Intracerebral haemorrhage: mechanisms of injury and therapeutic targets

Exploring medical gas therapy in hemorrhagic stroke treatment: A narrative review

Hemorrhagic stroke (HS) is a neurological disorder caused by the rupture of cerebral blood vessels, resulting in blood seeping into the brain parenchyma and causing varying degrees of neurological impairment, including intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH). Current treatment methods mainly include hematoma evacuation surgery and conservative treatment. However, these methods have limited efficacy in enhancing neurological function and prognosis. The current challenge in treating HS lies in inhibiting the occurrence and progression of secondary brain damage after bleeding, which is a key factor affecting the prognosis of HS patients. Studies have shown that medical gas therapy is gaining more attention and has demonstrated various levels of neuroprotective effects on central nervous system disorders, such as hyperbaric oxygen, hydrogen sulfide, nitric oxide, carbon monoxide, and other inhalable gas molecules. These medical gas molecules primarily improve brain tissue damage and neurological dysfunction by regulating inflammation, oxidative stress, apoptosis, and other processes. However, many of these medical gasses also possess neurotoxic properties. Therefore, the use of medical gases in HS deserves further exploration and research. In this review, we will elucidate the therapeutic effects and study the advances in medical gas molecules in HS.

Development of a 3D Brain Model to Study Sex-Specific Neuroinflammation After Hemorrhagic Stroke

Subarachnoid hemorrhage (SAH) accounts for 5% of stroke, with women having a decreased inflammatory response compared to men; however, this mechanism has yet to be identified. One hurdle in SAH research is the lack of human brain models. Studies in murine models are helpful, but human models should be used in conjunction for improved translatability. These observations lead us to develop a 3D system to study the sex-specific microglial and neuroglial function in a novel in vitro human SAH model and compare it to our validated in vivo SAH model. Our lab has developed a 3D, membrane-based in vitro cell culture system with human astrocytes, microglia, and neurons from both sexes. The 3D cultures were incubated with male and female cerebrospinal fluid from SAH patients in the Neuro-ICU. Furthermore, microglial morphology, erythrophagocytosis, microglial inflammatory cytokine production, and neuronal apoptosis were studied and compared with our murine SAH models. The human 3D system demonstrated intercellular interactions and proportions of the three cell types similar to the adult human brain. In vitro and in vivo models of SAH showed concordance in male microglia being more inflammatory than females via morphology and flow cytometry. On the contrary, both in vitro and in vivo models revealed that female microglia were more phagocytic and less prone to damaging neurons than males. One possible explanation for the increased phagocytic ability of female microglia was the increased expression of CD206 and MerTK. Our in vitro, human, 3D cell culture SAH model showed similar results to our in vivo murine SAH model with respect to microglial morphology, inflammation, and phagocytosis when comparing the sexes. A human 3D brain model of SAH may be a useful adjunct to murine models to improve translation to SAH patients.

Macrophage Lyn Kinase Is a Sex-Specific Regulator of Post-Subarachnoid Hemorrhage Neuroinflammation

BACKGROUND

Lyn kinase is a member of the Src family of tyrosine kinases, primarily known for its role in regulating immune cell signaling. It can phosphorylate and modulate the activity of various proteins involved in immune responses, including Toll-like receptor 4 (TLR4). TLR4-mediated inflammatory pathways have been extensively studied; however, the sex-specific interaction of TLR4 and Lyn in neuroinflammation after aneurysmal subarachnoid hemorrhage (SAH) has yet to be investigated. SAH occurs due to a ruptured aneurysm, and the consequences often lead to neuroinflammation and cognitive impairments. In our study, we investigated the sex-specific involvement of Lyn kinase in regulating TLR4 signaling to understand the TLR4-mediated inflammatory response after SAH.

METHODS

Cell-specific Lyn knockout mice of both sexes were used for this study. Wild-type and conditional knockout mouse brains were analyzed by multicolor flow cytometry, immunohistochemistry, and western blotting at postoperative day 7 following SAH surgery. An unbiased spatial transcriptomic analysis was performed with the frozen mouse brain tissues. A 3-dimensional brain stroke model and cerebrospinal fluid samples of patients with SAH were also used for this study.

RESULTS

Our overall animal and patient data from flow cytometry, immunohistochemistry, western blot, cognitive function tests, and spatial transcriptomic data revealed that Lyn kinase is a sex-specific regulator in inflammatory cytokine production, red blood cell phagocytosis, neuronal apoptosis, and cognitive function, as well as a negative regulator of TLR4 signaling pathways.

CONCLUSIONS

Our results highlight sex-specific modulation of Lyn kinase activity in TLR4 signaling after hemorrhagic stroke and indicate that successful treatment of neuroinflammation may require sex-specific treatments.

Differences in subacute motor recovery after intracerebral haemorrhage and ischaemic stroke: Analysis using the VISTA database cohort

BACKGROUND

Motor impairment is a significant contributor to disability after stroke, but recovery is often incomplete. Whether motor recovery differs between intracerebral haemorrhage (ICH), a subgroup of stroke with far worse outcomes, and ischaemic stroke is not clear.

METHODS

We performed a retrospective observational longitudinal cohort study using individual patient-level data from the Virtual International Stroke Trials Archive (VISTA) database (ICH n=892, ischaemic stroke n=6912). Differences in motor recovery to 90-days were examined between ICH and ischaemic stroke patients with mixed effect regression models adjusted for a priori determined confounders. Motor weakness was measured by NIHSS face, arm and leg sum with secondary analyses of total NIHSS, and NIHSS language score.

RESULTS

Recovery was observed in all NIHSS domains for both stroke types to 30-days (NIHSSmotorb=-2.78, 95%CI -2.89,-2.68; NIHSStotalb=-5.74, 95%CI -5.92,-5.56; NIHSSlanguageb=-0.28 95%CI -0.31,-0.24) and 90-days (NIHSSmotorb=-3.62, 95%CI -3.69,-3.54; NIHSStotalb=-7.17, 95%CI -7.30,-7.05; NIHSSlanguageb=-0.74, 95%CI -0.78,-0.71). Baseline impairment between groups was well matched with only motor impairment being slightly greater in ICH; NIHSSmotor mean(SD)=13.0 (5.3) vs 12.3 (5.4). To 30-days the extent of recovery was not different between stroke types but recovery to 90-days was greater in ICH for motor and statistically significant for total NIHSS score (b=-0.35, 95%CI -0.71,-0.002). Ischaemic stroke survivors recovered more in NIHSS language domain.

CONCLUSIONS

Timing and extent of recovery is different between stroke types. Motor recovery in ICH is greater and occurs later. Therefore, the assumption that most recovery occurs within 30-days and proportionality of recovery should be revisited in this population.

Low Hemoglobin Causes Hematoma Expansion and Poor Intracerebral Hemorrhage Outcomes

BACKGROUND

Although lower hemoglobin levels associate with worse intracerebral hemorrhage (ICH) outcomes, causal drivers for this relationship remain unclear. We investigated the hypothesis that lower hemoglobin relates to increased hematoma expansion risk and poor outcomes using human observational data and assessed causal relationships using a translational murine model of anemia and ICH.

METHODS

A multicenter, prospective observational cohort study of 2997 patients with ICH enrolled between 2010 and 2016 was assessed. Patients with baseline hemoglobin measurements and serial computed tomography neuroimaging were included for analyses. Patients with systemic evidence of coagulopathy were excluded. Separate regression models assessed relationships of baseline hemoglobin with hematoma expansion (≥33% and/or ≥6 mL growth) and poor long-term neurological outcomes (modified Rankin Scale score of 4-6) after adjusting for relevant covariates. Using a murine collagenase ICH model with serial neuroimaging in anemic versus nonanemic C57/BL6 mice, intergroup differences in ICH lesion volume, lesion volume changes, and early mortality were assessed.

RESULTS

Among 1190 ICH patients analyzed, the mean age was 61 years old, and 62% of the cohort were males. Lower baseline hemoglobin levels are associated with increased odds of hematoma expansion (adjusted odds ratio per -1 g/dL hemoglobin decrement, 1.10 [95% CI, 1.02-1.19]) and poor 3-month clinical outcomes (adjusted odds ratio per -1 g/dL hemoglobin decrement, 1.11 [95% CI, 1.03-1.21]). Similar relationships were seen with poor 6- and 12-month outcomes. In our animal model, anemic mice had significantly greater ICH lesion expansion, 24-hour lesion volumes, and greater mortality, as compared with nonanemic mice.

CONCLUSIONS

These results, in a human cohort and a mouse model, provide novel evidence suggesting that anemia has causal roles in hematoma expansion and poor ICH outcomes. Additional studies are required to clarify whether correcting anemia can improve these outcomes.

Targeting CDK1 inhibits Golgi apparatus stress-mediated neuroinflammation and neuronal apoptosis after intracerebral hemorrhage by modulating GRASP55 phosphorylation

Cyclin-dependent kinase 1 (CDK1) has been found to be associated with neuronal apoptosis. However, the role of CDK1 in intracerebral hemorrhage (ICH) remains unclear. The aim of this study was to investigate the role of CDK1 in mediating neuroinflammation and neuronal apoptosis through the modulation of Golgi apparatus stress (GAS) in ICH. In this study, rats received collagenase IV injections to induce ICH, while primary neurons and PC-12 cells were stimulated with Hemin to establish ICH models. We observed that CDK1 expression was upregulated and GAS levels increased after ICH. Downregulation of CDK1 significantly attenuated neuronal damage and GAS levels after ICH. In addition, CDK1 downregulation reduced inflammatory cytokine levels in both in vitro and in vivo models of ICH. Interestingly, the phosphorylation of Golgi reassembly-stacking protein 55 (GRASP55) was significantly increased after ICH. However, CDK1 downregulation was able to reverse this change. Our data show that CDK1 phosphorylates GRASP55 through the T225 site. Lastly, mutating the GRASP55 T225 phosphorylation site abolished the CDK1-mediated exacerbation of GAS, neuronal apoptosis, and inflammatory responses in vitro. In summary, targeted inhibition of CDK1 suppresses GAS-mediated neuroinflammation and neuronal apoptosis after ICH by regulating GRASP55 phosphorylation. Research on CDK1 may offer clinicians new insights into the treatment of patients with ICH.

