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Hao J, Wang T, Cao C, Li X, Li H, Gao H, Li J, Shen H, Chen G. LPCAT3 exacerbates early brain injury and ferroptosis after subarachnoid hemorrhage in rats. Brain Res 2024; 1832:148864. [PMID: 38484924 DOI: 10.1016/j.brainres.2024.148864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 02/19/2024] [Accepted: 03/11/2024] [Indexed: 03/18/2024]
Abstract
AIMS Lysophosphatidylcholine acyltransferase 3 (LPCAT3) is known to play a pivotal role in lipid metabolism, but its role in the early brain injury (EBI) following subarachnoid hemorrhage (SAH) remains unclear. This study provides insights into LPCAT3 expression alterations and functional implications in EBI following SAH. METHODS SAH models of adult male Sprague-Dawley (SD) rats were established by intravascular perforation. Lentivirus vectors were administered by intracerebroventricular injection (i.c.v.) to either induce LPCAT3 overexpression or knockdown 14 days before SAH induction. Western blot, immunofluorescence, Nissl staining, MDA detection, ROS detection, iron content detection, and short-term and long-term neurobehavioral tests were performed to investigate the effects of regulated-LPCAT3 after SAH. RESULTS LPCAT3 levels were found to be significantly elevated in SAH. Suppression of LPCAT3 expression via shRNA improved oxidative stress, reduced brain edema, alleviated behavioral and cognitive deficits following SAH and decreased neuronal death, while upregulating LPCAT3 expression showed opposing effects. CONCLUSION LPCAT3 is involved in SAH-induced EBI and associated with ferroptosis. Our findings provide a referential basis for potential therapeutic interventions aimed at alleviating EBI following SAH.
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Affiliation(s)
- Jiahui Hao
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou 215006, Jiangsu Province, China
| | - Tong Wang
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou 215006, Jiangsu Province, China
| | - Cheng Cao
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou 215006, Jiangsu Province, China; Department of Intensive Care Unit, The Affiliated Jiangyin Hospital of Nantong University, Jiangyin City 214400, Jiangsu Province, China; Department of Brain Center, The Affiliated Jiangyin Hospital of Nantong University, Jiangyin City 214400, Jiangsu Province, China
| | - Xiang Li
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou 215006, Jiangsu Province, China
| | - Haiying Li
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou 215006, Jiangsu Province, China
| | - Heng Gao
- Department of Brain Center, The Affiliated Jiangyin Hospital of Nantong University, Jiangyin City 214400, Jiangsu Province, China
| | - Jinquan Li
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou 215006, Jiangsu Province, China.
| | - Haitao Shen
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou 215006, Jiangsu Province, China.
| | - Gang Chen
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou 215006, Jiangsu Province, China
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Du W, Yang J, Lou Y, You J, Wang Q. Relationship between baseline bicarbonate and 30-day mortality in patients with non-traumatic subarachnoid hemorrhage. Front Neurol 2024; 14:1310327. [PMID: 38234976 PMCID: PMC10793108 DOI: 10.3389/fneur.2023.1310327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 12/13/2023] [Indexed: 01/19/2024] Open
Abstract
Objective This study aimed to explore the relationship between baseline bicarbonate levels and 30-day mortality in individuals with non-traumatic subarachnoid hemorrhage (SAH). Methods Patients with non-traumatic SAH were chosen from the Medical Information Mart for Intensive Care (MIMIC)-IV database. The relationship between baseline bicarbonate and 30-day mortality was examined using Cox regression models. Restricted cubic splines were used to test the hypothesis that there was an association between bicarbonate and mortality. With the use of Kaplan-Meier survival curve analysis, we looked deeper into the validity of these correlations. To find subgroups with differences, interaction tests were utilized. Results This retrospective cohort study consisted of 521 participants in total. Bicarbonate had a negative association with death at 30 days (HR = 0.93, 95%CI: 0.88-0.98, p = 0.004). Next, we divided bicarbonate into quartile groups. In comparison to the reference group Q1 (20 mEq/L), groups Q3 (23-25 mEq/L) and Q4 (26 mEq/L) had adjusted HR values of 0.47 (95%CI: 0.27-0.82, p = 0.007) and 0.56 (95%CI: 0.31-0.99, p = 0.047). No definite conclusions can be derived from this study, since there is no obvious curve link between baseline bicarbonate and 30-day mortality. Patients' 30-day mortality increased statistically significantly (p < 0.001, K-M analysis) in patients with low bicarbonate levels. The relationship between bicarbonate and 30-day mortality remained consistent in the stratified analysis, with no observed interactions. Conclusion Finally, 30-day mortality was negatively associated with baseline bicarbonate levels. Patients with non-traumatic SAH are more at risk of mortality if their bicarbonate levels are low.
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Affiliation(s)
- Wenyuan Du
- Department of Neurology, Shijiazhuang Traditional Chinese Medicine Hospital, Shijiazhuang, Hebei, China
| | - Jingmian Yang
- Department of Neurology, Shijiazhuang Traditional Chinese Medicine Hospital, Shijiazhuang, Hebei, China
| | - Yanfang Lou
- Department of Neurology, Shijiazhuang Traditional Chinese Medicine Hospital, Shijiazhuang, Hebei, China
| | - Jiahua You
- Department of Neurology, Shijiazhuang Traditional Chinese Medicine Hospital, Shijiazhuang, Hebei, China
| | - Qiang Wang
- Department of Cardiology, Shijiazhuang Traditional Chinese Medicine Hospital, Shijiazhuang, Hebei, China
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Liao B, Xu Q, Lu P, Zhang Y. The prognostic value of systemic immune-inflammation index in patients with aneurysmal subarachnoid hemorrhage: a systematic review. Neurosurg Rev 2023; 46:219. [PMID: 37659015 DOI: 10.1007/s10143-023-02133-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 06/30/2023] [Accepted: 08/28/2023] [Indexed: 09/05/2023]
Abstract
Aneurysmal subarachnoid hemorrhage (aSAH) is a devastating and life-threatening stroke subtype, that has a high disability and fatality rate. By the use of the systemic immune-inflammation index (SII), it is possible to understand the pathophysiology that underlies immune and inflammatory responses and anticipate consequences including delayed cerebral ischemia (DCI), delayed cerebral vasospasm, and functional outcome. A systematic search of the English-language literature in PubMed and Embase was performed to locate articles addressing the usage of SII in aSAH patients. The cutoff value, sensitivity, specificity, and area-under-the curve (AUC) of the receiver operating characteristic (ROC) curve were collected. Four publications were reviewed after applying the exclusion criteria from the 53 included articles. All the studies indicated that higher SII on admission was significantly associated with poor prognosis. The research examined in this paper provides the earliest indications that higher SII predicts DCI, delayed cerebral vasospasm, and functional outcome, even though other medical subspecialties have used this ratio for a long time to make such predictions.
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Affiliation(s)
- Bingyao Liao
- Department of Emergency, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, Chengdu, 610072, Sichuan, China
| | - Qingyu Xu
- Department of Neurosurgery, Sichuan Science City Hospital, Mianyang, 621000, Sichuan, China
| | - Peng Lu
- Department of Neurosurgery, Sichuan Science City Hospital, Mianyang, 621000, Sichuan, China
| | - Yunxia Zhang
- Department of Geriatric, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, 621000, Sichuan, China.
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Teng H, Wang Z, Yang X, Wu X, Chen Z, Wang Z, Chen G. The impact of COVID-19 on clinical outcomes in people undergoing neurosurgery: a systematic review and meta-analysis. Syst Rev 2023; 12:137. [PMID: 37550713 PMCID: PMC10405503 DOI: 10.1186/s13643-023-02291-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 07/17/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND The coronavirus disease-2019 (COVID-19) pandemic has created a global crisis unique to the healthcare system around the world. It also had a profound impact on the management of neurosurgical patients. In our research, we investigated the effect of the COVID-19 pandemic on clinical outcomes in people undergoing neurosurgery, particularly vascular and oncological neurosurgery. METHOD Two investigators independently and systematically searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrail.Gov, and Web of Science to identify relevant studies respecting the criteria for inclusion and exclusion published up to June 30, 2022. The outcomes of our research included mortality rate, length of stay, modified Rankin Score, delay in care, Glasgow outcome scale, and major complications. The risk of bias was assessed using the Methodological Index for Non-randomized Studies (MINORS) checklist. RESULTS Two investigators independently and systematically searched 1378 results from MEDLINE, EMBASE, Cochrane database, ClinicalTrail.Gov, and Web of Science and extracted the detailed data from 13 studies that met the review's eligibility criteria. Two articles reported on patients with intracerebral hemorrhages, five on patients with subarachnoid hemorrhages, four on patients undergoing surgery for neuro-oncology, and in two studies the patients' conditions were unspecified. A total of 26,831 patients were included in our research. The number who died was significantly increased in the COVID-19 pandemic group (OR 1.52, 95% CI 1.36-1.69, P < 0.001). No significant difference was found between the two groups in terms of length of stay (SMD - 0.88, 95% CI - 0.18-0.02, P = 0.111), but it differed between regions, according to our subgroup analysis. CONCLUSION Compared to the pre-pandemic group, the number who died was significantly increased in the COVID-19 pandemic group. Meanwhile, the effect of the pandemic on clinical outcomes in people undergoing neurosurgery might differ in different regions, according to our subgroup analysis.
