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Muengtaweepongsa S, Panpattanakul V. Is medical management useful in Moyamoya disease? World J Clin Cases 2024; 12:466-473. [PMID: 38322475 PMCID: PMC10841962 DOI: 10.12998/wjcc.v12.i3.466] [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: 10/13/2023] [Revised: 11/24/2023] [Accepted: 01/05/2024] [Indexed: 01/18/2024] Open
Abstract
Moyamoya disease (MMD), characterized by progressive internal carotid artery stenosis and collateral vessel formation, prompts cerebral perfusion complications and is stratified into idiopathic and Moyamoya syndrome subtypes. A multifaceted approach toward MMD management addresses cerebral infarctions through revascularization surgery and adjunctive medical therapy, while also navigating risks such as intracranial hemorrhage and cerebral infarction resulting from arterial stenosis and fragile collateral vessels. Addressing antithrombotic management reveals a potential role for treatments like antiplatelet agents and anticoagulants, despite the ambiguous contribution of thrombosis to MMD-related infarctions and the critical balance between preventing ischemic events and averting hemorrhagic complications. Transcranial doppler has proven useful in thromboembolic detection, despite persisting challenges concerning the efficacy and safety of antithrombotic treatments. Furthermore, antihypertensive interventions aim to manage blood pressure meticulously, especially during intracerebral hemorrhage, with recommendations and protocols varying based on the patient's hypertension status. Additionally, lipid-lowering therapeutic strategies, particularly employing statins, are appraised for their possible beneficial role in MMD management, even as comprehensive data from disease-specific clinical trials remains elusive. Comprehensive guidelines and protocols to navigate the multifaceted therapeutic avenues for MMD, while maintaining a delicate balance between efficacy and safety, warrant further meticulous research and development. This protocol manuscript seeks to elucidate the various aspects and challenges imbued in managing and navigating through the complex landscape of MMD treatment.
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Affiliation(s)
- Sombat Muengtaweepongsa
- Center of Excellence in Stroke, Division of Neurology, Department of Medicine, Faculty of Medicine, Thammasat University, Rangsit Campus, Klonglaung 12120, Pathum Thani, Thailand
| | - Vatcharasorn Panpattanakul
- Division of Neurology, Department of Internal Medicine, School of Medicine, University of Phayao, Phayao 56000, Thailand
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2
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Engrand N, Sene T, Caputo G, Sabben C, Gregoire C, Blanc R, Aldea S, Chauvet D, Vo-Thanh S, Teissier S, Versace N, Rohou L, Piotin M, Gueguen A. Ethical Management of COVID-19 Pandemic at a Neurological Hospital: The Ethicovid Report. J Neurosurg Anesthesiol 2023; 35:417-422. [PMID: 35543619 DOI: 10.1097/ana.0000000000000849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/30/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND During the first wave of the coronavirus disease-2019 (COVID-19) pandemic, it was necessary to prepare for the possibility of triaging patients who could benefit from access to an intensive care unit (ICU). In our neuroscience institution, the challenge was to continue to manage usual neurological emergencies as well as the influx of COVID-19 patients. METHODS We report the experience of an ethical consulting unit to support care clinical decisions during the first wave of the pandemic (March 16 to April 30, 2020). Three objective evaluation criteria were defined: 2 of these criteria, patient's factors and general disease severity (Simplified Acute Physiology Score II), were common to all patients, and the third was the specific severity of the disease (neurological for brain injury, respiratory for COVID-19). Given our scarce resources, we used a high probability of a 3-month modified Rankin Scale ≤3 as the criterion for further resuscitation and management. RESULTS A total of 295 patients were admitted during the first pandemic wave; 111 with COVID-19 and 184 with neurological emergencies. The ethical unit's expertise was sought for 75 clinical situations in 56 patients (35 COVID-19 and 21 neurological). Decisions were as follows: 11% no limitation on care, 5% expectant care with reassessment (maximum therapy to assess possible progress pending decision), 67% partial limitation (no intensification of care or no transfer to ICU), and 17% limitation of curative care. At no time did a lack of availability of ICU beds require the ethical unit to advise against admission to the ICU. CONCLUSIONS Our ethical consulting unit allowed for collegial ethical decision-making in line with international recommendations. This model could be easily transferred to other triage situations, provided it is adapted to the local context.
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Affiliation(s)
- Nicolas Engrand
- Intensive Care Unit-Anesthesiology/Mobile Palliative Care Team
| | | | | | | | | | | | - Sorin Aldea
- Neurosurgery, Rothschild Foundation Hospital
| | | | - Sophie Vo-Thanh
- Intensive Care Unit-Anesthesiology/Mobile Palliative Care Team
| | | | - Nathalie Versace
- Department of Neuroscience, Rothschild Foundation Hospital, Paris, France
| | - Léa Rohou
- Intensive Care Unit-Anesthesiology/Mobile Palliative Care Team
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Zou Y, Liao L, Dai J, Mazhar M, Yang G, Wang H, Dechsupa N, Wang L. Mesenchymal stem cell-derived extracellular vesicles/exosome: A promising therapeutic strategy for intracerebral hemorrhage. Regen Ther 2023; 22:181-190. [PMID: 36860266 PMCID: PMC9969203 DOI: 10.1016/j.reth.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 01/15/2023] [Accepted: 01/26/2023] [Indexed: 02/22/2023] Open
Abstract
Intracerebral hemorrhage (ICH) is the second largest type of stroke with high mortality and morbidity. The vast majority of survivors suffer from serious neurological defects. Despite the well-established etiology and diagnose, there is still some controversy over the ideal treatment strategy. MSC-based therapy has become an attractive and promising strategy for the treatment of ICH through immune regulation and tissue regeneration. However, accumulating studies have revealed that MSC-based therapeutic effects are mainly attributed to the paracrine properties of MSC, especially small extracellular vesicles/exosome (EVs/exo) which are considered to be the key mediators of the protective efficacy from MSCs. Moreover, some papers reported that MSC-EVs/exo have better therapeutic effects than MSCs. Therefore, EVs/exo has become a new choice for the treatment of ICH stroke in recent years. In this review, we mainly concentrate on the current research progress on the use of MSC-EVs/exo in the treatment of ICH and the existing challenges in their transplation from lab to clinical practice.
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Affiliation(s)
- Yuanxia Zou
- Research Center for Integrated Chinese and Western Medicine, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, 646000, China,Molecular Imaging and Therapy Research Unit, Department of Radiologic Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand,Department of Newborn Medicine, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, 646000, China
| | - Lishang Liao
- Department of Neurosurgery,The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, 646000, China
| | - Jian Dai
- College of Integrated Chinese and Western Medicine, Southwest Medical University, Luzhou, 646000, China
| | - Maryam Mazhar
- National Traditional Chinese Medicine Clinical Research Base and Drug Research Center of the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, 646000, China,Institute of Integrated Chinese and Western Medicine, Southwest Medical University, Luzhou, 646000, China
| | - Guoqiang Yang
- Research Center for Integrated Chinese and Western Medicine, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, 646000, China,Molecular Imaging and Therapy Research Unit, Department of Radiologic Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Honglian Wang
- Research Center for Integrated Chinese and Western Medicine, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, 646000, China
| | - Nathupakorn Dechsupa
- Molecular Imaging and Therapy Research Unit, Department of Radiologic Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand,Corresponding author.
| | - Li Wang
- Research Center for Integrated Chinese and Western Medicine, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, 646000, China,Institute of Integrated Chinese and Western Medicine, Southwest Medical University, Luzhou, 646000, China,Corresponding author.
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de Mendiola JMFP, Arboix A, García-Eroles L, Sánchez-López MJ. Acute Spontaneous Lobar Cerebral Hemorrhages Present a Different Clinical Profile and a More Severe Early Prognosis than Deep Subcortical Intracerebral Hemorrhages-A Hospital-Based Stroke Registry Study. Biomedicines 2023; 11:biomedicines11010223. [PMID: 36672731 PMCID: PMC9856131 DOI: 10.3390/biomedicines11010223] [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: 12/19/2022] [Revised: 01/09/2023] [Accepted: 01/13/2023] [Indexed: 01/18/2023] Open
Abstract
Acute spontaneous intracerebral hemorrhage (ICH) is the most severe stroke subtype, with a high risk of death, dependence, and dementia. Knowledge about the clinical profile and early outcomes of ICH patients with lobar versus deep subcortical brain topography remains limited. In this study, we investigated the effects of ICH topography on demographics, cerebrovascular risk factors, clinical characteristics, and early outcomes in a sample of 298 consecutive acute ICH patients (165 with lobar and 133 with subcortical hemorrhagic stroke) available in a single-center-based stroke registry over 24 years. The multiple logistic regression analysis shows that variables independently associated with lobar ICH were early seizures (OR 6.81, CI 95% 1.27−5.15), chronic liver disease (OR 4.55, 95% CI 1.03−20.15), hemianopia (OR 2.55, 95% CI 1.26−5.15), headaches (OR 1.90, 95% CI 1.90, 95% IC 1.06−3.41), alcohol abuse (>80 gr/day) (OR 0−10, 95% CI 0.02−0,53), hypertension (OR 0,41, 95% CI 0.23−0−70), sensory deficit (OR 0.43, 95% CI 0.25−0.75), and limb weakness (OR: 0.47, 95% CI 0.24−0.93). The in-hospital mortality was 26.7% for lobar and 16.5% for subcortical ICH. The study confirmed that the clinical spectrum, prognosis, and early mortality of patients with ICH depend on the site of bleeding, with a more severe early prognosis in lobar intracerebral hemorrhage.
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Affiliation(s)
| | - Adrià Arboix
- Department of Neurology, Hospital Universitari Sagrat Cor, Universitat de Barcelona, 08029 Barcelona, Spain
- Correspondence: ; Tel.: +34-93-4948940
| | - Luís García-Eroles
- Department of Neurology, Hospital Universitari Sagrat Cor, Universitat de Barcelona, 08029 Barcelona, Spain
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Deng X, Yang J, Qing R, Yuan H, Yue P, Tian S. Suppressive role of lovastatin in intracerebral hemorrhage through repression of autophagy. Metab Brain Dis 2023; 38:361-372. [PMID: 36306000 DOI: 10.1007/s11011-022-01101-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 10/08/2022] [Indexed: 02/03/2023]
Abstract
Statins possess critical function in the brain. Here, we intended to investigate the role of lovastatin in brain damage after intracerebral hemorrhage (ICH). A collagenase-induced ICH rat model was established followed by lovastatin treatment. Then, the effect of lovastatin on ICH-induced brain damage was explored with cognitive function, learning and memory abilities, and neurological damage of rats analyzed. Besides, brain water content, number of degenerate neurons, Nissl's body, and apoptosis of neurons were detected. Oxidative stress levels, inflammation, and autophagy levels in ICH were measured after treatment of lovastatin. Lovastatin improved the cognitive impairment of rats, enhanced their spatial learning and memory abilities, reduced nervous system damage, lesion area, and brain water content after ICH. Lovastatin was capable of reducing the number of degenerated neurons, the apoptosis level, autophagy level, and increasing the number of Nissl's body. Lovastatin inhibited the oxidative stress response and inflammatory factors in the brain tissue after ICH, and increased the expression of anti-inflammatory factor IL-10. Lovastatin inhibited AMPK/mTOR signaling pathway after ICH. Our study highlighted the suppressive role of lovastatin in ICH-induced brain damage.
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Affiliation(s)
- Xiong Deng
- Department of Neurosurgery, the First Affiliated Hospital of Shaoyang University, No. 39, Tongheng Street, Shuangqing District, Shaoyang, Hunan, 422001, People's Republic of China
| | - Jinmei Yang
- Department of Nursing, the First Affiliated Hospital of Shaoyang University, Shaoyang, Hunan, 422001, People's Republic of China
| | - Ruqi Qing
- Department of Neurosurgery, the First Affiliated Hospital of Shaoyang University, No. 39, Tongheng Street, Shuangqing District, Shaoyang, Hunan, 422001, People's Republic of China
| | - Heying Yuan
- Health Management Center, the First Affiliated Hospital of Shaoyang University, Shaoyang, Hunan, 422001, People's Republic of China
| | - Pinhua Yue
- Department of Neurosurgery, the First Affiliated Hospital of Shaoyang University, No. 39, Tongheng Street, Shuangqing District, Shaoyang, Hunan, 422001, People's Republic of China
| | - Song Tian
- Department of Neurosurgery, the First Affiliated Hospital of Shaoyang University, No. 39, Tongheng Street, Shuangqing District, Shaoyang, Hunan, 422001, People's Republic of China.
