Cerebral arterial blood flow,attention,and executive and cognitive functions in depressed patients after acute hypertensive cerebral hemorrhage

BACKGROUND Intracerebral hemorrhage mainly occurs in middle-aged and elderly patients with hypertension,and surgery is currently the main treatment for hypertensive cerebral hemorrhage,but the bleeding caused by surgery will cause damage to the patient's nerve cells,resulting in cognitive and motor dysfunction,resulting in a decline in the patient's quality of life.AIM To investigate associations between cerebral arterial blood flow and executive and cognitive functions in depressed patients after acute hypertensive cerebral hemorrhage.METHODS Eighty-nine patients with depression after acute hypertensive cerebral hemorrhage who were admitted to our hospital between January 2019 and July 2021 were selected as the observation group,while 100 patients without depression who had acute hypertensive cerebral hemorrhage were selected as the control group.The attention span of the patients was assessed using the Paddle Pin Test while executive function was assessed using the Wisconsin Card Sorting Test(WCST)and cognitive function was assessed using the Montreal Cognitive Assessment Scale(MoCA).The Hamilton Depression Rating Scale(HAMD-24)was used to evaluate the severity of depression of involved patients.Cerebral arterial blood flow was measured in both groups.RESULTS The MoCA score,net scores I,II,III,IV,and the total net score of the scratch test in the observation group were significantly lower than those in the control group(P<0.05).Concurrently,the total number of responses,number of incorrect responses,number of persistent errors,and number of completed responses of the first classification in the WCST test were significantly higher in the observation group than those in the control group(P<0.05).Blood flow in the basilar artery,left middle cerebral artery,right middle cerebral artery,left anterior cerebral artery,and right anterior cerebral artery was significantly lower in the observation group than in the control group(P<0.05).The basilar artery,left middle cerebral artery,right middle cerebral artery,left anterior cerebral artery,and right anterior cerebral artery were positively correlated with the net and total net scores of each part of the Paddle Pin test and the MoCA score(P<0.05),and negatively correlated with each part of the WCST test(P<0.05).In the observation group,the post-treatment improvement was more prominent in the Paddle Pin test,WCST test,HAMD-24 score,and MoCA score compared with those in the pre-treatment period(P<0.05).Blood flow in the basilar artery,left middle cerebral artery,right middle cerebral artery,left anterior cerebral artery,and right anterior cerebral artery significantly improved in the observation group after treatment(P<0.05).CONCLUSION Impaired attention,and executive and cognitive functions are correlated with cerebral artery blood flow in patients with depression after acute hypertensive cerebral hemorrhage and warrant further study.

Value of inflammatory mediator profiles and procalcitonin in predicting postoperative infection in patients with hypertensive cerebral hemorrhage

BACKGROUND Hypertensive cerebral hemorrhage(HICH)is a common clinical cerebrovascular disease and one of the most serious complications of hypertension.Early warning of the occurrence of infection during treatment and timely anti-infective treatment are of great significance for the early prevention and treatment of postoperative infection in patients with HICH.Changes in the levels of inflammatory mediators,which are closely related to the occurrence and development of postoperative infection,and procalcitonin(PCT),which is a sensitive indicator for diagnosing bacterial infections,are widely used in clinical practice.AIM To explore the application value of inflammatory mediator profiles and PCT in predicting postoperative infection in patients with HICH.METHODS A total of 271 patients who underwent HICH surgery at our hospital between March 2019 and March 2021 were selected and divided into the infection(n=80)and non-infection(n=191)groups according to whether postoperative infection occurred.The postoperative infection status and etiological characteristics of the infective pathogens in the infection group were analyzed.Changes in inflammatory mediator profile indices and PCT levels were compared between the two groups,pre-and postoperatively.RESULTS A total of 109 strains of pathogenic bacteria were detected in the infection group,including 67 strains(61.47%)of gram-negative bacteria,32 strains(29.36%)of gram-positive bacteria,and 10 strains(9.17%)of fungi.The main infection site of the patients in the infection group was the respiratory system(63.75%).Preoperative interleukin(IL)-4,IL-6,IL-10,tumor necrosis factor-α,interferon-γ,and PCT levels were higher in the infection group than in the non-infection group(P<0.05),and there were no significant differences in the IL-2 Levels between the two groups(P>0.05).The inflammatory mediator profile indices and PCT levels were higher in the two groups of patients on the first postoperative day than preoperatively(P<0.05),and were higher than those in the non-infection group(P<0.05).Logistic regression analysis showed that preoperative IL-6 and PCT levels correlated with postoperative infection(P<0.05).Operating characteristic curve analysis results showed that the area under the curve(AUC)values of preoperative IL-6 and PCT levels in predicting postoperative infection in patients with HICH were 0.755 and 0.824,respectively.The AUC value of joint detection was 0.866,which was significantly higher than that of the single index(P<0.05).CONCLUSION Preoperative IL-6 and PCT levels are correlated with postoperative infection in patients with HICH.Their detection is clinically significant for early identification of patients at high risk for postoperative infection.