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Affiliation(s)
- Haiying Teng
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu Province, China
- Suzhou Medical College of Soochow University, Suzhou, 215002, Jiangsu Province, China
| | - Zilan Wang
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu Province, China
| | - Xingyu Yang
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu Province, China
| | - Xiaoxiao Wu
- Suzhou Medical College of Soochow University, Suzhou, 215002, Jiangsu Province, China
| | - Zhouqing Chen
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu Province, China.
| | - Zhong Wang
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu Province, China.
| | - Gang Chen
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu Province, China
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Zhao L, Li P, Xu Z, Ji X, Guan L, Wang X, Luo J, Cheng H, Ye L. Diagnosis of post-neurosurgical bacterial meningitis in patients with aneurysmal subarachnoid hemorrhage based on the immunity-related proteomics signature of the cerebrospinal fluid. Front Neurol 2023; 14:1166598. [PMID: 37409018 PMCID: PMC10319054 DOI: 10.3389/fneur.2023.1166598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/30/2023] [Indexed: 07/07/2023] Open
Abstract
Introduction Post-neurosurgical bacterial meningitis (PNBM) is a serious complication for patients who receive neurosurgical treatment, but the diagnosis is difficult given the complicated microenvironment orchestrated by sterile brain injury and pathogenic infection. In this study, we explored potential diagnostic biomarkers and immunological features using a proteomics platform. Methods A total of 31 patients with aneurysmal subarachnoid hemorrhage (aSAH) who received neurosurgical treatment were recruited for this study. Among them, 15 were diagnosed with PNBM. The remaining 16 patients were categorized into the non-PNBM group. Proteomics analysis of the cerebrospinal fluid (CSF) was conducted on the Olink platform, which contained 92 immunity-related molecules. Results We found that the expressions of 27 CSF proteins were significantly different between the PNBM and non-PNBM groups. Of those 27 proteins, 15 proteins were upregulated and 12 were downregulated in the CSF of the PNBM group. The receiver operating characteristic curve analysis indicated that three proteins (pleiotrophin, CD27, and angiopoietin 1) had high diagnostic accuracy for PNBM. Furthermore, we also performed bioinformatics analysis to explore potential pathways and the subcellular localization of the proteins. Conclusion In summary, we found a cohort of immunity-related molecules that can serve as potential diagnostic biomarkers for PNBM in patients with aSAH. These molecules also provide an immunological profile of PNBM.
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Barpujari A, Kiley A, Ross JA, Veznedaroglu E. A Systematic Review of Non-Opioid Pain Management in Chiari Malformation (Type 1) Patients: Current Evidence and Novel Therapeutic Opportunities. J Clin Med 2023; 12:jcm12093064. [PMID: 37176505 PMCID: PMC10179593 DOI: 10.3390/jcm12093064] [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: 03/21/2023] [Revised: 04/12/2023] [Accepted: 04/20/2023] [Indexed: 05/15/2023] Open
Abstract
Chiari Malformation Type I (CM) includes a range of cranial abnormalities at the junction of the skull with the spine, with common symptoms including pain and headaches. Currently, CM pain is managed medically through anti-inflammatory drugs, muscle relaxants, and opioids, while surgical management includes posterior fossa decompression. Given the adverse effects of opioid use, and an ongoing opioid epidemic, there is a need for safe, non-opioid alternatives for clinical pain management. This systematic review was performed to provide an update on the current literature pertaining to the treatment of CM pain with non-opioid alternatives. A literature search was performed in June 2022 utilizing the PubMed and Google Scholar databases, and articles were identified that included information regarding non-opioid pain management in CM patients. A total of 90 articles were obtained from this search, including 10 relevant, drug-specific studies. Two independent reviewers selected and included all relevant articles based on the chosen search criteria to minimize bias risk. Currently available treatments for neurosurgical pain management include anticonvulsants, corticosteroids, NSAIDs, anti-inflammatory drugs, NMDA receptor antagonists, local anesthetics, nerve blocks, scalp blocks, and neuromuscular blocks. While more information is needed on the use of non-opioid pain management, the present literature provides potential evidence of its efficacy amongst the CM patient population, on account of the success that non-opioid pain management has demonstrated within other neurological pain syndromes. Further research into non-pharmacological pain management would also benefit the CM population and could be generalized to related conditions.
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Affiliation(s)
| | - Alina Kiley
- Drexel University College of Medicine, Philadelphia, PA 19129, USA
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Azeem S, Ashraf M, Kamboh UA, Raza MA, Farooq M, Cheema HA, Tariq S, Choudhary N, Hussain SS, Ashraf N. Association of ABO Blood Group with Delayed Cerebral Ischemia and Clinical Outcomes Following Aneurysmal Subarachnoid Hemorrhage in Pakistan. Asian J Neurosurg 2023; 18:108-116. [PMID: 37056873 PMCID: PMC10089742 DOI: 10.1055/s-0043-1760859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Abstract
Abstract
Background The ABO blood type, due to its various hemostaseologic properties, has been associated with several vascular diseases, including aneurysmal subarachnoid hemorrhage (aSAH). However, the role of ABO blood type in delayed cerebral ischemia (DCI) onset and other clinical outcomes after aSAH is largely unexplored. This study aimed to investigate the association between ABO blood type and outcomes after aSAH, primarily DCI.
Methods A retrospective analysis was made on the data collected from 175 aSAH patients at a tertiary supraregional neurosurgery department over 5 years. Socio-demographic factors, clinical variables (DCI, mFG, WFNS grade, and Glasgow Outcome Scale at discharge), EVD placement, and aneurysm size were analyzed for their association with ABO blood type.
Results DCI was reported in 25% of patients with ‘O’ blood type and 9.6% with ‘non-O’ blood type. A stepwise logistic regression model showed that after adjusting for BMI, mFG, WFNS grade, and EVD placement, ‘O’ type blood group was an independent risk factor for DCI, greatly increasing the risk of DCI as compared to ‘non-O’ type groups (OR = 3.27, 95% CI: 1.21–8.82).
Conclusion This study provides evidence that individuals with ‘O’ blood type may have a higher risk of DCI onset after aSAH. However, further studies are essential to address the limitations of our work and confirm our findings.
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Affiliation(s)
- Saleha Azeem
- King Edward Medical University, Lahore, Pakistan
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan
| | - Mohammad Ashraf
- Wolfson School of Medicine, University of Glasgow, Scotland, United Kingdom
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan
| | - Usman Ahmad Kamboh
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan
| | - Muhammad Asif Raza
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan
| | - Minaam Farooq
- King Edward Medical University, Lahore, Pakistan
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan
| | - Huzaifa Ahmad Cheema
- King Edward Medical University, Lahore, Pakistan
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan
| | - Simra Tariq
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan
| | - Nabeel Choudhary
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan
| | - Syed Shahzad Hussain
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan
- Department of Neurosurgery, Gujranwala Medical College, Gujranwala, Pakistan
| | - Naveed Ashraf
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan
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Hong Y, He S, Zou Q, Li C, Wang J, Chen R. Eupatilin alleviates inflammatory response after subarachnoid hemorrhage by inhibition of TLR4/MyD88/NF-κB axis. J Biochem Mol Toxicol 2023; 37:e23317. [PMID: 36872850 DOI: 10.1002/jbt.23317] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 10/28/2022] [Accepted: 02/02/2023] [Indexed: 03/07/2023]
Abstract
Early brain injury (EBI) is associated with the adverse prognosis of subarachnoid hemorrhage (SAH) patients. The key bioactive component of the Chinese herbal medicine Artemisia asiatica Nakai (Asteraceae) is eupatilin. Recent research reports that eupatilin suppresses inflammatory responses induced by intracranial hemorrhage. This work is performed to validate whether eupatilin can attenuate EBI and deciphers its mechanism. A SAH rat model was established by intravascular perforation in vivo. At 6 h after SAH in rats, 10 mg/kg eupatilin was injected into the rats via the caudal vein. A Sham group was set as the control. In vitro, BV2 microglia was treated with 10 μM Oxyhemoglobin (OxyHb) for 24 h, followed by 50 μM eupatilin treatment for 24 h. The SAH grade, brain water content, neurological score, and blood-brain barrier (BBB) permeability of the rats were measured 24 h later. The content of proinflammatory factors was detected via enzyme-linked immunosorbent assay. Western blot analysis was conducted to analyze the expression levels of TLR4/MyD88/NF-κB pathway-associated proteins. In vivo, eupatilin administration alleviated neurological injury, and decreased brain edema and BBB injury after SAH in rats. Eupatilin markedly reduced the levels of interleukin-1β (IL-1β), IL-6, and tumor necrosis factor-α (TNF-α), and suppressed the expression levels of MyD88, TLR4, and p-NF-κB p65 in the SAH rats' cerebral tissues. Eupatilin treatment also reduced the levels of IL-1β, IL-6, and TNF-α, and repressed the expression levels of MyD88, TLR4, and p-NF-κB p65 in OxyHb-induced BV2 microglia. Additionally, pyrrolidine dithiocarbamate or resatorvid enhanced the suppressive effects of eupatilin on OxyHb-induced inflammatory responses in BV2 microglia. Eupatilin ameliorates SAH-induced EBI via modulating the TLR4/MyD88/NF-κB pathway in rat model.
