Prognostic comparison of operative and non-operative therapies for intracerebral hemorrhage in a local hospital: Case retrospection

BACKGROUND： At present, it is satisfactory for micro-trauma craniopuncture therapy for cerebral hemorrhage to treat spontaneous intracerebral hemorrhage （ICH）. Surgical treatment can decrease fatality rate of ICH patients; however, some reports suggest that there are no obvious differences of therapeutic effects between surgical treatment and medical therapy because of various states, operative indications, contraindications and operative styles. OBJECTIVE： To observe the effect of surgical treatment on ICH prognosis, especially on fatality rate.DESIGN ： Retrospective-case study.SETTING： Huaibei People＇s Hospital.PARTICIPANTS： ① A total of 241 ICH patients selected from Huaibei People＇s Hospital from January 1988 to May 1989 were regarded as group A. They were all coincidence with Diagnostic Criteria of Intracerebral Hemorrhage in the National Cerebrovascular Disease Academic Meeting. There were 164 males and 87 females aged 34-94 years, and among them, 230 patients were older than 50 years （95.4%）. Hemorrhage sites： Among 142 patients, 85 cases had internal capsule hemorrhage, 18 external capsule hemorrhage, 15 thalamic hemorrhage, 9 cerebellar hemorrhage, 7 brain stem hemorrhage, 7 cerebral lobe hemorrhage, and 1 corpus callosum hemorrhage. Hemorrhage volume： Among 89 clear records, 44 cases had of 1-10 mL, 35 of 11-30 mL, 5 of 31-40 mL, and 5 of 41-80 mL. Except 2 patients, other ones were treated with medical operation. ② A total of 203 ICH patients selected from the same hospital from January 2003 to December 2005 were regarded as group B. Among them, 72 cases were treated with operation, but other 131 ones were treated with non-operation. They were all diagnosed with CT. There were 113 males and 90 females aged 30-88 years, and among them, 183 patients were older than 50 years （90.1%）, Hemorrhage sites： Among 203 patients, 104 cases had internal capsule hemorrhage, 17 external capsule hemorrhage, 19 thalamic hemorrhage, 9 cerebellar hemorrhage, 12 brain stem hemorrhage, 30 cerebral lobe hemorrhage, and 12 ventricular hemorrhage. Hemorrhage volume： Among 142 clear records, 53 cases had of 1- 10 mL, 42 of 11-30 mL, 16 of 31-40 mL, and 31 of 41-200 mL. Patients in both two groups consented, METHODS ： ① Therapeutic scheme： Both therapeutic methods and medicines in the both two groups were similar to each other. The main methods were as follows： dehydrating, controlling blood pressure, modifying agent of cerebral metabolism and preventing and curing complications. Therapeutic operation styles of group B： 23 patients accepted intracerebral hematoma clearance; 1 decompression by removal of cranio-bone flap; 14 centesis of lateral ventricle; 34 basilyst suction, Therapeutic styles of group A： 2 patients accepted intracerebral hematoma clearance, and others from the same as group B.② Effect estimate criteria： General recovery： Muscular force was above grade Ⅳ; meanwhile, patients could walk by themselves and care themselves partially; Improvement： Consciousness, hemiplegia and Iogagnosia took a turn for the better; Death.③ Statistical analysis： Four-table Chi-square test was used to compare differences of enumeration data. MAIN OUTCOME MEASURES： ① General prognosis of patients in the two groups; ② Prognosis of patients with various hemorrhage sites and volumes. RESULTS： All 444 patients were involved in the final analysis. ① Compared results of prognosis of patients in the two groups： Fatality rate was 18% （3/17） in group B, which was lower than that in group A [67% （12/18）, X^2=8.58, P 〈 0.05]; general recovery rate was 82% （14/17） in group B, which was higher than that in group A [11% （2/18）, X^2=17.88, P 〈 0.01]. ② Compared results of prognosis of patients with various hemorrhage sites in the two groups： Fatality rate of external capsule hemorrhage was decreased in group B as compared with that in group A （P 〈 0.05）; however, there was no significant difference at other hemorrhage sites. ③ Compared results of prognosis of patients with various hemorrhage volumes in the two groups： Fatality rate of patients with hemorrhage volume of 1-10 mL was 9% （5/53） in group B, which was lower than that in group A [64% （28/44）, X^2=7.20, P 〈 0.01]; general recovery rate was 85% （45/53） in group B, which was higher than that in group A [29% （13/44）, X^2=31,47, P 〈 0.01]. Fatality rate of patients with hemorrhage volume of 11-30 mL was 36% （15/42） in group B, which was lower than that in group A [71% （25/35）, X^2=30.64, P 〈 0.01]; general recovery rate was 50% （21/42） in group B, which was higher than that in group A [11% （4/35）, X^2=12,94, P 〈 0,01]. Fatality rate of patients with hemorrhage volume of 31-40 mL was 6% （1/16） in group B, which was lower than that in group A [60% （3/5）, X^2=9,76, P〈 0.05].CONELUSEON： Fatality rate of ICH patients who accepted more operative therapies is decreased as compared with those patients who have less operative therapies, and the prognosis is effective.