Injectable Brain Extracellular Matrix Hydrogels Enhance Neuronal Migration and Functional Recovery After Intracerebral Hemorrhage

Neural repair within the lesion cavity caused by intracerebral hemorrhage (ICH) remains a major therapeutic challenge. Hydrogels hold great potential in regenerative medicine as functional scaffolds. However, inadequate host cell infiltration and suboptimal delivery methods have limited their application in tissue engineering. Here, we describe an optimized decellularization approach to create injectable brain extracellular matrix (ECM) hydrogels for the treatment of ICH. The hydrogel exhibits excellent biodegradability and biocompatibility. In an ICH rat model, the hydrogel implanted into the stroke cavity promoted neural recovery, facilitated cell recruitment, enhanced angiogenesis, and inhibited inflammation in the peri-cavity region at 14 d post-implantation. Furthermore, the hydrogel improved cell proliferation and migration, reversed cell apoptosis, and modulated transcriptomic changes in vitro. Notably, the hydrogel may promote neuronal migration and neural functional recovery after ICH through the slit guidance ligand 2-receptor roundabout guidance receptor 1 (Slit2-Robo1) signaling pathway. These findings highlight the potential of brain ECM hydrogels as a promising strategy for brain tissue regeneration.

VSIG4 Alleviates Intracranial Hemorrhage Injury by Regulating Oxidative Stress and Neuroinflammation in Macrophages via the NRF2/HO-1 Signaling Pathway

BACKGROUND

Oxidative stress and neuroinflammation are important secondary injury mechanisms in intracranial hemorrhage (ICH). V-set and immunoglobulin domain-containing 4 (VSIG4) has an inhibitory effect on oxidative stress and the inflammatory response. This study aimed to explore the possible role of VSIG4 in ICH-related neuropathology.

METHODS

In this study, VSIG4 levels were investigated in an ICH mouse model and lipopolysaccharide (LPS)-stimulated RAW264.7 cells. Moreover, we examined oxidative stress levels, pro-inflammatory cytokine production, neuronal damage, inflammatory cell activation, brain water content, and neurological function. We performed these assays in ICH mice and macrophages with different VSIG4 levels. Additionally, the critical role of the nuclear factor erythroid 2 related factor 2/heme oxygenase-1 (NRF2/HO-1) signaling pathway in VSIG4 function was verified.

RESULTS

VSIG4 ameliorated neurological deficits in ICH mice (p < 0.01), alleviated cerebral edema (p < 0.05), and increased glutathione (p < 0.05) and decreased superoxide dismutase (SOD) levels (p < 0.01) in the perihematomal area and LPS-stimulated RAW264.7 cells. It also reduced Malondialdehyde (MDA) accumulation (p < 0.01), alleviated oxidative stress, and decreased interleukin-1β (IL-1β) (p < 0.01) and tumor necrosis factor-alpha (TNF-α) levels (p < 0.01), thereby attenuating the inflammatory response. Additionally, treatment of LPS-stimulated RAW264.7 cells with VSIG4 resulted in less damage to HT22 cells (p < 0.05). To further validate the involvement of the NRF2/HO-1 pathway in VSIG4-mediated neuroprotection, brusatol (an NRF2 inhibitor) was administered.

CONCLUSION

Our study demonstrates the neuroprotective effect and mechanism of action of VSIG4 in ICH.

Robot assisted stereotactic surgery improves hematoma evacuation in intracerebral hemorrhage compared to frame based method

Intracerebral hemorrhage (ICH) requires prompt hematoma evacuation to mitigate poor outcomes. This study compares robot-assisted stereotactic surgery with traditional frame-based methods for ICH evacuation. A retrospective analysis of 131 patients (45 robot-assisted, 86 frame-based) undergoing surgery within 72 h of supratentorial basal ganglia hemorrhage was conducted. Propensity score matching balanced baseline characteristics between 40 patients per group. Results showed robot-assisted surgery achieved a significantly higher median hematoma evacuation rate (78.7% vs. 66.2%) and shorter median hospital stay (12 vs. 15 days) compared to frame-based surgery, with no significant differences in residual hematoma volume, surgical time, postoperative complications, or short-term functional outcomes. While robot-assisted techniques enhance evacuation efficiency and reduce hospitalization without increasing risks, their long-term neurological benefits require further investigation. These findings highlight the potential of robotic assistance as a safe and effective minimally invasive approach for ICH management.

The Role of ICP Monitoring in Minimally Invasive Surgery for the Management of Intracerebral Hemorrhage

Intracerebral hemorrhage (ICH) is the second major stroke type, with high incidence, high disability rate, and high mortality. At present, there is no effective and reliable treatment for ICH. As a result, most patients have a poor prognosis. Minimally invasive surgery (MIS) is the fastest treatment method to remove hematoma, which is characterized by less trauma and easy operation. Some studies have confirmed the safety of MIS, but there are still no reports showing that it can significantly improve the functional outcome of ICH patients. Intracranial pressure (ICP) monitoring is considered to be an important part of successful treatment in traumatic brain diseases. By monitoring ICP in real time, keeping stable ICP could help patients with craniocerebral injury get a good prognosis. In the course of MIS treatment of ICH patients, keeping ICP stable may also promote patient recovery. In this review, we will take ICP monitoring as the starting point for an in-depth discussion.

Porous Three-Dimensional Polyurethane Scaffolds Promote Scar-Free Endogenous Regeneration After Acute Brain Hemorrhage

Intracerebral hemorrhage (ICH) is the most lethal subtype of stroke and is associated with significant morbidity and mortality. Despite advances in the clinical treatment of ICH, limited progress has been made regarding endogenous brain regeneration after ICH. Failure of brain regeneration is mainly attributed to the inhibitive regenerative microenvironment caused by secondary injury after ICH. In this study, we investigated a three-dimensional biodegradable waterborne polyurethane (BWPU) scaffold as a tool to promote brain regeneration after ICH. After implantation into the cavity following hematoma evacuation, these implanted scaffolds could act as a reservoir; store a series of necrotic debris, cytokines, and chemokines; and attract microglia/macrophages to their pores. Subsequently, these microglia/macrophages were polarized into the M1-like subtype to eliminate these substances. This process disperses M1-like immune cells and prevents the formation of dense glial scar-free structures after ICH. Inflammatory cells in scaffolds include scar-free secreted growth factors and extracellular matrix (ECM) proteins, and further induce a M2-like immune cells enriched regeneration-predominant microenvironment to promote endogenous brain regeneration with functional recovery. In summary, in this work, we have revealed the potential and mechanism of the BWPU scaffold as a tool to promote endogenous brain tissue regeneration after ICH.

Fucoxanthin alleviates secondary brain injury in mice following intracerebral hemorrhage via PI3K-mediated inhibition of NF-κB signaling pathway

BACKGROUND

ICH is an acute clinical cerebrovascular disease without effective treatments. This study was designed to investigate the therapeutic value of fucoxanthin in ICH treatment.

METHODS

Animal ICH models were established by collagenase IV injection. ICH mice were given intraperitoneal injection of fucoxanthin (100 mg/kg). Neurological deficits, brain edema, blood-brain barrier (BBB) integrity, and histological impairment were assessed. Nissl staining and TUNEL staining were performed to detect neuronal cell loss and apoptosis. The levels of tight junction proteins, apoptosis-related proteins, Iba-1, and pathway-related proteins were measured by immunofluorescence staining, western blotting, and ELISA.

RESULTS

Fucoxanthin administration attenuated neurological deficits and brain injuries following ICH. Additionally, fucoxanthin alleviated neuronal apoptosis caused by ICH. Moreover, fucoxanthin inhibited microglia-mediated inflammation and M1 polarization in ICH models. Mechanistically, fucoxanthin inactivated the NF-κB pathway and triggered the activation of PI3K/Akt signaling after ICH, and LY294002 (a PI3K inhibitor) compromised the protective effect of fucoxanthin.

CONCLUSION

Fucoxanthin alleviates ICH-induced neurological deficits and brain injuries by suppressing the PI3K/Akt-mediated NF-κB pathway to inhibit M1 polarization and attenuate neuroinflammation, neuronal apoptosis, BBB dysfunction, and brain edema.

Impact of Microglia-Derived Extracellular Vesicles on Resident Central Nervous System Cell Populations After Acute Brain Injury Under Various External Stimuli Conditions

Acute brain injuries (ABI) caused by various emergencies can lead to structural and functional damage to brain tissue. Common causes include traumatic brain injury, cerebral hemorrhage, ischemic stroke, and heat stroke. Globally, ABI represent a significant portion of neurosurgical cases. Previous studies have emphasized the significant therapeutic potential of stem cell-derived extracellular vesicles (EVs). Recent research indicates that EVs extracted from resident cells in the central nervous system (CNS) also show therapeutic potential following brain injury. Microglia, as innate immune cells of the CNS, respond to changes in the internal environment by altering their phenotype and secreting EVs that impact various CNS cells, including neurons, astrocytes, oligodendrocytes, endothelial cells, neural stem cells (NSCs), and microglia themselves. Notably, under different external stimuli, microglia can either promote neuronal survival, angiogenesis, and myelin regeneration while reducing glial scarring and inflammation, or they can exert opposite effects. This review summarizes and evaluates the current research findings on how microglia-derived EVs influence various CNS cells after ABI under different external stimuli. It analyzes the interaction mechanisms between EVs and resident CNS cells and discusses potential future research directions and clinical applications.

