chen YH, Ma HI, Liu MY, Hung HC. Clinical efficacy of minipterional craniotomy with rostral transsylvian-transinsular approach for hypertensive basal ganglion hemorrhage. JOURNAL OF MEDICAL SCIENCES 2020. [DOI: 10.4103/jmedsci.jmedsci_215_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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20
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Ju DT, Lin BJ, Chen YA, Chung TT, Liu WH, Tang CT, Hueng DY, Chen YH, Ma HI, Liu MY, Hung HC. Clinical efficacy of minipterional craniotomy with rostral transsylvian-transinsular approach for hypertensive basal ganglion hemorrhage. JOURNAL OF MEDICAL SCIENCES 2020. [DOI: 10.4103/1011-4564.283079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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21
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Sun G, Li X, Chen X, Zhang Y, Xu Z. Comparison of keyhole endoscopy and craniotomy for the treatment of patients with hypertensive cerebral hemorrhage. Medicine (Baltimore) 2019; 98:e14123. [PMID: 30633227 PMCID: PMC6336657 DOI: 10.1097/md.0000000000014123] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 12/17/2018] [Accepted: 12/20/2018] [Indexed: 12/15/2022] Open
Abstract
By comparing the intraoperative and postoperative conditions under different surgical methods, namely, keyhole endoscopy and craniotomy, we aim to provide more reasonable surgical treatment for patients with hypertensive cerebral hemorrhage.Eighty-nine patients with cerebral hemorrhage at Rizhao People's Hospital between January 2015 and December 2016 were analyzed retrospectively. Patients were assigned to the keyhole endoscopy group and the craniotomy group. The intraoperative (the duration of operation, operative blood transfusion and loss, and hematoma clearance rate) and the postoperative parameters (death rate, rebleeding rate, edema, and postoperative activity of daily living [ADL] scores) of the 2 groups were compared.Compared with the craniotomy group, the keyhole endoscopy group exhibited decreases in mean blood loss (P < .05, 180 ± 13.6 mL vs 812 ± 35.2 mL), blood transfusion (P < .05, 0 mL vs 480 ± 13.6 mL), the average surgical duration of operation (P < .05, 113 ± 14.3 minutes vs 231 ± 26.1 minutes), and the severe edema rate (P < .05, 10.9% vs 72.1%) and increases in the average hematoma clearance rate (P < .05, 95.6% vs 82.3%) and postoperative ADL scores (P < .05, 85.2% vs 39.0%). Neither the death rate (P > .05, 4.3% vs 4.7%) nor rebleeding rate (P > .05, 2.2% vs 2.3%) showed any obvious changes.Keyhole endoscopy for the treatment of hypertensive intracerebral hemorrhage has the advantages of minimal trauma with good effects, and its main reason for short operation time, reduced bleeding, and high hematoma clearance rate is the "brain-hematoma" pressure gradient. Use of the intraoperative micropull technique and removal of intracerebral hematoma in the shortest time possible are critical factors contributing to the high ADL scores in the keyhole endoscopy group. However, further validation on a larger sample size is required.
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Affiliation(s)
- Guoqing Sun
- Department of Neurosurgery, Rizhao Peoples Hospital Affiliated with Jining Medical University
| | - Xiaolong Li
- Department of Neurosurgery, Rizhao Peoples Hospital Affiliated with Jining Medical University
| | | | - Yuhai Zhang
- Department of Neurosurgery, Rizhao Peoples Hospital Affiliated with Jining Medical University
| | - Zhen Xu
- Department of Neurosurgery, Rizhao People's Hospital Affiliated with Jining Medical University Shandong Province, China
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Hessington A, Tsitsopoulos PP, Fahlström A, Marklund N. Favorable clinical outcome following surgical evacuation of deep-seated and lobar supratentorial intracerebral hemorrhage: a retrospective single-center analysis of 123 cases. Acta Neurochir (Wien) 2018; 160:1737-1747. [PMID: 30051159 PMCID: PMC6105225 DOI: 10.1007/s00701-018-3622-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 07/17/2018] [Indexed: 12/04/2022]
Abstract
Background In spontaneous supratentorial intracerebral hemorrhage (ICH), the role of surgical treatment remains controversial, particularly in deep-seated ICHs. We hypothesized that early mortality and long-term functional outcome differ between patients with surgically treated lobar and deep-seated ICH. Method Patients who underwent craniotomy for ICH evacuation from 2009 to 2015 were retrospectively evaluated and categorized into two subgroups: lobar and deep-seated ICH. The modified Rankin Scale (mRS) was used to evaluate long-term functional outcome. Result Of the 123 patients operated for ICH, 49.6% (n = 61) had lobar and 50.4% (n = 62) deep-seated ICH. At long-term follow-up (mean 4.2 years), 25 patients (20.3%) were dead, while 51.0% of survivors had a favorable outcome (mRS score ≤ 3). Overall mortality was 13.0% at 30 days and 17.9% at 6 months post-ictus, not influenced by ICH location. Mortality was higher in patients ≥ 65 years old (p = 0.020). The deep-seated group had higher incidence and extent of intraventricular extension, younger age (52.6 ± 9.0 years vs. 58.5 ± 9.8 years; p < 0.05), more frequently pupillary abnormalities, and longer neurocritical care stay (p < 0.05). The proportion of patients with good outcome was 48.0% in deep-seated vs. 54.1% in lobar ICH (p = 0.552). In lobar ICH, independent predictors of long-term outcome were age, hemorrhage volume, preoperative level of consciousness, and pupillary reaction. In deep-seated ICHs, only high age correlated significantly with poor outcome. Conclusions At long-term follow-up, most ICH survivors had a favorable clinical outcome. Neither mortality nor long-term functional outcome differed between patients operated for lobar or deep-seated ICH. A combination of surgery and neurocritical care can result in favorable clinical outcome, regardless of ICH location.