Relationship of Nogo-A gene expression in serum and cerebrospinal fluid with nerve injury and inflammatory factor levels in patients with craniocerebral trauma

Objective:To study the relationship of Nogo-A gene expression in serum and cerebrospinal fluid with nerve injury and inflammatory factor levels in patients with craniocerebral trauma. Methods:82 patients with craniocerebral trauma who were treated in our hospital between January 2015 and February 2017 were collected as observation group, and 58 normal subjects who received internal hemorrhoids surgery under lumbar anesthesia in our hospital during the same period were collected as control group. Fluorescence quantitative PCR method was used to detect Nogo-A gene expression in serum and cerebrospinal fluid of both groups, and enzyme-linked immunosorbent assay (ELISA) was used to determine serum levels of nerve injury indexes and inflammatory factors in two groups. Pearson test was used to assess the relationship of Nogo-A gene expression in serum and cerebrospinal fluid with disease severity in patients with craniocerebral trauma.Results: Nogo-A mRNA expression in the serum and cerebrospinal fluid of observation group were higher than those of the control group;serum IGF-Ⅱ level was lower than that of control group while NSE, MBP and S100B levels were higher than those of control group;serum HSP-70, PCT, IL-1β, IL-6 and CRP levels were higher than those of control group. Pearson test showed that Nogo-A gene expression in serum and cerebrospinal fluid of patients with craniocerebral trauma were directly correlated with the nerve injury degree and inflammatory factor levels.Conclusions: Nogo-A gene is highly expressed in patients with craniocerebral trauma, and its expression is directly correlated with the nerve injury and systemic inflammatory response.

Regulating effect of activated NF-κB on edema induced by traumatic brain injury of rats

Objective:To observe the effect of nuclear transcription factor- κB(NF- κB) on cerebral edema in rats with traumatic brain injury(TBI).Methods:Male SD rau with fluid percussion injury(FPI) were selected.After separation and culture,rats' astrocytes all suffered FPL The expression of NF-κB and the water content were detected at the animal and cellular levels,while the activity of NOX was evaluated at the cellular level.Results:According to the results,the positive expression of NF-κB and expression of mRNA were significantly increased and the water content was increased for rats after TBI.while NF-κB inhibitor BAY 11-7082 could significantly reduce the effect of TBI.1 and 3h after FPI of astrocytes,the activation of NFkB was incrcased and BAY 11-7082 could significantly improve the injury-induced swelling of astrocytes.After the injury of astrocytes,the activity of NOX was also increased,while BAY11-7082 could reduce the activity of NOX.Conclusions:The results show that the activation of NF- κB in astrocytes is a key factor in the process of cerebral edema after TBI of rats.

Ultrastructure of human neural stem/progenitor cells and neurospheres

BACKGROUND： Biological and morphological characteristics of neural stem/progenitor cells （NSPCs） have been widely investigated. OBJECTIVE： To explore the ultrastructure of human embryo-derived NSPCs and neurospheres cultivated in vitro using electron microscopy. DESIGN, TIME AND SETTING： A cell biology experiment was performed at the Brain Tumor Laboratory of Soochow University, and Jiangsu Province Key Laboratory of Neuroregeneration, Nantong University between August 2007 and April 2008. MATERIALS： Human fetal brain tissue was obtained from an 8-week-old aborted fetus; serum-free Dulbecco＇s modified Eagle＇s medium/F12 culture medium was provided by Gibco, USA; scanning electron microscope was provided by Hitachi Instruments, Japan; transmission electron microscope was provided by JEOL, Japan. METHODS： NSPCs were isolated from human fetal brain tissue and cultivated in serum-free Dulbecco＇s modified Eagle＇s medium/F12 culture medium. Cells were passaged every 5-7 days. After three passages, NSPCs were harvested and used for ultrastructural examination. MAIN OUTCOME MEASURES： Ultrastructural examination of human NSPCs and adjacent cells in neurospheres. RESULTS： Individual NSPCs were visible as spherical morphologies with rough surfaces under scanning electron microscope. Generally, they had large nuclei and little cytoplasm. Nuclei were frequently globular with large amounts of euchromatin and a small quantity of heterochromatin, and most NSPCs had only one nucleolus. The Golgi apparatus and endoplasmic reticulum were underdeveloped; however, autophagosomes were clearly visible. The neurospheres were made up of NSPCs and non-fixiform material inside. Between adjacent cells and at the cytoplasmic surface of apposed plasma membranes, there were vesicle-like structures. Some membrane boundaries with high permeabilities were observed between some contiguous NSPCs in neurospheres, possibly attributable to plasmalemmal fusion between adjacent cells. CONCLUSION： A large number of autophagosomes were observed in NSPCs and gap junctions were visible between adjacent NSPCs.