The predictive role of composite inflammatory ratio parameters in the conscious awareness recovery after severe acute ischemic stroke: a retrospective cohort study

BACKGROUND

Inflammatory mechanisms play a significant role in ischemic stroke. Peripheral neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), which are indicators capable of reflecting the magnitude of the inflammatory response, have been research hotspots. However, few research findings evaluate the prediction significance of these biomarkers in the recovery of conscious awareness following severe acute ischemic stroke.

METHODS

This was a retrospective cohort study of 142 patients with consciousness disorders after acute ischemic stroke (GCS score ≤ 8) treated from January 2022 to May 2024. The cases were divided into three groups according to the GCS score at discharge as died/ vegetative state (GCS ≤ 3),moderate/ severe coma(GCS = 4-11) and mild coma/ normal (GCS:12-15). Demographic and clinical assessment data were reviewed and abstracted. NLR, PLR, SII and SIRI were calculated based on the peripheral blood tests at admission. The study investigated the correlation between changes in GCS scores from admission to discharge (calculated as the GCS score at discharge minus the baseline GCS score, where a negative value indicates worsening and a positive value indicates improvement) and the levels of NLR, PLR, SII, and SIRI.

RESULTS

The level of NLR, PLR, SII and SIRI in died/ vegetative state group were significantly higher than those in moderate/ severe coma group (p = 0.0429, p = 0.0215, p = 0.0288, p = 0.026, respectively) and mild coma/ normal group (p = 0.0085, p = 0.0079, p = 0.0019, p = 0.0017, respectively). The area under the curve (AUC) values of NLR, PLR, SII, and SIRI to prognosis were 0.670, 0.661, 0.677, and 0.609, respectively. Spearman correlation analysis indicated NLR, PLR and SII were negatively correlated with GCS scores increase during hospitalization (r =- 0.317, p<0.0001 for NLR, r = -0.285, p = 0.001 for PLR, r = -0.3331, p < 0.0001 for SII, r= -0.199,p = 0.018 for SIRI).However, ordinal logistic regression analyses failed to indicate that NLR, PLR, SII and SIRI were independent predictors of poor consciousness response for severe acute ischemic stroke coma patients after adjusting for other confounders.

CONCLUSION

Patients with poorer consciousness outcomes exhibited a tendency towards elevated NLR, PLR, SII, and SIRI levels which were inversely correlated with GCS scores increase during hospitalization. However, the four indexes did not exhibit sufficient promise to be the valuable predictors for the prognosis of recovery from consciousness following severe acute ischemic stroke.

Pathophysiology of Intracerebral Hemorrhage: Recovery Trajectories

Recovery trajectories in intracerebral hemorrhage (ICH) are recognized as distinct from those observed in ischemic stroke. This narrative review aims to clarify the pathophysiology underlying ICH recovery patterns, highlighting the unique timeline and nature of functional improvements seen in ICH survivors. Population-based cohort studies tracking functional outcomes in a longitudinal fashion, along with randomized clinical trial data with standardized outcome assessments, have demonstrated that ICH recovery generally has a delayed onset in the first weeks, followed by a steep early subacute stage recovery (typically up to 3 months) continuing in protracted, gradual improvements beyond 3 to 6 months. Understanding these recovery patterns, and how these differ from ischemic stroke, is crucial for providing accurate prognostic information, facilitating targeted health care delivery, and optimizing therapeutic interventions and the design of ICH randomized trials. This article synthesizes current evidence on early- and late-stage functional recovery trajectories in primary, spontaneous ICH and cognitive outcomes, emphasizing the clinical and research implications of these recovery patterns.

Laser localization with soft‑channel minimally invasive surgery in cerebral hemorrhage

The aim of the present study was to evaluate the efficacy and safety of laser localization combined with soft-channel minimally invasive surgery (MIS) for the treatment of cerebral hemorrhage, and to develop stereotactic alternatives that are cost-effective, safe and precise for underdeveloped regions. To meet this aim, 60 patients with cerebral hemorrhage were randomly assigned to the control group (n=30) or the study group (n=30). The patients in the study group were treated with laser localization combined with soft-channel MIS to remove the hematoma, whereas the control group was treated with YL-1 needle puncture to drain the intracranial hemorrhage. All patients underwent successful surgical treatment. The hematoma clearance rate was revealed to be 88.72±2.82% in the study group and 84.50±4.26% in the control group. Both groups achieved residual hematoma volume <10 ml or a hematoma clearance rate >70%, and the difference in the hematoma clearance rate was found to be statistically significant (P<0.05), with the study group having an improved hematoma clearanc2e rate compared with the control group. The median 7-day postoperative Glasgow Coma Scale score was 13.0 [interquartile range (IQR), 12.0, 14.0] for the study group and 12.0 (IQR, 11.0, 13.0) for the control group, indicating an improved outcome in the study group. The puncture accuracy was 100% (30/30) in the study group compared with 76.66% (23/30) in the control group (P<0.05). The hematoma drainage time was found to be significantly shorter in the study group (40.57±8.24 h) compared with that in the control group (56.80±14.40 h) (P<0.05). At the 6-month follow-up, the median modified Rankin Scale score was found to be 2.0 (IQR, 2.0, 3.0) in both groups. Neither group experienced rebleeding, hydrocephalus or cerebral infarction. No intracranial infections occurred in the treatment group, whereas three cases of intracranial infection were observed in the control group. In conclusion, the findings of the present study have shown that laser localization combined with soft-channel MIS is effective and safe in the treatment of cerebral hemorrhage.

Perihematomal oligemia is associated with progression to ischemia and poor outcome in a subset of patients with intracerebral hemorrhage

OBJECTIVES

We aimed to characterize the longitudinal evolution of perihematomal oligemia in acute intracerebral hemorrhage (ICH).

MATERIALS AND METHODS

A single center prospectively collected cohort of 150 patients with primary spontaneous ICH were imaged with computed tomography perfusion within 6 h from onset (T0), at 24 h (T1) and at 7 days (T7). Perihematomal cerebral blood flow (pCBF) was measured in the manually outlined perihematomal low-density area and categorized into ischemic (< 20 mL/100 g/min), oligemic (20-39.9 mL/100 g/min), normal (40-55 mL/100 g/min) and hyperemic (> 55 mL/100 g/min).

RESULTS

pCBF values were ischemic in 20.7%, oligemic 47.3%, normal in 17.3%, and hyperemic in 14.7% of patients at T0. All patients with T0 ischemia remained ischemic at T7, normal and hyperemic patients at T0 maintained good perfusion values at T7, whereas 46.5% of oligemic patients at T0 developed delayed perihematomal ischemia. In patients with T0 perihematomal oligemia, the risk of conversion into delayed ischemia at T7 was higher in those with pCBF < 30 mL/100 g/min (p < 0.001). A total of 42.7% patients had perihematomal ischemia at T7 and this profile correlated with poor outcome, regardless of baseline perfusion status.

CONCLUSION

Our findings suggest that perihematomal oligemia may not represent a benign entity and indicate that delayed perihematomal ischemia is common and associated with unfavorable outcome.

KEY POINTS

Question The natural history and longitudinal evolution of perihematomal oligemia over time in patients with intracerebral hemorrhage (ICH) remains to be established. Findings Conversion of baseline perihematomal oligemia into ischemia occurs in 46.5% of oligemic ICH patients at 7 days, where a total of 42.7% patients were ischemic. Clinical relevance Evolution of perihematomal oligemia into ischemia during the transition from hyperacute to subacute phases is common. ICH patients with perihemorrhagic cerebral blood flow values < 30 mL/100 g/min are at high risk of ischemic progression, which in turn contributes to poor outcome.

Coenzyme Q10 alleviates neurological deficits in a mouse model of intracerebral hemorrhage by reducing inflammation and apoptosis

This research study was directed towards to assessing whether coenzyme Q10 (CoQ10) is linked to neuroprotection and induces anti-inflammatory and anti-neuronal death responses in an Intracerebral hemorrhage (ICH) mouse model via right caudate nucleus injection with collagenase VII. Autologous blood was injected into mice to induce ICH. We found that FoxM1 was upregulated in the ICH-injured animals. Moreover, CoQ10 treatment effectively ameliorated neurological deficits, mitigated cerebral edema, and minimized hematoma in model mice, demonstrating dose-dependent efficacy and promoting the functional recovery of the animals. ELISA and real-time PCR assays of pro-inflammatory cytokines indicated that CoQ10 was capable of alleviating neuroinflammation in ICH. In line with the part of CoQ10 in attenuating the inflammatory response, CoQ10 also suppressed cell apoptosis in the ICH-injured brain, which partly accounts for its neuroprotective effect. Furthermore, our analysis of different inflammatory pathways indicated that CoQ10 targeted the nuclear factor-kappa B signaling axis. Our findings suggest that CoQ10 protects against ICH by mitigating neuroinflammatory responses and preventing neuronal apoptosis, with the underlying mechanism possibly being connected with nuclear factor-kappa B pathway regulation. Therefore, CoQ10 holds significant potential as a therapeutic strategy for treating ICH.