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Affiliation(s)
- Yu Hong
- Department of Neurosurgery, Affiliated Nanhua Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Shiqing He
- Department of Neurosurgery, Affiliated Nanhua Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Qin Zou
- Department of Neurosurgery, Affiliated Nanhua Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Chong Li
- Department of Neurosurgery, Affiliated Nanhua Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Jianpeng Wang
- Department of Neurosurgery, Affiliated Nanhua Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Rui Chen
- Department of Neurosurgery, Affiliated Nanhua Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
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López-Callejas O, Ortiz-Giraldo AF, Vera DD, Ramirez-Rojas DA, Villamizar-Barahona AB, Ferreira-Prada CA, Galvis M, Vargas-Pérez O, Serrano-Gómez S, Reyes-Gonzalez A, Mantilla D. Flow Diverter Treatment for Non-Ruptured Carotid Aneurysms: Efficacy and Safety. Neurointervention 2023; 18:23-29. [PMID: 36809874 PMCID: PMC9986347 DOI: 10.5469/neuroint.2022.00458] [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: 12/01/2022] [Accepted: 02/10/2023] [Indexed: 02/24/2023] Open
Abstract
PURPOSE Internal carotid artery (ICA) aneurysm treatment with a flow diverter (FD) has shown an adequate efficacy and safety profile, presenting high complete occlusion or near occlusion rates with low complications during follow-up. The purpose of this study was to evaluate the efficacy and safety of FD treatment in non-ruptured internal carotid aneurysms. MATERIALS AND METHODS This is a retrospective, single-center, observational study evaluating patients diagnosed with unruptured ICA aneurysms treated with an FD between January 1, 2014, and January 1, 2020. We analyzed an anonymized database. The primary effectiveness endpoint was complete occlusion (O'Kelly-Marotta D, OKM-D) of the target aneurysm through 1-year follow-up. The safety endpoint was the evaluation of modified Rankin Scale (mRS) 90 days after treatment, considering a favorable outcome an mRS 0-2. RESULTS A total of 106 patients were treated with an FD, 91.5% were women; the mean follow- up was 427.2±144.8 days. Technical success was achieved in 105 cases (99.1%). All patients included had 1-year follow-up digital subtraction angiography control; 78 patients (73.6%) completed the primary efficacy endpoint by achieving total occlusion (OKM-D). Giant aneurysms had a higher risk of not achieving complete occlusion (risk ratio, 3.07; 95% confidence interval, 1.70 - 5.54]). The safety endpoint of mRS 0-2 at 90 days was accomplished in 103 patients (97.2%). CONCLUSION Treatment of unruptured ICA aneurysms with an FD showed high 1-year total occlusion results, with very low morbidity and mortality complications.
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Affiliation(s)
- Orlando López-Callejas
- Department of Interventional Radiology, Fundación Oftalmológica de Santander-Clínica Ardila Lülle, Floridablanca, Colombia.,Department of Radiology, Clínica Medicadiz, Ibagué, Colombia
| | - Andres F Ortiz-Giraldo
- Department of Interventional Radiology, Fundación Oftalmológica de Santander-Clínica Ardila Lülle, Floridablanca, Colombia
| | - Daniela D Vera
- Department of Radiology, Fundación Oftalmológica de Santander-Clínica Ardila Lülle, Floridablanca, Colombia
| | | | - Ana B Villamizar-Barahona
- Department of Interventional Radiology, Fundación Oftalmológica de Santander-Clínica Ardila Lülle, Floridablanca, Colombia
| | - Carlos A Ferreira-Prada
- Department of Interventional Radiology, Fundación Oftalmológica de Santander-Clínica Ardila Lülle, Floridablanca, Colombia.,Department of Interventional Radiology, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia
| | - Melquizidel Galvis
- Department of Interventional Radiology, Fundación Oftalmológica de Santander-Clínica Ardila Lülle, Floridablanca, Colombia.,Department of Interventional Radiology, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia
| | - Oliverio Vargas-Pérez
- Department of Interventional Radiology, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia.,Department of Radiology, Fundación Oftalmológica de Santander-Clínica Ardila Lülle, Floridablanca, Colombia
| | - Sergio Serrano-Gómez
- Clinical Research Group-UNAB, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia
| | - Adriana Reyes-Gonzalez
- Clinical Research Group-UNAB, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia
| | - Daniel Mantilla
- Department of Interventional Radiology, Fundación Oftalmológica de Santander-Clínica Ardila Lülle, Floridablanca, Colombia.,Department of Interventional Radiology, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia
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Bissenas A, Fleeting C, Patel D, Al-Bahou R, Patel A, Nguyen A, Woolridge M, Angelle C, Lucke-Wold B. CSF Dynamics: Implications for Hydrocephalus and Glymphatic Clearance. CURRENT RESEARCH IN MEDICAL SCIENCES 2022; 1:24-42. [PMID: 36649460 PMCID: PMC9840530 DOI: 10.56397/crms.2022.12.04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Beyond its neuroprotective role, CSF functions to rid the brain of toxic waste products through glymphatic clearance. Disturbances in the circulation of CSF and glymphatic exchange are common among those experiencing HCP syndrome, which often results from SAH. Normally, the secretion of CSF follows a two-step process, including filtration of plasma followed by the introduction of ions, bicarbonate, and water. Arachnoid granulations are the main site of CSF absorption, although there are other influencing factors that affect this process. The pathway through which CSF is through to flow is from its site of secretion, at the choroid plexus, to its site of absorption. However, the CSF flow dynamics are influenced by the cardiovascular system and interactions between CSF and CNS anatomy. One, two, and three-dimensional models are currently methods researchers use to predict and describe CSF flow, both under normal and pathological conditions. They are, however, not without their limitations. "Rest-of-body" models, which consider whole-body compartments, may be more effective for understanding the disruption to CSF flow due to hemorrhages and hydrocephalus. Specifically, SAH is thought to prevent CSF flow into the basal cistern and paravascular spaces. It is also more subject to backflow, caused by the presence of coagulation cascade products. In regard to the fluid dynamics of CSF, scar tissue, red blood cells, and protein content resulting from SAH may contribute to increased viscosity, decreased vessel diameter, and increased vessel resistance. Outside of its direct influence on CSF flow, SAH may result in one or both forms of hydrocephalus, including noncommunicating (obstructive) and communicating (nonobstructive) HCP. Imaging modalities such as PC-MRI, Time-SLIP, and CFD model, a mathematical model relying on PC-MRI data, are commonly used to better understand CSF flow. While PC-MRI utilizes phase shift data to ultimately determine CSF speed and flow, Time-SLIP compares signals generated by CSF to background signals to characterizes complex fluid dynamics. Currently, there are gaps in sufficient CSF flow models and imaging modalities. A prospective area of study includes generation of models that consider "rest-of-body" compartments and elements like arterial pulse waves, respiratory waves, posture, and jugular venous posture. Going forward, imaging modalities should work to focus more on patients in nature in order to appropriately assess how CSF flow is disrupted in SAH and HCP.