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Li L, Zhan Y, Xia H, Wu Y, Wu X, Chen S. Sevoflurane protects against intracerebral hemorrhage via microRNA-133b/FOXO4/BCL2 axis. Int Immunopharmacol 2023; 114:109453. [PMID: 36476488 DOI: 10.1016/j.intimp.2022.109453] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/03/2022] [Accepted: 11/10/2022] [Indexed: 12/12/2022]
Abstract
The application of Sevoflurane (Sev) in neurological diseases has been documented. We herein clarified the role of Sev in intracerebral hemorrhage (ICH). Through bioinformatics analysis, ICH-related microRNA (miRNA) was collected with microRNA-133b (miR-133b) chosen for the study subject. Then, the related downstream gene Forkhead box O4 (FOXO4) was identified. For in vivo assays, an ICH mouse model was established by autologous blood injection. For in vitro assays, hippocampal neurons were extracted from mouse brain tissues, and erythrocyte lysates were employed to simulate in vitro hemorrhage. Interaction between miR-133b and FOXO4 as well as between FOXO4 and BCL2 were assayed. We found decreased miR-133b in the brain tissue of ICH mice and erythrocyte lysate-treated hippocampal neurons. Sev treatment attenuated ICH and hippocampal neuronal apoptosis in mice by upregulating miR-133b. miR-133b targeted FOXO4 expression, and inhibition of FOXO4 attenuated hippocampal neuronal apoptosis by increasing BCL2 expression. Sev attenuated ICH in mice by increasing BCL2 expression through regulation of miR-133b-mediated FOXO4 expression. The findings highlighted the protective effect of Sev on ICH mice through the regulation of miR-133b-mediated FOXO4 expression.
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Affiliation(s)
- Lei Li
- Department of Anesthesiology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, PR China
| | - Yanping Zhan
- Department of Anesthesiology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, PR China
| | - Haimei Xia
- Department of Anesthesiology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, PR China
| | - Yunkun Wu
- Department of Anesthesiology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, PR China
| | - Xiongzhi Wu
- Nanchang University, Nanchang 330006, PR China
| | - Shibiao Chen
- Department of Anesthesiology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, PR China.
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Zuo W, Wang Y, Sun J, Zhang Y. Effects and mechanism of myeloperoxidase on microglia in the early stage of intracerebral hemorrhage. Front Neurosci 2022; 16:1046244. [PMID: 36570834 PMCID: PMC9783921 DOI: 10.3389/fnins.2022.1046244] [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: 09/16/2022] [Accepted: 11/07/2022] [Indexed: 12/13/2022] Open
Abstract
Objectives (1) To clarify the dynamic relationship between the expression of myeloperoxidase (MPO) and microglial activation of intracerebral hemorrhage (ICH), (2) to explore the effect of inhibition of MPO on microglial activation, and (3) to observe the improvement in the neurobehavior of mice with inhibition of MPO. Methods C57 BL/6 mice and CX3CR1 + /GFP mice were used to establish a phosphate-buffered saline (PBS) group, an ICH group, and a 4-aminobenzoic acid hydrazide (ABAH) group. Longa score, open field locomotion, hind-limb clasping test, immunohistochemistry, immunofluorescence, blood routine detection, and flow cytometry were used. Results The neurobehavior of the mice was significantly impaired following ICH (P < 0.01); the expression of MPO was significantly increased following ICH, and reached a peak value at 6 h post-injury (P < 0.001). Moreover, the microglial activation increased significantly following ICH, and reached a peak level at 24 h post-injury (P < 0.01). Following inhibition of MPO, the activation of microglia in the ICH group decreased significantly (P < 0.001). Moreover, the neurobehavior of the ICH group was significantly improved with MPO inhibition (P < 0.05). Conclusion MPO may be an upstream molecule activated by microglia and following inhibition of MPO can improve secondary injury resulting from ICH.
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Affiliation(s)
- Wei Zuo
- Department of Neuro-Oncological Surgery, Neurosurgery Center, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Yunchang Wang
- Xiangya Hospital, Central Southern University, Changsha, China,Department of Neurosurgery, Lanzhou University Second Hospital, Lanzhou, China
| | - Jiali Sun
- College of Life Sciences, Central Southern University, Changsha, China
| | - Yinian Zhang
- Department of Neuro-Oncological Surgery, Neurosurgery Center, Zhujiang Hospital of Southern Medical University, Guangzhou, China,Department of Neurosurgery, Lanzhou University Second Hospital, Lanzhou, China,*Correspondence: Yinian Zhang,
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Wang B, Gao L, Zhang Y, Su MM, Shi W, Wang Y, Ge SN, Zhu G, Guo H, Gao F, Shi YW, Cui WX, Li ZH, Qu Y, Wang XL. Pre-operative external ventricle drainage improves neurological outcomes for patients with traumatic intracerebellar hematomas. Front Neurol 2022; 13:1006227. [DOI: 10.3389/fneur.2022.1006227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 09/02/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectivesTraumatic intracerebellar hematoma (TICH) is a very rare entity with a high morbidity and mortality rate, and there is no consensus on its optimal surgical management. In particular, whether and when to place external ventricle drainage in TICH patients without acute hydrocephalus pre-operation is still controversial.MethodsA single-institutional, retrospective analysis of total of 47 TICH patients with craniectomy hematoma evacuation in a tertiary medical center from January 2009 to October 2020 was performed. Primary outcomes were mortality in hospital and neurological function evaluated by GOS at discharge and 6 months after the ictus. Special attention was paid to the significance of external ventricular drainage (EVD) in TICH patients without acute hydrocephalus on admission.ResultsAnalysis of the clinical characteristics of the TICH patients revealed that the odds of use of EVD were seen in patients with IVH, fourth ventricle compression, and acute hydrocephalus. Placement of EVD at the bedside can significantly improve the GCS score before craniotomy, as well as the neurological score at discharge and 6 months. Compared with the only hematoma evacuation (HE) group, there is a trend that EVD can reduce hospital mortality and decrease the occurrence of delayed hydrocephalus, although the difference is not statistically significant. In addition, EVD can reduce the average NICU stay time, but has no effect on the total length of stay. Moreover, our data showed that EVD did not increase the risk of associated bleeding and intracranial infection. Interestingly, in terms of neurological function at discharge and 6 month after the ictus, even though without acute hydrocephalus on admission, the TICH patients can still benefit from EVD insertion.ConclusionFor TICH patients, perioperative EVD is safe and can significantly improve neurological prognosis. Especially for patients whose GCS dropped by more than 2 points before the operation, EVD can significantly improve the patient's GCS score, reduce the risk of herniation, and gain more time for surgical preparation. Even for TICH patients without acute hydrocephalus on admission CT scan, EVD placement still has positive clinical significance.
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Wang D, Ousaka D, Qiao H, Wang Z, Zhao K, Gao S, Liu K, Teshigawara K, Takada K, Nishibori M. Treatment of Marmoset Intracerebral Hemorrhage with Humanized Anti-HMGB1 mAb. Cells 2022; 11:cells11192970. [PMID: 36230933 PMCID: PMC9563572 DOI: 10.3390/cells11192970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/09/2022] [Accepted: 09/15/2022] [Indexed: 11/16/2022] Open
Abstract
Intracerebral hemorrhage (ICH) is recognized as a severe clinical problem lacking effective treatment. High mobility group box-1 (HMGB1) exhibits inflammatory cytokine-like activity once released into the extracellular space from the nuclei. We previously demonstrated that intravenous injection of rat anti-HMGB1 monoclonal antibody (mAb) remarkably ameliorated brain injury in a rat ICH model. Therefore, we developed a humanized anti-HMGB1 mAb (OKY001) for clinical use. The present study examined whether and how the humanized anti-HMGB1 mAb ameliorates ICH injury in common marmosets. The results show that administration of humanized anti-HMGB1 mAb inhibited HMGB1 release from the brain into plasma, in association with a decrease of 4-hydroxynonenal (4-HNE) accumulation and a decrease in cerebral iron deposition. In addition, humanized anti-HMGB1 mAb treatment resulted in a reduction in brain injury volume at 12 d after ICH induction. Our in vitro experiment showed that recombinant HMGB1 inhibited hemoglobin uptake by macrophages through CD163 in the presence of haptoglobin, suggesting that the release of excess HMGB1 from the brain may induce a delay in hemoglobin scavenging, thereby allowing the toxic effects of hemoglobin, heme, and Fe2+ to persist. Finally, humanized anti-HMGB1 mAb reduced body weight loss and improved behavioral performance after ICH. Taken together, these results suggest that intravenous injection of humanized anti-HMGB1 mAb has potential as a novel therapeutic strategy for ICH.
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Affiliation(s)
- Dengli Wang
- Department of Pharmacology, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama 7008558, Japan
| | - Daiki Ousaka
- Department of Pharmacology, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama 7008558, Japan
| | - Handong Qiao
- Department of Pharmacology, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama 7008558, Japan
| | - Ziyi Wang
- Research Fellow of Japan Society for the Promotion of Science, Tokyo 1020083, Japan
- Department of Molecular Biology and Biochemistry, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 7008558, Japan
| | - Kun Zhao
- Department of Molecular Biology and Biochemistry, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 7008558, Japan
| | - Shangze Gao
- School of Pharmaceutical Sciences, Tsinghua University, Beijing 100084, China
| | - Keyue Liu
- Department of Pharmacology, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama 7008558, Japan
| | - Kiyoshi Teshigawara
- Department of Pharmacology, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama 7008558, Japan
| | - Kenzo Takada
- Sapporo Laboratory, EVEC, Inc., Sapporo 0606642, Japan
| | - Masahiro Nishibori
- Department of Translational Research and Drug Development, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 7008558, Japan
- Correspondence:
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Li Y, Yang S, Zhou X, Lai R, Tan D. A Retrospective Cohort Study of Neuroendoscopic Surgery versus Traditional Craniotomy on Surgical Success Rate, Postoperative Complications, and Prognosis in Patients with Acute Intracerebral Hemorrhage. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:2650795. [PMID: 36035835 PMCID: PMC9410956 DOI: 10.1155/2022/2650795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/30/2022] [Accepted: 07/09/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVE A case-control study was adopted to explore the effect of neuroendoscopy compared with traditional craniotomy on the success rate, postoperative complications, and prognosis of patients with intracerebral hemorrhage (ICH). METHODS The clinical data of 106 patients with ICH treated in our hospital from March 2019 to June 2021 were collected and analyzed retrospectively and divided into two groups according to different treatment methods. The patients who were cured by craniotomy were in the control group (n = 53), and those who received neuroendoscopic surgery were in the research group (n = 53).The clinical efficacy of patients was compared, and the cognition and daily living ability were evaluated by the Trier cognitive assessment scale, limb motor function score, and activity of daily living scale. The National Institutes of Health Stroke scale (NIHSS) and Glasgow coma scale (GCS) were used to compare the neurological function of the two groups before and after treatment, and the Glasgow outcome scale (GOS) and disability rating scale (DRS) were adopted to evaluate the functional prognosis. The simplified Fugl-Meyer motor function score was adopted to evaluate the patient's limb function, the Montreal cognitive assessment scale was adopted to evaluate the patient's cognitive function, the Barthel index score was adopted to evaluate the daily living ability of patients, and the treatment of patients was recorded. RESULTS In comparison with groups, the effective rate of treatment in the research group was higher, and the difference between groups was statistically significant (P < 0.05). Regarding the surgical indicators, the hospital stay, intraoperative blood loss, postoperative residual blood flow, and total hospital stay in the research group were remarkably lower, the hematoma clearance rate in the research group was remarkably higher, and the difference between groups was statistically significant(P < 0.05). After operation, the KPS scores indicated a gradual upward trend, and those of the research group were higher at 1 month, 2 months, and 3 months after operation. The Barthel index scores were compared. After treatment, the Barthel index scores increased. In comparison with the two groups, the Barthel index scores of the research group were higher at 1 month, 2 months, and 3 months after surgery, and the difference between groups was statistically significant (P < 0.05). The NIHSS, GCS, and DRS scores were compared. After treatment, the NIHSS, GCS, and DRS scores were decreased. In comparison with the two groups, the NIHSS, GCS, and DRS scores of the research group were remarkably lower, and the difference between groups was statistically significant (P < 0.05). With regard to the cognitive and physical function recovery after treatment, the MoCA score and Fugl-Meyer score of the research group were remarkably higher, and the difference between groups was statistically significant(P < 0.05). The quality of life scores was compared. After treatment, the quality of life scores decreased. In comparison with the two groups, the scores of physiological function, psychological function, social function, and healthy self-awareness of the research group were lower, and the difference between groups was statistically significant (P < 0.05). The incidence of postoperative complications in the research group was significantly lower than that in the control group, and the difference between groups was statistically significant (P < 0.05). CONCLUSION Compared with conventional craniotomy, neuroendoscopic surgery can remarkably reduce the operation time and blood loss, enhance the hematoma clearance rate, and have a better prognosis, which is more conducive to the recovery of postoperative neurological function, life activities, and quality of life of patients.