A new perspective on the regulation of neuroinflammation in intracerebral hemorrhage: mechanisms of NLRP3 inflammasome activation and therapeutic strategies

Intracerebral hemorrhage (ICH), a specific subtype within the spectrum of stroke disorders, is characterized by its high mortality and significant risk of long-term disability. The initiation and progression of neuroinflammation play a central and critical role in the pathophysiology of ICH. The NOD-like receptor family pyrin domain-containing 3 (NLRP3) inflammasome, a protein complex involved in initiating inflammation, is the central focus of this article. Microglia and astrocytes play critical roles in the inflammatory damage process associated with neuroinflammation. The NLRP3 inflammasome is expressed within both types of glial cells, and its activation drives these cells toward a pro-inflammatory phenotype, which exacerbates inflammatory damage in the brain. However, the regulatory relationship between these two cell types remains to be explored. Targeting NLRP3 inflammasomes in microglia or astrocytes may provide an effective approach to mitigate neuroinflammation following ICH. This article first provides an overview of the composition and activation mechanisms of the NLRP3 inflammasome. Subsequently, it summarizes recent research findings on novel signaling pathways that regulate NLRP3 inflammasome activity. Finally, we reviewed recent progress in NLRP3 inflammasome inhibitors, highlighting the clinical translation potential of certain candidates. These inhibitors hold promise as innovative strategies for managing inflammation following ICH.

Microglial Mechanisms and Therapeutic Potential in Brain Injury Post-Intracerebral Hemorrhage

Intracerebral hemorrhage (ICH) is a particularly common public health problem with a high mortality and disability rate and no effective treatments to enhance clinical prognosis. The increased aging population, improved vascular prevention, and augmented use of antithrombotic agents have collectively contributed to the rise in ICH incidence over the past few decades. The exploration and understanding of mechanisms and intervention strategies has great practical significance for expanding treatments and improving prognosis of ICH. Microglia, as resident macrophages of central nervous system, are responsible for the first immune defense post-ICH. After ICH, M1 microglia is firstly activated by primary injury and thrombin; subsequently, reactive microglia can further amplify the immune response and exert secondary injury (eg, oxidative stress, neuronal damage, and brain edema). The pro-inflammatory phenotype transmits to M2 microglia within 7 days post-ICH, which plays a key role in erythrophagocytosis and limiting the inflammatory secondary injury. Microglial M2 polarization has significant implications for improving prognosis, this process can be mediated through crosstalk with other cells, metabolic changes, and microbiota interaction. Clarifying the effect, timing, and potential downstream effects of multiple mechanisms that synergistically trigger anti-inflammatory responses may be necessary for clinical translation. Analyses of such intricate interaction between microglia cells and brain injury/repair mechanisms will contribute to our understanding of the critical microglial responses to microenvironment and facilitating the discovery of appropriate intervention strategies. Here, we present a comprehensive overview of the latest evidences on microglial dynamics following ICH, their role in driving primary/secondary injury mechanisms as well as neurorepair/plasticity, and possible treatment strategies targeting microglia.

Cinnamaldehyde and its combination with deferoxamine ameliorate inflammation, ferroptosis and hematoma expansion after intracerebral hemorrhage in mice

Intracerebral hemorrhage (ICH) is a most serious type of hemorrhagic stroke with a continuously rising incidence globally, without effective cure available. The underlying mechanisms driving brain injury are complex and include inflammation, oxidative stress, glutamate excitotoxicity, membrane damage, lipid peroxidation, ferroptosis and other cellular death modes. Hematoma clearance is the key to limit brain damage and foster the recovery process. The quest for effective ICH remedies is continuing and strategically evolving with the expansion of knowledge and understanding of target mechanisms and novel lead compounds. In this study, we have investigated the effects of cinnamaldehyde after ICH as an individual treatment as well as in combination with deferoxamine. The autologous blood injection model was employed using C57BL/6 mice. Following 2 h of ICH induction, animals received IP injection once per day for three days; normal saline in ICH model group, cinnamaldehyde, deferoxamine, and combined cinnamaldehyde and deferoxamine in respective groups. Measurement of neurobehavioral scoring, markers of inflammation NFкB, TNFα, IL-1, IL6, iNOS; oxidative stress and ferroptosis GSH, TBARS, glutamate, choline containing phospholipids, GPX4, SLC7A11, SLC40A1, ACSL4; and hematoma clearance hemoglobin, haptoglobin, hemopexin, zonulin, CD163, LRP1, HO1, CD36, CD206, were investigated using ELISA, PCR, and western blot. Immunofluorescence for NeuN/SLC40A1, GFAP/GPX4, NeuN/HO1, Iba1/HO1 was also performed. We have found that cinnamaldehyde possess anti-inflammatory, antioxidant, anti-ferroptotic and hematoma limiting properties that were comparable to those obtained with deferoxamine. However, combination of cinnamaldehyde and deferoxamine demonstrated remarkable effectiveness in restoration of these parameters indicating their synergistic effect in ICH model.

Minimally Invasive Surgery for Spontaneous Intracerebral Hemorrhage: A Review

Background: Spontaneous intracerebral hemorrhage (ICH) accounts for approximately 20% of all strokes and is associated with high mortality and disability rates. Despite numerous trials, conventional surgical approaches have not demonstrated consistent improvements in functional outcomes. Minimally invasive surgery (MIS) for ICH evacuation has emerged as a promising alternative, with the potential to improve functional outcomes and reduce mortality. Objectives: This narrative review aims to provide a comprehensive overview of various MIS techniques and their reported impact on functional outcomes in patients with spontaneous ICH while discussing key limitations in the existing literature. Methods: We systematically searched PubMed to identify studies published from 1 January 2010 to 22 March 2024. The search strategy included the following terms: ("minimally*"[All Fields] AND "invasive*"[All Fields] AND "surgery*"[All Fields] AND "intracerebral*"[All Fields] AND "hemorrhage*"[All Fields]) AND (2010:2024[pdat]). This review focuses on randomized controlled trials (RCTs) that evaluate MIS techniques for ICH and their clinical outcomes. Results: Our search identified six RCTs conducted between January 2010 and March 2024, encompassing 2180 patients with a mean age of 58.03 ± 4.5 years. Four trials demonstrated significantly improved functional recovery (mRs ≤ 3), reduced mortality, and fewer adverse events compared with standard medical management or conventional craniotomy. All MIS techniques rely on stereotactic planning and the use of tools such as exoscopes, endoscopes, craniopuncture, or thrombolytic irrigation for precise hematoma evacuation. These approaches reduce brain tissue disruption and improve precision. However, the variability in techniques, costs, and lack of an external validation limit the generalizability of these findings. Conclusions: MIS shows potential as an alternative to conventional management strategies for ICH, offering encouraging evidence for improved functional outcomes and reduced mortality in selected studies. However, these findings remain limited by gaps in the literature, including the need for external validation, significant methodological heterogeneity, and economic challenges. Further rigorous trials are essential to confirm the generalizability and long-term impact of these approaches.

Electroacupuncture alleviates motor dysfunction after intracerebral hemorrhage via the PPARγ-EAAT2 pathway

Nowadays, intracerebral hemorrhage (ICH) is the main cause of death and disability, and motor impairment is a common sequel to ICH. Electroacupuncture (EA) has been widely used for functional recovery after ICH. However, its role and associated regulatory mechanisms in rehabilitation after ICH remain poorly understood. This study investigated whether EA can have a neuroprotective effect in motor function after ICH by inhibiting glutamate-mediated excitotoxicity on the primary motor cortex. The model was established using autologous tail artery blood, followed by administration of EA at Quchi (LI11) and Zusanli (ST36) for 3 or 7 consecutive days. The rats' behavior was examined by modified neurological severity score (mNSS) and open-field test (OFT). Nissl staining, immunofluorescence detection, and transmission electron microscopy were used to observe the degree of neuron damage. The level of the cortical glutamate was detected by the ELISA. Peroxisome proliferator-activated receptor gamma (PPARγ) expression was detected by immunohistochemistry and western blot. The protein and mRNA expression of excitatory amino acid transporter 2 (EAAT2) was detected by western blot and quantitative real-time PCR. Our data demonstrated that EA significantly reduces glutamate levels, alleviates neuronal damage, and promotes motor function recovery in rats after ICH. In addition, EA upregulates PPARγ and EAAT2 expression. However, the protective effect of EA on motor function and EAAT2 expression are partially abolished by T0070907, an antagonist of PPARγ. EA at LI11 and ST36 improved glutamate excitotoxicity and promoted motor function recovery after ICH by activating the PPARγ-EAAT2 pathway and reducing the glutamate level.

Efficacy and Prognosis of ROSA Robot-Assisted Stereotactic Intracranial Hematoma Removal in Patients with Cerebral Hemorrhage in Basal Ganglia Region: Comparison with Craniotomy and Neuroendoscopy

This study compares the clinical efficacy and outcomes of three surgical techniques-robot-assisted stereotactic assistance (ROSA), neuroendoscopy, and craniotomy-in the removal of intracranial hematomas in patients with cerebral hemorrhage affecting the basal ganglia. This retrospective study included 110 patients, who were grouped based on the surgical method used: 40 patients in the ROSA group, 50 in the craniotomy group, and 20 in the endoscopy group. We then compared the outcomes of the ROSA group with those of the craniotomy and endoscopy groups. Compared with the craniotomy group, the ROSA group had a significantly shorter operation time, higher hematoma clearance rate, lesser intraoperative blood loss, fewer postoperative pulmonary infections, and lower modified Rankin Scale (mRS) score at discharge and > 3 months after discharge. Compared with the endoscopy group, the ROSA group had a shorter operation time, lesser intraoperative blood loss, and fewer intraoperative blood transfusions. The ROSA robot provided superior surgical outcomes and patient prognoses compared to craniotomy and neuroendoscopy for the removal of intracranial hematomas in patients with basal ganglia cerebral hemorrhage.

