Early cisternal fibrinolysis is more effective than rescue spasmolysis for the prevention of delayed infarction after subarachnoid haemorrhage

Background To compare the efficacy of two different concepts of cisternal therapy—PREVENTIVE fibrinolysis plus on-demand spasmolysis versus RESCUE spasmolysis—for the prevention of cerebral vasospasm(CVS)and delayed cerebral infarction(DCI)in patients with aneurysmal subarachnoid haemorrhage(aSAH).Methods Retrospective analysis of 84 aSAH patients selected for cisternal therapy for DCI prevention.66 high-risk patients received PREVENTIVE cisternal therapy to enhance blood clearance.Either stereotactic catheter ventriculocisternostomy(STX-VCS)or intraoperative placement of a cisterno-ventriculostomy catheter(CVC),followed by fibrinolytic cisternal lavage using urokinase was performed.In case of vasospasm,nimodipine was applied intrathecally.22 low-risk patients who developed CVS against expectations were selected for STX-VCS as RESCUE intervention for cisternal spasmolysis with nimodipine.Rates of DCI and mean flow velocities of daily transcranial Doppler(TCD)ultrasonographies were evaluated.Results Despite a higher prespecified DCI risk,patients selected for PREVENTIVE intervention primarily aiming at blood clearance had a lower DCI rate compared with patients selected for intrathecal spasmolysis as a RESCUE therapy(11.3%vs 18.2%).After intrathecal treatment onset,CVS(TCD>160 cm/s)occurred in 45%of patients with PREVENTIVE and 77%of patients with RESCUE therapy(p=0.013).A stronger response of CVS to intrathecal nimodipine was observed in patients with PREVENTIVE intervention as the mean CVS duration after start of intrathecal nimodipine was 3.2 days compared with 5.8 days in patients with RESCUE therapy(p=0.026).Conclusions PREVENTIVE cisternal therapy directed at blood clearance is more effective for the prevention of CVS and delayed infarction compared with cisternal RESCUE spasmolysis.

Ethanol Extract of Glycyrrhiza uralensis Fisch:Antidiarrheal Activity in Mice and Contraction Effect in Isolated Rabbit Jejunum

Objective:To evaluate the antidiarrheal effect of ethanol extract of Glycyrrhiza uralensis Fisch root(GFR)in vivo and jejunal contraction in vitro.Methods:In vivo,50 mice were divided into negative control,positive control(verapamil),low-,medium-and high-dose GFR(250,500,1,000 mg/kg)groups by a random number table,10 mice in each group.The antidiarrheal activity was evaluated in castor oil-induced diarrhea mice model by evacuation index(El).In vitro,the effects of GFR(0.01,0.03,0.1,0.3,1,3,and 10 g/L)on the spontaneous contraction of isolated smooth muscle of rabbit jejunum and contraction of pretreated by Acetylcholine(ACh,10μmol/L)and KCl(60 mmol/L)were observed for 200 s.In addition,CaCl_(2)was accumulated to further study its mechanism after pretreating jejunal smooth muscle with GFR(1 and 3 g/L)or verapamil(0.03 and 0.1μmol/L)in a Ca^(2+)-free-high-K+solution containing ethylene diamine tetraacetic acid(EDTA).Results:GFR(500 and 1,000 mg/kg)significantly reduced El in castor oil-induced diarrhea model mice(P<0.01).Meanwhile,GFR(0.01,0.03,0.1,0.3,1,3,and 10 g/L)inhibited the spontaneous contraction of rabbit jejunum(P<0.05 or P<0.01).Contraction of jejunums samples pretreated by ACh and KCI with 50% effective concentration(EC50)values was 1.05(0.71-1.24),0.34(0.29-0.41)and 0.15(0.11-0.20)g/L,respectively.In addition,GFR moved the concentration-effect curve of CaCl_(2)down to the right,showing a similar effect to verapamil.Conclusions:GFR can effectively reduce diarrhea and inhibit intestinal contraction,and these antidiarrheal effects may be based on blocking L-type Ca^(2+) channels and muscarinic receptors.