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Affiliation(s)
- Yong Li
- Department of Neurosurgery, First Affiliated Hospital of Shantou University Medical College, Shantou 515041, China
| | - Senyuan Yang
- Department of Neurosurgery, First Affiliated Hospital of Shantou University Medical College, Shantou 515041, China
| | - Xiaobin Zhou
- Department of Neurosurgery, First Affiliated Hospital of Shantou University Medical College, Shantou 515041, China
| | - Runlong Lai
- Department of Neurosurgery, First Affiliated Hospital of Shantou University Medical College, Shantou 515041, China
| | - Dianhui Tan
- Department of Neurosurgery, First Affiliated Hospital of Shantou University Medical College, Shantou 515041, China
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Zhao X, Qiao D, Guan D, Wang K, Cui Y. Chrysophanol Ameliorates Hemin-Induced Oxidative Stress and Endoplasmic Reticulum Stress by Regulating MicroRNA-320-5p/Wnt3a Pathway in HT22 Cells. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2022:9399658. [PMID: 35936221 PMCID: PMC9355772 DOI: 10.1155/2022/9399658] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/07/2022] [Indexed: 11/17/2022]
Abstract
Oxidative stress, endoplasmic reticulum (ER) stress, and neuronal cell apoptosis have been considered as the main pathogenesis factors of brain injury after intracerebral hemorrhage (ICH). Chrysophanol (CHR) has been proved to have neuroprotective effects, but the role and underlying mechanisms of CHR in ICH remain unclear. HT22 cells were dealt with hemin to mimic an in vitro ICH model and then subjected to treatment with or without CHR. The cell viability, apoptosis, ER stress, and oxidative stress were evaluated by conducting the cell counting kit-8 (CCK-8), TdT-mediated dUTP nick end labeling (TUNEL) staining assays, western blot, and corresponding kit, respectively. Further, microRNA-sequencing, bioinformatic analysis, dual-luciferase reporter method, and rescue experiments were conducted to explore the molecular mechanisms of CHR alleviating hemin-induced ER in HT22 cell. Our data revealed that CHR increased cells viability, antiapoptosis, anti-ER stress, and antioxidative stress under conditions of hemin-induced HT22 cell injury. Mechanically, it was observed that Wnt3a was competitively sponged by miR-320-5p, and CHR activated β-catenin pathway by regulating miR-320-5p/Wnt3a molecular axis. Finally, results from the rescue experiment suggested that CHR inhibited hemin-induced cells apoptosis, ER stress, and oxidative stress through regulating the miR-320-5p/Wnt3a axis in HT22 cells. In conclusion, CHR prevented hemin-induced apoptosis, ER stress, and oxidative stress via inhibiting the miR-320-5p/Wnt3a/β-catenin pathway in HT22 cells. Our results certified that CHR could be served as a promising treatment for brain damage following ICH.
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Affiliation(s)
- Xu Zhao
- Department of Pharmacy, Henan Province Hospital of TCM (The Second Clinical Medical College, Henan University of Traditional Chinese Medicine), Zhengzhou 450002, China
| | - Dongge Qiao
- Nursing Department, Henan Province Hospital of TCM (The Second Clinical Medical College, Henan University of Traditional Chinese Medicine), Zhengzhou 450002, China
| | - Dongsheng Guan
- Department of Encephalopathy, Henan Province Hospital of TCM (The Second Clinical Medical College, Henan University of Traditional Chinese Medicine), Zhengzhou 450002, China
| | - Kun Wang
- Department of Pharmacy, Henan Province Hospital of TCM (The Second Clinical Medical College, Henan University of Traditional Chinese Medicine), Zhengzhou 450002, China
| | - Yinglin Cui
- Department of Encephalopathy, Henan Province Hospital of TCM (The Second Clinical Medical College, Henan University of Traditional Chinese Medicine), Zhengzhou 450002, China
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12
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Microglia Phenotypes in Aging and Neurodegenerative Diseases. Cells 2022; 11:cells11132091. [PMID: 35805174 PMCID: PMC9266143 DOI: 10.3390/cells11132091] [Citation(s) in RCA: 77] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 06/24/2022] [Accepted: 06/29/2022] [Indexed: 02/08/2023] Open
Abstract
Neuroinflammation is a hallmark of many neurodegenerative diseases (NDs) and plays a fundamental role in mediating the onset and progression of disease. Microglia, which function as first-line immune guardians of the central nervous system (CNS), are the central drivers of neuroinflammation. Numerous human postmortem studies and in vivo imaging analyses have shown chronically activated microglia in patients with various acute and chronic neuropathological diseases. While microglial activation is a common feature of many NDs, the exact role of microglia in various pathological states is complex and often contradictory. However, there is a consensus that microglia play a biphasic role in pathological conditions, with detrimental and protective phenotypes, and the overall response of microglia and the activation of different phenotypes depends on the nature and duration of the inflammatory insult, as well as the stage of disease development. This review provides a comprehensive overview of current research on the various microglia phenotypes and inflammatory responses in health, aging, and NDs, with a special emphasis on the heterogeneous phenotypic response of microglia in acute and chronic diseases such as hemorrhagic stroke (HS), Alzheimer’s disease (AD), and Parkinson’s disease (PD). The primary focus is translational research in preclinical animal models and bulk/single-cell transcriptome studies in human postmortem samples. Additionally, this review covers key microglial receptors and signaling pathways that are potential therapeutic targets to regulate microglial inflammatory responses during aging and in NDs. Additionally, age-, sex-, and species-specific microglial differences will be briefly reviewed.
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13
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Wang J, Xiong X, Ye J, Yang Y, He J, Liu J, Yin YL. A Radiomics Nomogram for Classifying Hematoma Entities in Acute Spontaneous Intracerebral Hemorrhage on Non-contrast-Enhanced Computed Tomography. Front Neurosci 2022; 16:837041. [PMID: 35757547 PMCID: PMC9226370 DOI: 10.3389/fnins.2022.837041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 05/02/2022] [Indexed: 11/13/2022] Open
Abstract
Aim To develop and validate a radiomics nomogram on non-contrast-enhanced computed tomography (NECT) for classifying hematoma entities in patients with acute spontaneous intracerebral hemorrhage (ICH). Materials and Methods One hundred and thirty-five patients with acute intraparenchymal hematomas and baseline NECT scans were retrospectively analyzed, i.e., 52 patients with vascular malformation-related hemorrhage (VMH) and 83 patients with primary intracerebral hemorrhage (PICH). The patients were divided into training and validation cohorts in a 7:3 ratio with a random seed. After extracting the radiomics features of hematomas from baseline NECT, the least absolute shrinkage and selection operator (LASSO) regression was applied to select features and construct the radiomics signature. Multivariate logistic regression analysis was used to determine the independent clinical-radiological risk factors, and a clinical model was constructed. A predictive radiomics nomogram was generated by incorporating radiomics signature and clinical-radiological risk factors. Nomogram performance was assessed in the training cohort and tested in the validation cohort. The capability of models was compared by calibration, discrimination, and clinical benefit. Results Six features were selected to establish radiomics signature via LASSO regression. The clinical model was constructed with the combination of age [odds ratio (OR): 6.731; 95% confidence interval (CI): 2.209–20.508] and hemorrhage location (OR: 0.089; 95% CI: 0.028–0.281). Radiomics nomogram [area under the curve (AUC), 0.912 and 0.919] that incorporated age, location, and radiomics signature outperformed the clinical model (AUC, 0.816 and 0.779) and signature (AUC, 0.857 and 0.810) in the training cohort and validation cohorts, respectively. Good calibration and clinical benefit of nomogram were achieved in the training and validation cohorts. Conclusion Non-contrast-enhanced computed tomography-based radiomics nomogram can predict the individualized risk of VMH in patients with acute ICH.
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Affiliation(s)
- Jia Wang
- Department of Radiology, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Xing Xiong
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jing Ye
- Department of Radiology, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Yang Yang
- Department of Radiology, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Jie He
- Department of Radiology, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Juan Liu
- Department of Radiology, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Yi-Li Yin
- Department of Radiology, Northern Jiangsu People's Hospital, Yangzhou, China
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14
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Lin G, Xu X, Luan X, Qiu H, Shao S, Wu Q, Xu W, Huang G, He J, Feng L. A Longitudinal Research on the Distribution and Prognosis of Intracerebral Hemorrhage During the COVID-19 Pandemic. Front Neurol 2022; 13:873061. [PMID: 35518200 PMCID: PMC9062182 DOI: 10.3389/fneur.2022.873061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/17/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose Globally, intracerebral hemorrhage (ICH) is a common cerebrovascular disease. At the beginning of 2020, due to the coronavirus disease 2019 (COVID-19) pandemic, the allocation of medical resources and the patient treatment and referrals were affected to varying degrees. We aimed to determine the characteristics and prognoses and associated factors of patients with ICH. Patients and Methods The baseline demographic characteristics and ICH outcomes were compared between patients diagnosed with ICH between January and June 2020 (the 2020 group) and between January and June 2019 (the 2019 group). COVID-19 positive patients were excluded from the study. A 30-day data from patients in the 2019 and 2020 groups were analyzed to create survival curves for these patients. We also used regression models to identify the significant determinants of poor outcomes [modified Rankin score (mRS): 3-6] and death. Results The number of patients diagnosed with ICH was slightly lower in the 2020 group (n = 707) than in the 2019 group (n = 719). During the lockdown period (February 2020), the admission rates for ICH decreased greatly by 35.1%. The distribution of the patients' domicile (P = 0.002) and the mRS (P < 0.001) differed significantly between the years. The survival curve revealed that the highest risk of death was in the acute stage (especially in the first 5 days) of ICH. At 30 days, mortality was 19.8% in February 2019 and 29.4% in February 2020 (P = 0.119). Multivariate analysis revealed age, baseline mRS, postoperative complications, massive brainstem hemorrhage, and creatinine as factors significantly associated with poor outcomes and death following ICH. Neurosurgery and massive supratentorial hemorrhage were only correlated with the risk of death. Conclusion During the lockdown period, the COVID-19 pandemic caused a decrease in the admission rates and severe conditions at admission due to strict traffic constraints for infection control. This led to high mortality and disability in patients with ICH. It is necessary to ensure an effective green channel and allocate adequate medical resources for patients to receive timely treatment and neurosurgery.
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Affiliation(s)
- Gangqiang Lin
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xueqian Xu
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaoqian Luan
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Huihua Qiu
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Shengfang Shao
- Department of Emergency, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qingsong Wu
- Medical Record Room, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Wei Xu
- Outpatient Office, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,Teaching and Research Section of Epidemiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Guiqian Huang
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jincai He
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Liang Feng
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,Teaching and Research Section of Epidemiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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15
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Thomas SM, Reindorp Y, Christophe BR, Connolly ES. Systematic Review of Resource Use and Costs in the Hospital Management of Intracerebral Hemorrhage. World Neurosurg 2022; 164:41-63. [PMID: 35489599 DOI: 10.1016/j.wneu.2022.04.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 04/12/2022] [Accepted: 04/13/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND While clinical guidelines provide a framework for hospital management of spontaneous intracerebral hemorrhage (ICH), variation in the resource use and costs of these services exists. We sought to perform a systematic literature review to assess the evidence on hospital resource use and costs associated with management of adult patients with ICH, as well as identify factors that impact variation in such hospital resource use and costs, regarding clinical characteristics and delivery of services. METHODS A systematic literature review was performed using PubMed, Cochrane Central Register of Controlled Trials, and Ovid MEDLINE(R) 1946 to present. Articles were assessed against inclusion and exclusion criteria. Study design, ICH sample size, population, setting, objective, hospital characteristics, hospital resource use and cost data, and main study findings were abstracted. RESULTS In total, 43 studies met the inclusion criteria. Pertinent clinical characteristics that increased hospital resource use included presence of comorbidities and baseline ICH severity. Aspects of service delivery that greatly impacted hospital resource consumption included intensive care unit length of stay and performance of surgical procedures and intensive care procedures. CONCLUSIONS Hospital resource use and costs for patients with ICH were high and differed widely across studies. Making concrete conclusions on hospital resources and costs for ICH care was constrained, given methodologic and patient variation in the studies. Future research should evaluate the long-term cost-effectiveness of ICH treatment interventions and use specific economic evaluation guidelines and common data elements to mitigate study variation.