Periodic Table of Immunomodulatory Elements and Derived Two-Dimensional Biomaterials

Periodic table of chemical elements serves as the foundation of material chemistry, impacting human health in many different ways. It contributes to the creation, growth, and manipulation of functional metallic, ceramic, metalloid, polymeric, and carbon-based materials on and near an atomic scale. Recent nanotechnology advancements have revolutionized the field of biomedical engineering to tackle longstanding clinical challenges. The use of nano-biomaterials has gained traction in medicine, specifically in the areas of nano-immunoengineering to treat inflammatory and infectious diseases. Two-dimensional (2D) nanomaterials have been found to possess high bioactive surface area and compatibility with human and mammalian cells at controlled doses. Furthermore, these biomaterials have intrinsic immunomodulatory properties, which is crucial for their application in immuno-nanomedicine. While significant progress has been made in understanding their bioactivity and biocompatibility, the exact immunomodulatory responses and mechanisms of these materials are still being explored. Current work outlines an innovative "immunomodulatory periodic table of elements" beyond the periodic table of life, medicine, and microbial genomics and comprehensively reviews the role of each element in designing immunoengineered 2D biomaterials in a group-wise manner. It recapitulates the most recent advances in immunomodulatory nanomaterials, paving the way for the development of new mono, hybrid, composite, and hetero-structured biomaterials.

Serial Diffusion Tensor Imaging and Rate of Ventricular Blood Clearance in Patients with Intraventricular Hemorrhage

BACKGROUND

We developed a noninvasive biomarker to quantify the rate of ventricular blood clearance in patients with intracerebral hemorrhage and extension to the ventricles-intraventricular hemorrhage.

METHODS

We performed magnetic resonance imaging in 26 patients at 1, 14, 28, and 42 days of onset and measured their hematoma volume (HV), ventricular blood volume (VBV), and two diffusion metrics: fractional anisotropy (FA), and mean diffusivity (MD). The ipasilesional ventricular cerebral spinal fluid's FA and MD were associated with VBV and stroke severity scores (National Institute of Health Stroke Scale [NIHSS]). A subcohort of 14 patients were treated with external ventricular drain (EVD). A generalized linear mixed model was applied for statistical analysis.

RESULTS

At day 1, the average HVs and NIHSS scores were 14.6 ± 16.7 cm3 and 16 ± 8, respectively. A daily rate of 2.1% and 1.3% blood clearance/resolution were recorded in HV and VBV, respectively. Ipsilesional ventricular FA (vFA) and ventricular MD (vMD) were simultaneously decreased (vFA = 1.3% per day, posterior probability [PP] > 99%) and increased (vMD = 1.5% per day, PP > 99%), respectively. Patients with EVD exhibited a faster decline in vFA (1.5% vs. 1.1% per day) and an increase in vMD (1.8% vs. 1.5% per day) as compared with patients without EVD. Temporal change in vMD was associated with VBV; a 1.00-cm3 increase in VBV resulted in a 5.2% decrease in vMD (PP < 99%). VBV was strongly associated with NIHSS score (PP = 97-99%). A larger cerebral spinal fluid drained volume was associated with a greater decrease (PP = 83.4%) in vFA, whereas a smaller volume exhibited a greater increase (PP = 94.8%) in vMD.

CONCLUSIONS

In conclusion, vFA and vMD may serve as biomarkers for VBV status.

Nicotinamide riboside restores nicotinamide adenine dinucleotide levels and alleviates brain injury by inhibiting oxidative stress and neuroinflammation in a mouse model of intracerebral hemorrhage

Hemorrhagic stroke is a global health problem owing to its high morbidity and mortality rates. Nicotinamide riboside is an important precursor of nicotinamide adenine dinucleotide characterized by a high bioavailability, safety profile, and robust effects on many cellular signaling processes. This study aimed to investigate the protective effects of nicotinamide riboside against collagenase-induced hemorrhagic stroke and its underlying mechanisms of action. An intracerebral hemorrhage model was constructed by stereotactically injecting collagenase into the right striatum of adult male Institute for Cancer Research mice. After 30 minutes, nicotinamide riboside was administered via the tail vein. The mice were sacrificed at different time points for assessments. Nicotinamide riboside reduced collagenase-induced hemorrhagic area, significantly reduced cerebral water content and histopathological damage, promoted neurological function recovery, and suppressed reactive oxygen species production and neuroinflammation. Nicotinamide riboside exerts neuroprotective effects against collagenase-induced intracerebral hemorrhage by inhibiting neuroinflammation and oxidative stress.

Cognitive impairment after hemorrhagic stroke is less common in patients with elevated body mass index and private insurance

BACKGROUND

Hemorrhagic stroke survivors may have cognitive impairment. We sought to identify preadmission and admission factors associated with cognitive impairment after hemorrhagic stroke.

DESIGN

Patients with nontraumatic intracerebral or subarachnoid hemorrhage (ICH or SAH) were assessed 3-months post-bleed using the Quality of Life in Neurological Disorders (Neuro-QoL) Cognitive Function short form. Univariate and multivariate analysis were used to evaluate the relationship between poor cognition (Neuro-QoL t-score ≤50) and preadmission and admission factors.

RESULTS

Of 101 patients (62 ICH and 39 SAH), 51 (50 %) had poor cognition 3-months post-bleed. On univariate analysis, poor cognition was associated with (p < 0.05): age [66.0 years (52.0-77.0) vs. 54.5 years (40.8-66.3)]; private insurance (37.3 % vs. 74.0 %); BMI > 30 (13.7 % vs. 34.0 %); and admission mRS score > 0 (41.2 % vs. 14.0 %), NIHSS score [8.0 (2.0-17.0) vs. 0.5 (0.0-4.0)], and APACHE II score [16.0 (11.0-19.0) vs. 9.0 (6.0-14.3)]. On multivariate analysis, poor cognition was associated with mRS score > 0 [OR 4.97 (1.30-19.0), p = 0.019], NIHSS score [OR 1.14 (1.02-1.28), p = 0.026], private insurance [OR 0.21 (0.06-0.76), p = 0.017] and BMI > 30 [OR 0.13 (0.03-0.56), p = 0.006].

CONCLUSIONS

Cognitive impairment after hemorrhagic stroke is less common in patients with BMI > 30 and private insurance. Heightened surveillance for non-obese patients without private insurance is suggested. Additional investigation into the relationship between cognition and both BMI and insurance type is needed.

Exosomes from polarized Microglia: Proteomic insights into potential mechanisms affecting intracerebral hemorrhage

Intracerebral hemorrhage (ICH) is a devastating form of stroke associated with significant morbidity and mortality. Microglia are intracranial innate immune cell that play critical roles in Intracerebral hemorrhage through direct or indirect means. Vesicle transport is a fundamental mechanism of intercellular communication. Recent studies have identified microglia in specific polarized states correlate with pathogenesis, material and signal transmission in ICH through derived extracellular vesicles. Diverse polarization states trigger distinct functions, however, the exosome proteomes across these states remain poorly characterized. Here, we hypothesized that microglia exosomal profiles vary with polarization states, impacting their functional repertoire and influencing outcomes in cerebral hemorrhage. In vitro model of cerebral hemorrhage, administration of 20 μg/ml LPS-induced M1 microglia derived exosomes (M1-Exo) with HT22 enhanced hemin-induced neuronal death, while IL-4-induced M2 microglia derived exosomes (M2-Exo) significantly reduced hemin-induced cell apoptosis and inflammation. Then we identified novel state-specific proteomic profiles of microglia-derived exosomes under these polarization conditions through label-free quantitative mass spectrometry (LFQ-MS). Analysis of protein content identified several exosomal signature proteins and hundreds of differentially expressed proteins across polarization states. Specifically, proteins including UMOD, NLRP3, ACOD1, IL1RN, heme oxygenase 1 (HMOX1), CCL4, and TNFRSF1B in M1-Exo were enriched in inflammatory pathways, while those in M2-Exo exhibited enrichment in autophagy, ubiquitination, and mitochondrial respiration. The analysis of those diverse exosomal proteins suggested unique proteomic profiles and possible intracellular signal transmission and regulation mechanisms. Together, these findings offer new insights and resources for studying microglia-derived exosome and pave the way for the development of novel therapeutic strategies targeting microglial exosome-mediated pathways.

Skull bone marrow and skull meninges channels: redefining the landscape of central nervous system immune surveillance

The understanding of neuroimmune function has evolved from concepts of immune privilege and protection to a new stage of immune interaction. The discovery of skull meninges channels (SMCs) has opened new avenues for understanding central nervous system (CNS) immunity. Here, we characterize skull bone marrow and SMCs by detailing the anatomical structures adjacent to the skull, the differences between skull and peripheral bone marrow, mainstream animal processing methods, and the role of skull bone marrow in monitoring various CNS diseases. Additionally, we highlight several unresolved issues based on current research findings, aiming to guide future research directions.

Interleukin-1 Receptor-Associated Kinase-3 Aggravates Neuroinflammatory Injury After Intracerebral Hemorrhage via Activation NF-κB/IL-17A Pathway in Mice

Background

Neuroinflammatory reactions are crucial factors in secondary brain damage following intracerebral hemorrhage (ICH). Although previous studies have shown that IRAK3 is involved in immune responses, the potential effects of IRAK3 on ICH remain unclear.

Methods

Collagenase IV-induced ICH mouse model. Western blotting was used to determine the expression of IRAK3 at different time points following ICH. Immunofluorescence was used to investigate the cellular localization of IRAK3. The ICH model was treated with recombinant human IRAK3 (rh-IRAK3) or IRAK3 siRNA via an intracerebroventricular injection. The effect of IRAK3 on ICH mice was assessed by Western blotting and short-term and long-term neurological function evaluation. RNA-seq was performed to explore the mechanism by which IRAK3 promotes inflammation after ICH. The mechanisms of IRAK3 and neuroinflammation will be further investigated by Western blotting, qRT-PCR and immunofluorescence. Recombinant IL-17A was used to investigate the connection between IRAK3 and the NF-κB/IL-17A signaling pathway in vivo and in vitro experiments.