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Xia Z, Wu X, Li J, Liu Z, Chen F, Zhang L, Zhang H, Wan X, Cheng Q. Minimally Invasive Surgery is Superior to Conventional Craniotomy in Patients with Spontaneous Supratentorial Intracerebral Hemorrhage: A Systematic Review and Meta-Analysis. World Neurosurg 2018; 115:266-273. [PMID: 29730105 DOI: 10.1016/j.wneu.2018.04.181] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 04/23/2018] [Accepted: 04/24/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Outcomes of minimally invasive surgery (MIS) versus conventional craniotomy (CC) for patients with spontaneous supratentorial intracerebral hemorrhage (SICH) have not been compared previously. We reviewed the current evidence regarding the safety and efficacy of MIS compared with CC in patients with SICH. METHODS We conducted a meta-analysis of studies comparing MIS and CC in patients with computed tomography-confirmed SICH published between January 2000 and April 2018 in MEDLINE, Embase, and the Cochrane Controlled Trials Register based on PRISMA inclusion and exclusion criteria. Binary outcomes comparisons between MIS and CC were described using odds ratios (ORs). RESULTS Five randomized controlled trials (RCTs) and 9 prospective controlled studies (non-RCTs), involving a total of 2466 patients, met our inclusion criteria. There was a statistically significant difference in mortality rate between MIS and CC (OR, 0.76; 95% confidence interval [CI], 0.60-0.97). MIS was associated with a lower rate of rebleeding (OR, 0.42; 95% CI, 0.28-0.64) and a higher rate of good recovery compared with CC (OR, 2.27; 95% CI, 1.34-3.83). CONCLUSIONS Patients with SICH may benefit more from MIS than CC. Our study could help clinicians optimize treatment strategies in SICH.
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Affiliation(s)
- Zhiwei Xia
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xinlong Wu
- Department of Neurosurgery, XinJiang Karamay DuShanZi People's Hospital, Karamay, Xinjiang, China
| | - Jing Li
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhixiong Liu
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Fenghua Chen
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Longbo Zhang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Hongfu Zhang
- Department of Neurosurgery, Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, Henan, China
| | - Xin Wan
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China.
| | - Quan Cheng
- Department of Neurosurgery, XinJiang Karamay DuShanZi People's Hospital, Karamay, Xinjiang, China.
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Ge C, Zhao W, Guo H, Sun Z, Zhang W, Li X, Yang X, Zhang J, Wang D, Xiang Y, Mao J, Zhang W, Guo H, Zhang Y, Chen J. Comparison of the clinical efficacy of craniotomy and craniopuncture therapy for the early stage of moderate volume spontaneous intracerebral haemorrhage in basal ganglia: Using the CTA spot sign as an entry criterion. Clin Neurol Neurosurg 2018; 169:41-48. [PMID: 29625339 DOI: 10.1016/j.clineuro.2018.04.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 03/21/2018] [Accepted: 04/01/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Surgical treatment is widely used for haematoma removal in spontaneous intracerebral haemorrhage (ICH) patients, but there is controversy about the selection of surgical methods. The CT angiography (CTA) spot sign has been proven to be a promising factor predicting haematoma expansion and is recommended as an entry criterion for haemostatic therapy in patients with ICH. This trial was designed to evaluate the clinical efficacy of two surgical methods (haematoma removal by craniotomy and craniopuncture combined with urokinase infusion) for patients in the early stage (≤6h from symptom onset) of spontaneous ICH with a moderate haematoma volume (30 ml - 60 ml). PATIENTS AND METHODS From January 2012 to July 2017, 196 eligible patients treated in our institution were enrolled according to the inclusion criteria. The patients were divided into the CTA spot sign positive type and CTA spot sign negative type according to the presence or absence of the CTA spot sign. For each type, the patients were randomly assigned to two groups, i.e., the craniotomy group, in which patients underwent craniotomy with haematoma removal, and the craniopuncture group, in which patients underwent minimally invasive craniopuncture combined with urokinase infusion therapy. Neurological function was evaluated with the Scandinavian Stroke Scale (SSS) at day 14. The disability level and the activities of daily living were assessed using a modified Rankin Scale (mRS) and Barthel Index (BI) at day 90. Case fatalities were recorded at day 14 and 90. Complications were recorded during hospitalization. RESULTS For the CTA spot sign positive type, the craniotomy group had a higher SSS than that in the craniopuncture group (P < 0.05) at day 14. The rebleeding rate was higher in the craniopuncture group than that in the craniotomy group (P < 0.05) during hospitalization. The craniotomy group had a lower mRS than that in the craniopuncture group (P < 0.01) and had a higher BI than that in the craniopuncture group (P < 0.05) at day 90. There was no statistically significant difference in the fatality rate between the two groups. For the CTA spot sign negative type, there were no significant differences in the SSS, mRS, BI, fatality rate and complication rate between the two groups. CONCLUSION ICH can be divided into the CTA spot sign positive and negative type according to the presence or absence of the CTA spot sign. For the CTA spot sign positive type, patients can benefit from craniotomy with haematoma removal, which can reduce the postoperative rebleeding rate and improve the prognosis. For the CTA spot sign negative type, both craniotomy and craniopuncture are applicable. Considering simple procedure and minor surgical injury, craniopuncture can be a more reasonable choice.