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Affiliation(s)
- Ashley Bissenas
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Chance Fleeting
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Drashti Patel
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Raja Al-Bahou
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Aashay Patel
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Andrew Nguyen
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Maxwell Woolridge
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Conner Angelle
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
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11
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Wang L, Geng G, Zhu T, Chen W, Li X, Gu J, Jiang E. Progress in Research on TLR4-Mediated Inflammatory Response Mechanisms in Brain Injury after Subarachnoid Hemorrhage. Cells 2022; 11:cells11233781. [PMID: 36497041 PMCID: PMC9740134 DOI: 10.3390/cells11233781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022] Open
Abstract
Subarachnoid hemorrhage (SAH) is one of the common clinical neurological emergencies. Its incidence accounts for about 5-9% of cerebral stroke patients. Even surviving patients often suffer from severe adverse prognoses such as hemiplegia, aphasia, cognitive dysfunction and even death. Inflammatory response plays an important role during early nerve injury in SAH. Toll-like receptors (TLRs), pattern recognition receptors, are important components of the body's innate immune system, and they are usually activated by damage-associated molecular pattern molecules. Studies have shown that with TLR 4 as an essential member of the TLRs family, the inflammatory transduction pathway mediated by it plays a vital role in brain injury after SAH. After SAH occurrence, large amounts of blood enter the subarachnoid space. This can produce massive damage-associated molecular pattern molecules that bind to TLR4, which activates inflammatory response and causes early brain injury, thus resulting in serious adverse prognoses. In this paper, the process in research on TLR4-mediated inflammatory response mechanism in brain injury after SAH was reviewed to provide a new thought for clinical treatment.
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Affiliation(s)
- Lintao Wang
- Institute of Nursing and Health, Henan University, Kaifeng 475004, China
- School of Clinical Medicine, Henan University, Kaifeng 475004, China
- Department of Neurology, The First Affiliated Hospital of Henan University, Kaifeng 475001, China
| | - Guangping Geng
- Henan Technician College of Medicine and Health, Kaifeng 475000, China
| | - Tao Zhu
- Department of Geriatrics, Kaifeng Traditional Chinese Medicine Hospital, Kaifeng 475001, China
| | - Wenwu Chen
- Department of Neurology, The First Affiliated Hospital of Henan University, Kaifeng 475001, China
| | - Xiaohui Li
- Department of Neurology, The First Affiliated Hospital of Henan University, Kaifeng 475001, China
| | - Jianjun Gu
- Department of Neurosurgery, Henan Provincial People’s Hospital, Zhengzhou 450003, China
| | - Enshe Jiang
- Institute of Nursing and Health, Henan University, Kaifeng 475004, China
- Henan International Joint Laboratory for Nuclear Protein Regulation, Henan University, Kaifeng 475004, China
- Correspondence:
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12
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Wang L, Zhang Q, Zhang G, Zhang W, Chen W, Hou F, Zheng Z, Guo Y, Chen Z, Wang Y, Hernesniemi J, Andrade-Barazarte H, Li X, Li T, Feng G, Gu J. Risk factors and predictive models of poor prognosis and delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage complicated with hydrocephalus. Front Neurol 2022; 13:1014501. [PMID: 36353134 PMCID: PMC9638116 DOI: 10.3389/fneur.2022.1014501] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/10/2022] [Indexed: 11/20/2022] Open
Abstract
Objective To evaluate the correlation of serum biological markers and related scales to the occurrence of delayed cerebral ischemia and clinical prognosis in patients with aneurysmal subarachnoid hemorrhage (aSAH) complicated with acute hydrocephalus before admission. Methods The clinical data of 227 patients with pre-admission aSAH complicated with acute hydrocephalus admitted to Henan Provincial People's Hospital from April 2017 to December 2020 were retrospectively analyzed. Patients were grouped according to the presence or absence of delayed cerebral ischemia (DCI) after surgery and the prognosis at 6 months after discharge. Univariate and multivariable logistic regression analysis were performed to analyze the relationship between serum biological indicators combined with aneurysm related clinical score scale and the occurrence and prognosis of delayed cerebral ischemia. ROC curves and nomogram were drawn. Results Multivariable Logistic regression analysis showed that high Hunt-Hess grade and surgical clipping were independent risk factors for postoperative DCI (P < 0.05). Older age, higher Hunt-Hess grade, higher CRP and neutrophil levels were independent risk factors for poor prognosis at 6 months after surgery (P < 0.05). ROC curve analysis showed that the area under the curve (AUC) of Hunt-Hess grade and surgical method for predicting DCI in patients with aSAH combined with hydrocephalus after surgery were 0.665 and 0.593. The combined AUC of Hunt-Hess grade and surgical method was 0.685, the sensitivity was 64.9%, and the specificity was 64.7%. The AUC of CRP, neutrophil, age and Hunt-Hess grade for predicting poor prognosis in patients with aSAH combined with hydrocephalus at 6 months after surgery were 0.804, 0.735, 0.596, 0.757, respectively. The combined AUC of CRP, neutrophil, age, Hunt-Hess grade was 0.879, the sensitivity was 79%, and the specificity was 84.5%. According to the correction curve, the predicted probability of the nomogram is basically consistent with the actual probability. Conclusion Hunt-Hess grade and surgical method are independent predictors of postoperative DCI in patients with aSAH complicated with hydrocephalus. “CRP,” “neutrophil,” “age” and “Hunt-Hess grade” at admission are independent predictors of clinical prognosis in patients with aSAH complicated with hydrocephalus. The combination of the above indicators has high predictive value.
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Affiliation(s)
- Lintao Wang
- Department of Neurology, The First Affiliated Hospital of Henan University, Kaifeng, China
- School of Clinical Medicine, Henan University, Kaifeng, China
| | - Qingqing Zhang
- School of Clinical Medicine, Henan University, Kaifeng, China
- Department of Neurosurgery, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Gaoqi Zhang
- School of Clinical Medicine, Henan University, Kaifeng, China
- Department of Neurosurgery, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Wanwan Zhang
- School of Clinical Medicine, Henan University, Kaifeng, China
- Department of Neurosurgery, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Wenwu Chen
- Department of Neurology, The First Affiliated Hospital of Henan University, Kaifeng, China
- School of Clinical Medicine, Henan University, Kaifeng, China
| | - Fandi Hou
- Department of Neurosurgery, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Zhanqiang Zheng
- Department of Neurosurgery, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Yong Guo
- Department of Neurosurgery, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Zhongcan Chen
- Department of Neurosurgery, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Yanxia Wang
- Department of Neurology, The First Affiliated Hospital of Henan University, Kaifeng, China
- School of Clinical Medicine, Henan University, Kaifeng, China
| | - Juha Hernesniemi
- Department of Neurosurgery, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Hugo Andrade-Barazarte
- Department of Neurosurgery, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Xiaohui Li
- Department of Neurology, The First Affiliated Hospital of Henan University, Kaifeng, China
- School of Clinical Medicine, Henan University, Kaifeng, China
| | - Tianxiao Li
- School of Clinical Medicine, Henan University, Kaifeng, China
- Department of Neurosurgery, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
- Department of Neurosurgery, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Guang Feng
- Department of Neurosurgery, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
- Department of Neurosurgery, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
- Guang Feng
| | - Jianjun Gu
- School of Clinical Medicine, Henan University, Kaifeng, China
- Department of Neurosurgery, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
- Department of Neurosurgery, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
- *Correspondence: Jianjun Gu
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Rabelo NN, Pipek LZ, Nascimento RFV, Telles JPM, Barbato NC, Coelho ACSDS, Barbosa GB, Yoshikawa MH, Teixeira MJ, Figueiredo EG. Could outcomes of intracranial aneurysms be better predict using serum creatinine and glomerular filtration rate? Acta Cir Bras 2022; 37:e370107. [PMID: 35416861 PMCID: PMC9000976 DOI: 10.1590/acb370107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 12/19/2021] [Indexed: 12/04/2022] Open
Abstract
Purpose: To analyze the role of serum creatinine levels as a biomarker of intracranial
aneurysm outcomes. Methods: This is a prospective analysis of outcomes of patients with intracranial
aneurysm. One hundred forty-seven patients with serum creatinine at
admission and 6 months follow up were included. Linear and logistic
regressions were used to analyze the data. Modified Rankin scale (mRS) was
used to assess outcome. Results: Creatinine level was not directly related to aneurysm outcome nor aneurysm
rupture (p > 0.05). However, patients with a glomerular filtration rate
(GFR) lower than 72.50 mL·min–1 had an odds ratio (OR) of 3.049
(p = 0.006) for worse outcome. Similarly, aneurysm rupture had an OR of
2.957 (p = 0.014) for worse outcomes. Stepwise selection model selected 4
variables for outcomes prediction: serum creatinine, sex, hypertension and
treatment. Hypertensive patients had, on average, an increase in 0.588 in
mRS (p = 0.022), while treatment with microsurgery had a decrease in 0.555
(p = 0.038). Conclusions: Patients with higher GFR had better outcomes after 6 months. Patients with
higher GFR had better outcomes after 6 months. Creatinine presented an
indirect role in GFR values and should be included in models for outcome
prediction.