Results

The expression of IRAK3 increased, peaking at 24 h, followed by a subsequent decrease after ICH. IRAK3 is mainly expressed in the microglia. RNA-seq analysis revealed 1,797 differentially expressed genes around the perihematomal brain tissue after IRAK3 siRNA treatment, with multiple inflammatory pathways being downregulated. Rh-IRAK3 treatment resulted in upregulation of the levels of inflammatory cytokines around the perihematomal tissue and exacerbated neurological function deficits. Furthermore, IRAK3 siRNA treatment markedly decreased the expression of inflammatory cytokines and microglial activation via the NF-κB/IL-17A signaling pathway. Recombinant IL-17A exacerbated the inflammatory response in vivo and in vitro; however, IRAK3 knockdown reversed this process.

Conclusion

IRAK3 aggravates neuroinflammation by activating the NF-κB/IL-17A signaling pathway, thereby exacerbating neurological deficits following ICH. Therefore, inhibition IRAK3 may be a promising approach for treating ICH.

Classification Prediction of Hydrocephalus After Intercerebral Haemorrhage Based on Machine Learning Approach

In order to construct a clinical classification prediction model for hydrocephalus after intercerebral haemorrhage(ICH) to guide clinical treatment decisions, this paper retrospectively analyses the clinical data of 844 cases of ICH and hydrocephalus inpatients admitted to Yueyang People's Hospital from May 2019 to October 2022, of which 95 cases of hydrocephalus occurred after ICH and no hydrocephalus in 749 cases. The following indicators were compared between the two groups of patients: gender, age, Glasgow Coma Scale(GCS)score, whether the amount of bleeding was greater than 30 ml, whether it broke into the ventricle or not, modified Graeb score(MGS), modified Rankin Scale (MRS) score, whether surgery was performed or not, red blood cells, white blood cells, and platelets. After variable screening, the following six variables were selected: GCS score, MGS, MRS score, whether the bleeding volume was greater than 30 ml, whether it broke into the ventricle or not, and whether surgery was performed or not were modelled and analysed using logistic regression model and support vector machine model in machine learning. The results showed that under the same conditions, the accuracy of the support vector machine model was 0.89 and F1 was 0.838 ,the value of the AUC of the support vector machine model is 0.888; the accuracy of the logistic regression model was 0.902 and F1 was 0.89, the value of the AUC of the support vector machine model is 0.903. Compared with the group without hydrocephalus, patients in the group with hydrocephalus had bleeding volume greater than 30 ml, haemorrhage into the ventricles of the brain, and had undergone surgery in the brain, and the difference was statistically significant (P 0.001). Statistical analysis showed that GCS score ≤ 8.8, modified Graeb score (MGS) ≥ 10 and MRS score ≥ 3 were independent risk factors for the development of hydrocephalus after spontaneous ventricular haemorrhage. Therefore, patients with lower GCS score, higher modified Graeb score, higher MRS score, bleeding volume > 30 ml, haemorrhage into the ventricles of the brain, and experience of having undergone surgery in the brain should be operated on early to remove the intraventricular haematoma in order to reduce the incidence of hydrocephalus.

Involvement of the posterior limb of the internal capsule independently predicts the prognosis of patients with basal ganglia and thalamic hemorrhage

Background

Intracerebral hemorrhage (ICH) is the most lethal and devastating subtype of stroke. Basal ganglia hemorrhage and thalamic hemorrhage are the most common types of ICH, accounting for 50-70% of all ICH cases, leading to disability and death, and it involves the posterior limb of the internal capsule to varying degrees. In this study, we investigated the impact of varying degrees of the involvement of the posterior limb of the internal capsule on the prognosis of patients with basal ganglia and thalamic ICH and assessed whether it improves the predictive accuracy of the max-ICH score, an existing scale for ICH functional outcome.

Methods

This is a multicenter, retrospective, observational study. We graded the involvement of the posterior limb of the internal capsule according to the degree of compression and injury (called iICH, ranging from 0 to 4). An unfavorable outcome was defined as a 90-day modified Rankin Scale (mRS) of > 2. Multivariate logistic regression analysis was used to identify independent risk factors associated with unfavorable prognosis. The discrimination was verified using receiver operating characteristic curve (ROC) analysis, while the calibration was verified by the Hosmer-Lemeshow test.

Results

Of the 305 patients included, 188 from Nanfang Hospital were assigned to the development cohort, and 117 from Heyuan People's Hospital and Huadu District People's Hospital were assigned to the validation cohort. In the development cohort, iICH was identified as an independent factor of a 90-day unfavorable outcome, and the area under the ROC (AUC) was 0.774. When combined with the iICH, the AUC of max-ICH was significantly elevated from 0.816 to 0.866. Comparable results were found in the validation cohort.

Conclusions

Increased involvement of the posterior limb of the internal capsule is associated with a worse outcome in patients with basal ganglia and thalamic ICH.

Isoform-selective and non-selective rho-kinase inhibitors do not affect collagenase-induced intracerebral hemorrhage outcomes in mice: Influence of sex and circadian cycle

Rho-associated protein kinase (ROCK) inhibitors are therapeutic candidates in ischemic stroke and subarachnoid hemorrhage. However, their efficacy in intracerebral hemorrhage (ICH) is unknown. Here, we tested the efficacy of fasudil (10 mg/kg), an isoform-nonselective ROCK inhibitor, and NRL-1049 (10 mg/kg), a novel inhibitor with 43-fold higher selectivity for ROCK2 isoform compared with ROCK1, in a collagenase-induced ICH model in mice. Both short (1-3 days) and prolonged (14 days) therapeutic paradigms were tested using robust sample sizes in both males and females and in active and inactive circadian stages. Outcome readouts included weight loss, mortality, hematoma volume, hemispheric swelling, brain water content, BBB permeability to large molecules, and sensorimotor and cognitive function. We found the treatments safe but not efficacious in improving the hematoma volume, BBB disruption, or neurological deficits in this collagenase-induced ICH model. Intriguingly, however, induction of ICH during the active circadian stage was associated with worse tissue and behavioral outcomes compared with the inactive stage.

Association between short-term exposure to meteorological factors on hospital admissions for hemorrhagic stroke: an individual-level, case-crossover study in Ganzhou, China

BACKGROUND

Hemorrhagic stroke (HS) is associated with significant disability and mortality. However, the relationship between meteorological factors and hemorrhagic stroke, as well as the potential moderating role of these factors, remains unclear.

METHODS

Daily data on HS, air pollution, and meteorological conditions were collected from January 2015 to December 2021 in Ganzhou to analyze the relationship between meteorological factors and HS admissions. This analysis employed a time-stratified case-crossover design in conjunction with a distributional lag nonlinear model. Additionally, a bivariate response surface modelling was utilized to further investigate the interaction between meteorological factors and particulate matter. The study also stratified the analyses by gender and age. To investigate the potential impact of extreme weather conditions on HS, this study defined the 97.5th percentile as representing extremely high weather conditions, while the 2.5th percentile was classified as extremely low.

RESULTS

In single-day lags, the risk of admissions for HS was significantly associated with extremely low temperature (lag 1-2 and lag 13-14), extremely low humidity (lag 1 and lag 9-12), and extremely high precipitation (lag 2-7). Females exhibited greater susceptibility to extremely low temperature than males within the single-day lag pattern in the subcomponent layer, with a maximum relative risk (RR) that was 7% higher. In the cumulative lag analysis, the risk of HS admissions was significantly associated with extremely high temperature (lag 0-8∼lag 0-14), extremely low humidity (lag 0-2∼lag 0-14), and extremely high precipitation (lag 0-4∼lag 0-14). Within the cumulative lag day structure of the subcomponent layer, both extremely low and extremely high temperature had a more pronounced effect on females and aged ≥65 years. The risk of HS admissions was positively associated with extremely high barometric pressure in the female subgroups (lag 0-1 and lag 0-2). The highest number of HS admissions occurred when high PM2.5 concentrations coexisted with low precipitation.

CONCLUSIONS

Meteorological factors were significantly associated with the risk of hospital admissions for HS. Individuals who were female and aged ≥65 years were found to be more susceptible to these meteorological influences. Additionally, an interaction was observed between airborne particulate matter and meteorological factors. These findings contributed new evidence to the association between meteorological factors and HS.

Zhongfeng Xingnao prescription alleviates injury of intracerebral hemorrhage via regulating the CaMKII/NF-κB p65/NLRP3/GSDMD signaling axis

Background and aim

The NLRP3 inflammasome can be activated after intracerebral hemorrhage (ICH), triggering an inflammatory response in the brain. Chinese herbal medicine Zhongfeng Xingnao Prescription (ZFXN) is commonly used in China for intracerebral hemorrhage treatment. However, the underlying treatment mechanism of it is unclear. The purpose of our study is to investigate whether ZFXN alleviates injury after intracerebral hemorrhage by blocking the activation of CaMKII/NF-κB p65/NLRP3/GSDMD signaling axis.

Experimental procedure

We evaluated the protective effect of ZFXN in a rat model of collagenase Ⅶ-induced ICH. The neurological deficit score, cerebral hematoma-injury ratio, pathology, and ultrastructure of tissue surrounding the hematoma were evaluated after 5 days of ZFXN treatment, CaMKII/NF-κB p65/NLRP3/GSDMD signaling axis-related protein expression around the hematoma was assessed by Western blot and immunohistochemistry. Meanwhile, ELISA measured the levels of IL-1β, IL-18, IL-6 and TNF-α in serum.