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Affiliation(s)
- Chunyan Ge
- Department of Neurosurgery, Harrison International Peace Hospital (Hengshui People's Hospital) Affiliated to Hebei Medical University, Postal address: No. 180, East Renmin Road, Hengshui City, Hebei Province, China.
| | - Wangmiao Zhao
- Department of Neurosurgery, Harrison International Peace Hospital (Hengshui People's Hospital) Affiliated to Hebei Medical University, Postal address: No. 180, East Renmin Road, Hengshui City, Hebei Province, China.
| | - Hong Guo
- Department of Neurosurgery, Harrison International Peace Hospital (Hengshui People's Hospital) Affiliated to Hebei Medical University, Postal address: No. 180, East Renmin Road, Hengshui City, Hebei Province, China.
| | - Zhaosheng Sun
- Department of Neurosurgery, Harrison International Peace Hospital (Hengshui People's Hospital) Affiliated to Hebei Medical University, Postal address: No. 180, East Renmin Road, Hengshui City, Hebei Province, China.
| | - Wanzeng Zhang
- Department of Neurosurgery, Harrison International Peace Hospital (Hengshui People's Hospital) Affiliated to Hebei Medical University, Postal address: No. 180, East Renmin Road, Hengshui City, Hebei Province, China.
| | - Xiaowei Li
- Department of Neurosurgery, Harrison International Peace Hospital (Hengshui People's Hospital) Affiliated to Hebei Medical University, Postal address: No. 180, East Renmin Road, Hengshui City, Hebei Province, China.
| | - Xuehui Yang
- Department of Neurosurgery, Harrison International Peace Hospital (Hengshui People's Hospital) Affiliated to Hebei Medical University, Postal address: No. 180, East Renmin Road, Hengshui City, Hebei Province, China.
| | - Jinrong Zhang
- Department of Neurosurgery, Harrison International Peace Hospital (Hengshui People's Hospital) Affiliated to Hebei Medical University, Postal address: No. 180, East Renmin Road, Hengshui City, Hebei Province, China.
| | - Dongxin Wang
- Department of Radiology, Harrison International Peace Hospital (Hengshui People's Hospital) Affiliated to Hebei Medical University, Postal address: No. 180, East Renmin Road, Hengshui City, Hebei Province, China.
| | - Yi Xiang
- Department of Neurosurgery, Harrison International Peace Hospital (Hengshui People's Hospital) Affiliated to Hebei Medical University, Postal address: No. 180, East Renmin Road, Hengshui City, Hebei Province, China.
| | - Jianhui Mao
- Department of Neurosurgery, Harrison International Peace Hospital (Hengshui People's Hospital) Affiliated to Hebei Medical University, Postal address: No. 180, East Renmin Road, Hengshui City, Hebei Province, China.
| | - Wenchao Zhang
- Department of Neurosurgery, Harrison International Peace Hospital (Hengshui People's Hospital) Affiliated to Hebei Medical University, Postal address: No. 180, East Renmin Road, Hengshui City, Hebei Province, China.
| | - Hao Guo
- Department of Neurosurgery, Harrison International Peace Hospital (Hengshui People's Hospital) Affiliated to Hebei Medical University, Postal address: No. 180, East Renmin Road, Hengshui City, Hebei Province, China.
| | - Yazhao Zhang
- Department of Neurosurgery, Harrison International Peace Hospital (Hengshui People's Hospital) Affiliated to Hebei Medical University, Postal address: No. 180, East Renmin Road, Hengshui City, Hebei Province, China.
| | - Jianchao Chen
- Department of Neurosurgery, Harrison International Peace Hospital (Hengshui People's Hospital) Affiliated to Hebei Medical University, Postal address: No. 180, East Renmin Road, Hengshui City, Hebei Province, China.