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Terasaki Y, Yokota H, Tashiro K, Maejima T, Takeuchi T, Kurosawa R, Yamauchi S, Takada A, Mukai H, Ohira K, Ota J, Horikoshi T, Mori Y, Uno T, Suyari H. Multidimensional Deep Learning Reduces False-Positives in the Automated Detection of Cerebral Aneurysms on Time-Of-Flight Magnetic Resonance Angiography: A Multi-Center Study. Front Neurol 2022; 12:742126. [PMID: 35115991 PMCID: PMC8805516 DOI: 10.3389/fneur.2021.742126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 12/07/2021] [Indexed: 11/16/2022] Open
Abstract
Current deep learning-based cerebral aneurysm detection demonstrates high sensitivity, but produces numerous false-positives (FPs), which hampers clinical application of automated detection systems for time-of-flight magnetic resonance angiography. To reduce FPs while maintaining high sensitivity, we developed a multidimensional convolutional neural network (MD-CNN) designed to unite planar and stereoscopic information about aneurysms. This retrospective study enrolled time-of-flight magnetic resonance angiography images of cerebral aneurysms from three institutions from June 2006 to April 2019. In the internal test, 80% of the entire data set was used for model training and 20% for the test, while for the external tests, data from different pairs of the three institutions were used for training and the remaining one for testing. Images containing aneurysms > 15 mm and images without aneurysms were excluded. Three deep learning models [planar information-only (2D-CNN), stereoscopic information-only (3D-CNN), and multidimensional information (MD-CNN)] were trained to classify whether the voxels contained aneurysms, and they were evaluated on each test. The performance of each model was assessed using free-response operating characteristic curves. In total, 732 aneurysms (5.9 ± 2.5 mm) of 559 cases (327, 120, and 112 from institutes A, B, and C; 469 and 263 for 1.5T and 3.0T MRI) were included in this study. In the internal test, the highest sensitivities were 80.4, 87.4, and 82.5%, and the FPs were 6.1, 7.1, and 5.0 FPs/case at a fixed sensitivity of 80% for the 2D-CNN, 3D-CNN, and MD-CNN, respectively. In the external test, the highest sensitivities were 82.1, 86.5, and 89.1%, and 5.9, 7.4, and 4.2 FPs/cases for them, respectively. MD-CNN was a new approach to maintain sensitivity and reduce the FPs simultaneously.
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Affiliation(s)
- Yuki Terasaki
- Graduate School of Science and Engineering, Chiba University, Chiba, Japan
- Department of EC Platform, ZOZO Technologies, Inc., Tokyo, Japan
| | - Hajime Yokota
- Department of Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan
- *Correspondence: Hajime Yokota
| | - Kohei Tashiro
- Graduate School of Science and Engineering, Chiba University, Chiba, Japan
- Kohei Tashiro
| | - Takuma Maejima
- Department of Radiology, Chiba University Hospital, Chiba, Japan
| | - Takashi Takeuchi
- Department of Radiology, Chiba University Hospital, Chiba, Japan
| | - Ryuna Kurosawa
- Department of Radiology, Chiba University Hospital, Chiba, Japan
| | - Shoma Yamauchi
- Department of Radiology, Chiba University Hospital, Chiba, Japan
| | - Akiyo Takada
- Department of Radiology, Chiba University Hospital, Chiba, Japan
| | - Hiroki Mukai
- Department of Radiology, Chiba University Hospital, Chiba, Japan
| | - Kenji Ohira
- Department of Radiology, Chiba University Hospital, Chiba, Japan
| | - Joji Ota
- Department of Radiology, Chiba University Hospital, Chiba, Japan
| | - Takuro Horikoshi
- Department of Radiology, Chiba University Hospital, Chiba, Japan
| | - Yasukuni Mori
- Graduate School of Engineering, Chiba University, Chiba, Japan
| | - Takashi Uno
- Department of Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hiroki Suyari
- Graduate School of Engineering, Chiba University, Chiba, Japan
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15
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QU X, SHANG F, XU Y, CHENG W, CHEN W, QI M, JIANG L, WANG N. The effect of step-wised protocol on critical care management of severe aneurysmal subarachnoid hemorrhage. FOOD SCIENCE AND TECHNOLOGY 2022. [DOI: 10.1590/fst.38420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Xin QU
- Xuanwu Hospital of Capital Medical University, China
| | - Feng SHANG
- Xuanwu Hospital of Capital Medical University, China
| | - Yueqiao XU
- Xuanwu Hospital of Capital Medical University, China
| | - Weitao CHENG
- Xuanwu Hospital of Capital Medical University, China
| | - Wenjin CHEN
- Xuanwu Hospital of Capital Medical University, China
| | - Meng QI
- Xuanwu Hospital of Capital Medical University, China
| | - Lidan JIANG
- Xuanwu Hospital of Capital Medical University, China
| | - Ning WANG
- Xuanwu Hospital of Capital Medical University, China
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16
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Hosseini Siyanaki MR, Lucke-Wold B, Khan M. Exploration of treatments for subarachnoid hemorrhage. JOURNAL OF BIOMED RESEARCH 2022; 3:48-55. [PMID: 36589526 PMCID: PMC9802631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Subarachnoid hemorrhage (SAH) continues to be a leading cause of morbidity and mortality, with cerebral vasospasm as a common etiology of worse clinical progression. The purpose of this study was to evaluate and review the current literature concerning the effective treatment of SAH. The treatment options for SAH are expanding as new therapeutic targets are identified. Nimodipine is the primary medication prescribed due to its neuroprotective properties. In addition, certain drugs can enhance lymphatic flow and influence the recovery process, such as Dexmedetomidine, SSRIs, and DL-3-n-butylphthalide. Vasospastic and ischemic patients commonly undergo transluminal balloon angioplasty. Clinical trials have not yet provided conclusive evidence to support the use of magnesium or statins. Moreover, other agents such as calcium channel blockers, milrinone, hydrogen sulfide, exosomes, erythropoietin, cilostazol, fasudil, albumin, Eicosapentaenoic acid, corticosteroids, minocycline, and stellate ganglion blockade should be investigated further.
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Affiliation(s)
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Majid Khan
- University of Nevada, Reno School of Medicine, Reno, NV, USA
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Shi M, Yang C, Tang QW, Xiao LF, Chen ZH, Zhao WY. The Prognostic Value of Neutrophil-to-Lymphocyte Ratio in Patients With Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis of Observational Studies. Front Neurol 2021; 12:745560. [PMID: 34867727 PMCID: PMC8636120 DOI: 10.3389/fneur.2021.745560] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 10/12/2021] [Indexed: 12/26/2022] Open
Abstract
The neutrophil–to-lymphocyte ratio (NLR), as an essential systemic inflammation factor, has been widely used as a prognostic indicator in various diseases, such as malignant tumors, cardiovascular disease, and intracranial hemorrhage. An increasing number of studies have believed that NLR is a valuable predictor of prognosis for patients with aneurysmal subarachnoid hemorrhage (aSAH). However, these results remain controversial. In the current study, we planned to carry out a systematic review and meta-analysis to investigate the association between NLR and poor outcome, and the occurrence of delayed cerebral ischemia (DCI). We carried out a comprehensive search for published literatures on PubMed, EMBASE, Cochrane Library, and Web of Science databases from inception to April 1, 2021. We conducted an assessment of all included studies based on the principles proposed in the Newcastle-Ottawa Quality Assessment Scale (NOS). Poor outcome and the occurrence of DCI were considered as the main outcome measure. We calculated the pooled odds ratio (OR) and corresponding 95% confidence interval (CI) to examine the strength of the association of NLR with poor outcome or the occurrence of DCI. We strictly selected a total of 10 studies comprising 4,989 patients. Nine studies reported the association between NLR and poor outcome, and five studies reported the association between NLR and the occurrence of DCI. The pooled results indicated higher NLR was significantly associated with both poorer outcomes (OR = 1.32, 95%CI 1.11–1.57; P = 0.002, I2 = 87%), and the occurrence of DCI (OR = 1.72, 95%CI 1.22–2.41; P = 0.002, I2 = 82%) in aSAH patients. The NLR is a valuable indicator of inflammation to independently predict poor outcome and occurrence of DCI after aSAH, where a higher NLR is significantly associated with poor outcomes and occurrence of DCI. These findings suggest that the NLR can help clinicians evaluate the prognosis and identify potentially severe patients early, which may contribute to better management and improve poor prognosis of aSAH patients.