Results and conclusion

After 5 days of ZFXN treatment, the score of neurological deficit and hematoma damage ratio decreased, and the cell destruction such as edema and vacuole conditions around the hematoma improved. The mechanism investigation results showed that ZFXN down-regulated expressions of CaMKII/NF-κB p65/NLRP3/GSDMD signaling axis-related protein around the hematoma area. In addition, ZFXN could attenuate the inflammatory response by regulating the activation of NLRP3 inflammasome after ICH. For the first time, we found that the efficacy of ZFXN on ICH might be related to the regulation of NLRP3 inflammasome.

Role of Regulatory T Cells in Intracerebral Hemorrhage

Intracerebral hemorrhage (ICH) is a common cerebrovascular disease that can lead to severe neurological dysfunction in surviving patients, resulting in a heavy burden on patients and their families. When ICH occurs, the blood‒brain barrier is disrupted, thereby promoting immune cell migration into damaged brain tissue. As important immunosuppressive T cells, regulatory T (Treg) cells are involved in the maintenance of immune homeostasis and the suppression of immune responses after ICH. Treg cells mitigate brain tissue damage after ICH in a variety of ways, such as inhibiting the neuroinflammatory response, protecting against blood‒brain barrier damage, reducing oxidative stress damage and promoting nerve repair. In this review, we discuss the changes in Treg cells in ICH clinical patients and experimental animals, the mechanisms by which Treg cells regulate ICH and treatments targeting Treg cells in ICH, aiming to support new therapeutic strategies for clinical treatment.

Therapeutic implications for the PD-1 axis in cerebrovascular injury

Since the discovery and characterization of the PD-1/PD-L pathway, mounting evidence has emerged regarding its role in regulating neuroinflammation following cerebrovascular injury. Classically, PD-L1 on antigen-presenting cells or tissues binds PD-1 on T cell surfaces resulting in T cell inhibition. In myeloid cells, PD-1 stimulation induces polarization of microglia and macrophages into an anti-inflammatory, restorative phenotype. The therapeutic potential of PD-1 agonism in ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage-related vasospasm, and traumatic brain injury rests on the notion of harnessing the immunomodulatory function of immune checkpoint pathways to temper the harmful effects of immune overactivation and secondary injury while promoting repair and recovery. Immune checkpoint agonism has greater specificity than the wider and non-specific anti-inflammatory effects of other agents, such as steroids. PD-1 agonism has already demonstrated success in clinical trials for rheumatoid arthritis and is being tested in other chronic inflammatory diseases. Further investigation of PD-1 agonism as a therapeutic strategy in cerebrovascular injury can help clarify the mechanisms underlying clinical benefit, develop drugs with optimal pharmacodynamic and pharmacokinetic properties, and mitigate unwanted side effects.

Preclinical evaluation on human platelet lysate for the treatment of secondary injury following intracerebral hemorrhage

Intracerebral hemorrhage (ICH) is a condition with high mortality and disability. Secondary injury processes following ICH include neuroinflammation, oxidative stress, and neuronal apoptosis. Human platelet lysate (HPL), derived from crushed platelets, is rich in cytokines and has demonstrated therapeutic potential in neurological disorders in several studies. However, studies on HPL for ICH remain limited. In this study, we prepared HPL for intranasal administration in ICH treatment. We determined the concentration of growth factors in HPL, validated the targeting of HPL, and established a mouse model of ICH. We observed that HPL improved neuromotor deficits in ICH mice. Barnes maze training showed that HPL enhanced spatial memory and learning ability in mice. Furthermore, HPL reduced neuroinflammation, brain edema, oxidative stress, neuronal apoptosis, and neural axonal damage. Additionally, 5 % HPL demonstrated potent functional activity with no cytotoxicity in SH-5YSY cell cultures. These findings indicate that HPL is a promising therapeutic approach for mitigating secondary brain injury following ICH.

Multimodal and serial MRI monitors brain peri-hematomal injury and repair mechanisms after experimental intracerebral hemorrhage

The peri-hematomal area (PHA) emerges as a key but puzzling interface where edematous and neuroinflammatory events co-occur after intracerebral hemorrhage (ICH), while being considered either as deleterious or protective. We aimed at unraveling the pathogeny and natural history of PHA over time after experimental ICH. Male and female rats were longitudinally followed up to day 7 using multimodal brain MRI. MRI measures were compared to neuropathological and behavioural results. While the peak of PHA volume at day 3 was predictive for spontaneous locomotor deficit without sex-effect, its drop at day 7 fitted with locomotor recovery and hematoma resorption. The PHA highest water density was observed at onset despite microvascular hypoperfusion, taken over by blood-brain barrier (BBB) leakage at day 3. Water density dropped at day 7, when vascular integrity was normalized, and the highest number of reactive astrocytes, microglial cells, and siderophages found. This study shows that the PHA with edematous component is hematoma-driven at onset and BBB-driven at day 3, but this excess neuroinflammation enabled PHA volume reduction and significant hematoma resorption as soon as day 7. Therapeutic interventions should consider this pathogeny, and be monitored by multimodal MRI in preclinical ICH models.

The protective effects of gastrodin on neurological disorders: an update and future perspectives

Neurological disorders are characterized by high mortality and disability rates. Furthermore, the burden associated with disability and mortality resulting from neurological disorders has been increasing at an alarming rate. Botanical drugs and their bioactive components have emerged as a prominent area of research, offering a promising avenue for developing novel alternatives for treating neurological diseases. Gastrodin is the principal active component derived from the traditional Chinese medicinal plant Gastrodia elata Blume (GEB). Existing literature reveals that gastrodin exerts various pharmacological protective actions against neurological disorders. This review aimed to collate novel literature on gastrodin for treating neurological disorders from Web of Science, PubMed, Embase and CNKI. The pharmacokinetics of gastrodin, its therapeutic role in neurological disorders, the main mechanisms of action and clinical application were addressed. Furthermore, a detailed overview of gastrodin drug delivery systems and physical enhancement methods was presented, offering invaluable insights into potential research and the extensive applications of gastrodin.

Risk factors for post-stroke spasticity: a retrospective study

Background

Post-stroke spasticity (PSS) is a common complication after stroke and is an important cause of high rates of disability after stroke. At present, modern medicine has made great progress in the treatment of PSS, 'early detection, early treatment' has become a general consensus for the treatment of PSS in the clinic. Clarifying the risk factors of PSS can help to detect and treat the functional disorders caused by PSS at an earlier stage.

Methods

This is a retrospective study. 436 stroke patients who visited the Neurology Department of the Third Affiliated Clinical Hospital of Changchun University of Chinese Medicine from June 2020 to November 2020 were selected as study subjects, and finally 257 patients were included in the final analysis, and divided into 101 cases with spasticity and 156 cases without spasticity, depending on whether or not the stroke victim had a spasm at the time of admission.

Results

The multivariate regression analysis showed that basal ganglia as the cerebral hemorrhage or infarction site (OR = 4.930, 95%CI = 2.743-8.86, p = 0.000), cerebral hemorrhage or infarction volume (OR = 1.087, 95%CI = 1.016-1.164, p = 0.016) and NIHSS scores (OR = 1.232, 95%CI = 1.089-1.393, p = 0.001) are independent influencing factors and independent risk factors for spasticity (p < 0.05). A risk prediction model for spasticity in stroke patients is derived with the multivariate logistic regression analysis Logit (P) = 1.595 * Basal ganglia +0.084 * infarct volume + 0.208 * NIHSS scores - 2.092. An evaluation of the goodness of fit using the ROC curve showed AUC (95% CI) = 0.786 (0.730-0.843), an indication of a high degree of model fit.

Conclusion

Independent risk factors for Post-stroke spasticity include basal ganglia as the cerebral hemorrhage or infarction site, cerebral hemorrhage or infarction volume and NIHSS scores.

Exploration and comparison of stress hyperglycemia-related indicators to predict clinical outcomes in patients with spontaneous intracerebral hemorrhage

Spontaneous intracerebral hemorrhage (ICH) is a prevalent hemorrhagic stroke characterized by a significant fatality rate and severe neurological impairments. Stress hyperglycemia has been confirmed to have a significant prognostic role in a range of diseases. However, studies on the association between stress hyperglycemia and the outcome of ICH have not currently been reported. Critically ill patients diagnosed with ICH in the Medical Information Mart for Intensive Care IV (MIMIC-IV) database were included in our study. Logistic regression and Cox regression were used to analyze the correlation between stress hyperglycemia and the outcome of ICH. The predictive ability of different glucose metrics was demonstrated by the receiver-operating characteristic (ROC) curve and was further compared by the integrated discrimination improvement (IDI) index. A total of 880 ICH patients in the MIMIC-IV database were included in this study. In logistic regression and Cox regression, blood glucose level (BGL), glycemic gap (GG), and stress hyperglycemia ratio (SHR) were independent predictors of unfavorable outcomes in ICH after adjustment for other confounders. The IDI results indicated that the 5-day maximum stress hyperglycemia ratio had better predictive performance than glycemic gap and blood glucose level in-hospital mortality and 1-year mortality, and the predictive performance of the 5-day maximum stress hyperglycemia ratio was better than that of stress hyperglycemia ratio measured at admission. In the age-stratified subgroup analysis, the 5-day maximum stress hyperglycemia ratio was more sensitive in predicting long-term outcomes in the young subgroup than in the elderly subgroup. The 5-day maximum stress hyperglycemia ratio is strongly correlated with an elevated risk of mortality in ICH patients and displays a better predictive ability than glycemic gap and blood glucose level in the short/long-term prognosis of ICH.

Predictors of mortality at 3 months in patients with skull base tumor resections in a low-income setting

Objective

Globally, skull base tumors are among the most challenging tumors to treat and are known for their significant morbidity and mortality. Hence, this study aimed to identify robust associated factors that contribute to mortality of patients following surgical resection for a variety of skull base tumors at the 3-month follow-up period. This in turn helps devise an evidence-based meticulous treatment strategy and baseline input for quality improvement work.