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Kim DB, Park SK, Moon BH, Cho BR, Jang DK, Jang KS. Comparison of craniotomy and decompressive craniectomy in large supratentorial intracerebral hemorrhage. J Clin Neurosci 2018; 50:208-213. [DOI: 10.1016/j.jocn.2018.01.066] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 12/26/2017] [Accepted: 01/11/2018] [Indexed: 11/24/2022]
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Treatment Efficacy of the Transsylvian Approach Versus the Transtemporal Cortex Approach to Evacuate Basal Ganglia Hematoma Under a Microscope. J Craniofac Surg 2016; 27:308-12. [DOI: 10.1097/scs.0000000000002323] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
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Faigle R, Marsh EB, Llinas RH, Urrutia VC, Gottesman RF. Novel score predicting gastrostomy tube placement in intracerebral hemorrhage. Stroke 2014; 46:31-6. [PMID: 25468881 DOI: 10.1161/strokeaha.114.006891] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Dysphagia after intracerebral hemorrhage (ICH) contributes significantly to morbidity, often necessitating placement of a percutaneous endoscopic gastrostomy (PEG) tube. This study describes a novel risk prediction score for PEG placement after ICH. METHODS We retrospectively analyzed data from 234 patients with ICH presenting during a 4-year period. One hundred eighty-nine patients met inclusion criteria. The sample was randomly divided into a development and a validation cohort. Logistic regression was used to develop a risk score by weighting predictors of PEG placement based on strength of association. RESULTS Age (odds ratio [OR], 1.64 per 10-year increase in age; 95% confidence interval [CI], 1.02-2.65), black race (OR, 3.26; 95% CI, 0.96-11.05), Glasgow Coma Scale (OR, 0.80; 95% CI, 0.62-1.03), and ICH volume (OR, 1.38 per 10-mL increase in ICH volume) were independent predictors of PEG placement. The final model for score development achieved an area under the curve of 0.7911 (95% CI, 0.6931-0.8892) in the validation group. The score was named the GRAVo score: Glasgow Coma Scale ≤12 (2 points), Race (1 point for black), Age >50 years (2 points), and ICH Volume >30 mL (1 point). A score >4 was associated with ≈12× higher odds of PEG placement when compared with a score ≤4 (OR, 11.81; 95% CI, 5.04-27.66), predicting PEG placement with 46.55% sensitivity and 93.13% specificity. CONCLUSIONS The GRAVo score, combining information about Glasgow Coma Scale, race, age, and ICH volume, may be a useful predictor of PEG placement in ICH patients.
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Affiliation(s)
- Roland Faigle
- From the Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Elisabeth B Marsh
- From the Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Rafael H Llinas
- From the Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Victor C Urrutia
- From the Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Rebecca F Gottesman
- From the Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
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Wang L, Wang F, Wu G, Shi J. Early-stage minimally invasive procedures decrease perihematomal endothelin-1 levels and improve neurological functioning in a rabbit model of intracerebral hemorrhage. Neurol Res 2014; 37:320-7. [PMID: 25258111 DOI: 10.1179/1743132814y.0000000446] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
INTRODUCTION To determine the effects of minimally invasive surgery (MIS) at various stages after intracerebral hemorrhage (ICH) on perihematomal endothelin (ET)-1 levels and neurological functioning. METHODS Sixty rabbits were randomly distributed into a model control group (MC group, 30 rabbits) or a MIS group (MI group, 30 rabbits). An ICH model was established in all animals. In the MI group, ICH was evacuated by MIS at 6, 12, 18, 24, and 48 hours (six rabbits at each time point) after the ICH was established. The animals in the MC group underwent the same procedures for ICH evacuation, but with a sham operation without hematoma aspiration. All the animals were sacrificed 7 days after the ICH was established. Neurological deficit scores were determined, and the perihematomal brain tissue was removed to determine the ET-1 levels, blood-brain barrier (BBB) permeability, and brain water content (BWC). RESULTS The neurological deficit scores, perihematomal ET-1 levels, BBB permeability, and BWC all decreased significantly in the MI group compared to the MC group. Performing the MIS for evacuating the ICH at 6 hours resulted in the most remarkable decreases in these indices, followed by a significant difference observed at 12 hours within the MI subgroups. CONCLUSIONS Performing MIS at 6-12 hours after ICH resulted in the most significant decreases in neurological deficit scores, ET-1 levels, BBB permeability, and brain edema. The optimal time window for performing MIS for ICH evacuation might be within 6-12 hours after hemorrhage.
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Garrett JS, Zarghouni M, Layton KF, Graybeal D, Daoud YA. Validation of clinical prediction scores in patients with primary intracerebral hemorrhage. Neurocrit Care 2014; 19:329-35. [PMID: 24132566 DOI: 10.1007/s12028-013-9926-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Initial reports of the FUNC score suggest that it may accurately identify those patients suffering from intracerebral hemorrhage (ICH) with an ultra low chance of functional neurologic recovery. This study's aim is to validate the FUNC score and determine if it accurately identifies the cohort of patients with an ultra low chance of survival with good neurologic recovery. METHODS Retrospective review of 501 consecutive primary ICH patients admitted from the Emergency Department to a large healthcare system. Performance of the FUNC, ICH-GS, and oICH scores was determined by calculating areas under the receiver-operator-characteristic curves. Patients with a predicted 100 % chance of poor neurologic outcome (PNO) (FUNC <4 and ICH-GS >10) scores were evaluated to determine if DNR impacted 90 day survival or rate of survival with a Glasgow Outcome Score of <3. RESULTS In 366 cases of primary ICH who presented during the study period, 222(61 %) survived to discharge. Both the FUNC (AUC: 0.873) and ICH-GS (AUC: 0.888) outperformed the oICH (AUC: 0.743) in predicting 90-day mortality (p = <0.001). Of 68 patients with a FUNC score <4, 67 (98.5 %) had PNO at discharge. The presence of DNR was not associated with a significant difference in the rate of PNO at discharge (40/40 = 100 % vs. 27/28 = 96.4 % p = 0.42) or 90-day mortality (40/40 = 100 % vs. 21/28 = 75 %, p = 0.06). CONCLUSION The FUNC and ICH-GS appear superior to the oICH in predicting outcome in patients with primary ICH. In addition, the FUNC score appears to accurately identify patients with low chance of functional neurologic recovery at discharge.