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Affiliation(s)
- Steven Mulackal Thomas
- Department of Neurological Surgery, Columbia University Irving Medical Center, New York, New York, USA.
| | - Yarin Reindorp
- Department of Neurological Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Brandon R Christophe
- Department of Neurological Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Edward Sander Connolly
- Department of Neurological Surgery, Columbia University Irving Medical Center, New York, New York, USA
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16
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Zhou Z, Wan H, Zhang H, Chen X, Wang X, Lili S, Zhang T. Segmentation of Spontaneous Intracerebral Hemorrhage on CT With a Region Growing Method Based on Watershed Preprocessing. Front Neurol 2022; 13:865023. [PMID: 35422751 PMCID: PMC9002175 DOI: 10.3389/fneur.2022.865023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 03/01/2022] [Indexed: 11/13/2022] Open
Abstract
Intracerebral hemorrhage (ICH) poses a great threat to human life due to its high incidence and poor prognosis. Identification of the bleeding location and quantification of the volume based on CT images are of great significance for assisting the diagnosis and treatment of ICH. In this study, a region-growing algorithm based on watershed preprocessing (RG-WP) was proposed to segment and quantify the hemorrhage. The lowest points yielded by the watershed algorithm were used as seed points for region growing and then hemorrhage was segmented based on the region growing method. At the same time, to integrate the rich experience of clinicians with the algorithm, manual selection of seed points on the basis of watershed segmentation was performed. With the application of segmentation on CT images of 55 patients with ICH, the performance of the RG-WP algorithm was evaluated by comparing it with manual segmentations delineated by professional clinicians as well as the traditional ABC/2 method and the deep learning algorithm U-net. The mean deviation of hemorrhage volume of the RG-WP algorithm from manual segmentation was −0.12 ml (range: −1.05–1.16), while that of the ABC/2 from the manual was 1.05 ml (range: −0.77–9.57). Strong agreement of the algorithm and the manual was confirmed with a high intraclass correlation coefficient (ICC) (0.998, 95% CI: 0.997–0.999), which was superior to that of the ABC/2 and the manual (0.972, 95% CI: 0.953–0.984). The sensitivity (Sen), positive predictive value (PPV), dice similarity index (DSI), and Jaccard index (JI) of the RG-WP algorithm compared to the manual were 0.92 ± 0.04, 0.95 ± 0.04, 0.93 ± 0.02, and 0.88 ± 0.04, respectively, showing high consistency. Besides, the accuracy of the algorithm was also comparable to that of the deep learning method U-net, with Sen, PPV, DSI, and JI being 0.91 ± 0.09, 0.91 ± 0.06, 0.91 ± 0.05, and 0.91 ± 0.06, respectively.
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Affiliation(s)
- Zhengsong Zhou
- Department of Electronic Information Engineering, Chengdu Jincheng College, Chengdu, China
| | - Hongli Wan
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Haoyu Zhang
- Department of Electronic Information Engineering, Chengdu Jincheng College, Chengdu, China
| | - Xumiao Chen
- Department of Electronic Information Engineering, Chengdu Jincheng College, Chengdu, China
| | - Xiaoyu Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Shiluo Lili
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Tao Zhang
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
- *Correspondence: Tao Zhang
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17
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Carpenter AB, Lara-Reyna J, Hardigan T, Ladner T, Kellner C, Yaeger K. Use of emerging technologies to enhance the treatment paradigm for spontaneous intraventricular hemorrhage. Neurosurg Rev 2021; 45:317-328. [PMID: 34392456 DOI: 10.1007/s10143-021-01616-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/24/2021] [Accepted: 07/25/2021] [Indexed: 12/16/2022]
Abstract
The presence of intraventricular hemorrhage (IVH) portends a worse prognosis in patients presenting with spontaneous intracerebral hemorrhage (ICH). Intraventricular hemorrhage increases the rates of hydrocephalus, ventriculitis, and long-term shunt dependence. Over the past decade, novel medical devices and protocols have emerged to directly treat IVH. Presently, we review new technological adaptations to treating intraventricular hemorrhage in an effort to focus further innovation in treating this morbid neurosurgical pathology. We summarize current and historical treatments as well as innovations in IVH including novel procedural techniques, use of the Integra Surgiscope, use of the Artemis evacuator, use of BrainPath, novel catheter technology, large bore external ventricular drains, the IRRAflow, the CerebroFlo, and the future directions of the field. Technology and medical devices for both surgical and nonsurgical methods are advancing the treatment of IVH. With many promising new technologies on the horizon, prospects for improved clinical care for IVH and its etiologies remain hopeful.
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Affiliation(s)
| | - Jacques Lara-Reyna
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai Medical System, New York, NY, USA
| | - Trevor Hardigan
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai Medical System, New York, NY, USA
| | - Travis Ladner
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai Medical System, New York, NY, USA
| | - Christopher Kellner
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai Medical System, New York, NY, USA
| | - Kurt Yaeger
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai Medical System, New York, NY, USA.
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18
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Li D, Zhao Y, Bai P, Li Y, Wan S, Zhu X, Liu M. Baihui (DU20)-penetrating-Qubin (GB7) acupuncture regulates microglia polarization through miR-34a-5p/Klf4 signaling in intracerebral hemorrhage rats. Exp Anim 2021; 70:469-478. [PMID: 34108361 PMCID: PMC8614016 DOI: 10.1538/expanim.21-0034] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Intracerebral hemorrhage (ICH) is the most devastating subtype of stroke with high morbidity and mortality. The previous study has confirmed the therapeutic effect of Baihui (DU20)-penetrating-Qubin (GB7) acupuncture on ICH, while the related mechanism is left to be revealed. The aim of this study was to investigate the relevant mechanisms. ICH rat models were established utilizing the autologous blood injection method and the beneficial effect was found after DU20-penetrating-GB7 acupuncture along with decreased miR-34a-5p levels in the perihemorrhagic penumbra. Inversely, upregulating miR-34a-5p expression inhibited microglia M2 polarization while accelerated M1 polarization through targeting Krüppel-like factor 4 (Klf4), and thereby diminished the protective effect of DU20-penetrating-GB7 acupuncture on ICH. The results suggested the therapeutic effect of DU20-penetrating-GB7 acupuncture on ICH might be attributed to its modulation on microglia polarization through miR-34a-5p/Klf4 signaling.
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Affiliation(s)
- Dan Li
- Department of Acupuncture, Beijing University of Chinese Medicine Third Affiliated Hospital
| | - Yonghou Zhao
- Department of Psychiatry, Heilongjiang Mental Hospital
| | - Peng Bai
- Department of Acupuncture, Beijing University of Chinese Medicine Third Affiliated Hospital
| | - Yan Li
- Department of Otolaryngology, First Affiliated Hospital, Heilongjiang University of Chinese Medicine
| | - Siqi Wan
- School of Traditionnal Chinese Internal Medicine, Dongzhimen Hosptial, Beijing University of Chinese Medicine
| | - Xi Zhu
- School of Acupuncture and Massage, Beijing University of Chinese Medicine
| | - Mengyu Liu
- Department of Acupuncture, Beijing University of Chinese Medicine Third Affiliated Hospital
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19
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Li J, Song G, Jin Q, Liu L, Yang L, Wang Y, Zhang X, Zhao Z. The α2δ-1/NMDA receptor complex is involved in brain injury after intracerebral hemorrhage in mice. Ann Clin Transl Neurol 2021; 8:1366-1375. [PMID: 34032393 PMCID: PMC8283164 DOI: 10.1002/acn3.51372] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 03/15/2021] [Accepted: 04/15/2021] [Indexed: 12/12/2022] Open
Abstract
Background Intracerebral hemorrhage (ICH), a common cerebrovascular disease, seriously threatens human health and has severe secondary injuries, while existing treatment methods have many limitations. α2δ‐1 is a subunit of voltage‐gated Ca2+ channels (VGCCs) and can act on glutamate receptor N‐methyl‐D‐aspartate receptors (NMDARs) to relieve neuropathic pain. Methods We first performed ICH modeling on WT mice and Cacna2d1 knockout (KO) mice. The expression levels of GluN1 and α2δ‐1 were measured by Western blot and q‐PCR, and the interaction between the two proteins was evaluated by co‐precipitation. The neuronal apoptosis was detected by the TUNEL assay, and the expression levels of inflammatory factors were assessed by ELISA. The nerve functions of mice were evaluated using behavioral experiments including corner turn test and forelimb use asymmetry. Cerebral hematoma was indicated by brain water content and lesion volume. Results ICH up‐regulated the expression levels of α2δ‐1 and GluN1. KO of Cacna2d1 significantly reduced the ICH‐induced apoptosis. The treatment of gabapentin on α2δ‐1 also significantly reduced the occurrence of apoptosis. KO of Cacna2d1 also reduced the ICH‐induced levels of inflammatory factors. Furthermore, neural functions were also significantly improved. Conclusion Cacna2d1 KO alleviates cerebral hematoma in ICH mice, exhibits a significant regulating effect on its secondary injuries such as neuronal apoptosis and inflammation, and restores the nerve functions of ICH mice. Loss of Cacna2d1 can provide useful therapeutic clues for ICH treatment.
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Affiliation(s)
- Jingchen Li
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, No. 215 Hepingxi Road, Shijiazhuang, Hebei, 050000, China
| | - Guoqiang Song
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, No. 215 Hepingxi Road, Shijiazhuang, Hebei, 050000, China
| | - Qianxu Jin
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, No. 215 Hepingxi Road, Shijiazhuang, Hebei, 050000, China
| | - Liqiang Liu
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, No. 215 Hepingxi Road, Shijiazhuang, Hebei, 050000, China
| | - Liang Yang
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, No. 215 Hepingxi Road, Shijiazhuang, Hebei, 050000, China
| | - Yuanyu Wang
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, No. 215 Hepingxi Road, Shijiazhuang, Hebei, 050000, China
| | - Xuesong Zhang
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, No. 215 Hepingxi Road, Shijiazhuang, Hebei, 050000, China
| | - Zongmao Zhao
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, No. 215 Hepingxi Road, Shijiazhuang, Hebei, 050000, China
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AKINCI AT, ÖZDEMİR G. Comparison of the Ellipsoid Methods and the Cavalieri Method, for Calculating Hematoma Volume in Computed Tomography by non-Specialist. KOCAELI ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2021. [DOI: 10.30934/kusbed.732215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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21
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Schuss P, Bode C, Borger V, Coch C, Güresir Á, Hadjiathanasiou A, Hamed M, Kuchelmeister K, Lehmann F, Müller M, Schneider M, Solymosi L, Vatter H, Velten M, Güresir E. MR-Imaging and Histopathological Diagnostic Work-Up of Patients with Spontaneous Lobar Intracerebral Hemorrhage: Results of an Institutional Prospective Registry Study. Diagnostics (Basel) 2021; 11:diagnostics11020368. [PMID: 33671532 PMCID: PMC7926429 DOI: 10.3390/diagnostics11020368] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/15/2021] [Accepted: 02/19/2021] [Indexed: 02/06/2023] Open
Abstract
Intracerebral hemorrhage (ICH) is a frequently disabling or fatal disease. The localization of ICH often allows an etiological association. However, in atypical/lobar ICH, the cause of bleeding is less obvious. Therefore, we present prospective histopathological and radiological studies which were conducted within the diagnostic workup to identify causes for lobar ICH other than hypertension. From 2016 to 2018, 198 patients with spontaneous, non-traumatic ICH requiring neurosurgical monitoring were enrolled in an institutional prospective patient registry. Patients with deep-seated ICH and/or hemorrhagically transformed cerebral infarcts were excluded from further analysis. Data to evaluate the source of bleeding based on histopathological and/or radiological workup were prospectively evaluated and analyzed. After applying the inclusion criteria and excluding patients with incomplete diagnostic workup, a total of 52 consecutive patients with lobar ICH were further analyzed. Macrovascular disease was detected in 14 patients with lobar ICH (27%). In 11 patients, diagnostic workup identified cerebral amyloid angiopathy-related ICH (21%). In addition, five patients with tumor-related ICH (10%) and six patients with ICH based on infectious pathologies (11%) were identified. In four patients, the cause of bleeding remained unknown despite extensive diagnostic workup (8%). The present prospective registry study demonstrates a higher probability to identify a cause of bleeding other than hypertension in patients with lobar ICH. Therefore, a thorough diagnostic work-up in patients with ICH is essential to accelerate treatment and further improve outcome or prevent rebleeding.
