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Hou Y, Sang Y, Ma M, Yang K, Yang F, Wei G. Relationship between changes in neurological deficit severity and adverse cardiac events in elderly patients with hypertensive intracerebral hemorrhage: a retrospective cohort study. Int J Neurosci 2024:1-6. [PMID: 38651276 DOI: 10.1080/00207454.2024.2346795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 04/18/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE To explore the relationship between changes in neurological deficit severity and the occurrence of adverse cardiac events in elderly patients with hypertensive intracerebral hemorrhage. METHODS Receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive value of NIHSS scores for adverse cardiac events. RESULTS There were significant differences between the two groups. Multivariate logistic regression analysis showed that advanced age, high NIHSS score, large intracerebral hemorrhage volume, and high CK level were independent risk factors for adverse cardiac events in elderly patients with hypertensive intracerebral hemorrhage (p < 0.05). The NIHSS scores of both groups gradually increased after admission, peaking at 48 h after admission. In Group A, this elevation persisted until 72 h after admission, while in Group B, there was a significant decrease at 72 h after admission (p < 0.05). From admission to 7 days after admission, the NIHSS scores in Group A were higher than those in Group B (p < 0.05). The area under the curve (AUC) of the NIHSS scores at 48 h after admission was 0.776, with sensitivity and specificity of 80.9% and 84.5%, respectively, which were higher than those of other indicators (p < 0.05). CONCLUSION The occurrence of adverse cardiac events in elderly patients with hypertensive intracerebral hemorrhage is influenced by multiple factors, and as the NIHSS score increases, the risk of such events gradually increases. Clinicians should pay attention to monitoring NIHSS scores after admission, as they have value in predicting adverse cardiac events in elderly patients with hypertensive intracerebral hemorrhage.
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Affiliation(s)
- Ying Hou
- Department of Electrocardiography, Affiliated People's Hospital of Shandong First Medical University, Jinan, Shandong, China
| | - Yunfeng Sang
- Emergency Department, Affiliated People's Hospital of Shandong First Medical University, Jinan, Shandong Province, China
| | - Min Ma
- Emergency Department, Affiliated People's Hospital of Shandong First Medical University, Jinan, Shandong Province, China
| | - Kun Yang
- Emergency Department, Affiliated People's Hospital of Shandong First Medical University, Jinan, Shandong Province, China
| | - Fengyong Yang
- Department of Critical Care Medicine, Affiliated People's Hospital of Shandong First Medical University, China
| | - Guangchen Wei
- Department of Critical Care Medicine, Affiliated People's Hospital of Shandong First Medical University, China
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Zhang L, Shen T, Zhou Y, Xie X, Wang J, Gao H. Multidisciplinary management based on clinical nursing pathway model for the treatment of hypertensive intracerebral hemorrhage: A randomized controlled trial. Medicine (Baltimore) 2024; 103:e37644. [PMID: 38517993 PMCID: PMC10956948 DOI: 10.1097/md.0000000000037644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 02/23/2024] [Indexed: 03/24/2024] Open
Abstract
OBJECTIVE To explore the effectiveness of multidisciplinary management based on a clinical nursing pathway model for the treatment of hypertensive intracerebral hemorrhage (HICH). METHODS A total of 124 patients with HICH admitted to our hospital between February 2021 and June 2023 were selected as research subjects in this randomized, controlled, unblinded study. They were divided into Control-group and Study-group using a random number table method, with 62 cases in each group. The Control-group received routine care and the Study-group adopted a multidisciplinary management approach based on the clinical nursing pathway model. A multidisciplinary intervention group including 1 attending physician, 1 psychotherapist, 1 nutritionist, 1 rehabilitation specialist, and 4 responsible nurses was constructed. From preoperative to postoperative day, patients were provided with psychological intervention, health education, respiratory tract management, and specific care for patients who were restless. One to 3 days after operation, the patients and their family members were guided in basic postoperative care and nutrition care. From the 4th day after surgery to the 1st day before discharge, patients were guided for rehabilitation exercises. Patients also received discharge advices upon discharge. Activities of daily living, neurological function, stress response indicators, incidence of complications, and nursing satisfaction before and after the intervention were compared between the 2 groups. RESULTS After the intervention, the activities of daily living and neurological function of the 2 groups were significantly improved compared to before the intervention, and the Study-group was significantly higher than the Control-group (P < .05). After intervention, the levels of stress response indicators in both groups significantly decreased compared to before the intervention, and the Study-group was significantly lower than the Control-group (P < .05). The incidence of complications in the Study-group (3.23%) was lower than that in the Control-group (15.00%) (P < .05). Nursing satisfaction in the Study-group (95.16%) was higher than that in the Control-group (83.33%) (P < .05). CONCLUSIONS Our findings indicate that adopting a multidisciplinary management approach based on clinical nursing pathways to intervene in patients with HICH can reduce stress response levels, reduce the risk of complications, and facilitate the recovery of neurological function and activities of daily living with high patient satisfaction.