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Affiliation(s)
- John S Garrett
- Department of Emergency Medicine, Baylor University Medical Center, 3500 Gaston Avenue, Dallas, TX, 75246, USA,
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Huynh TJ, Symons SP, Aviv RI. Advances in CT for prediction of hematoma expansion in acute intracerebral hemorrhage. ACTA ACUST UNITED AC 2013. [DOI: 10.2217/iim.13.64] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Fan SJ, Lee FY, Cheung MM, Ding AY, Yang J, Ma SJ, Khong PL, Wu EX. Bilateral substantia nigra and pyramidal tract changes following experimental intracerebral hemorrhage: an MR diffusion tensor imaging study. NMR IN BIOMEDICINE 2013; 26:1089-1095. [PMID: 23417762 DOI: 10.1002/nbm.2922] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 11/29/2012] [Accepted: 12/18/2012] [Indexed: 06/01/2023]
Abstract
The amelioration of secondary neurological damage is among the most important therapeutic goals for patients with intracerebral hemorrhage (ICH). Secondary injury of the ipsilateral substantia nigra (SN) and pyramidal tract (PY) is common after cerebral stroke. Such injury has been characterized previously by anatomical or diffusion MRI, but not in a comprehensive manner, and the knowledge regarding the contralateral changes is relatively poor. This study examined longitudinally both contralateral and ipsilateral SN and PY changes following experimental ICH with diffusion tensor imaging (DTI) and histology. ICH was induced in 14 Sprague-Dawley rats by the infusion of collagenase into the right striatum. Four-shot, spin-echo, echo-planar DTI was performed at 7 T with a b value of 1000 s/mm(2) and 30 diffusion gradient directions at 3.5 h and days 1, 3, 7, 14, 42 and 120 after ICH. Fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (λ// ) and radial diffusivity (λ┴ ) were measured in SN and PY accordingly. Two to three rats were sacrificed at days 3, 7, 42 and 120 for histology. The contralateral SN showed an increase in λ// with perivascular enlargement during the first 3 days after ICH. The ipsilateral SN showed increases in FA, λ// , λ┴ and MD at day 1, dramatic decreases at day 3 with neuronal degeneration and neuropil vacuolation, and subsequent gradual normalization. The contralateral PY showed diffusivity decreases at day 1. The ipsilateral PY showed early decreases and then late increases in MD and λ┴, and continuously decreasing FA and λ// with progressive axonal loss and demyelination. In summary, DTI revealed early bilateral changes in SN and PY following ICH. The evolution of the ipsilateral parameters correlated with the histological findings. In the ipsilateral PY, λ// and λ┴ changes indicated evolving and complex pathological processes underlying the monotonic FA decrease. These results support the use of quantitative multiparametric DTI for the evaluation of SN and PY injuries in clinical and preclinical investigations of ICH.
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Affiliation(s)
- Shu-Juan Fan
- Laboratory of Biomedical Imaging and Signal Processing, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
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Jiménez Caballero PE. [Spontaneous intracerebral hemorrhage: current perspectives]. Med Clin (Barc) 2013; 142:23-4. [PMID: 23790580 DOI: 10.1016/j.medcli.2013.04.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 04/18/2013] [Indexed: 11/29/2022]
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Hayes SB, Benveniste RJ, Morcos JJ, Aziz-Sultan MA, Elhammady MS. Retrospective comparison of craniotomy and decompressive craniectomy for surgical evacuation of nontraumatic, supratentorial intracerebral hemorrhage. Neurosurg Focus 2013; 34:E3. [DOI: 10.3171/2013.2.focus12422] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Surgical evacuation of nontraumatic, supratentorial intracerebral hemorrhage (SICH) is uncommonly performed, and outcomes are generally poor. On the basis of published experimental data and the authors' anecdotal observations, a retrospective chart review study was performed to test the hypothesis that large decompressive craniectomies (DCs), compared with craniotomies, would improve clinical outcomes after surgical evacuation of SICH. For patients with putaminal SICH, DC was associated with a statistically significant improvement in midline shift, compared with craniotomy. Decompressive craniectomies also resulted in a strong trend toward decreased likelihood of poor neurological outcome (modified Rankin Scale score > 3). For patients with lobar SICH, no associations were found between DC or craniotomy and clinical outcomes. For patients selected to undergo surgical evacuation of putaminal SICH, a DC in addition to surgical evacuation of the hematoma might improve outcome.