Methodology

A retrospective cohort study of patients undergoing skull base tumor resection was conducted at two large-volume neurosurgery centers in Ethiopia. The categorical variables were expressed in frequencies and percentages. Normal distribution of continuous data was checked by histogram and the Shapiro-Wilk test. Median with interquartile range (IQR) was calculated for skewed data, while mean with standard deviation (SD) was used for normally distributed data. Odds ratio and adjusted odds ratio (AOR) were used to express the result of univariate and multivariate binary logistic analyses, respectively. A p-value <0.005 was considered statistically significant at 95% confidence interval (CI).

Result

The study involved 266 patients. Of this, women accounted for 63.5% of patients. The median age of patients was 37 (±IQR = 17) years while the median size of the tumor in this study was 4.9 (±IQR 1.5) cm. The mean duration of symptoms at time of presentation was 17.3 (±SD = 11.1) months. Meningioma, pituitary adenoma, and craniopharyngioma contributed to 68.4%, 19.2%, and 9% of the skull-based tumors, respectively. Mortality following skull base tumor resection was 21.1%. On multivariable binary logistic regression analysis, intraoperative iatrogenic vascular insult (AOR = 28.76, 95% CI: 6.12-135.08, p = 0.000), intraventricular hemorrhage (AOR = 6.32, 95% CI: 1.19-33.63, p = 0.031), hospital-associated infection (AOR = 6.96, 95% CI: 2.04-23.67, p = 0.002), and extubation time exceeding 24 h (AOR = 12.89, 95% CI: 4.89-40.34, p = 0.000) were statistically significant with 3-month mortality.

Conclusion

Mortality from skull base tumor resection remains high in our setting. Holistic pre-operative surgical planning, meticulous intraoperative execution of procedures, and post-operative dedicated follow-up of patients in a neurointensive care unit alongside quality improvement works on identified risks of mortality are strongly recommended to improve patient outcomes. The urgent need for setup improvement and further training of neurosurgeons is also underscored.

Intranasal Delivery of Curcumin Nanoparticles Improves Neuroinflammation and Neurological Deficits in Mice with Intracerebral Hemorrhage

Intracerebral hemorrhage (ICH) represents one of the most severe subtypes of stroke. Due to the complexity of the brain injury mechanisms following ICH, there are currently no effective treatments to significantly improve patient functional outcomes. Curcumin, as a potential therapeutic agent for ICH, is limited by its poor water solubility and oral bioavailability. In this study, mPEG-PCL is used to encapsulate curcumin, forming curcumin nanoparticles, and utilized the intranasal administration route to directly deliver curcumin nanoparticles from the nasal cavity to the brain. By inhibiting pro-inflammatory neuroinflammation of microglia following ICH in mice, reprogramming pro-inflammatory microglia toward an anti-inflammatory function, and consequently reducing neuronal inflammatory death and hematoma volume, this approach improved blood-brain barrier damage in ICH mice and promoted the recovery of neurological function post-stroke. This study offers a promising therapeutic strategy for ICH to mediate neuroinflammatory microenvironments.

MicroRNA-451 Regulates Angiogenesis in Intracerebral Hemorrhage by Targeting Macrophage Migration Inhibitory Factor

Intracerebral hemorrhage (ICH) is a subtype of stroke with the highest fatality and disability rate. Up to now, commonly used first-line therapies have limited value in improving prognosis. Angiogenesis is essential to neurological recovery after ICH. Recent studies have shown that microRNA-451(miR-451) plays an important role in angiogenesis by regulating the function of vascular endothelial cells. We found miR-451 was significantly decreased in the peripheral blood of ICH patients in the acute stage. Based on the clinical findings, we conducted this study to investigate the potential regulatory effect of miR-451 on angiogenesis after ICH. The expression of miR-451 in ICH mouse model and in a hemin toxicity model of human brain microvascular endothelial cells (hBMECs) was decreased the same as in ICH patients. MiR-451 negatively regulated the proliferation, migration, and tube formation of hBMECs in vitro. MiR-451 negatively regulated the microvessel density in the perihematoma tissue and affected neural functional recovery of ICH mouse model. Knockdown of miR-451 could recovered tight junction and protect the integrity of blood-brain barrier after ICH. Based on bioinformatic programs, macrophage migration inhibitory factor (MIF) was predicted to be the target gene and identified to be regulated by miR-451 inhibiting the protein translation. And p-AKT and p-ERK were verified to be downstream of MIF in angiogenesis. These results all suggest that miR-451 will be a potential target for regulating angiogenesis in ICH.

Gas6/Axl signaling promotes hematoma resolution and motivates protective microglial responses after intracerebral hemorrhage in mice

BACKGROUND

Intracerebral hemorrhage (ICH) stands out as the most fatal subtype of stroke, currently devoid of effective therapy. Recent research underscores the significance of Axl and its ligand growth arrest-specific 6 (Gas6) in normal brain function and a spectrum of neurological disorders, including ICH. This study is designed to delve into the role of Gas6/Axl signaling in facilitating hematoma clearance and neuroinflammation resolution following ICH.

METHODS

Adult male C57BL/6 mice were randomly assigned to sham and ICH groups. ICH was induced by intrastriatal injection of autologous arterial blood. Recombinant mouse Gas6 (rmGas6) was administered intracerebroventricularly 30 min after ICH. Virus-induced knockdown of Axl or R428 (a selective inhibitor of Axl) treatment was administrated before ICH induction to investigate the protective mechanisms. Molecular changes were assessed using western blot, enzyme-linked immunosorbent assay and immunohistochemistry. Coronal brain slices, brain water content and neurobehavioral tests were employed to evaluate histological and neurofunctional outcomes, respectively. Primary glia cultures and erythrophagocytosis assays were applied for mechanistic studies.

RESULTS

The expression of Axl increased at 12 h after ICH, peaking on day 3. Gas6 expression did not remarkably changed until day 3 post-ICH. Early administration of rmGas6 following ICH significantly reduced hematoma volume, mitigated brain edema, and restored neurological function. Both Axl-knockdown and Axl inhibitor treatment abolished the neuroprotection of exogenous Gas6 in ICH. In vitro studies demonstrated that microglia exhibited higher capacity for phagocytosing eryptotic erythrocytes compared to normal erythrocytes, a process reversed by blocking the externalized phosphatidylserine on eryptotic erythrocytes. The erythrophagocytosis by microglia was Axl-mediated and Gas6-dependent. Augmentation of Gas6/Axl signaling attenuated neuroinflammation and drove microglia towards pro-resolving phenotype.

CONCLUSIONS

This study demonstrated the beneficial effects of recombinant Gas6 on hematoma resolution, alleviation of neuroinflammation, and neurofunctional recovery in an animal model of ICH. These effects were primarily mediated by the phagocytotic role of Axl expressed on microglia.

Edaravone Alleviates Traumatic Brain Injury by Inhibition of Ferroptosis via FSP1 Pathway

Traumatic brain injury (TBI) is a highly severe form of trauma with complex series of reactions in brain tissue which ultimately results in neuronal damage. Previous studies proved that neuronal ferroptosis, which was induced by intracranial haemorrhage and other reasons, was one of the most primary causes of neuronal damage following TBI. However, the association between neuronal mechanical injury and ferroptosis in TBI and relevant treatments remain unclear. In the present study, we first demonstrated the occurrence of neuronal ferroptosis in the early stage of TBI and preliminarily elucidated that edaravone (EDA), a cerebroprotective agent that eliminates oxygen radicals, was able to inhibit ferroptosis induced by TBI. A cell scratching model was established in PC12 cells, and it was confirmed that mechanical injury induced ferroptosis in neurons at the early stage of TBI. Ferroptosis suppressor protein 1 (FSP1) plays a significant role in inhibiting ferroptosis, and we found that iFSP, a ferroptosis agonist which is capable to inhibit FSP1 pathway, attenuated the anti-ferroptosis effect of EDA. In conclusion, our results suggested that EDA inhibited neuronal ferroptosis induced by mechanical injury in the early phase of TBI by activating FSP1 pathway, which could provide evidence for future research on prevention and treatment of TBI.

Association between the C-reactive protein to albumin ratio and poor clinical outcome in patients with spontaneous intracerebral hemorrhage

BACKGROUND

The C-reactive protein-to-albumin ratio (CAR) is a novel prognostic biomarker of systemic inflammation and nutritional status. The association between CAR and the long-term outcome of spontaneous intracerebral hemorrhage (ICH) remains unclear.

METHODS

From January 2014 to September 2016, 497 patients with spontaneous ICH were enrolled in our study from 13 hospitals in Beijing. According to the CAR quartiles, patients were classified into four groups (Q1-Q4). Logistic regression was applied to analyze the relationship between different CAR levels and main outcome (90-day and 1-year mRS 4-6). Restricted cubic splines and receiver operating characteristic (ROC) curves of CAR for poor clinical outcomes were assessed.

RESULTS

In the multivariate logistic regression model, compared with the lowest quartile of CAR, the adjusted odds ratios of the Q2, Q3, and Q4 group for 90-day mRS score of 4-6 were 3.64 (1.61-8.23), 3.83 (1.67-8.77), and 8.91 (3.85-20.64). In terms of 1-year mRS score of 4-6, compared with the lowest quartile of CAR, the adjusted odds ratios of the Q3 and Q4 group were 3.31 (1.33-8.22) and 6.87 (2.81-16.78).

CONCLUSIONS

A high CAR level was associated with a high risk of long-term adverse prognosis in patients with ICH, and the risk of ICH poor outcome increased steadily with CAR rising in a certain range, and maintained in a high level thereafter.