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Affiliation(s)
- Lan Zhang
- Department of Neurosurgery Ward 3, Xingtai Third Hospital, Xingtai Cardiovascular Disease Hospital, Xingtai City, Hebei Province, China
| | - Tingting Shen
- Department of Neurosurgery Ward 3, Xingtai Third Hospital, Xingtai Cardiovascular Disease Hospital, Xingtai City, Hebei Province, China
| | - Yan Zhou
- Department of Neurosurgery Ward 3, Xingtai Third Hospital, Xingtai Cardiovascular Disease Hospital, Xingtai City, Hebei Province, China
| | - Xing Xie
- Department of Neurosurgery Ward 3, Xingtai Third Hospital, Xingtai Cardiovascular Disease Hospital, Xingtai City, Hebei Province, China
| | - Jing Wang
- Department of Neurosurgery Ward 3, Xingtai Third Hospital, Xingtai Cardiovascular Disease Hospital, Xingtai City, Hebei Province, China
| | - Haixiao Gao
- Department of Neurosurgery Ward 3, Xingtai Third Hospital, Xingtai Cardiovascular Disease Hospital, Xingtai City, Hebei Province, China
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Liu YT, Lei CY, Zhong LM. Research Advancements on the Correlation Between Spontaneous Intracerebral Hemorrhage of Different Etiologies and Imaging Markers of Cerebral Small Vessel Disease. Neuropsychiatr Dis Treat 2024; 20:307-316. [PMID: 38405425 PMCID: PMC10893791 DOI: 10.2147/ndt.s442334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 01/24/2024] [Indexed: 02/27/2024] Open
Abstract
Objective The purpose of this review is to identify the correlation between ICH and CSVD imaging markers under SMASH-U classification by searching and analyzing a large number of literatures in recent years, laying a theoretical foundation for future clinical research. At the same time, by collecting clinical data to evaluate patient prognosis, analyzing whether there are differences or supplements between clinical trial conclusions and previous theories, and ultimately guiding clinical diagnosis and treatment through the analysis of imaging biomarkers. Methods In this review, by searching CNKI, Web of Science, PubMed, FMRS and other databases, the use of "spontaneous intracerebral hemorrhage", "hypertensive hemorrhagic cerebral small vessel disease", "cerebral small vessel disease imaging", "Based cerebral small vessel diseases", "SMASH the -u classification" and their Chinese equivalents for the main search term. We focused on reading and analyzing hundreds of relevant literatures in the last decade from August 2011 to April 2020, and also included some earlier literatures with conceptual data sources. After screening and ranking the degree of relevance to this study, sixty of them were cited for analysis and elaboration. Results In patients with ICH, the number of cerebral microbleeds in lobes, basal ganglia, and the deep brain is positively correlated with ICH volume and independently correlated with neurological functional outcomes; white matter hyperintensity severity is positively correlated with ICH recurrence risk; multiple lacunar infarction independently predict the risk of ICH; severe brain atrophy is an independent risk factor for a poor prognosis in the long term in patients diagnosed with ICH; and the number of enlarged perivascular spaces is correlated with ICH recurrence. However, small subcortical infarct and ICH are the subject of few studies. Higher CSVD scores are independently associated with functional outcomes at 90 days in patients diagnosed with ICH.
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Affiliation(s)
- Yu-Tong Liu
- Department of Neurology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, People’s Republic of China
| | - Chun-Yan Lei
- Department of Neurology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, People’s Republic of China
| | - Lian-Mei Zhong
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, People’s Republic of China
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Wang S, Su F, Zhou X, Liu L, Zhang R, Xue Z. Comparison of therapeutic effects of endoscopic assisted different surgical approaches in hypertensive intracerebral hemorrhage: A retrospective cohort study. Medicine (Baltimore) 2024; 103:e37211. [PMID: 38335374 PMCID: PMC10860973 DOI: 10.1097/md.0000000000037211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/12/2024] [Accepted: 01/18/2024] [Indexed: 02/12/2024] Open
Abstract
We aimed to explore the therapeutic effects of endoscopically assisted surgical approaches for HICH. In this retrospective cohort study, we retrospectively analyzed the treatment status of 118 patients with HICH who underwent surgery for hematoma removal. Among them, 61 patients underwent endoscopically assisted hematoma removal surgery through the frontal lobe approach (frontal lobe group); 57 patients underwent endoscopic hematoma assisted via the temporal lobe approach (temporal lobe group). Treatment effects, cerebral hemodynamic status before and after treatment, postoperative prognosis at one month, and incidence of complications were compared between the 2 groups. We found that the total effective treatment rate in the frontal lobe group was higher than that in the temporal lobe group (P < .05). After surgery, the R during the contraction period of the common cerebral artery in both groups decreased compared to that before surgery, and the frontal lobe group was significantly lower than the temporal lobe group; the V and Q were higher than those before surgery, and the frontal lobe group was significantly higher than the temporal lobe group (P < .05). The prognosis of the frontal lobe group was better than that of the temporal lobe group (P < .05). Compared to the endoscopic-assisted temporal approach, the endoscopic-assisted frontal lobe approach for the treatment of HICH can improve cerebral hemodynamic status, enhance treatment efficacy, and improve prognosis.