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What does the CT angiography “spot sign” of intracerebral hemorrhage mean in modern neurosurgical settings with minimally invasive endoscopic techniques? Neurosurg Rev 2012; 36:341-8. [DOI: 10.1007/s10143-012-0437-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2011] [Revised: 04/28/2012] [Accepted: 10/03/2012] [Indexed: 01/19/2023]
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Zhou X, Chen J, Li Q, Ren G, Yao G, Liu M, Dong Q, Guo J, Li L, Guo J, Xie P. Minimally invasive surgery for spontaneous supratentorial intracerebral hemorrhage: a meta-analysis of randomized controlled trials. Stroke 2012; 43:2923-30. [PMID: 22989500 DOI: 10.1161/strokeaha.112.667535] [Citation(s) in RCA: 156] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND PURPOSE There has been a nonstandard surgical procedure and extensive international controversy in minimally invasive surgery (MIS) for the management of spontaneous supratentorial intracerebral hemorrhage. This meta-analysis assessed the effectiveness of MIS as compared with other treatment options, including conservative medical treatment and conventional craniotomy, in patients with supratentorial intracerebral hemorrhage. METHODS PubMed, Embase, Cochrane Controlled Trials Register (CCTR), Web of Science, European Association for Grey Literature Exploitation (EAGLE), National Technical Information Service (NTIS), Current Controlled Trials, Clinical Trials, International Clinical Trials Registry, Internet Stroke Center, Chinese Biomedical Literature Database (CBM), Chinese National Knowledge Infrastructure (CNKI) (last searched December 2011) were searched. Randomized controlled trials on MIS in patients with computed tomography-confirmed supratentorial intracerebral hemorrhage were included. We excluded low-quality randomized controlled trials. The death or dependence at the end of follow-up was defined as the primary outcome, and the death at the end of follow-up was defined as the secondary outcome. RESULTS The 313 randomized controlled trials met the included criteria. We only analyzed 12 high-quality randomized controlled trials involving 1955 patients. The quality of the included trials was consistently high. OR of the primary outcome and secondary outcome of MIS both showed significant reductions (OR, 0.54, P<0.00001; OR, 0.53, P<0.00001). CONCLUSIONS Patients with supratentorial intracerebral hemorrhage may benefit more from MIS than other treatment options. The most likely candidates to benefit from MIS are both sexes, age of 30 to 80 years with superficial hematoma, Glasgow Coma Scale score of ≥9, hematoma volume between 25 and 40 mL, and within 72 hours after onset of symptoms. Our study could help select appropriate patients for MIS and guide clinicians to optimize treatment strategies in supratentorial intracerebral hemorrhage.
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Affiliation(s)
- Xinyu Zhou
- Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, 1 Yixueyuan Road, Yuzhong District, Chongqing 400016, PR China
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Stereotactic aspiration plus subsequent thrombolysis for moderate thalamic hemorrhage. World Neurosurg 2011; 77:122-9. [PMID: 22115547 DOI: 10.1016/j.wneu.2011.06.036] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Revised: 05/05/2011] [Accepted: 06/23/2011] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This study aimed to evaluate the efficacy and safety of stereotactic aspiration combined with subsequent thrombolysis in treating moderate thalamic hemorrhage (TH). METHODS A total of 105 patients with TH were nonrandomly assigned to the conservative treatment group (n = 60) or to the aspiration group (n = 45). Patients in the aspiration group were treated with stereotactic aspiration plus subsequent thrombolysis for removal for their hematomas. RESULTS The 30-day mortality in the conservative group was significantly higher than that in the aspiration group (28.3% (17/60) vs. 11.2% (5/45), P = 0.032). The rank of the 30-day Glasgow outcome scale in the conservative group was significantly lower than that in the aspiration group (P = 0.041), and the mean 30-day National Institutes of Health Stroke Scale score of the survivors in the conservative group was significantly higher than that in the aspiration group (16.5 ± 4. 2 vs. 14.2 ± 3.9, P = 0.012). There were a greater reduction in TH volume in the aspiration group than in the conservative group from day 1 to day 3 (-0.24% and 39.28%, respectively, P < 0.0001) and from day 1 to day 7 (26.58% and 63.26%, respectively, P < 0.0001). The rank of 90-day Glasgow outcome scale was significantly lower in the conservative group than that in the aspiration group (P = 0.015). Eighteen of 60 patients (30.0%) had a favorable outcome in the conservative group, whereas 23 of 45 patients (51.1%) had a favorable outcome in the aspiration group, and this difference was significant (P = 0.028). The 90-day cumulative mortality rate in the conservative group was significantly higher than that in the aspiration group (33.3% (20/60)) vs. 15.6% (7/45), P = 0.039). CONCLUSIONS Stereotactic aspiration plus subsequent thrombolysis is effective and safe for moderate TH.
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Jin K, Mao X, Xie L, Greenberg DA. Neuroglobin expression in human arteriovenous malformation and intracerebral hemorrhage. ACTA NEUROCHIRURGICA. SUPPLEMENT 2011; 111:315-9. [PMID: 21725774 DOI: 10.1007/978-3-7091-0693-8_52] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
We reported previously that Notch signaling is activated in human arteriovenous malformations (AVMs) and that intracerebral hemorrhage (ICH) in humans is accompanied by increased neurogenesis. The former phenomenon may be involved in AVM pathogenesis and the latter in the brain's response to ICH-induced injury. Here we describe increased expression of the hypoxia-inducible neuroprotective protein, neuroglobin (Ngb), in neurons surrounding unruptured AVMs and in the perihematomal region adjacent to ICH. In these disorders, as in other clinical settings, such as ischemic stroke, AVM- and ICH-induced overexpression of Ngb may be stimulated by ischemic hypoxia and may help to constrain brain injury.