Effects of septal nucleus lesion on dopamine D_2 receptor expression in the prefrontal lobe, striatum, and brainstem in a rat model of schizophrenia

BACKGROUND： It has been demonstrated that the septal nucleus is involved in the pathogenesis of schizophrenia. Based on autopsies of schizophrenia patients, studies have shown a reduced number of septal nucleus neurons and glia. In addition, experimental rat models of schizophrenia have shown increased dopamine receptor D2 binding sites in the basal ganglia, septal nuclei, and substantia nigra. Previous studies have demonstrated that the septal nucleus modulates dopamine metabolic disorder and dopamine D2 receptor balance. OBJECTIVE： Dopamine D2 receptor expression in a rat model of schizophrenia, combined with antipsychotic drugs, was analyzed in the prefrontal lobe, striatum, and brainstem. In situ hybridization was used to observe the effects of stereotactic septal nucleus lesions on dopamine D2 receptor expression in the brains of methylamphetamine-treated rats. DESIGN, TIME AND SETTING： A randomized, controlled, animal experiment was performed in the Laboratory of General Institute of Psychosurgery, Third Hospital of Chinese PLA from November 2005 to June 2006. MATERIALS： A total of 120 healthy, adult Sprague Dawley rats, weighing approximately 200 g, were included. Methylamphetamine （Sigma, USA） and an in situ hybridization detection kit for dopamine D2 receptor （Boster, China） were also used for this study. METHODS： All rats were randomly allocated to the following 4 groups, with 30 rats in each group： normal control, simple administration, septal nucleus lesion, and sham-operated groups. In the normal control group, rats were not administered or lesioned. In the remaining 3 groups, rats were intraperitoneally administered 10 mg/kg methylamphetamine, once per day, for 15 successive days to establish a schizophrenia model. Following successful model establishment, rats from the septal nucleus lesion group were subjected to stereotactic septal nucleus lesions. The cranial bone was exposed in rats from the sham-operated group, and the septal nucleus was not lesioned. MAIN OUTCOME MEASURES： At 7 days post-surgery, dopamine D2 receptor expression in the prefrontal lobe, striatum, and brainstem were detected by in situ hybridization. RESULTS： Dopamine D2 receptor expression in the rat prefrontal lobe, striatum, and brainstem was significantly higher in the simple administration group and sham-operated group, compared with the normal control group （P 〈 0.01）. In the septal nucleus lesion group, dopamine D2 receptor expression was significantly less than the simple administration and sham-operated groups, （P 〈 0.01）. There was no significant difference in dopamine D2 receptor expression between the simple administration and sham-operated groups （P 〉 0.05）. CONCLUSION： Septal nucleus lesions reduce dopamine D2 receptor expression in the prefrontal lobe, striatum, and brainstem in a rat model of schizophrenia, indicating that the septal nucleus modulates dopamine D2 receptor expression.

Whole-cell recordings of voltage-gated Calcium,Potassium and Sodium currents in acutely isolated hippocampal pyramidal neurons

Objective：To record Calcium, Potassium and Sodium currents in acutely isolated hippocampal pyramidal neurons. Methods：Hippocampal CA3 neurons were freshly isolated by 1 mg protease/3 ml SES and mechanical trituration with polished pipettes of progressively smaller tip diameters. Patch clamp technique in whole-cell mode was employed to record voltage-gated channel currents. Results：The procedure dissociated hippocampal neurons, preserving apical dendrites and several basal dendrites, without impairing the electrical characteristics of the neurons. Whole-cell patch clamp configuration was successfully used to record voltage-gated Ca^2＋ currents, delayed rectifier K^＋ current and voltage-gated Na^＋ currents. Conclusion：Protease combined with mechanical trituration may be used for the dissociation of neurons from rat hippocampus. Voltage-gated channels currents could be recorded using a patch clamp technique.