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Affiliation(s)
- Song Wang
- Department of Neurosurgery, Xingtai Third Hospital, Xingtai City, China
| | - Fei Su
- Department of Neurosurgery, Xingtai Third Hospital, Xingtai City, China
| | - Xiguang Zhou
- Department of Neurosurgery, Xingtai Third Hospital, Xingtai City, China
| | - Long Liu
- Department of Neurosurgery, Xingtai Third Hospital, Xingtai City, China
| | - Ruishan Zhang
- Department of Neurosurgery, Xingtai Third Hospital, Xingtai City, China
| | - Zhensheng Xue
- Department of Neurosurgery, Xingtai Third Hospital, Xingtai City, China
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Li W, Li SG, Li L, Yang LJ, Li ZS, Li X, Ye AY, Xiong Y, Zhang Y, Xiong YY. Soyasaponin I alleviates hypertensive intracerebral hemorrhage by inhibiting the renin-angiotensin-aldosterone system. Clin Exp Hypertens 2023; 45:2177667. [PMID: 36809885 DOI: 10.1080/10641963.2023.2177667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
BACKGROUND Hypertensive intracerebral hemorrhage (HICH) is a life-threatening disease and lacks effective treatments. Previous studies have confirmed that metabolic profiles altered after ischemic stroke, but how brain metabolism changes after HICH was unclear. This study aimed to explore the metabolic profiles after HICH and the therapeutic effects of soyasaponin I on HICH. METHODS HICH model was established first. Hematoxylin and eosin staining was used to estimate the pathological changes after HICH. Western blot and Evans blue extravasation assay were applied to determine the integrity of the blood-brain barrier (BBB). Enzyme-linked immunosorbent assay was used to detect the activation of the renin-angiotensin-aldosterone system (RAAS). Next, liquid chromatography-mass spectrometry-untargeted metabolomics was utilized to analyze the metabolic profiles of brain tissues after HICH. Finally, soyasaponin I was administered to HICH rats, and the severity of HICH and activation of the RAAS were further assessed. RESULTS We successfully constructed HICH model. HICH significantly impaired BBB integrity and activated RAAS. HICH increased PE(14:0/24:1(15Z)), arachidonoyl serinol, PS(18:0/22:6(4Z, 7Z, 10Z, 13Z, 16Z, and 19Z)), PS(20:1(11Z)/20:5(5Z, 8Z, 11Z, 14Z, and 17Z)), glucose 1-phosphate, etc., in the brain, whereas decreased creatine, tripamide, D-N-(carboxyacetyl)alanine, N-acetylaspartate, N-acetylaspartylglutamic acid, and so on in the hemorrhagic hemisphere. Cerebral soyasaponin I was found to be downregulated after HICH and supplementation of soyasaponin I inactivated the RAAS and alleviated HICH. CONCLUSION The metabolic profiles of the brains changed after HICH. Soyasaponin I alleviated HICH via inhibiting the RAAS and may serve as an effective drug for the treatment of HICH in the future.
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Affiliation(s)
- Wei Li
- Department of Neurosurgery, The Affiliated Changsha Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Shao-Guang Li
- Department of Neurosurgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Lan Li
- Department of Neurosurgery, The Affiliated Changsha Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Li-Jian Yang
- Department of Neurosurgery, The Affiliated Changsha Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Zeng-Shi Li
- Department of Neurosurgery, The Affiliated Changsha Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Xi Li
- Department of Neurosurgery, The Affiliated Changsha Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - An-Yuan Ye
- Department of Neurosurgery, People's Hospital of Yiyang, Yiyang, China
| | - Yang Xiong
- Department of Comprehensive Intervention, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yi Zhang
- Department of Neurology, People's Hospital of Wuning County, Wuning, China
| | - Yuan-Yuan Xiong
- Department of Neurosurgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
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Lv K, Wang Y, Chao H, Cao S, Cao W. Comparison of the Efficacy of Subosseous Window Neuro-Endoscopy and Minimally Invasive Craniotomy in the Treatment of Basal Ganglia Hypertensive Intracerebral Hemorrhage. J Craniofac Surg 2023; 34:e724-e728. [PMID: 37271862 PMCID: PMC10597438 DOI: 10.1097/scs.0000000000009461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 04/17/2023] [Indexed: 06/06/2023] Open
Abstract
OBJECTIVE To compare the perioperative indexes and long-term effects of craniotomy and neuro-endoscopic hematoma removal in patients with hypertensive intracerebral hemorrhage (HICH) in the basal ganglia region. METHODS This study involved 128 patients with HICH in the basal ganglia region who were admitted to our hospital from February 2020 to June 2022. They were divided into 2 groups according to the random number table method. The craniotomy group (n = 70) underwent microsurgery with small bone window craniotomy with a side cleft, and the neuro-endoscopy group (n = 58) underwent small bone window neuro-endoscopic surgery. A 3-dimensional Slicer was used to calculate the hematoma volume and clearance rate and the postoperative brain tissue edema volume. The operation time, intraoperative blood loss, postoperative intracranial pressure, complications, mortality, and improvement in the modified Rankin scale score at 6 months postoperatively were compared between the two groups. RESULTS The clearance rate was significantly higher in the neuro-endoscopy group than in the craniotomy group (94.16% ± 1.86% versus 90.87% ± 1.89%, P < 0.0001). The operation time was significantly lower in the neuro-endoscopy group than in the craniotomy group (89.9 ± 11.7 versus 203.7 ± 57.6 min, P < 0.0001). Intraoperative blood loss was significantly higher in the craniotomy group (248.31 ± 94.65 versus 78.66 ± 28.96 mL, P < 0.0001). The postoperative length of stay in the intensive care unit was 12.6 days in the neuro-endoscopy group and 14.0 days in the craniotomy group with no significant difference ( P = 0.196). Intracranial pressure monitoring showed no significant difference between the two groups on postoperative days 1 and 7. Intracranial pressure was significantly higher in the craniotomy group than in the neuro-endoscopy group on postoperative day 3 (15.1 ± 6.8 versus 12.5 ± 6.8 mm Hg, P = 0.029). There was no significant difference in the mortality or outcome rate at 6 months postoperatively between the two groups. CONCLUSIONS In patients with HICH in the basal ganglia region, neuro-endoscopy can significantly improve the hematoma clearance rate, reduce intraoperative hemorrhage and postoperative cerebral tissue edema, and improve surgical efficiency. However, the long-term prognosis of patients who undergo craniotomy through the lateral fissure is similar to that of patients who undergo neuro-endoscopic surgery.