Clinical Study on Zhuyu Tongfu (逐瘀通腑) Serial Recipe Combined with Acupuncture and Massotherapy in Treating Hypertensive Cerebral Hemorrhage

Objective. To observe the clinical efficacy and mechanism of Zhuyu Tongfu （逐瘀通腑, ZYTF） Serial Recipe combined with acupuncture and massotherapy in treating hypertensive cerebral hemorrhage （HCH）. Methods： One hundred and eighteen patients with hypertensive cerebral hemorrhage, on the basis of conventional Western medicine treatment, were randomly divided into ZYTF combined with acupuncture and massotherapy group （treated group） and simple Western medicine group （control group） ; the clinical efficacy, neurofunction deficit scoring （NDS） alterations and hematoma absorption rate of both groups were observed, and also the plasma superoxide dismutase （SOD） activity, plasma lipid peroxidase （LPO） content, erythrocyte glutathion peroxidase （GSH-Px） activity, hematocrit （Ht） and the whole blood viscosity （Va） change were also observed. Results： In the treated group, the clinical efficacy, NDS improvement and hematoma absorption rate were superior to that of the control group; comparison between the two groups after treatment showed that plasma SOD activity and GSH-Px activity got more elevated and plasma LPO content, Ht and Va more lowered in the the treated group than those in the control group. Cenclusien： ZYTF combined with acupuncture and massotherapy has better effect, its therapeutic mechanism was possibly correlated to the elevation of plasma SOD activity, GSH-Px activity and lowering of plasma LPO content, Ht and Va.

EXPRESSION OF IL-2 AND SIL-2R AND ALTERATION OF CELL IMMUNITY IN PATIENTS WITH HYPERTENSIVE CEREBRAL HEMORRHAGE

Objective To study the expression of interleukin-2(IL-2), soluble interleukin-2 receptor (sIL-2R), determine the alteration of erythrocytic immunity and T cell subgroup in the blood of outer circulation in patients with hypertensive cerebral hemorrhage so and to probe into the relationship between them, and to explore the clinical significance. Methods Enzyme linked immnunosorbent assay (ELISA) was used to determine the content of IL-2 and sIL-2R. The immunoadsorption was employed to examine the erythrocytic immune activity and its regulating function. Streptavidin-peroxidase(S-P) was used to determine the cell number of CD3 (cluster of differentiation3), CD4 and CD8. Results The content of IL-2 in the group with hypertensive cerebral hemorrhage was significantly lower than that in the control group (P<0.01), and the content of sIL-2R increased. Red blood cell C_ 3b receptor (RBC.C_ 3b R) and RBC immune adherence enhancing factor (RFEB) dropped greatly (P<0.01), while RBC immune complex rosette (RBC.ICR) and RBC immune adherence inhibiting factor (RFIR) increased greatly. The cell number of CD3 and CD4decreased (P<0.01) and there was no obvious change in CD8 (P<0.05). Conclusion The decrease of immune function was observed in patients with hypertensive cerebral hemorrhage. The determination of the content of IL-2, sIL-2R, erythrocytic immunity and the activity of T subgroup has an important clinical significance in the occurrence, development, treatment, and prognosis of hypertensive cerebral hemorrhage.

Study on Compound Salvia Pellet in Treating HypertensiveCerebral Hemorrhage

Objective:To assess the efficacy and safety of compound Salvia pellet (CSP) in treating hypertensive cerebral hemorrhage (HCH). Methods: Control group (n=116) was given HCH conventional therapy, and the treated group (n=118) given the same conventional therapy plus CSP 10 pills through sublingual sucking/6 hrs, the efficacy was compared. Results: (1) The 3rd day after admission CT monitoring showed both the volume of hematoma and hematoma plus edema in the treated group were smaller than those in the control group, the difference was significant (P<0.05); comparison between 14th day and 28th day after admission showed that the difference was significant (P<0.01). (2) The 14th day, 28th day and 3 months after admission, regarding the Chinese stroke scale (CSS), activity of daily living (ADD and modified Barthol index (Bl), the treated group was better than that of control group, the difference was significant (P<0.01). (3) The incidence of brain-heart syndrome reduced as time went by in both groups, but that of the treated group lowered more than that of control group, the difference being significant (P<0.05, or P< 0.01). Conclusion: CSP in treating HCH patients could cease the expansion of cerebral hematoma in the early phase, and accelerate the absorption of cerebral hematoma, improve the cerebral blood flow, alleviate cerebral edema, lower the disability, and elevate the quality of life. Besides, CSP also could prevent and treat brain-heart syndrome. CSP is cheap, convenient in administration, effective and safe.