Study on cerebral edema in the rat model with closed craniocerebral injury and its relationship with apoptosis, inflammatory factor generation and AQPs expression

Objective:To study the relationship of cerebral edema with apoptosis, inflammatory factor generation and AQPs expression in the rat model with closed craniocerebral injury.Methods:Male SD rats were selected as experimental animals and divided into model group and control group. Model group were established into the closed craniocerebral injury models and control group received sham operation. The water content of damaged brain tissue as well as the expression of apoptosis molecules, the generation of inflammatory factors and the expression of aquaporins (AQPs) molecules were measured 7 d after model establishment.Results:The water content of brain tissue of model group was significantly higher than that of control group;Homer1a, Pim-3, Bcl-2, AQP1, AQP4 and AQP9 mRNA expression in brain tissue of model group were significantly lower than those of control group while Cdk5, FasL and Caspase-3 mRNA expression as well as NF-kB, TNF-α, IL-1β, IL-6 and p-JNK generation were significantly higher than those of control group. Homer1a, Pim-3, Bcl-2, AQP1, AQP4 and AQP9 mRNA expression in brain tissue of model group were negatively correlated with water content while Cdk5, FasL and Caspase-3 mRNA expression as well as NF-kB, TNF-α, IL-1β, IL-6 and p-JNK generation were positively correlated with water content.Conclusion:The excessive apoptosis, increased inflammatory factor generation and decreased AQPs expression are closely related to the occurrence of cerebral edema in the process of closed craniocerebral injury.

Correlation of MMP-2 gene polymorphism with disease relapse as well as inflammatory mediators and oxidative stress molecules in patients with ischemic stroke

Objective:To study the correlation of MMP-2 gene polymorphism with disease relapse as well as inflammatory mediators and oxidative stress molecules in patients with ischemic stroke. Methods: Patients with primary and recurrent ischemic stroke who were treated in Shaanxi Provincial People's Hospital between January 2015 and December 2016 were selected as the primary group and recurrent group respectively;healthy volunteers who received physical examination during the same period were selected as control group. Serum MMP-2 gene polymorphism and inflammatory mediator levels as well as peripheral blood oxidative stress molecule expression were determined.Results: Serum MMP2 gene 735 loci CC genotype constituent ratio of recurrent group was significantly higher than that of control group and primary group while CT genotype and TT genotype constituent ratio were significantly lower than those of control group and primary group;serum HMBG1, FKN, TNF-α, IL-1β and IL-17 levels as well as peripheral blood Keap1 mRNA expression in stoke patients with MMP2 gene CC genotype were significantly higher than those in stoke patients with MMP2 gene CT genotype and MMP2 gene TT genotype while peripheral blood Nrf2, ARE, NQO1 and HO1 mRNA expression were significantly lower than those in stoke patients with MMP2 gene CT genotype and MMP2 gene TT genotype.Conclusions:MMP-2 gene CC genotype in patients with ischemic stroke can aggravate inflammatory response and oxidative stress response, and is closely related to disease relapse.

Hypothalamic paraventricular nucleus stimulation reduces intestinal injury in rats with ulcerative colitis

AIM: To investigate the effect and mechanism of stimulation of the hypothalamic paraventricular nucleus with glutamate acid in rats with ulcerative colitis(UC).METHODS: The rats were anesthetized with 10% chloral hydrate via abdominal injection and treated with an equal volume of TNBS + 50% ethanol enema, injected into the upper section of the anus with the tail facing up. Colonic damage scores were calculated after injecting a certain dose of glutamic acid into the paraventricular nucleus(p VN), and the effect of the nucleus tractus solitarius(NTS) and vagus nerve in alleviating UC injury through chemical stimulation of the p VN was observed in rats. Expression changes of C-myc, Apaf-1, caspase-3, interleukin(IL)-6, and IL-17 during the protection against UC injury through chemical stimulation of the p VN in rats were detected by Western blot. Malondialdehyde(MDA) content and superoxide dismutase(SOD) activity in colon tissues of rats were measured by colorimetric methods. RESULTS: Chemical stimulation of the PVN significantly reduced UC in rats in a dose-dependent manner. The protective effects of the chemical stimulationof the p VN on rats with UC were eliminated after chemical damage to the p VN. After glutamate receptor antagonist kynurenic acid was injected into the p VN, the protective effects of the chemical stimulation of the p VN were eliminated in rats with UC. After AVpVl receptor antagonist([Deamino-penl, val4, D-Arg8]-vasopressin) was injected into NTS or bilateral chemical damage to NTS, the protective effect of the chemical stimulation of p VN on UC was also eliminated. After chemical stimulation of the p VN, SOD activity increased, MDA content decreased, C-myc protein expression significantly increased, caspase-3 and Apaf-1 protein expression significantly decreased, and IL-6 and IL-17 expression decreased in colon tissues in rats with UC. CONCLUSION: Chemical stimulation of the hypothalamic p VN provides a protective effect against UC injury in rats. Hypothalamic p VN, NTS and vagus nerve play key roles in this process.