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Katano H, Nishikawa Y, Uchida M, Yamanaka T, Hayashi Y, Yamada S, Tanikawa M, Yamada K, Mase M. Secular trends and features of thalamic hemorrhages compared with other hypertensive intracerebral hemorrhages: an 18-year single-center retrospective assessment. Front Neurol 2023; 14:1205091. [PMID: 37649871 PMCID: PMC10464616 DOI: 10.3389/fneur.2023.1205091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 07/28/2023] [Indexed: 09/01/2023] Open
Abstract
Introduction Trends regarding the locations of hypertensive cerebral hemorrhages are unclear. To clarify hypertensive hemorrhage trends, we investigated intracerebral hemorrhages (ICHs) over an 18-year period, focusing on thalamic hemorrhages compared with other sites of hemorrhages. Methods We reviewed the cases of patients hospitalized for hypertensive ICH in 2004-2021 at our hospital; 1,320 eligible patients were registered with a primary ICH/intraventricular hemorrhage. After exclusion criteria were applied, we retrospectively analyzed 1,026 hypertensive ICH cases. Results The proportions of thalamic and subcortical hemorrhages increased over the 18-year period, whereas putaminal hemorrhage decreased. Multivariate logistic regression analyses revealed that for thalamic hemorrhage, ≥200 mmHg systolic blood pressure (p = 0.031), bleeding <15 mL (p = 0.001), and higher modified Rankin scale (mRS) score ≥ 4 at discharge (p = 0.006) were significant variables in the late period (2013-2021) versus the early period (2004-2012), whereas for putaminal hemorrhage, significant factors in the late period were triglyceride <150 mg/dL (p = 0.006) and mRS score ≥ 4 at discharge (p = 0.002). Among the features of the thalamic hemorrhages in the late period revealed by our group comparison with the putaminal and subcortical hemorrhages, the total and subcortical microbleeds were more notable in the thalamic hemorrhages than in the other two types of hemorrhage, whereas cerebellar microbleeds were more prominent when compared only with subcortical hemorrhages. Discussion Our findings revealed an increasing trend for thalamic hypertensive hemorrhage and a decreasing trend for putaminal hemorrhage. The thalamic hemorrhage increase was observed in both young and older patients, regardless of gender. The main features of thalamic hemorrhage in the late period versus the early period were decrease in larger hemorrhage (≥15 mL) and an increase in cases with higher systolic blood pressure (at least partially involved a small number of untreated hypertensive patients who developed major bleeding). The total and subcortical microbleeds were more notable in the thalamic hemorrhages of the late period than in the putaminal and subcortical hemorrhages. These results may contribute to a better understanding of the recent trends of hypertensive ICHs and may help guide their appropriate treatments for this condition.
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Affiliation(s)
- Hiroyuki Katano
- Department of Neurosurgery, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
- Department of Medical Informatics and Integrative Medicine, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | - Yusuke Nishikawa
- Department of Neurosurgery, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | - Mitsuru Uchida
- Department of Neurosurgery, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | - Tomoyasu Yamanaka
- Department of Neurosurgery, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | - Yuki Hayashi
- Department of Neurosurgery, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | - Shigeki Yamada
- Department of Neurosurgery, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | - Motoki Tanikawa
- Department of Neurosurgery, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | - Kazuo Yamada
- Nagoya City Rehabilitation Center Hospital, Nagoya, Japan
| | - Mitsuhito Mase
- Department of Neurosurgery, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
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Zhao H, Zhang T, Li M, Gao Y, Wang S, Jiang R, Li Z. Three-dimensional laser combined with C-arm computed tomography-assisted puncture of intracerebral hemorrhage. Front Endocrinol (Lausanne) 2023; 14:1198564. [PMID: 37448466 PMCID: PMC10338172 DOI: 10.3389/fendo.2023.1198564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 05/18/2023] [Indexed: 07/15/2023] Open
Abstract
Background Intracerebral hemorrhage (ICH) is the deadliest subtype of stroke, with a 30-day case fatality rate of approximately 40%. Timely and accurate treatment is essential to facilitate recovery. The introduction of stereotactic instruments and navigation systems has greatly improved the accuracy of surgical treatment. In this study, we explored the application and effects of a three-dimensional (3D) laser combined with C-arm computed tomography (CT) on ICH puncture. Materials and methods According to the principle of randomness, 118 patients with ICH were divided into control and experimental groups. The control group was treated with CT-guided puncture, and the experimental group was treated with 3D laser combined with C-arm CT puncture. The hematoma clearance rates at 3, 5, and 7 days after surgery and the prognosis at 1, 3, and 6 months after surgery were compared between the two groups. Results The hematoma clearance rates of the group using 3D laser combined with C-arm CT at 3, 5, and 7 days after surgery were significantly higher than those of the control group, and the difference was statistically significant (p < 0.05). One month postoperatively, the daily living ability (ADL) grading and recovery of the patients in the test group was significantly better than those of the control group (p < 0.05), but there was no statistically significant difference in ADL 3 and 6 months after surgery (p > 0.05). Conclusion 3D laser combined with C-arm CT puncture has the advantages of real-time guidance, accurate positioning, and simple operation. It is an effective minimally invasive surgical method that is easy to master.