Treatment of Hypertensive Cerebral Hemorrhage by Activating Blood Circulation to Remove Stasis

The treatment of hy-pertensive cerebral hemorrhage(HCH)by activatingblood circulation to removestasis(ABCRS)is a newtherapeutic approach,which is initiated by clinical specialists of TCM andintegrative Chinese andwestern medicine.Al-though it is not a flawless

EFFECT OF ELECTROACUPUNCTURE ON GENE EXPRESSION OF α- SUBUNIT OF Go-PROTEIN IN THE HIPPOCAMPUS OF RATS WITH HYPERTENSIVE CEREBRAL HEMORRAGE

Objective: To observe the effect of electroacupuncture (EA) on gene expr ession o f α subunit of Go-protein in the brain of rats with hypertensive cerebral hem or rage and study its underlying mechanisms of EA in ameliorating cerebral hemorrag e. Methods: A total of 130 SD rats were randomly divided into nor mal control gro up (n=10), sham operation group (n=40), model group (n=40) and EA group (n=40). The latter 3 groups were further divided into 6 h, 24 h, 48 h and 72 h (tim e course s) subgroups, with 10 rats being in each subgroup. The hypertensive cerebral hem orrage model was induced by injecting 1 μL of collagenase (0.5 U/μL collagena se Type Ⅶ) and heparin (7 U/μL) into the caudate nucleus in rats with renovascul ar hypertension (by clipping the bilateral renal arteries). The gene expression of α subunit of Go-protein in the hippocampus tissue of rats was detected with No rthern blotting hybridization analysis. EA (continuous waves, 120 pulses/min in frequency, 1 mA in intensity and duration of 30 min) was applied to "Shuigou" (水沟 GV 26), bilateral "Neiguan"(内关 PC 6) and bilateral "Housanli"(Zusanl i, 足三里 ST 36). Results: The gene expression of α subunit of Go-protein in th e hippocampus tis sue of the rats was obviously downregulated in hypertensive cerebral hemorrage m odel group and significantly upregulated after EA treatment wit h the extension of time. Conlusion: EA may relieve cerebral hemorr age by regulating the gene transcription of α subunit of Go-protein and incre asing the expression of Go-α protein. This may be one of the molecular mechani sm s of EA in improving hypertensive cerebral hemorrhage.

Evidence and thinking on risk factors of hypertensive intracerebral hemorrhage: a meta-analysis

Background:To explore the related risk factors of hypertensive intracerebral hemorrhage(ICH)through meta-analysis,and to provide evidence-based medical basis for preventing ICH in hypertensive patients.Methods:The databases of CNKI,Wanfang,VIP,CBM,PubMed,Web of Science and Cochrane Library were searched by computer.Case control study on risk factors for hypertensive intracerebral hemorrhage were collected from the database establishment to October 2021.Two reviewers independently screened the literature,extracted the data,and evaluated the bias risk of the included studies.Meta-analysis was conducted on the results of the included studies using RevMan5.3 software.Results:A total of 7 studies were included,including 1512 patients.Meta-analysis results showed that:Smoking history(OR=6.23,95%CI(4.32,8.99),P<0.00001),drinking history(OR=7.24,95%CI(1.96,26.72),P=0.003),diabetes mellitus(OR=47.52,95%CI(10.31,219.31),P<0.00001),coronary heart disease(OR=9.90,95%CI(2.96,33.13),P=0.0002),daily salt intake(OR=10.21,95%CI(2.69,38.79),P=0.0006),failure to take medication regularly on time(OR=10.62,95%CI(5.40,20.91),P<0.00001),total cholesterol(OR=6.58,95%CI(2.45,17.65),P=0.0002),triglyceride(OR=8.63,95%CI(6.70,11.12),P<0.00001),body mass index(OR=6.63,95%CI(4.56,9.64),P<0.00001)and experiencing severe economic difficulties(OR=23.97,95%CI(14.82,38.77),P<0.00001)were risk factors for hypertensive intracerebral hemorrhage.Conclusion:Controlling smoking,drinking,reducing daily salt intake,controlling body weight,preventing diabetes and coronary heart disease,low-fat diet,controlling total cholesterol and triglyceride,taking antihypertensive drugs regularly and improving economic status can prevent hypertensive cerebral hemorrhage.