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Affiliation(s)
- Kunlin Jin
- Buck Institute for Age Research, 8001 Redwood Boulevard, Novato, CA 94945, USA
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Zhou H, Zhang Y, Liu L, Han X, Tao Y, Tang Y, Hua W, Xue J, Dong Q. A prospective controlled study: minimally invasive stereotactic puncture therapy versus conventional craniotomy in the treatment of acute intracerebral hemorrhage. BMC Neurol 2011; 11:76. [PMID: 21699716 PMCID: PMC3142495 DOI: 10.1186/1471-2377-11-76] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2010] [Accepted: 06/23/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Spontaneous intracerebral hemorrhage (ICH) is a devastating form of stroke with the high mortality twofold to sixfold higher than that for ischemic stroke. But the treatment of haematomas within the basal ganglia continues to be a matter of debate among neurologists and neurosurgeons. The purpose of this study is to judge the clinical value of minimally invasive stereotactic puncture therapy (MISPT) on acute ICH. METHODS A prospective controlled study was undertaken. The clinical trial was in compliance with the WMA Declaration of Helsinki-Ethical Principles for Medical Research Involving Human Subjects. According to the enrollment criterion, there were 168 acute ICH cases analyzed, of which 90 cases were performed by MISPT (MISPT group, MG) and 78 cases by Conventional craniotomy (CC group, CG), by means of compare of Glasgow Coma Scale (GCS) score, postoperative complications (PC) and rebleeding incidence (RI), moreover, long-term outcome of 1 year postoperation judged by Glasgow Outcome Scale (GOS), Barthel Index (BI), modified Rankin Scale (mRS) and case fatality(CF). RESULTS MG patients showed obvious amelioration in GCS score compared with that of CG. The total incidence of PC in MG decreased obviously compared with that of CG. The incidences of rebleeding in MG and CG were 10.0% and 15.4% respectively. There was no obvious difference between CFs of MG and CG. For three parameters representing long-term outcome, the GOS, BI and mRS in MG were ameliorated significantly than that of CG. CONCLUSION These data suggested that the advantage of MISPT was displayed in minute trauma and safety, and seemed to be feasible and to had a trend towards improved long-term outcome. TRIAL REGISTRATION The Australian New Zealand Clinical Trials Registry (ANZCTR), the registration number: ACTRN12610000945022.
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Affiliation(s)
- Houguang Zhou
- Department of Geriatrics, Huashan Hospital, Fudan University, Shanghai, China
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Dubourg J, Messerer M. State of the art in managing nontraumatic intracerebral hemorrhage. Neurosurg Focus 2011; 30:E22. [DOI: 10.3171/2011.3.focus1145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Nontraumatic intracerebral hemorrhage constitutes a major public health problem worldwide. Intracerebral hemorrhage leads to a high rate of morbidity and mortality. To date, no medical or surgical trials have clearly attested to the benefit of a particular therapy. The aim of this review was to summarize the best evidence for management decision-making in intracerebral hemorrhage.
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Affiliation(s)
- Julie Dubourg
- 1Centre d'Investigation Clinique CIC201, EPICIME, Groupement Hospitalier Est, Hospices Civils de Lyon, Université Claude Bernard Lyon 1; and
| | - Mahmoud Messerer
- 2Département de Neurochirurgie A, Hôpital Neurologique Pierre Wertheimer, Groupement Hospitalier Est, Hospices Civils de Lyon, Université Claude Bernard Lyon, Lyon, France
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Zhou H, Zhang Y, Liu L, Huang Y, Tang Y, Su J, Hua W, Han X, Xue J, Dong Q. Minimally invasive stereotactic puncture and thrombolysis therapy improves long-term outcome after acute intracerebral hemorrhage. J Neurol 2011; 258:661-9. [PMID: 21340523 PMCID: PMC3065646 DOI: 10.1007/s00415-011-5902-7] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Revised: 12/10/2010] [Accepted: 01/03/2011] [Indexed: 11/29/2022]
Abstract
The purpose of this study was to judge the clinical value of minimally invasive stereotactic puncture and thrombolysis therapy (MISPTT) for acute intracerebral hemorrhage (ICH). A randomized control clinical trial was undertaken. According to the enrollment criteria, 122 acute ICH cases were analyzed, of which 64 cases received MISPTT (MISPTT group, MG) and 58 cases received conventional craniotomy (CC group, CG). The Glasgow coma scale (GCS) scores, postoperative complications (PC), and rebleeding incidences were compared. Moreover, 1 year postoperation, the long-term outcomes of patients with regard to hematoma volume (HV) <50 mL and HV ≥50 mL were judged, respectively, by the Glasgow outcome scale (GOS), Barthel index (BI), modified Rankin Scale (mRS), and case fatality (CF). MG patients showed obvious amelioration in GCS score compared with that of CG patients. The total incidence of PC in MG decreased compared with that of CG. The incidences of rebleeding in MG and CG were 9.4 and 17.2%, respectively (P = 0.243). There were no obvious differences between the CFs of MG and CG (17.2 and 25.9%, respectively, P = 0.199). The GOS, BI, and mRS representing long-term outcome for both HV <50 mL and HV ≥50 mL in MG were ameliorated significantly greater than that in CG patients (all P < 0.05). These data suggest that there are advantages with MISPTT not only in trauma and safety, but the MISPTT group had fewer complications and a trend toward improved short-term and long-term outcomes.