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Affiliation(s)
- Hongwei Zhao
- Tianjin Medical University, Tianjin, China
- Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, China
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Tao Zhang
- Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, China
| | - Min Li
- Department of Ultrasound Medicine, Binzhou Medical University Hospital, Binzhou, China
| | - Yang Gao
- Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, China
| | - Shuangquan Wang
- Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, China
| | - Rongcai Jiang
- Tianjin Medical University, Tianjin, China
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Tianjin Medical University General Hospital, Ministry of Education, Tianjin, China
| | - Zefu Li
- Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, China
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Zhang P, Zhang Y. Association of Homocysteine with Acute Stroke and Its Subtypes in the Chinese Population. Neuropsychiatr Dis Treat 2023; 19:1435-1442. [PMID: 37342757 PMCID: PMC10278861 DOI: 10.2147/ndt.s409591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 06/09/2023] [Indexed: 06/23/2023] Open
Abstract
Purpose Homocysteine (Hcy) is recognized as a risk factor for stroke. Our study examined the relationship between plasma Hcy levels and stroke, along with its subtypes, among Chinese patients who experienced an acute stroke episode. Patients and Methods We retrospectively enrolled patients with acute stroke and age- and sex-matched healthy controls admitted to the First Affiliated Hospital of Xi'an Jiaotong University from October 2021 to September 2022. Ischemic stroke subtypes were classified using the modified TOAST criteria. Multivariate logistic regression models were employed to probe the associations of plasma Hcy levels with total stroke, ischemic stroke and its subtypes, and hypertensive intracerebral hemorrhage (HICH), and the correlation between plasma Hcy levels and the National Institute of Health Stroke Scale (NIHSS). Results The mean age of the total group was 63 years, with women representing 30.6% (246 individuals). Elevated Hcy levels were significantly associated with total stroke (OR 1.054, 95% CI: 1.038-1.070), HICH (OR 1.040, 95% CI: 1.020-1.060), ischemic stroke (OR 1.049, 95% CI: 1.034-1.065), and the TOAST subtypes of ischemic stroke in large-artery atherosclerosis (LAA) (OR 1.044, 95% CI: 1.028-1.062) and small-artery occlusion (SAO) (OR 1.035, 95% CI: 1.018-1.052), but not with cardioembolic (CE) stroke. Moreover, only in the case of SAO stroke were the Hcy levels positively correlated with the NIHSS score (B=0.030, 95% CI: 0.003-0.056, P=0.030). Conclusion Plasma Hcy levels were found to be positively correlated with the risk of stroke, particularly in the context of LAA, SAO stroke, and HICH. Additionally, Hcy levels demonstrated a positive correlation with stroke severity in patients presenting with SAO stroke. These findings suggest potential clinical implications in stroke prevention, particularly for ischemic stroke (LAA, SAO subtypes) and HICH by employing homocysteine-lowering therapies. Future investigations are warranted to fully elucidate these associations.
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Affiliation(s)
- Panpan Zhang
- Department of Neurology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Yurong Zhang
- Department of Neurology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
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Jiang A, Wu W, Ma L, Yan M, Zhao Z, Chen Q. Effect of electroacupuncture on the treatment of pneumonia in patients with hypertensive intracerebral hemorrhage. World Neurosurg 2023:S1878-8750(23)00562-4. [PMID: 37094709 DOI: 10.1016/j.wneu.2023.04.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 04/26/2023]
Abstract
AIM Pneumonia is a serious postoperative complication of hypertensive intracerebral hemorrhage (HICH), and there is no specific treatment for pneumonia. In this study, we conducted randomized controlled trials to evaluate the effects of electroacupuncture (EA) on the treatment of pneumonia in HICH patients. METHODS An equal number of HICH patients complicated with pneumonia (n = 80 in total) were randomly placed in either the EA group (EA treatment and routine basic treatment) or the control group (routine basic treatment). After 14 days of treatment, clinical symptoms and signs, blood oxygen saturation (SpO2), the level of inflammatory factors, the effective rate, the scores of the Barthel Index (BI), National Institutes of Health Stroke Scale (NIHSS), and Glasgow Coma Scale (GCS), the hospitalization time, and expenses were compared between the groups. RESULTS The general information of the patients in the Ctrl and EA groups were similar. After 14 days of intervention, the patients in the EA group showed better symptom and sign scores, SpO2 levels, BI scores, GCS scores, and NIHSS scores than the patients in the Ctrl group. Furthermore, the EA treatment also lowered the levels of inflammatory factors and white blood cell count. Additionally, the patients in the EA group showed higher effective rates than those in the control group. CONCLUSION Electroacupuncture benefits the treatment of pneumonia in HICH patients.