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Affiliation(s)
- Min Shi
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Chao Yang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Qing-Wen Tang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Ling-Fei Xiao
- Department of Orthopaedics, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Zu-Han Chen
- Institute of Hepatobiliary Diseases of Wuhan University, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Wen-Yuan Zhao
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
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18
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Debs LH, Rahimi SY, Rutkowski MJ, Macomson SD. Endoscopic third ventriculostomy may decrease shunt-dependency in patients with post-hemorrhagic hydrocephalus following aneurysmal subarachnoid hemorrhage. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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19
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Yao H, Lv C, Luo F, He C. Plasma cellular prion protein concentrations correlate with severity and prognosis of aneurysmal subarachnoid hemorrhage. Clin Chim Acta 2021; 523:114-119. [PMID: 34537219 DOI: 10.1016/j.cca.2021.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/13/2021] [Accepted: 09/13/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cellular prion protein (PrPc) is greatly expressed in injured brain tissues. We investigates correlation of plasma PrPc concentrations with severity, delayed cerebral ischemia (DCI) plus prognosis following aneurysmal subarachnoid hemorrhage (aSAH). METHODS Plasma PrPc concentrations were measured in 110 aSAH patients and 110 healthy controls. The World Federation of Neurological Surgeons scale (WFNS) score, Glasgow coma scale (GCS) score, Hunt-Hess score and modified Fisher score were utilized to assess hemorrhagic severity. Relations of plasma PrPc concentrations to DCI and 90-day poor outcome (Glasgow outcome scale score of 1-3) were analyzed using multivariate analysis. Prognostic predictive capabilities were determined under receiver operating characteristic curve. RESULTS Plasma PrPc concentrations were significantly higher in patients than in controls. Plasma PrPc concentrations were tightly correlated with WFNS score, GCS score, Hunt-Hess score and modified Fisher score. Plasma PrPc emerged as an independent predictor for 90-day poor outcome, but not for DCI. Plasma PrPc concentrations exhibited similar prognostic predictive abilities, as compared to WFNS score, GCS score, Hunt-Hess score and modified Fisher score. CONCLUSIONS Plasma PrPc concentrations are highly associated with severity and poor outcome after hemorrhagic stroke, indicating that plasma PrPc may serve as a useful prognostic biomarker for aSAH.
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Affiliation(s)
- Hongfeng Yao
- Medical Laboratory, Zhuji Affiliated Hospital of Wenzhou Medical University, 9 Jianmin Road, Zhuji 311800, China
| | - Caiping Lv
- Medical Laboratory, Zhuji Affiliated Hospital of Wenzhou Medical University, 9 Jianmin Road, Zhuji 311800, China
| | - Fangjun Luo
- Medical Laboratory, Zhuji Affiliated Hospital of Wenzhou Medical University, 9 Jianmin Road, Zhuji 311800, China.
| | - Chao He
- Department of Neurosurgery, Zhuji Affiliated Hospital of Wenzhou Medical University, 9 Jianmin Road, Zhuji 311800, China
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20
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Fu QR, Wang Y, Lin SB, Yang Y. Evaluation of efficacy and safety of endovascular coiling for patients with aneurysmal subarachnoid hemorrhage: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e25728. [PMID: 34011030 PMCID: PMC8137089 DOI: 10.1097/md.0000000000025728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 04/13/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND There is an elevated risk of rebleeding when the aneurysm is left untreated in patients diagnosed with aneurysmal subarachnoid hemorrhage (SAH). Occlusion of the lumen of the aneurysm using endovascular coiling is a common method to prevent rebleeding by occluding the aneurysm. This study aims to evaluate the efficacy and safety of endovascular coiling in patients with aneurysmal SAH. METHODS A systematic search for relevant articles will be performed in 4 English electronic databases, including MEDLINE (from 1966 to October 2020), EMBASE (from 1980 to October 2020), the Cochrane Library (from 2020, issue 10), Scopus (from 1823 to October 2020), and 3 Chinese electronic databases, including Chinese Biomedical Literature Database (from 1995 to October 2020), WanFang (last searched October 2020), and China National Knowledge Infrastructure (last searched October 2020). This study will comprise randomized controlled trials (RCTs) that evaluate the effectiveness and safety of using endovascular coiling in the treatment of aneurysmal SAH. The articles in the databases will be independently screened by 2 authors to select potential studies, extract data, and evaluate the bias risk in the selected studies. This study will use suitable statistical methods to merge result data. RESULTS The results of this study will be useful in determining the efficacy and safety of endovascular coiling for treating patients with aneurysmal SAH. CONCLUSION The findings of this study will summarize the most recent evidence on the effectiveness and safety of using endovascular coiling to treat aneurysmal SAH. ETHICS AND DISSEMINATION The present work does not involve any humans or animals; therefore, ethical approval is not needed. SYSTEMATIC REVIEW REGISTRATION December 2, 2020.osf.io/yj4gq (https://osf.io/yj4gq/).
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Effects of COVID-19 on the admissions of aneurysmal subarachnoid hemorrhage: the West Greece experience. Neurol Sci 2021; 42:2167-2172. [PMID: 33745041 PMCID: PMC7981384 DOI: 10.1007/s10072-021-05190-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 03/15/2021] [Indexed: 12/04/2022]
Abstract
Background Acute subarachnoid hemorrhage (SAH) due to aneurysmal rupture is a devastating vascular disease accounting for 5% of strokes. COVID-19 pandemic resulted in a decrease in elective and emergency admissions in the majority of neurosurgical centers. The main hypothesis was that fear of COVID-19 may have prevented patients with critical medical or surgical emergencies from actively presenting in emergency departments and outpatient clinics. Methods We conducted a single-center, retrospective, observational study searching our institutional data regarding the incidence of spontaneous subarachnoid hemorrhage (SAH) and compare the admissions in two different periods: the pre COVID-19 with the COVID-19 period. Results The study cohort was comprised of a total of 99 patients. The mean (SD) weekly case rate of patients with SAH was 1.1 (1.1) during the pre-COVID-19 period, compared to 1.7 (1.4) during the COVID-19 period. Analysis revealed that the volume of admitted patients with SAH was 1.5-fold higher during the COVID period compared to the pre-COVID period and this was statistically significant (ExpB = 1.5, CI 95% 1–2.3, p = 0.044). Difference in mortality did not reach any statistical significance between the two periods (p = 0.097), as well as patients’ length of stay (p = 0.193). Conclusions The presented data cover a more extended time period than so far published reports; it is reasonable that our recent experience may well be demonstrating a general realistic trend of overall increase in aneurysmal rupture rates during lockdown. Hospitalization of patients with SAH cannot afford any reductions in facilities, equipment, or personnel if optimum outcomes are desirable.
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Poor grade subarachnoid hemorrhage: Treatment decisions and timing influence outcome. Should we, and when should we treat these patients? BRAIN HEMORRHAGES 2021. [DOI: 10.1016/j.hest.2020.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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Anesthetic management of unruptured intracranial aneurysms: a qualitative systematic review. Neurosurg Rev 2021; 44:2477-2492. [PMID: 33415519 DOI: 10.1007/s10143-020-01441-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 10/31/2020] [Accepted: 11/12/2020] [Indexed: 12/11/2022]
Abstract
Intracranial aneurysms (IA) occur in 3-5% of the general population and may require surgical or endovascular obliteration if the patient is symptomatic or has an increased risk of rupture. These procedures carry an inherent risk of neurological complications, and the outcome can be influenced by the physiological and pharmacological effects of the administered anesthetics. Despite the critical role of anesthetic agents, however, there are no current studies to systematically assess the intraoperative anesthetic risks, benefits, and outcome effects in this population. In this systematic review of the literature, we carefully examine the existing evidence on the risks and benefits of common anesthetic agents during IA obliteration, their physiological and clinical characteristics, and effects on neurological outcome. The initial search strategy captured a total of 287 published studies. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, 28 studies were included in the final report. Our data showed that both volatile and intravenous anesthetics are commonly employed, without evidence that either is superior. Although no specific anesthetic regimens are promoted, their unique neurological, cardiovascular, and physiological properties may be critical to the outcome in vulnerable patients. In particular, patients at risk for perioperative ischemia may benefit from timely administration of anesthetic agents with neuroprotective properties and optimization of their physiological parameters. Further studies are warranted to examine if these anesthetic regimens can reduce the risk of neurological injury and improve the overall outcome in these patients.