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Affiliation(s)
- Patrick Schuss
- Department of Neurosurgery, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (V.B.); (Á.G.); (A.H.); (M.H.); (M.S.); (H.V.); (E.G.)
- Correspondence:
| | - Christian Bode
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (C.B.); (F.L.); (M.V.)
| | - Valeri Borger
- Department of Neurosurgery, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (V.B.); (Á.G.); (A.H.); (M.H.); (M.S.); (H.V.); (E.G.)
| | - Christoph Coch
- Study Center Bonn (SZB), Clinical Study Core Unit, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany;
| | - Ági Güresir
- Department of Neurosurgery, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (V.B.); (Á.G.); (A.H.); (M.H.); (M.S.); (H.V.); (E.G.)
| | - Alexis Hadjiathanasiou
- Department of Neurosurgery, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (V.B.); (Á.G.); (A.H.); (M.H.); (M.S.); (H.V.); (E.G.)
| | - Motaz Hamed
- Department of Neurosurgery, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (V.B.); (Á.G.); (A.H.); (M.H.); (M.S.); (H.V.); (E.G.)
| | - Klaus Kuchelmeister
- Institute of Neuropathology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany;
| | - Felix Lehmann
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (C.B.); (F.L.); (M.V.)
| | - Marcus Müller
- Department of Neurology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany;
| | - Matthias Schneider
- Department of Neurosurgery, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (V.B.); (Á.G.); (A.H.); (M.H.); (M.S.); (H.V.); (E.G.)
| | - László Solymosi
- Department of Neuroradiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany;
| | - Hartmut Vatter
- Department of Neurosurgery, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (V.B.); (Á.G.); (A.H.); (M.H.); (M.S.); (H.V.); (E.G.)
| | - Markus Velten
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (C.B.); (F.L.); (M.V.)
| | - Erdem Güresir
- Department of Neurosurgery, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (V.B.); (Á.G.); (A.H.); (M.H.); (M.S.); (H.V.); (E.G.)
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Li Y, Cheng H, Li Z, Zhao H, Wang J, Wang P, Jin T, Zheng G, Ye H, Li S, Zhang J. Clinical Value of 3D-Printed Navigation Technology Combined with Neuroendoscopy for Intracerebral Hemorrhage. Transl Stroke Res 2021; 12:1035-1044. [PMID: 33492652 DOI: 10.1007/s12975-021-00893-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 01/03/2021] [Accepted: 01/17/2021] [Indexed: 11/25/2022]
Abstract
Intracerebral hemorrhage (ICH) is the most common form of hemorrhagic stroke with high morbidity and mortality. Rapid and massive bleeding may compress the brain tissue, causing space-occupying and pathological effects, such as reduced local cerebral blood flow, acidosis, and inflammatory and immune responses. Although the development of minimally invasive technique provides a new option for the treatment of ICH, their application is limited due to the difficulty in achieving accurate puncture localization under the guidance of the marks on CT. We selected 30 patients treated with neuroendoscopic surgery guided by 3D-printed navigation technology (experimental group) and 30 patients treated with neuroendoscopic surgery guided by hand-painted on the patient's body surface according to the marks on CT (control group). Our results showed that patients in the experimental group had a lower number of intraoperative punctures, shorter operation time, less intraoperative blood loss, higher hematoma clearance rate, and smaller volume of perihematomal edema than the patients in the control group. Moreover, patients in the experimental group had higher Glasgow Coma Scale score at discharge, shorter postoperative hospitalization time and ICU stay, and a lower rate of postoperative complications, despite the lack of statistically significant differences. In addition, no statistically significant differences were observed in mortality and Glasgow Outcome Scale score between the two groups. In conclusion, 3D-printed navigation technology used for the neuroendoscopic hematoma removal is a more reliable and less invasive approach in the treatment of ICH. This technique has great application prospects and deserves promotion in the future clinical practice.
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Affiliation(s)
- Yuqian Li
- Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, Xi'an, Shaanxi, China
| | - Hongyu Cheng
- Department of Ultrasound Diagnosis, Tangdu Hospital, Air Force Medical University, Xi'an, Shaanxi, China
| | - Zhenzhu Li
- Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, Shandong, China
| | - Haikang Zhao
- Department of Neurosurgery, The Second Hospital Affiliated of Xi'an Medical University, Xi'an, Shaanxi, China
| | - Jiancai Wang
- Department of Neurosurgery, PLA 982 hospital, Tangshan, Hebei, China
| | - Peng Wang
- Department of Neurosurgery, Dalang Hospital, Dongguan, Guangdong, China
| | - Tongxin Jin
- Department of Intensive Care Unit, Dalang Hospital, Dongguan, Guangdong, China
| | - Guiyong Zheng
- Department of Anesthesiology, Dalang Hospital, Dongguan, Guangdong, China
| | - Haoxiang Ye
- Department of Radiology, Dalang Hospital, Dongguan, Guangdong, China
| | - Shaopeng Li
- Department of Neurosurgery, Dongguan People's Hospital, Affiliated Dongguan People's Hospital of Southern Medical University, Dongguan, China.
| | - Jun Zhang
- Department of Neurosurgery, Dalang Hospital, Dongguan, Guangdong, China.
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23
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Yang Y, Mu A, Wang Y. Early path nursing improves neurological function recovery in patients with intracerebral hemorrhage: Protocol for a randomized controlled trial. Medicine (Baltimore) 2021; 100:e24020. [PMID: 33429767 PMCID: PMC7793312 DOI: 10.1097/md.0000000000024020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND To explore the influence of the early path nursing on life quality and the neurological function recovery in the intracerebral hemorrhage (ICH) patients. METHODS The experiment was implemented from January 2018 to October 2020 at the First Affiliated Hospital of Soochow University. The experiment was granted through the Research Ethics Committee of the First Affiliated Hospital of Soochow University (2017033). In this experiment, the criteria for inclusion includes: hemorrhagic stroke diagnosed via the MRI or head CT; over 18 years of age; patients with motor dysfunction; The Glasgow Coma Scale > 12. The patients with these symptoms will be excluded: severe cognitive impairment; ischemic stroke; onset time > 3 days; and severe complications. The scale used for the evaluation the neurological function is the American Stroke Scale. This scale contains a total of eleven items, that is, the movements of upper and lower limb, the consciousness level, gaze, visual field, etc. Other outcomes include patient satisfaction and complications. RESULTS Evaluation the neurological function and quality of life will be shown in Table 1. CONCLUSION The early path nursing can promote the neurological function recovery in the ICH patients. TRIAL REGISTRATION NUMBER researchregistry6327.
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24
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Wang G, He CJ, Liang XS, Zhou YF, Chen SH. Potential role of serum substance P as a favorable biomarker of functional outcome in acute spontaneous intracerebral hemorrhage. Clin Chim Acta 2020; 510:111-116. [PMID: 32653487 DOI: 10.1016/j.cca.2020.07.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/03/2020] [Accepted: 07/06/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Substance P (SP) is implicated in brain inflammation. We clarified relationship between serum SP concentrations and functional outcome of acute intracerebral hemorrhage (ICH). METHODS We quantified admission serum SP concentrations in 106 ICH patients. The primary outcome measure was a poor outcome at 90 days (modified Rankin Scale score ≥ 3) after onset. RESULTS Patients with a poor outcome compared with the rest had substantially higher serum SP concentrations. The area under the curve for serum SP concentrations with regard to discriminating a poor outcome was 0.795 (95% CI, 0.706 to 0.867). Serum SP concentrations >449 pg/ml predicted the risk of a poor outcome with 63.0% sensitivity and 78.9% specificity, and were independently associated with a poor outcome (odds ratio, 5.437; 95% CI, 2.156 to 13.715). There were the positive associations between serum SP concentrations, National Institutes of Health Stroke Scale score (r = 0.480), hematoma volume (r = 0.464) and serum C-reactive protein concentrations (r = 0.398). CONCLUSIONS Higher serum SP concentrations in the acute phase of ICH were intimately associated with aggravated inflammation response, rising severity and increased risk of a poor functional outcome, suggesting that serum SP could be an inflammatory prognostic factor for ICH.
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Affiliation(s)
- Gang Wang
- Department of Neurosurgery, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), 568 North Zhongxing Road, Shaoxing 312000, Zhejiang Province, PR China
| | - Chen-Jun He
- Department of Neurosurgery, Affiliated Hospital of Shaoxing University (Shaoxing Municipal Hospital), 999 South Zhongxing Road, Shaoxing 312000, Zhejiang Province, PR China.
| | - Xiao-Song Liang
- Department of Neurosurgery, Affiliated Hospital of Shaoxing University (Shaoxing Municipal Hospital), 999 South Zhongxing Road, Shaoxing 312000, Zhejiang Province, PR China
| | - Yi-Fu Zhou
- Department of Neurosurgery, Affiliated Hospital of Shaoxing University (Shaoxing Municipal Hospital), 999 South Zhongxing Road, Shaoxing 312000, Zhejiang Province, PR China
| | - Si-Hua Chen
- Department of Neurosurgery, Affiliated Hospital of Shaoxing University (Shaoxing Municipal Hospital), 999 South Zhongxing Road, Shaoxing 312000, Zhejiang Province, PR China
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25
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Wang P, Sun Y, Yi D, Xie Y, Luo Y. Clinical features of Chinese patients in different age groups with spontaneous intracerebral hemorrhage based on multicenter inpatient information. Neurol Res 2020; 42:657-664. [PMID: 32552613 DOI: 10.1080/01616412.2020.1782082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Patients with spontaneous intracerebral hemorrhage (ICH) have poor functional outcomes. This study investigated the status of hospitalized patients with ICH based on multicenter inpatient information. METHODS We analyzed data from the hospital information systems (HISs) of 14 tertiary hospitals, including 6 Chinese medicine hospitals and 8 western hospitals from 7 provinces and 2 municipalities. The inclusion criteria were age ≥25 years and radiologically confirmed spontaneous ICH within two weeks of symptom onset. Age groups were as follows: 25-44, 45-59, 60-74, 75-89, 90 and over 90 years old. Data are presented as the proportion (%), median (interquartile range) or mean (standard deviation). Descriptive statistical analyses were conducted to analyze demographic features, lengths of hospital stay, hospitalization expenses, hematoma locations, mortality and major comorbid conditions or complications. RESULTS Patients were recruited from October 2003 to September 2011. A total of 9475 inpatients were recruited from 14 Class III Grade A hospitals. Baseline characteristics included a mean age of 58 (20) years old and 37.2% female (3303). The largest number of ICH patients were in the 44-59-year-old group. The ratio of males to females in the 25-44-year-old age group was 2.36:1, which was the highest of all groups; the lowest male to female ratio was 1.56:1 in the 45-59-year-old age group. The ratios of males to females in the 60-74, 75-89 and ≥90-year-old age groups were 1.60:1, 1.62:1 and 1.64:1, respectively. The proportion of males in all age groups was higher than that of females, significantly greater in the 25-44-year-old age group (P < 0.001). The lengths of hospital stay ranged from 15 to 28 days. The hospitalization expenses of the 25-44-year-old patients were 50,000-100,000 RMB, and the costs of the remaining age groups were 10,000-20,000 RMB. Basal ganglia/thalamic hemorrhage was the most common site of ICH in different age groups. Lobar and multiple locations were higher in those aged >75 years. Hypertension was the primary comorbid condition in all age groups, and it showed a rising trend with increasing age. The second most common comorbidity in the 25-44-year-old age group was vascular abnormality, while in the other age groups, comorbidities included cerebral infarction, dyslipidemia, coronary heart disease, diabetes mellitus and arrhythmia. Mortality increased with age; mortality for those under the age of 74 years fluctuated between 4.09% and 5.93%, whereas in those in the 75-89 and ≥90-year-old age groups, mortality was 13.34% and 34.09%, respectively. CONCLUSIONS As age increased, the length of hospital stay, financial burden and mortality due to ICH increased. Different age groups had different distributions of neuroimaging features, major comorbid conditions or complications.