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Affiliation(s)
- Aiyu Jiang
- Department of Mental Health, Zhejiang Hospital, Hangzhou 310013, Zhejiang, China
| | - Wanzhen Wu
- Department of Mental Health, Zhejiang Hospital, Hangzhou 310013, Zhejiang, China
| | - Liling Ma
- Department of Mental Health, Zhejiang Hospital, Hangzhou 310013, Zhejiang, China
| | - Miaofang Yan
- Department of Nursing of Cardiovascular, Zhejiang Hospital, Hangzhou 310013, Zhejiang, China
| | - Zhulin Zhao
- Department of Mental Health, Zhejiang Hospital, Hangzhou 310013, Zhejiang, China
| | - Qinping Chen
- Department of Neurology, Zhejiang Hospital, Hangzhou 310013, Zhejiang, China;.
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Kobayashi H, Ogura T, Kowata K, Nakajima M, Ohmori S, Kurita H. Deep Ganglionic Intracerebral Hemorrhage Due to Cavernous Malformation Mimicking Hypertensive Hemorrhage: A Report of Two Cases. Cureus 2023; 15:e36448. [PMID: 37090334 PMCID: PMC10116365 DOI: 10.7759/cureus.36448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2023] [Indexed: 04/25/2023] Open
Abstract
Cavernous malformation (CM) is a type of vascular malformation that is an important cause of intracerebral hemorrhage. However, because CM is a low-flow vascular malformation, the occurrence of major hemorrhage is rare. We present two patients with deep ganglionic intracerebral hemorrhage that caused a significant mass effect, mimicking hypertensive hemorrhage. In both cases, we performed evacuation of the hematoma as a lifesaving treatment and made a pathological diagnosis of CM. In conclusion, preoperative diagnosis of CM using any kind of radiological evaluation is difficult, especially in patients with major hemorrhage. The possibility of CM should be remembered in cases with deep ganglionic intracerebral hemorrhage.
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Affiliation(s)
- Hiroki Kobayashi
- Department of Neurosurgery, International Medical Center, Saitama Medical University, Saitama, JPN
| | - Takeshi Ogura
- Department of Neurosurgery, Kurosawa Hospital, Gunma, JPN
| | - Kazuma Kowata
- Department of Neurosurgery, Kurosawa Hospital, Gunma, JPN
| | - Mayu Nakajima
- Department of Neurosurgery, Kurosawa Hospital, Gunma, JPN
| | | | - Hiroki Kurita
- Department of Neurosurgery, International Medical Center, Saitama Medical University, Saitama, JPN
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12
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Wang J, Zhou L, Chen Y, Zhou H, Tan Y, Zhong W, Zhou Z. Prediction of short-term prognosis of patients with hypertensive intracerebral hemorrhage by radiomic-clinical nomogram. Front Neurol 2023; 14:1053846. [PMID: 36816560 PMCID: PMC9935706 DOI: 10.3389/fneur.2023.1053846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 01/10/2023] [Indexed: 02/05/2023] Open
Abstract
Hypertensive intracerebral hemorrhage (HICH) is the most common type of spontaneous intracerebral hemorrhage in China which is associated with high mortality and disability. We sought to develop and validate a noncontrast computed tomography (NCCT)-based nomogram model to achieve short-term prognostic prediction for patients with HICH. We retrospectively studied 292 patients with HICH from two medical centers, and they were divided into training (n = 151), validation (n = 66), and testing cohorts (n = 75). Based on radiomics, univariate and multivariate, and logistic regression analyses, four models (black hole sign, clinical, radiomics score, and combined models) were established to predict the prognosis of patients with HICH 30 days after the onset. The results suggested that the combined model had the best predictive performance with the area under the receiver operating characteristic curve (AUC) of 0.821, 0.816, and 0.815 in the training, validation, and testing cohorts, respectively. In addition, a radiomics-clinical (R-C) nomogram was visualized. A calibration curve analysis showed that the R-C nomogram had satisfactory calibration in the three cohorts. A decision curve analysis demonstrated that the R-C nomogram was clinically valuable. Our results suggest that the R-C nomogram can accurately and reliably predict the short-term prognosis of patients with HICH and provide a useful evaluation for making individualized treatment plans.