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Affiliation(s)
- Houguang Zhou
- Department of Neurology, Huashan Hospital, Fudan University, 12# Middle WuLuMuQi Rd, Shanghai, 200040 China
| | - Yu Zhang
- Department of Geriatrics, Huashan Hospital, Fudan University, 12# Middle WuLuMuQi Rd, Shanghai, 200040 China
| | - Ling Liu
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, 305# East Zhongshan Rd, Nanjing, 210002 China
| | - Yanyan Huang
- Department of Geriatrics, Huashan Hospital, Fudan University, 12# Middle WuLuMuQi Rd, Shanghai, 200040 China
| | - Yuping Tang
- Department of Neurology, Huashan Hospital, Fudan University, 12# Middle WuLuMuQi Rd, Shanghai, 200040 China
| | - Jingjing Su
- Department of Neurology, Huashan Hospital, Fudan University, 12# Middle WuLuMuQi Rd, Shanghai, 200040 China
| | - Wei Hua
- Department of Neurosurgery, Huashan Hospital, Fudan University, 12# Middle WuLuMuQi Rd, Shanghai, 200040 China
| | - Xu Han
- Department of Neurology, Huashan Hospital, Fudan University, 12# Middle WuLuMuQi Rd, Shanghai, 200040 China
| | - Jianzhong Xue
- Department of Neurology, Affiliated ChangShu Hospital, Yangzhou University, 68# South HaiYu Rd, Changshu, 215500 China
| | - Qiang Dong
- Department of Neurology, Huashan Hospital, Fudan University, 12# Middle WuLuMuQi Rd, Shanghai, 200040 China
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Staykov D, Huttner HB, Köhrmann M, Bardutzky J, Schellinger PD. Novel approaches to the treatment of intracerebral haemorrhage. Int J Stroke 2011; 5:457-65. [PMID: 21050402 DOI: 10.1111/j.1747-4949.2010.00487.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Intracerebral haemorrhage is the most devastating subtype of stroke. It affects approximately two million patients worldwide every year and is a major cause of morbidity and mortality. After decades of research, we still face the fact that there is no evidence-based treatment strategy for this disease. However, research has contributed to a better understanding of the pathophysiology of intracerebral haemorrhage and also to the identification of new treatment targets. Several novel aspects of treatment of spontaneous intracerebral haemorrhage are reviewed in the present article.
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Affiliation(s)
- Dimitre Staykov
- Department of Neurology, University Clinic Erlangen, Schwabachanlage 6, 91054 Erlangen, Germany
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Apotransferrin protects cortical neurons from hemoglobin toxicity. Neuropharmacology 2010; 60:423-31. [PMID: 21034753 DOI: 10.1016/j.neuropharm.2010.10.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Revised: 10/18/2010] [Accepted: 10/19/2010] [Indexed: 11/23/2022]
Abstract
The protective effect of iron chelators in experimental models of intracerebral hemorrhage suggests that nonheme iron may contribute to injury to perihematomal cells. Therapy with high affinity iron chelators is limited by their toxicity, which may be due in part to sequestration of metals in an inaccessible complex. Transferrin is unique in chelating iron with very high affinity while delivering it to cells as needed via receptor-mediated endocytosis. However, its efficacy against iron-mediated neuronal injury has never been described, and was therefore evaluated in this study using an established cell culture model of hemoglobin neurotoxicity. At concentrations similar to that of CSF transferrin (50-100 micrograms/ml), both iron-saturated holotransferrin and apotransferrin were nontoxic per se. Overnight exposure to 3 μM purified human hemoglobin in serum-free culture medium resulted in death, as measured by lactate dehydrogenase release assay, of about three-quarters of neurons. Significant increases in culture iron, malondialdehyde, protein carbonyls, ferritin and heme oxygenase-1 were also observed. Holotransferrin had no effect on these parameters, but all were attenuated by 50-100 micrograms/ml apotransferrin. The effect of apotransferrin was very similar to that of deferoxamine at a concentration that provided equivalent iron binding capacity, and was not antagonized by concomitant treatment with holotransferrin. Transferrin receptor-1 expression was localized to neurons and was not altered by hemoglobin or transferrin treatment. These results suggest that apotransferrin may mitigate the neurotoxicity of hemoglobin after intracerebral hemorrhage. Increasing its concentration in perihematomal tissue may be beneficial.
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Abstract
Intracerebral hemorrhage (ICH) carries higher risk of long-term disability and mortality than any other form of stroke. Despite greater understanding of ICH pathophysiology, treatment options for this devastating condition remain limited. Moreover, a lack of a standard, universally accepted clinical grading scale for ICH has contributed to variations in management protocols and clinical trial designs. Grading scales are essential for standardized assessment and communication among physicians, selecting optimized treatment regiments, and designing effective clinical trials. There currently exist a number of ICH grading scales and prognostic models that have been developed for mortality and/or functional outcome, particularly 30 days after the ICH onset. Numerous reliable scales have been externally validated in heterogeneous populations. We extensively reviewed the inherent strengths and limitations of all the existing clinical ICH grading scales based on their development and validation methodology. For all ICH grading scales, we carefully observed study design and the definition and timing of outcome assessment to elucidate inconsistencies in grading scale derivation and application. Ultimately, we call for an expansive, prospective, multi-center clinical outcome study to clearly define all aspects of ICH, establish ideal grading scales, and standardized management protocols to enable the identification of novel and effective therapies in ICH.
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