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Affiliation(s)
- Pingping Wang
- Department of Neurology and Institute of Cerebrovascular Diseases Research, Xuanwu Hospital of Capital Medical University , Beijing, China
| | - Yong Sun
- School of Statistics, Renmin University of China , Beijing, China
| | - Danhui Yi
- School of Statistics, Renmin University of China , Beijing, China
| | - Yanming Xie
- Institute of Clinical Basic Medical Sciences, China Academy of Chinese Medical Sciences , Beijing, China
| | - Yumin Luo
- Department of Neurology and Institute of Cerebrovascular Diseases Research, Xuanwu Hospital of Capital Medical University , Beijing, China
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26
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Godoy DA, Núñez-Patiño RA, Zorrilla-Vaca A, Ziai WC, Hemphill JC. Intracranial Hypertension After Spontaneous Intracerebral Hemorrhage: A Systematic Review and Meta-analysis of Prevalence and Mortality Rate. Neurocrit Care 2020; 31:176-187. [PMID: 30565090 DOI: 10.1007/s12028-018-0658-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The objective of this study was to determine the prevalence of intracranial hypertension (IHT) and the associated mortality rate in patients who suffered from primary intracerebral hemorrhage (ICH). A secondary objective was to assess predisposing factors to IHT development. We conducted a systematic literature search of major electronic databases (MEDLINE, EMBASE, and Cochrane Library), for studies that assessed intracranial pressure (ICP) monitoring in patients with acute ICH. Study level and outcome measures were extracted. The meta-analysis was performed using a random-effects model. A total of six studies comprising 381 patients were pooled to estimate the overall prevalence of any episode of IHT (ICP > 20 mmHg) after ICH. The pooled prevalence rate for any episode of IHT after ICH was 67% (95% CI 51-84%). Four studies comprising 239 patients were pooled in order to estimate the overall mortality rate associated with IHT. Pooled mortality rate was 50% (95% CI 24-76%). For both outcomes, heterogeneity was statistically significant, and risk of bias was nonsignificant. Reported variables correlated significantly with increased ICP were lower Glasgow Coma Scale score at admission, midline shift, hemorrhage volume, and hydrocephalus. The prevalence and mortality rates associated with IHT after ICH are high and may be underestimated. Predicting factors for the development of IHT reflect the magnitude of the primary injury. However, the results of present meta-analysis should be interpreted with caution due to methodological limitations such as selection bias of patients who had ICP monitoring, and lack of standardized IHT definition.
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Affiliation(s)
- Daniel Agustín Godoy
- Neurointensive Care Unit, Sanatorio Pasteur, Intensive Care Unit, Hospital San Juan Bautista, Chacabuco 675, 4700, Catamarca, Argentina.
| | - Rafael A Núñez-Patiño
- Faculty of Health Sciences, School of Medicine, Pontificia Universidad Javeriana, Cali, Colombia
| | - Andres Zorrilla-Vaca
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, MD, USA.,Faculty of Health, Universidad del Valle, Hospital Universitario del Valle, Cali, Colombia
| | - Wendy C Ziai
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, MD, USA.,Division of Neurosciences Critical Care, Departments of Neurology, Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - J Claude Hemphill
- Kenneth Rainin Endowed Chair in Neurocritical Care, Professor of Neurology and Neurological Surgery, University of California, San Francisco, USA
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27
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Zhenzhu L, Ruiyu X, Wei C, Henglu W, Jinke D, Wei S, Hongpeng D, Wenbo G, Pengfei L, Yongliang L, Meng L, Jianmin L, Zefu L. Novel Cost-Effective Tubular Port Based on Glove and Syringe for Endoscopic Surgery of Intracerebral Hematomas. World Neurosurg 2020; 135:367-374.e1. [DOI: 10.1016/j.wneu.2019.11.097] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 11/15/2019] [Accepted: 11/17/2019] [Indexed: 11/29/2022]
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Expert-level detection of acute intracranial hemorrhage on head computed tomography using deep learning. Proc Natl Acad Sci U S A 2019; 116:22737-22745. [PMID: 31636195 PMCID: PMC6842581 DOI: 10.1073/pnas.1908021116] [Citation(s) in RCA: 114] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Computed tomography (CT) of the head is the workhorse medical imaging modality used worldwide to diagnose neurologic emergencies. However, these gray scale images are limited by low signal-to-noise, poor contrast, and a high incidence of image artifacts. A unique challenge is to identify tiny subtle abnormalities in a large 3D volume with near-perfect sensitivity. We used a single-stage, end-to-end, fully convolutional neural network to achieve accuracy levels comparable to that of highly trained radiologists, including both identification and localization of abnormalities that are missed by radiologists. Computed tomography (CT) of the head is used worldwide to diagnose neurologic emergencies. However, expertise is required to interpret these scans, and even highly trained experts may miss subtle life-threatening findings. For head CT, a unique challenge is to identify, with perfect or near-perfect sensitivity and very high specificity, often small subtle abnormalities on a multislice cross-sectional (three-dimensional [3D]) imaging modality that is characterized by poor soft tissue contrast, low signal-to-noise using current low radiation-dose protocols, and a high incidence of artifacts. We trained a fully convolutional neural network with 4,396 head CT scans performed at the University of California at San Francisco and affiliated hospitals and compared the algorithm’s performance to that of 4 American Board of Radiology (ABR) certified radiologists on an independent test set of 200 randomly selected head CT scans. Our algorithm demonstrated the highest accuracy to date for this clinical application, with a receiver operating characteristic (ROC) area under the curve (AUC) of 0.991 ± 0.006 for identification of examinations positive for acute intracranial hemorrhage, and also exceeded the performance of 2 of 4 radiologists. We demonstrate an end-to-end network that performs joint classification and segmentation with examination-level classification comparable to experts, in addition to robust localization of abnormalities, including some that are missed by radiologists, both of which are critically important elements for this application.
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29
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Hu S, Ma Q, Li B, Wu Q, Han R. Association of Hypothyroidism with Hypertensive Intracerebral Hemorrhage: A Case-Control Study. World Neurosurg 2019; 134:e8-e11. [PMID: 31421295 DOI: 10.1016/j.wneu.2019.08.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 08/06/2019] [Accepted: 08/07/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Hypothyroidism is widely thought to cause vascular endothelial disorders and atherosclerosis. The purpose of this study was to explore whether patients with hypertension and hypothyroidism may have a higher incidence of hypertensive intracerebral hemorrhage. METHODS Cases of hypertensive intracerebral hemorrhage collected from the neurology department and neurosurgery department of our hospital from January 1, 2018, to December 31, 2018, were retrospectively collected. A case-control study was conducted on an equal number of patients with hypertension without hypertensive intracerebral hemorrhage randomly selected through age matching in the same period. The history of hypothyroidism and other common risk factors at admission was recorded. RESULTS A total of 231 patients with hypertensive intracerebral hemorrhage were included and 231 patients with hypertension were selected for control subjects according to the age matching and random screening principles. Hypothyroidism was present in 54 patients (23.4%) and 33 matched controls (14.3%). Multivariate logistic regression analysis showed that hypothyroidism was an independent risk factor for hypertensive intracerebral hemorrhage (odds ratio, 2.29; 95% confidence interval, 1.38-3.79; P = 0.001). CONCLUSIONS Hypothyroidism may be independently associated with hypertensive intracerebral hemorrhage. In view of the known pathophysiologic relationship between hypothyroidism and vascular endothelial dysfunction and atherosclerosis, further research and exploration are necessary.
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Affiliation(s)
- Si Hu
- Department of Neurosurgery, 98th Hospital of Chinese People's Liberation Army, Huzhou, ZheJiang, China
| | - Qiang Ma
- Department of Neurosurgery, 98th Hospital of Chinese People's Liberation Army, Huzhou, ZheJiang, China
| | - Bin Li
- Department of Neurosurgery, 98th Hospital of Chinese People's Liberation Army, Huzhou, ZheJiang, China
| | - QianQian Wu
- Department of Neurology, 98th Hospital of Chinese People's Liberation Army, Huzhou, ZheJiang, China
| | - RuiZhang Han
- Department of Neurosurgery, 98th Hospital of Chinese People's Liberation Army, Huzhou, ZheJiang, China.
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30
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Reyes R, Viswanathan M, Aiyagari V. An update on neurocritical care for intracerebral hemorrhage. Expert Rev Neurother 2019; 19:557-578. [PMID: 31092052 DOI: 10.1080/14737175.2019.1618709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Introduction: Intracerebral hemorrhage remains one of the leading causes of death and disability worldwide with few established interventions that improve neurologic outcome. Research dedicated to better understanding and treating hemorrhagic strokes has multiplied in the past decade. Areas Covered: This review aims to discuss the current landscape of management of intracerebral hemorrhage in a critical care setting and provide updates regarding developments in therapeutic interventions and targets. PubMed was utilized to review recent literature, with a focus on large trials and meta-analyses, which have shaped current practice. Published committee guidelines were also included. A focus was placed on research published after 2015 in an effort to supplement previous reviews included in this publication. Expert Opinion: Literature pertaining to ICH management has allowed for a greater understanding of ineffective strategies as opposed to those of benefit. Despite this, mortality has improved worldwide, which may be the result of growing research efforts. Areas of future research that will impact mortality and improve neurologic outcomes include prevention of hematoma expansion, optimization of blood pressure targets, effective coagulopathy reversal, and minimally invasive surgical techniques to reduce hematoma burden.
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Affiliation(s)
- Ranier Reyes
- a Neurological Surgery & Neurology and Neurotherapeutics , The University of Texas Southwestern Medical Center , Dallas , TX , USA
| | - Meera Viswanathan
- a Neurological Surgery & Neurology and Neurotherapeutics , The University of Texas Southwestern Medical Center , Dallas , TX , USA
| | - Venkatesh Aiyagari
- a Neurological Surgery & Neurology and Neurotherapeutics , The University of Texas Southwestern Medical Center , Dallas , TX , USA
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31
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Wan J, Ren H, Wang J. Iron toxicity, lipid peroxidation and ferroptosis after intracerebral haemorrhage. Stroke Vasc Neurol 2019; 4:93-95. [PMID: 31338218 PMCID: PMC6613877 DOI: 10.1136/svn-2018-000205] [Citation(s) in RCA: 138] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 12/06/2018] [Accepted: 12/18/2018] [Indexed: 01/10/2023] Open
Abstract
Intracerebral haemorrhage (ICH) is a devastating type of stroke with high mortality and morbidity. However, we have few options for ICH therapy and limited knowledge about post-ICH neuronal death and related mechanisms. In the aftermath of ICH, iron overload within the perihaematomal region can induce lethal reactive oxygen species (ROS) production and lipid peroxidation, which contribute to secondary brain injury. Indeed, iron chelation therapy has shown efficacy in preclinical ICH studies. Recently, an iron-dependent form of non-apoptotic cell death known as ferroptosis was identified. It is characterised by an accumulation of iron-induced lipid ROS, which leads to intracellular oxidative stress. The ROS cause damage to nucleic acids, proteins and lipid membranes, and eventually cell death. Recently, we and others discovered that ferroptosis does occur after haemorrhagic stroke in vitro and in vivo and contributes to neuronal death. Inhibition of ferroptosis is beneficial in several in vivo and in vitro ICH conditions. This minireview summarises current research on iron toxicity, lipid peroxidation and ferroptosis in the pathomechanisms of ICH, the underlying molecular mechanisms of ferroptosis and the potential for combined therapeutic strategies. Understanding the role of ferroptosis after ICH will provide a vital foundation for cell death-based ICH treatment and prevention.
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Affiliation(s)
- Jieru Wan
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Honglei Ren
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Jian Wang
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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32
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Li Q, Lan X, Han X, Wang J. Expression of Tmem119/ Sall1 and Ccr2/ CD69 in FACS-Sorted Microglia- and Monocyte/Macrophage-Enriched Cell Populations After Intracerebral Hemorrhage. Front Cell Neurosci 2019; 12:520. [PMID: 30687011 PMCID: PMC6333739 DOI: 10.3389/fncel.2018.00520] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 12/12/2018] [Indexed: 11/30/2022] Open
Abstract
Activation and polarization of microglia and macrophages are critical events in neuroinflammation and hematoma resolution after intracerebral hemorrhage (ICH). However, distinguishing microglia and monocyte-derived macrophages histologically can be difficult. Although they share most cell surface markers, evidence indicates that the gene regulation and function of these two cell types might be different. Flow cytometry is the gold standard for discriminating between the two cell populations, but it is rarely used in the ICH research field. We developed a flow cytometry protocol to identify and sort microglia and monocyte-derived macrophages from mice that have undergone well-established ICH models induced by collagenase or blood injection. In addition, we combined a recently established magnetic-activated cell separation system that allows eight tissue samples to be assessed together. This protocol can be completed within 5–8 h. Sorted cells are fully preserved and maintain expression of microglia-specific (Tmem119/Sall1) and macrophage-specific (Ccr2/CD69) markers. They retain phagocytic ability, respond to lipopolysaccharide stimulation, and engulf fluorescent latex beads. Thus, this protocol represents a very important tool for researching microglial and monocyte-derived macrophage biologic function after ICH and other brain diseases.