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Affiliation(s)
- Jing Wang
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lu Zhou
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China,Department of Radiology, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuanyuan Chen
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hongli Zhou
- Department of Radiology, Nanchong Central Hospital, Nanchong, Sichuan, China
| | - Yuanxin Tan
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Weijia Zhong
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China,*Correspondence: Weijia Zhong ✉ ; ✉
| | - Zhiming Zhou
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China,Zhiming Zhou ✉
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13
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Yuan Z, Wang Q, Sun Q, Li C, Xiong F, Li Z. Hypertensive intracerebral hemorrhage: Which one should we choose between laser navigation and 3D navigation mold? Front Surg 2023; 10:1040469. [PMID: 36911606 PMCID: PMC10001900 DOI: 10.3389/fsurg.2023.1040469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 01/17/2023] [Indexed: 03/14/2023] Open
Abstract
Background Hypertensive intracerebral hemorrhage (HICH) is a severe life-threatening disease, and its incidence has gradually increased in recent years. Due to the particularity and diversity of its bleeding sites, the early treatment of hematoma needs to be more meticulous and accurate, and minimally invasive surgery is often one of the measures that are commonly adopted now. The lower hematoma debridement and the navigation template created by 3D printing technology were compared in the external drainage of a hypertensive cerebral hemorrhage. Then the effect and feasibility of the two operations were explicitly evaluated. Material and methods We performed a retrospective analysis of all eligible patients with HICH who underwent laser-guided hematoma evacuation or hematoma puncture under 3D-navigated molds at the Affiliated Hospital of Binzhou Medical University from January 2019 to January 2021. A total of 43 patients were treated. Twenty-three patients were treated with laser navigation-guided hematoma evacuation (group A); 20 patients were treated with 3D navigation minimally invasive surgery (group B). A comparative study was conducted between the two groups to evaluate the preoperative and postoperative conditions. Results The preoperative preparation time of the laser navigation group was significantly shorter than that of the 3D printing group. The operation time of the 3D printing group was better than that of the laser navigation group (0.73 ± 0.26 h vs. 1.03 ± 0.27 h P = 0.00070). In the improvement in the short-term postoperatively, there was no statistically significant difference between the laser navigation group and the 3D printing group (Median hematoma evacuation rate P = 0.14); And in the three-month follow-up NIHESS score, there was no significant difference between the two (P = 0.82). Conclusion Laser-guided hematoma removal is more suitable for emergency operations, with real-time navigation and shortened preoperative preparation time; hematoma puncture under a 3D navigation mold is more personalized and shortens the intraoperative time course. There was no significant difference in therapeutic effect between the two groups.
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Affiliation(s)
- Zhengbo Yuan
- Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, China
| | - Qingbo Wang
- Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, China.,Department of Neurosurgery, Qilu Hospital of Shandong University, Jinan, China
| | - Qikai Sun
- Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, China
| | - Chenglong Li
- Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, China
| | - Fengzhen Xiong
- Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, China
| | - Zefu Li
- Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, China
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14
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Zhou Y, Dong W, Wang L, Ren S, Wei W, Wu G. Lower serum cystatin C level predicts poor functional outcome in patients with hypertensive intracerebral hemorrhage independent of renal function. J Clin Hypertens (Greenwich) 2022; 25:86-94. [PMID: 36545837 PMCID: PMC9832235 DOI: 10.1111/jch.14609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 11/19/2022] [Accepted: 11/22/2022] [Indexed: 12/24/2022]
Abstract
We explored the association between the serum level of cystatin C (CysC) at admission and short-term functional outcome in patients with hypertensive intracerebral hemorrhage (HICH) without chronic kidney disease (CKD). A total of 555 patients with HICH were consecutively recruited after admission and were followed-up for 3 months after admission. The primary outcome was poor functional outcome (modified Rankin Scale [mRS] score ≥ 3). The median serum CysC level in our cohort was 1.03 mg/L (interquartile range, .89-1.20). Patients were categorized into four groups according to the serum CysC quartiles. Multivariate logistic regression analysis revealed a negative association between serum CysC and poor functional outcome at 3-month follow-up (quartile [Q]1 vs. Q4: adjusted odds ratio [OR] = .260, 95% confidence interval [CI] = .098, .691, p < .001). The negative association between serum CysC and poor functional outcome at 3 months was more pronounced in subgroups with smaller hematoma volume (≤ 30 mL), and absence of secondary intraventricular hemorrhage (IVH). Addition of serum CysC to a model containing conventional risk factors improved the model performance with net reclassification index (NRI) of .426% (p < .001) and integrated discrimination improvement (IDI) of .043% (p < .001) for poor functional outcome. Serum CysC was found to be a negative predictor of poor short-term functional outcome in HICH patients independent of renal function.