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Ma M, Li H, Wu J, Zhang Y, Shen H, Li X, Wang Z, Chen G. Roles of Prokineticin 2 in Subarachnoid Hemorrhage-Induced Early Brain Injury via Regulation of Phenotype Polarization in Astrocytes. Mol Neurobiol 2020; 57:3744-3758. [PMID: 32572760 DOI: 10.1007/s12035-020-01990-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 06/10/2020] [Indexed: 12/11/2022]
Abstract
Previous studies have postulated that neuroinflammation can induce two different types of reactive astrocytes, A1 and A2. A1 astrocytes may be harmful, whereas A2 astrocytes may be protective. Specifically, prokineticin 2 (PK2) has been shown to regulate neuron-astrocyte signaling mechanism by promoting an alternative A2-protective phenotype in astrocytes. This study aimed to examine the role of PK2 in early brain injury (EBI) caused by subarachnoid hemorrhage (SAH). SAH-induced astrocytic activation was confirmed by Western blotting. We confirmed C3 and PTX3 as appropriate reactivity markers for discriminating A1 and A2 astrocytes, respectively. We also observed SAH-induced astrocytic activation in SAH patients. The increase of PK2 in neurons after SAH in both humans and rats suggested a possible relationship between PK2 and SAH pathology. PK2 knockdown promoted an A1 astrocytic phenotype with upregulation of neurodegenerative indicators, while intravascular injection of recombinant PK2 (rPK2) promoted A2 astrocytic phenotype and reduced SAH-induced neuronal injury and behavioral dysfunction. Finally, we identified that tumor necrosis factor alpha (TNF-α) was sufficient to elevate the protein level of PK2 in neurons and enhance astrocytic activation in vitro. Moreover, rPK2 selectively promoted astrocytic polarization to an A2 phenotype under a TNF-α stimulus and induced phosphorylation of signal transducer and activator of transcription 3 (STAT3), suggesting that SAH-induced increases in PK2 may function as an endogenous mechanism for self-repair. Collectively, our findings support that enhancing PK2 expression or administration of rPK2 may induce a selective modulation of astrocytic polarization to a protective phenotype following SAH-like stimuli.
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Affiliation(s)
- Mian Ma
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
- Department of Neurosurgery, Suzhou Municipal Hospital, Suzhou, Jiangsu Province, China
| | - Haiying Li
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Jiang Wu
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Yunhai Zhang
- Jiangsu Key Laboratory of Medical Optics, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China
| | - Haitao Shen
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Xiang Li
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Zhong Wang
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China.
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, China.
| | - Gang Chen
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China.
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, China.
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Lai X, Zhang W, Ye M, Liu X, Luo X. Development and validation of a predictive model for the prognosis in aneurysmal subarachnoid hemorrhage. J Clin Lab Anal 2020; 34:e23542. [PMID: 32860455 PMCID: PMC7755773 DOI: 10.1002/jcla.23542] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/22/2020] [Accepted: 07/29/2020] [Indexed: 12/12/2022] Open
Abstract
Background This study was to conduct a predictive model for the prognosis of aneurysmal subarachnoid hemorrhage (aSAH) and validate the clinical data. Methods A total of 235 aSAH patients were enrolled in this study, dividing into the favorable or poor prognosis groups based on Modified Rankin Scale (mRS) at 3 months postoperatively. Multivariate analysis was assessed using binary Logistic regression and Fisher discriminant analysis. The receiver operating characteristic (ROC) curve was used to determine the cut‐off value. Results Our findings showed that the high Glasgow Coma Scale (GCS) score 24‐hour after surgery reduced the risk of poor prognosis, and the surgical clipping and elevated neutrophil‐lymphocyte ratio (NLR) increased the risk of poor prognosis. The discriminant function was V = 0.881 × GCS score − 0.523 × NLR − 0.422 × therapeutic approach, and V = −0.689 served as a cut‐off value. When V ≥ −0.689, the good prognosis was considered among these patients with aSAH. The correctness for predicting the prognostic outcomes by self‐validation was 85.11%. Conclusion This predictive model established by a discriminant analysis is a useful tool for predicting the prognostic outcomes of aSAH patients, which may help clinicians identify patients at high risk for poor prognosis and optimize treatment after surgery.
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Affiliation(s)
- Xiang Lai
- Department of Neurosurgery, Meizhou People's Hospital (Huangtang Hospital), Meizhou Hospital Affiliated to Sun Yat-Sen University, Meizhou, China
| | - Wenbo Zhang
- Department of Neurosurgery, Meizhou People's Hospital (Huangtang Hospital), Meizhou Hospital Affiliated to Sun Yat-Sen University, Meizhou, China
| | - Min Ye
- Department of Neurosurgery, Meizhou People's Hospital (Huangtang Hospital), Meizhou Hospital Affiliated to Sun Yat-Sen University, Meizhou, China
| | - Xiaoping Liu
- Department of Neurosurgery, Meizhou People's Hospital (Huangtang Hospital), Meizhou Hospital Affiliated to Sun Yat-Sen University, Meizhou, China
| | - Xingda Luo
- Department of Neurosurgery, Meizhou People's Hospital (Huangtang Hospital), Meizhou Hospital Affiliated to Sun Yat-Sen University, Meizhou, China
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Choudhary N, Singh R, Bhalotra AR, Magoon R. Effect of intraoperative intravenous lignocaine infusion on the haemodynamic stability and postoperative recovery following intracranial aneurysm surgery: A case series. Indian J Anaesth 2020; 64:S205-S208. [PMID: 33162603 PMCID: PMC7641061 DOI: 10.4103/ija.ija_437_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/22/2020] [Accepted: 06/28/2020] [Indexed: 01/25/2023] Open
Affiliation(s)
- Nitin Choudhary
- Department of Anaesthesiology and Intensive Care, Maulana Azad Medical College, New Delhi, India
| | - Rahil Singh
- Department of Anaesthesiology and Intensive Care, Maulana Azad Medical College, New Delhi, India
| | - Anju R Bhalotra
- Department of Anaesthesiology and Intensive Care, Maulana Azad Medical College, New Delhi, India
| | - Rohan Magoon
- Department of Cardiac Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India
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Wang HY, Song GF, Yang HW, Chang XF, Shen RB, Yang FY. Efficacy of fasudil for the treatment of aneurysmal subarachnoid hemorrhage: A systematic review protocol of randomized controlled trial. Medicine (Baltimore) 2019; 98:e16885. [PMID: 31464917 PMCID: PMC6736033 DOI: 10.1097/md.0000000000016885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 07/29/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND This study aims to systematically assess the efficacy and safety of fasudil for the treatment of aneurysmal subarachnoid hemorrhage (ASH). METHODS This study will include all of randomized controlled trials on the efficacy and safety of fasudil for the treatment of ASH. Ten electronic databases of PubMed, Embase, Cochrane Library, Google Scholar, Web of Science, Ovid, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure will be searched from inception to the May 1, 2019 without language restrictions. We will also search gray literatures to avoid missing any other potential studies. Two authors will independently perform study selection, data extraction and management, and methodologic quality assessment. The primary outcome is limbs function. The secondary outcomes comprise of muscle strength, muscle tone, quality of life, and adverse events. RESULTS This study will provide a comprehensive literature search on the current evidence of fasudil for the treatment of ASH from primary and secondary outcomes. CONCLUSION The results of this study will present evidence to determine whether fasudil is an effective and safety treatment for patients with ASH. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019136215.
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Affiliation(s)
| | | | | | - Xue-feng Chang
- Department of Ophthalmology, First Affiliated Hospital of Jiamusi University, Jiamusi, China
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Ren C, Xu H, Xu G, Liu L, Liu G, Zhang Z, Cao JL. Effect of intraoperative infusion of dexmedetomidine on postoperative recovery in patients undergoing endovascular interventional therapies: A prospective, randomized, controlled trial. Brain Behav 2019; 9:e01317. [PMID: 31099992 PMCID: PMC6625481 DOI: 10.1002/brb3.1317] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 04/25/2019] [Accepted: 04/27/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Rapid emergence from general anesthesia during endovascular interventional therapies (EITs) is important. However, the solution that improved quality of both analepsia and postoperative recovery after EITs has not been specifically addressed. We conducted this prospective, randomized, controlled trial to evaluate the intraoperative infusion of dexmedetomidine on quality of analepsia and postoperative recovery in patients undergoing EITs. METHODS Eighty-six patients undergoing EITs were divided into three groups: RD1 (dexmedetomidine at an initial dose of 0.5 μg/kg for 10 min adjusted to 0.2 μg kg-1 hr-1 throughout EIT), RD2 (dexmedetomidine at an initial dose of 0.5 μg/kg for 10 min adjusted to 0.4 μg kg-1 hr-1 throughout EIT), and RD3 (dexmedetomidine at an initial dose of 0.5 μg/kg for 10 min adjusted to 0.6 μg kg-1 hr-1 throughout EIT). An analgesia system delivered sufentanil only. The primary outcome measure was the total consumption of nimodipine during the first 48 hr after surgery. The secondary outcome measures were sufentanil consumption, pain intensity, hemodynamics, functional activity score (FAS), neurologic examination, level of sedation (LOS), and Bruggrmann comfort scale (BCS). We also recorded the intraoperative hemodynamic data, requirement of narcotic and vasoactive drugs, prevalence of complications and symptomatic cerebral vasospasm, duration of postanesthesia care unit (PACU) stay, Glasgow Outcome Score (GOS) at 3 months, and prevalence of cerebral infarction 30 days after surgery. RESULTS Dexmedetomidine application in the regimen RD3 reduced the consumption of the total dose of nimodipine and sufentanil 48 hr after surgery, prevalence of symptomatic cerebral vasospasm, consumption of narcotic drugs and nimodipine during surgery, pain intensity during the first 8 hr after surgery, and increased both BCS during the first 4 hr after surgery and hemodynamic stability. However, the LOS was increased at the 0.5 hr after surgery and surgeon satisfaction score was lower. There were no significant differences among the groups for consumption of vasoactive drugs except urapidil, Glasgow coma scale (GCS) and FAS during the first 48 hr after surgery, GOS at 3 months, and cerebral infarction after 30 days. CONCLUSIONS Dexmedetomidine (an initial dose of 0.5 μg/kg for 10 min adjusted to 0.6 μg kg-1 hr-1 throughout EIT) could reduce the total consumption of nimodipine and opioid during the first 48 hr after surgery, the concerning adverse effects, and improve pain scores. The optimal dosage of dexmedetomidine during EITs merits further investigation.