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Affiliation(s)
- Qian Li
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Xi Lan
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Xiaoning Han
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Jian Wang
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Xu YM, Wang XC, Zhang SJ, Xu TT, Li HY, Hei SY, Wen ZH, Ma YZ, Wang Q, Liang WX. Role of Xingnaojing combined with naloxone in treating intracerebral haemorrhage: A systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) 2018; 97:e12967. [PMID: 30412118 PMCID: PMC6221641 DOI: 10.1097/md.0000000000012967] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Xingnaojing injection (XNJ) sharpen the mind and induce consciousness and are widely used in acute phases of intracerebral hemorrhage (ICH). Naloxone hydrochloride injection (NX) performs equally well and replace the effects of morphine-like substances to promote conscious awareness. The applications of XNJ combined with NX for ICH show some advantages compared with NX applied individually. The aim of this systematic review is to evaluate the effectiveness and safety of XNJ combined with NX for ICH. METHODS Comprehensive searches were conducted in 8 medical databases (PubMed, Cochrane Library, Web of Science, Embase, CNKI, VIP, CBM and Wanfang database) from inceptions to October 2017 for randomized controlled trials (RCTs) that compared the applications of XNJ and NX with NX applied individually in ICH. Literature screening, assessing risk of bias and data extraction were conducted by 2 reviewers independently. According to the Cochrane Collaboration's RevMan5.3 software to perform the data analysis. RESULTS 32 RCTs (3068 cases) were selected and the quality of studies were low. All trials compared XNJ and NX with NX applied individually. The overall meta-analysis results showed that XNJ combined with NX have significant effect on clinical efficacy (OR 3.78, 95% CI: 3.03-4.73; P < .00001), GCS score (MD 3.86, 95% CI: 3.46-4.25; P < .00001), coma duration (MD -5.59, 95% CI: -6.96 to -4.22; P < .00001), NIHSS score (MD -6.24, 95% CI: -8.05 to -4.42; P < .00001), Barthel Index score (MD 14.12, 95% CI: 6.7-21.54; P < .0002), cerebral hematoma volume (MD -6.05, 95% CI: -6.85 to -5.24; P < .00001) than NX applied individually. Adverse events reported in 4 studies and included mild discomfort symptoms. CONCLUSION The effectiveness and safety of XNJ combined with NX for ICH cannot be determined due to the low quality of literature, publication bias and heterogeneity. More rigorous RCTs are necessary to verify the role of XNJ combined with NX in the treatment of ICH.
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Affiliation(s)
- Yu-Min Xu
- The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
- Institute of Clinical Pharmacology, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xin-Chen Wang
- Institute of Clinical Pharmacology, Guangzhou University of Chinese Medicine, Guangzhou, China
- School of Food and Pharmaceutical Engineering, Zhaoqing University, Guangdong, China
| | - Shi-Jie Zhang
- Institute of Clinical Pharmacology, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ting-Ting Xu
- Institute of Clinical Pharmacology, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Hong-Ying Li
- Institute of Clinical Pharmacology, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shang-Yan Hei
- Institute of Clinical Pharmacology, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ze-Huai Wen
- Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Yun-Zhi Ma
- The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Qi Wang
- Institute of Clinical Pharmacology, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wei-Xiong Liang
- Institute of Clinical Pharmacology, Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
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Li QQ, Li LJ, Wang XY, Sun YY, Wu J. Research Progress in Understanding the Relationship Between Heme Oxygenase-1 and Intracerebral Hemorrhage. Front Neurol 2018; 9:682. [PMID: 30177908 PMCID: PMC6109777 DOI: 10.3389/fneur.2018.00682] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 07/30/2018] [Indexed: 01/14/2023] Open
Abstract
Intracerebral hemorrhage (ICH) is a fatal acute cerebrovascular disease, with a high morbidity and mortality. Following ICH, erythrocytes release heme and several of its metabolites, thereby contributing to brain edema and secondary brain damage. Heme oxygenase is the initial and rate-limiting enzyme of heme catabolism, and the expression of heme oxygenase-1 (HO-1) is rapidly induced following acute brain injury. As HO-1 exerts it effects via various metabolites, its role during ICH remains complex. Therefore, in-depth studies regarding the role of HO-1 in secondary brain damage following ICH may provide a theoretical basis for neuroprotective function after ICH. The present review aims to summarize recent key studies regarding the effects of HO-1 following ICH, as well as its influence on ICH prognosis.
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Affiliation(s)
- Qian-Qian Li
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Lan-Jun Li
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Xin-Yu Wang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Yu-Ying Sun
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Jun Wu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
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Moore P, Le T, Blakley B, Beiko J, Meen E. Hemorrhagic stroke after Epley maneuver: a case report. J Otolaryngol Head Neck Surg 2018; 47:25. [PMID: 29631624 PMCID: PMC5891963 DOI: 10.1186/s40463-018-0268-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 03/12/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This is the first case to our knowledge of a serious adverse event following the Epley maneuver, which is the treatment of choice for benign paroxysmal positional vertigo (BPPV), the most common vestibular disorder in adults. CASE PRESENTATION A 77 year old female presented for outpatient evaluation of vertigo at a tertiary otolaryngology clinic. She was found to have BPPV clinically, and elected to have a particle repositioning maneuver (Epley maneuver) performed in clinic. Immediately following Epley maneuver, she had severe nausea and vomiting, with evolving visual changes. A CT angiogram of the brain was performed urgently through the emergency department and demonstrated an acute intraparenchymal hemorrhage in the occipital lobe. After medical stabilization and rehabilitation, the patient continues to have a permanent visual field deficit. CONCLUSION The Epley maneuver is safe and effective, and there are no prior reports of serious adverse events associated with its use. This case, in which a patient experienced a hemorrhagic stroke after undergoing the Epley maneuver, is the first and sole case in the medical literature of an Epley-associated serious adverse event. The indirect causation and extreme rarity of this event do not warrant any change to patterns of practice.
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Affiliation(s)
- Paige Moore
- Department of Otolaryngology - Head & Neck Surgery, University of Manitoba, GB421 - 820 Sherbrook Street, Winnipeg, MB, R3A 1R9, Canada.
| | - Trung Le
- Department of Otolaryngology - Head & Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Brian Blakley
- Department of Otolaryngology - Head & Neck Surgery, University of Manitoba, GB421 - 820 Sherbrook Street, Winnipeg, MB, R3A 1R9, Canada
| | - Jason Beiko
- Department of Neurosurgery, University of Manitoba, Winnipeg, MB, Canada
| | - Eric Meen
- Department of Otolaryngology - Head & Neck Surgery, University of Manitoba, GB421 - 820 Sherbrook Street, Winnipeg, MB, R3A 1R9, Canada
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Koschnitzky JE, Keep RF, Limbrick DD, McAllister JP, Morris JA, Strahle J, Yung YC. Opportunities in posthemorrhagic hydrocephalus research: outcomes of the Hydrocephalus Association Posthemorrhagic Hydrocephalus Workshop. Fluids Barriers CNS 2018; 15:11. [PMID: 29587767 PMCID: PMC5870202 DOI: 10.1186/s12987-018-0096-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 03/09/2018] [Indexed: 12/19/2022] Open
Abstract
The Hydrocephalus Association Posthemorrhagic Hydrocephalus Workshop was held on July 25 and 26, 2016 at the National Institutes of Health. The workshop brought together a diverse group of researchers including pediatric neurosurgeons, neurologists, and neuropsychologists with scientists in the fields of brain injury and development, cerebrospinal and interstitial fluid dynamics, and the blood-brain and blood-CSF barriers. The goals of the workshop were to identify areas of opportunity in posthemorrhagic hydrocephalus research and encourage scientific collaboration across a diverse set of fields. This report details the major themes discussed during the workshop and research opportunities identified for posthemorrhagic hydrocephalus. The primary areas include (1) preventing intraventricular hemorrhage, (2) stopping primary and secondary brain damage, (3) preventing hydrocephalus, (4) repairing brain damage, and (5) improving neurodevelopment outcomes in posthemorrhagic hydrocephalus.
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Affiliation(s)
| | - Richard F. Keep
- University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109 USA
| | - David D. Limbrick
- Washington University in St. Louis School of Medicine, 660 S. Euclid Ave, St. Louis, MO 63110 USA
| | - James P. McAllister
- Washington University in St. Louis School of Medicine, 660 S. Euclid Ave, St. Louis, MO 63110 USA
| | - Jill A. Morris
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Neuroscience Center, 6001 Executive Blvd, NSC Rm 2112, Bethesda, MD 20892 USA
| | - Jennifer Strahle
- Washington University in St. Louis School of Medicine, 660 S. Euclid Ave, St. Louis, MO 63110 USA
| | - Yun C. Yung
- Sanford Burnham Prebys Medical Discovery Institute, 10901 North Torrey Pines Rd., Building 7, La Jolla, CA 92037 USA
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Vahidy FS, Meyer EG, Bambhroliya AB, Meeks JR, Begley CE, Wu TC, Tyson JE, Miller CC, Bowry R, Ahmed WO, Gealogo GA, McCullough LD, Warach S, Savitz SI. Rationale and Design of a Statewide Cohort to examine efficient resource utilization for patients with Intracerebral hemorrhage (EnRICH). BMC Neurol 2018; 18:31. [PMID: 29562884 PMCID: PMC5863437 DOI: 10.1186/s12883-018-1036-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 03/12/2018] [Indexed: 11/14/2022] Open
Abstract
Background Intracerebral hemorrhage is a devastating disease with no specific treatment modalities. A significant proportion of patients with intracerebral hemorrhage are transferred to large stroke treatment centers, such as Comprehensive Stroke Centers, because of perceived need for higher level of care. However, evidence of improvement in patient-centered outcomes for these patients treated at larger stroke treatment centers as compared to community hospitals is lacking. Methods / design “Efficient Resource Utilization for Patients with Intracerebral Hemorrhage (EnRICH)” is a prospective, multisite, state-wide, cohort study designed to assess the impact of level of care on long-term patient-centered outcomes for patients with primary / non-traumatic intracerebral hemorrhage. The study is funded by the Texas state legislature via the Lone Star Stroke Research Consortium. It is being implemented via major hub hospitals in large metropolitan cities across the state of Texas. Each hub has an extensive network of “spoke” hospitals, which are connected to the hub via traditional clinical and administrative arrangements, or by telemedicine technologies. This infrastructure provides a unique opportunity to track outcomes for intracerebral hemorrhage patients managed across a health system at various levels of care. Eligible patients are enrolled during hospitalization and are followed for functional, quality of life, cognitive, resource utilization, and dependency outcomes at 30 and 90 days post discharge. As a secondary aim, an economic analysis of the incremental cost-effectiveness of treating intracerebral hemorrhage patients at higher levels of care will be conducted. Discussion Findings from EnRICH will provide much needed evidence of the effectiveness and efficiency of regionalized care for intracerebral hemorrhage patients. Such evidence is required to inform policy and streamline clinical decision-making.
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Affiliation(s)
- Farhaan S Vahidy
- Department of Neurology and the Institute for Stroke and Cerebrovascular Disease, McGovern Medical School, University of Texas - Health, Houston, TX, USA.
| | - Ellie G Meyer
- Department of Neurology and the Institute for Stroke and Cerebrovascular Disease, McGovern Medical School, University of Texas - Health, Houston, TX, USA
| | - Arvind B Bambhroliya
- Department of Neurology and the Institute for Stroke and Cerebrovascular Disease, McGovern Medical School, University of Texas - Health, Houston, TX, USA
| | - Jennifer R Meeks
- Department of Neurology and the Institute for Stroke and Cerebrovascular Disease, McGovern Medical School, University of Texas - Health, Houston, TX, USA
| | - Charles E Begley
- Department of Management, Policy, and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Tzu-Ching Wu
- Department of Neurology and the Institute for Stroke and Cerebrovascular Disease, McGovern Medical School, University of Texas - Health, Houston, TX, USA
| | - Jon E Tyson
- Center for Clinical Research and Evidence Based Medicine at McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Charles C Miller
- Center for Clinical Research and Evidence Based Medicine at McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Ritvij Bowry
- Department of Neurosurgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Wamda O Ahmed
- Department of Neurosurgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Gretchel A Gealogo
- Department of Neurology, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - Louise D McCullough
- Department of Neurology and the Institute for Stroke and Cerebrovascular Disease, McGovern Medical School, University of Texas - Health, Houston, TX, USA
| | - Steven Warach
- Department of Neurology, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - Sean I Savitz
- Department of Neurology and the Institute for Stroke and Cerebrovascular Disease, McGovern Medical School, University of Texas - Health, Houston, TX, USA
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Wang LG, Huangfu XQ, Tao B, Zhong GJ, Le ZD. Serum tenascin-C predicts severity and outcome of acute intracerebral hemorrhage. Clin Chim Acta 2018; 481:69-74. [PMID: 29499198 DOI: 10.1016/j.cca.2018.02.033] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 01/22/2018] [Accepted: 02/25/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Tenascin-C is a matricellular protein related to brain injury. We studied serum tenascin-C in acute intracerebral hemorrhage (ICH) and examined the associations with severity and outcome following the acute event. METHODS Tenascin-C samples were obtained from 162 patients with acute hemorrhagic stroke and 162 healthy controls. Poor 90-day functional outcome was defined as modified Rankin Scale score > 2. Early neurological deterioration (END) and hematoma growth (HG) were recorded at 24 h. RESULTS Patients had higher tenascin-C levels than controls. Tenascin-C levels were positively correlated with hematoma volume or National Institutes of Health Stroke Scale score at baseline. Elevated tenascin-C levels were independently associated with END, HG, 90-day mortality and poor functional outcome. Moreover, tenascin-C levels significantly predicted END, HG and 90-day outcomes under receiver operating characteristic curves. CONCLUSIONS An increase in serum tenascin-C level is associated with an adverse outcome in ICH patients, supporting the potential role of serum tenascin-C as a prognostic biomarker for hemorrhagic stroke.
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Affiliation(s)
- Lin-Guo Wang
- Department of Neurosurgery, The First People's Hospital of Tonglu County, 338 Xuesheng Road, Tonglu 311500, China.
| | - Xue-Qin Huangfu
- Department of Neurosurgery, The First People's Hospital of Tonglu County, 338 Xuesheng Road, Tonglu 311500, China
| | - Bo Tao
- Department of Neurosurgery, The First People's Hospital of Tonglu County, 338 Xuesheng Road, Tonglu 311500, China
| | - Guan-Jin Zhong
- Department of Neurosurgery, The First People's Hospital of Tonglu County, 338 Xuesheng Road, Tonglu 311500, China
| | - Zhou-Di Le
- Department of Neurosurgery, The First People's Hospital of Tonglu County, 338 Xuesheng Road, Tonglu 311500, China
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Zhou Z, Liang Y, Qu H, Zhao M, Guo F, Zhao C, Teng W. Plasma homocysteine concentrations and risk of intracerebral hemorrhage: a systematic review and meta-analysis. Sci Rep 2018; 8:2568. [PMID: 29416106 PMCID: PMC5803270 DOI: 10.1038/s41598-018-21019-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 01/29/2018] [Indexed: 12/27/2022] Open
Abstract
Intracerebral hemorrhage (ICH) has the highest mortality rate in all strokes. However, controversy still exists concerning the association between plasma homocysteine (Hcy) and ICH. A systematic review and meta-analysis was conducted using Pubmed, Embase, and Web of Science up to April 18, 2017. Standard mean difference (SMD) for mean differences of plasma Hcy levels with 95% confidence intervals (CI) was calculated. Seven studies including 667 ICH patients and 1821 ischemic stroke patients were identified for meta-analysis. Our results showed that Hcy levels in ICH patients were significantly higher than those in healthy controls (SMD = 0.59, 95% CI = 0.51–0.68, P < 0.001); no statistic differences were found in the comparisons of Hcy levels between ICH and ischemic stroke (SMD = −0.03, 95% CI = −0.13–0.06, P > 0.05); further subgroup analysis of ethnicity (Asians: SMD = 0.57, 95% CI = 0.48–0.66, P < 0.001; Caucasians: SMD = 0.77, 95% CI = 0.51–1.02, P < 0.001) and sample size (small samples: SMD = 0.55, 95% CI = 0.30–0.80, P < 0.001; large samples size: SMD = 0.60, 95% CI = 0.51–0.69, P < 0.001) in relation to Hcy levels between ICH and healthy controls did not change these results. In conclusion, Hcy level may be an aggravating factor in atherosclerosis, which is positively associated with high risk of ICH. Race-specific differences between Asians and Caucasians have no impact on the risk of ICH.
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Affiliation(s)
- Zhike Zhou
- Department of Geriatrics, The First Affiliated Hospital, China Medical University, Shenyang, 110001, Liaoning, PR China
| | - Yifan Liang
- Department of Neurology, The First Affiliated Hospital, China Medical University, Shenyang, 110001, Liaoning, PR China
| | - Huiling Qu
- 3Department of Neurology, The People's Hospital of Liaoning Province, Shenyang, 110016, Liaoning, PR China
| | - Mei Zhao
- Department of Cardiology, The Shengjing Affiliated Hospital, China Medical University, Shenyang, 110004, Liaoning, PR China
| | - Feng Guo
- Department of Neurology, Fuxin Central Hospital, fuxin, 123000, Liaoning, PR China
| | - Chuansheng Zhao
- Department of Neurology, The First Affiliated Hospital, China Medical University, Shenyang, 110001, Liaoning, PR China.
| | - Weiyu Teng
- Department of Neurology, The First Affiliated Hospital, China Medical University, Shenyang, 110001, Liaoning, PR China.
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Serum S100A12 and 30-day mortality after acute intracerebral hemorrhage. Clin Chim Acta 2018; 477:1-6. [DOI: 10.1016/j.cca.2017.11.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 11/24/2017] [Accepted: 11/27/2017] [Indexed: 11/18/2022]
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Ji WJ, Chou XM, Wu GQ, Shen YF, Yang XG, Wang ZF, Lan LX, Shi XG. Association between serum periostin concentrations and outcome after acute spontaneous intracerebral hemorrhage. Clin Chim Acta 2017; 474:23-27. [DOI: 10.1016/j.cca.2017.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Revised: 09/01/2017] [Accepted: 09/01/2017] [Indexed: 02/07/2023]
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Lan X, Han X, Li Q, Yang QW, Wang J. Modulators of microglial activation and polarization after intracerebral haemorrhage. Nat Rev Neurol 2017; 13:420-433. [PMID: 28524175 PMCID: PMC5575938 DOI: 10.1038/nrneurol.2017.69] [Citation(s) in RCA: 519] [Impact Index Per Article: 74.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Intracerebral haemorrhage (ICH) is the most lethal subtype of stroke but currently lacks effective treatment. Microglia are among the first non-neuronal cells on the scene during the innate immune response to ICH. Microglia respond to acute brain injury by becoming activated and developing classic M1-like (proinflammatory) or alternative M2-like (anti-inflammatory) phenotypes. This polarization implies as yet unrecognized actions of microglia in ICH pathology and recovery, perhaps involving microglial production of proinflammatory or anti-inflammatory cytokines and chemokines. Furthermore, alternatively activated M2-like microglia might promote phagocytosis of red blood cells and tissue debris, a major contribution to haematoma clearance. Interactions between microglia and other cells modulate microglial activation and function, and are also important in ICH pathology. This Review summarizes key studies on modulators of microglial activation and polarization after ICH, including M1-like and M2-like microglial phenotype markers, transcription factors and key signalling pathways. Microglial phagocytosis, haematoma resolution, and the potential crosstalk between microglia and T lymphocytes, neurons, astrocytes, and oligodendrocytes in the ICH brain are described. Finally, the clinical and translational implications of microglial polarization in ICH are presented, including the evidence that therapeutic approaches aimed at modulating microglial function might mitigate ICH injury and improve brain repair.
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Affiliation(s)
- Xi Lan
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, 720 Rutland Avenue, Ross Building 370B, Baltimore, Maryland 21205, USA
| | - Xiaoning Han
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, 720 Rutland Avenue, Ross Building 370B, Baltimore, Maryland 21205, USA
| | - Qian Li
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, 720 Rutland Avenue, Ross Building 370B, Baltimore, Maryland 21205, USA
| | - Qing-Wu Yang
- Department of Neurology, Xinqiao Hospital, Third Military Medical University, 183 Xinqiao Main Street, Shapingba District, Chongqing 400037, China
| | - Jian Wang
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, 720 Rutland Avenue, Ross Building 370B, Baltimore, Maryland 21205, USA
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Li Y, Yang R, Li Z, Yang Y, Tian B, Zhang X, Wang B, Lu D, Guo S, Man M, Yang Y, Luo T, Gao G, Li L. Surgical Evacuation of Spontaneous Supratentorial Lobar Intracerebral Hemorrhage: Comparison of Safety and Efficacy of Stereotactic Aspiration, Endoscopic Surgery, and Craniotomy. World Neurosurg 2017; 105:332-340. [PMID: 28578111 DOI: 10.1016/j.wneu.2017.05.134] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 05/19/2017] [Accepted: 05/22/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND The safety and efficacy of craniotomy, endoscopic surgery, and stereotactic aspiration for surgical evacuation of spontaneous supratentorial lobar intracerebral hemorrhage (ICH) is yet uncertain. The present study analyzed the clinical and radiographic data from 99 patients with spontaneous supratentorial lobar ICH, retrospectively, to address this issue. METHODS Patients who underwent craniotomy, endoscopy surgery, or stereotactic aspiration were assigned to the craniotomy group (n = 31), endoscopy surgery group (n = 32), or stereotactic aspiration group (n = 36), respectively. The characteristics of all the enrolled patients at the time of admission were assimilated. Also, the therapeutic effects of the three surgical procedures were evaluated based on short-term outcomes within 30 days and long-term outcomes at 6 months after the ictus. RESULTS The results showed that stereotactic aspiration and endoscopic surgery were associated with a superior clinical therapeutic effect in both short-term and long-term outcomes than craniotomy for the treatment of spontaneous supratentorial lobar ICH. Notably, severely affected patients with hematoma volume > 60 mL or Glasgow Coma Scale score 4-8 may benefit more from endoscopic surgery than the two other surgical procedures. CONCLUSIONS The current findings demonstrate that both stereotactic aspiration and endoscopic surgery possess an apparent advantage over craniotomy for the evacuation of spontaneous supratentorial lobar ICH. The endoscopic surgery might be more safe and effective with higher evacuation rate, better functional neurological outcomes, and lower complication and mortality rates.
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Affiliation(s)
- Yuqian Li
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Ruixin Yang
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Zhihong Li
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Yanping Yang
- Department of Neurosurgery, Xi'an Central Hospital, Xi'an, Shaanxi, China
| | - Bo Tian
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Xingye Zhang
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Bao Wang
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Dan Lu
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Shaochun Guo
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Minghao Man
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Yang Yang
- Department of Neurosurgery, The 451th hospital of PLA, Xi'an, Shaanxi, China
| | - Tao Luo
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Guodong Gao
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China.
| | - Lihong Li
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China.
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Sun DB, Xu MJ, Chen QM, Hu HT. Significant elevation of serum caspase-3 levels in patients with intracerebral hemorrhage. Clin Chim Acta 2017; 471:62-67. [PMID: 28526532 DOI: 10.1016/j.cca.2017.05.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 05/13/2017] [Accepted: 05/15/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Caspase-3 is a potential marker of apoptosis. We investigated whether serum caspase-3 concentrations were increased and its association with severity and prognosis after intracerebral hemorrhage (ICH). METHODS This prospective clinical study recruited 112 ICH patients and 112 healthy individuals. Serum was assayed for caspase-3 using enzyme-linked immunosorbent assay. Stroke severity was quantified by National Institute of Health Stroke Scale (NIHSS) and hematoma volume. Six-month outcome was measured by modified Rankin Scale. Analyses were performed using univariate and multivariate analyses. RESULTS Patients had significantly higher serum caspase-3 concentrations than controls. Capase-3 concentrations correlated with NIHSS score and hematoma volume. Serum caspase-3 emerged as an independent predictor for 6-month mortality and bad prognosis (modified Rankin scale score>2). Based on receiver operating characteristic curve, caspase-3 concentrations showed similar prognostic value when compared with NIHSS score and hematoma volume. CONCLUSION Serum caspase-3 concentrations are increased in ICH patients as well as correlate with clinical severity and prognosis.
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Affiliation(s)
- De-Biao Sun
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China
| | - Meng-Jun Xu
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China
| | - Qing-Meng Chen
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China
| | - Hai-Tao Hu
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China.
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