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Affiliation(s)
- Chunguang Ren
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, China.,Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou Medical University, Xuzhou, China.,Department of Anesthesiology, Liaocheng People's Hospital, Liaocheng, Shandong, China
| | - Huiying Xu
- Department of Anesthesiology, Liaocheng People's Hospital, Liaocheng, Shandong, China
| | - Guangjun Xu
- Department of Anesthesiology, Liaocheng People's Hospital, Liaocheng, Shandong, China
| | - Lei Liu
- Department of Anesthesiology, Liaocheng People's Hospital, Liaocheng, Shandong, China
| | - Guoying Liu
- Department of Anesthesiology, Liaocheng People's Hospital, Liaocheng, Shandong, China
| | - Zongwang Zhang
- Department of Anesthesiology, Liaocheng People's Hospital, Liaocheng, Shandong, China
| | - Jun-Li Cao
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, China.,Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou Medical University, Xuzhou, China.,Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
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Petridis AK, Kamp MA, Cornelius JF, Beez T, Beseoglu K, Turowski B, Steiger HJ. Aneurysmal Subarachnoid Hemorrhage. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 114:226-236. [PMID: 28434443 DOI: 10.3238/arztebl.2017.0226] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 08/29/2016] [Accepted: 11/28/2016] [Indexed: 01/10/2023]
Abstract
BACKGROUND Aneurysmal subarachnoid hemorrhage (SAH) is associated with a mortality of more than 30%. Only about 30% of patients with SAB recover sufficiently to return to independent living. METHODS This article is based on a selective review of pertinent literature retrieved by a PubMed search. RESULTS Acute, severe headache, typically described as the worst headache of the patient's life, and meningismus are the characteristic manifestations of SAH. Computed tomog raphy (CT) reveals blood in the basal cisterns in the first 12 hours after SAH with approximately 95% sensitivity and specificity. If no blood is seen on CT, a lumbar puncture must be performed to confirm or rule out the diagnosis of SAH. All patients need intensive care so that rebleeding can be avoided and the sequelae of the initial bleed can be minimized. The immediate transfer of patients with acute SAH to a specialized center is crucially important for their outcome. In such centers, cerebral aneurysms can be excluded from the circulation either with an interventional endovascular procedure (coiling) or by microneurosurgery (clipping). CONCLUSION SAH is a life-threatening condition that requires immediate diagnosis, transfer to a neurovascular center, and treatment without delay.
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Affiliation(s)
- Athanasios K Petridis
- Department of Neurosurgery, Düsseldorf University Hospital; Department of Diagnostic and Interventional Radiology, Düsseldorf University Hospital; Department of Diagnostic and Interventional Radiology, Düsseldorf University Hospital
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Aneurysm rebleeding after placement of external ventricular drainage: a systematic review and meta-analysis. Acta Neurochir (Wien) 2017; 159:695-704. [PMID: 28243810 DOI: 10.1007/s00701-017-3124-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 02/16/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND The association between external ventricular drainage (EVD) and aneurysm rerupture is still a controversial issue. We performed a systematic review and meta-analysis of published series reporting data of EVD placement in aneurysmal subarachnoid hemorrhage (SAH) with the aim to evaluate the relationship between ventricular drainage and aneurysm rebleeding. METHOD PRISMA/MOOSE guidelines were followed. The Newcastle-Ottawa Scale was used to assess the quality of the studies. We conducted a comprehensive literature search of three databases (PubMed, Ovid MEDLINE, and Ovid EMBASE) on series reporting patients with EVD placement and aneurysmal SAH. The reported studies were analyzed with a primary aim to calculate the strength of the association (odds ratio) between rebleeding and EVD placement in patients with SAH. RESULTS Our systematic review included 16 articles with a total of 6804 patients with SAH of which 595 (8.7%) had aneurysmal rebleeding. Ventricular drainage was inserted in 19% of patients. Rebleeding occurred in 18.8% (95% CI = 16.4-20.6%) of patients requiring EVD and in 6.4% (95% CI = 5.8-7.1%) of patients who did not require EVD (OR = 3.92, p < 0.0001). The mean time between EVD placement and rebleeding was 1 h (range, 0-8 h). The maximal aneurysm diameter of patients with rerupture was larger when compared with patients without rerupture (9.9 mm vs. 7.5 mm; p < 0.04). High Fisher grades (III-IV) were present in 75% of patients with rerupture and in 60% of patients without aneurysmal rerupture (p < 0.0001). CONCLUSIONS Our study conclusively defined an association between EVD and rebleeding. However, the effective role of EVD in aneurysm rebleeding is insufficiently investigated in the literature. Other significant factors of rebleeding are usually observed in patients requiring ventricular drainage. According to our findings, a causal relationship between EVD and aneurysm rebleeding could be a plausible hypothesis, at least in certain cases.
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Vadivelu N, Kai AM, Tran D, Kodumudi G, Legler A, Ayrian E. Options for perioperative pain management in neurosurgery. J Pain Res 2016; 9:37-47. [PMID: 26929661 PMCID: PMC4755467 DOI: 10.2147/jpr.s85782] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Moderate-to-severe pain following neurosurgery is common but often does not get attention and is therefore underdiagnosed and undertreated. Compounding this problem is the traditional belief that neurosurgical pain is inconsequential and even dangerous to treat. Concerns about problematic effects associated with opioid analgesics such as nausea, vomiting, oversedation, and increased intracranial pressure secondary to elevated carbon dioxide tension from respiratory depression have often led to suboptimal postoperative analgesic strategies in caring for neurosurgical patients. Neurosurgical patients may have difficulty or be incapable of communicating their need for analgesics due to neurologic deficits, which poses an additional challenge. Postoperative pain control should be a priority, because pain adversely affects recovery and patient outcomes. Inconsistent practices and the quality of current analgesic strategies for neurosurgical patients still leave room for improvement. Given the complexity of postoperative pain management for these patients, multimodal strategies are often required to optimize pain control and at the same time limit undesired side effects.
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Affiliation(s)
- Nalini Vadivelu
- Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA
| | - Alice M Kai
- Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - Daniel Tran
- Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA
| | - Gopal Kodumudi
- California Northstate University College of Medicine, Elk Grove, CA, USA
| | - Aron Legler
- Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA
| | - Eugenia Ayrian
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
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Feil M, Irick NA. Principles of Neuro-anesthesia in Neurosurgery for Intensive Care Unit Nurses. Crit Care Nurs Clin North Am 2015; 28:87-94. [PMID: 26873761 DOI: 10.1016/j.cnc.2015.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
As neurosurgical interventions and procedures are advancing, so is the specialty of neuro-anesthesia. The neurosurgeon and the neuro-anesthetist are focused on providing each patient with the best possible outcome. Throughout the surgery, the main priorities of the neuro-anesthetist are patient safety, patient well-being, surgical field exposure, and patient positioning. Potential postoperative complications include nausea and vomiting. Postoperative visual loss is a complication of neurosurgery, most specifically spine surgery, whose origins are unknown. Postoperative considerations for the intensive care unit nurse should include receiving a thorough clinical handoff from the anesthesia provider to ensure care continuity and patient safety.
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Affiliation(s)
- Marian Feil
- Thomas Jefferson University, Philadelphia, PA, USA.
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