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Affiliation(s)
- Yongfang Zhou
- Second Affiliated Hospital of Soochow UniversitySuzhouChina,Department of EmergencyAffiliated Hospital of Guizhou Medical UniversityGuiyangChina
| | - Wentao Dong
- Department of EmergencyAffiliated Hospital of Guizhou Medical UniversityGuiyangChina
| | - Likun Wang
- Department of EmergencyAffiliated Hospital of Guizhou Medical UniversityGuiyangChina
| | - Siying Ren
- Department of EmergencyAffiliated Hospital of Guizhou Medical UniversityGuiyangChina
| | - Weiqing Wei
- Department of EmergencyAffiliated Hospital of Guizhou Medical UniversityGuiyangChina
| | - Guofeng Wu
- Second Affiliated Hospital of Soochow UniversitySuzhouChina,Department of EmergencyAffiliated Hospital of Guizhou Medical UniversityGuiyangChina
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15
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Ren P, Cao L, Zhao XK, Zhu BB, Liu K. [Network Meta-analysis of Chinese medicine injections in treatment of hypertensive intracerebral hemorrhage]. Zhongguo Zhong Yao Za Zhi 2022; 47:3637-3647. [PMID: 35850818 DOI: 10.19540/j.cnki.cjcmm.20220214.501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
To systematically evaluate the efficacy and safety of Chinese medicine injections in the treatment of hypertensive intracerebral hemorrhage, we collected the relevant randomized controlled trials(RCTs) by computer retrieval from PubMed, EMbase, Cochrane Library, Web of Science, Wanfang, CNKI, VIP, and CBM within the timespan from inception to December 30, 2021. The obtained index data were analyzed by RevMan 5.3 and Stata 15.0. Finally, 63 RCTs were selected for analysis, involving 5 953 patients. The experimental groups involved 9 Chinese medicine injections, including Danshen Injection, Danhong Injection, Sodium Aescinate Injection, Qingkailing Injection, Compound Shexiang Injection, Shuxuening Injection, Yinxing Damo Injection, Ginkgolide Injection, and Xingnaojing Injection. The network Meta-analysis showcased the following trends.(1)The surface under the cumulative ranking curve(SUCRA) in improving neurological function ranked in the order of surgical operation+conventional treatment of western medicine combined with Danhong Injection>combined with Xingnaojing Injection>combined with Ginkgolide Injection>combined with Compound Shexiang Injection>combined with Danshen Injection>combined with Sodium Aescinate Injection>combined with Qingkailing Injection>combined with Shuxuening Injection>combined with Yinxing Damo Injection.(2)In terms of National Institutes of Health stroke scale(NIHSS) score, the SUCRA ranked in the order of surgical operation+conventional treatment of western medicine combined with Xingnaojing Injection>combined with Compound Shexiang Injection>combined with Yinxing Damo Injection>combined with Ginkgolide Injection>combined with Danhong Injection>combined with Sodium Aescinate Injection.(3)In terms of Glasgow coma scale(GCS) score, the ranking of SUCRA was surgical operation+conventional treatment of western medicine combined with Yinxing Damo Injection>combined with Qingkailing Injection>combined with Sodium Aescinate Injection>combined with Danhong Injection>combined with Ginkgolide Injection>combined with Xingnaojing Injection.(4)The SUCRA in volume of residual cerebral hematoma ranked in the order of surgical operation+conventional treatment of western medicine combined with Sodium Aescinate Injection>combined with Xingnaojing Injection>combined with Danhong Injection>combined with Ginkgolide Injection>combined with Shuxuening Injection>combined with Compound Shexiang Injection. The experimental group had lower incidence of adverse reactions than the control group. The results of network Meta-analysis suggest that on the basis of surgical operation+conventional treatment of western medicine, the application of Chinese medicine injections can improve the efficacy of treating hypertensive intracerebral hemorrhage. However, in view of the great differences in the quality and number of studies included for different therapies, the SUCRA of Chinese medicine injections need to be further verified with high-quality multi-center, large-sample, randomized double-blind trials.
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Affiliation(s)
- Peng Ren
- Gansu University of Chinese Medicine Lanzhou 730000, China Evidence-based Medical Center, Gansu University of Chinese Medicine Lanzhou 730000, China
| | - Lu Cao
- Gansu University of Chinese Medicine Lanzhou 730000, China Evidence-based Medical Center, Gansu University of Chinese Medicine Lanzhou 730000, China
| | - Xin-Ke Zhao
- Gansu University of Chinese Medicine Lanzhou 730000, China Evidence-based Medical Center, Gansu University of Chinese Medicine Lanzhou 730000, China
| | - Bei-Bei Zhu
- Gansu University of Chinese Medicine Lanzhou 730000, China Evidence-based Medical Center, Gansu University of Chinese Medicine Lanzhou 730000, China
| | - Kai Liu
- Gansu University of Chinese Medicine Lanzhou 730000, China Evidence-based Medical Center, Gansu University of Chinese Medicine Lanzhou 730000, China
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16
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Yang Y, Pan Y, Chen C, Zhao P, Hang C. Clinical Significance of Multiparameter Intracranial Pressure Monitoring in the Prognosis Prediction of Hypertensive Intracerebral Hemorrhage. J Clin Med 2022; 11:jcm11030671. [PMID: 35160123 PMCID: PMC8836722 DOI: 10.3390/jcm11030671] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/19/2022] [Accepted: 01/26/2022] [Indexed: 11/23/2022] Open
Abstract
Objective: The present study aimed to investigate the clinical significance of multiparameter intracranial pressure (ICP) monitoring in the prediction of the prognosis of hypertensive intracerebral hemorrhage (HICH). Methods: A retrospective analysis was performed on the clinical data of 53 HICH patients. The patients underwent removal of intracranial hemorrhage and decompressive craniectomy after admission. A ventricular ICP monitoring probe was used to continuously and invasively monitor mean arterial pressure (MAP) and ICP after surgery. The NEUMATIC system was used to collect ICP data, including pressure reactivity index (PRx), ICP dose (DICP), amplitude and pressure regression (RAP), and cerebral perfusion pressure (CPP). The mean PRx, CPP, RAP, ICP, and DICP20 mmHg × h were calculated with 1 h as the time segment. According to the Glasgow outcome scale (GOS) scores after discharge, the patients were grouped into the poor prognosis group (GOS I–III) and the good prognosis group (GOS IV and V). The two groups were compared in terms of GOS scores in the treatment and prediction of prognosis of patients. Results: The good prognosis group showed significantly lower values of mean ICP, DICP20 mmHg × h, RAP, and PRx than the poor prognosis group, while CPP was significantly higher (p < 0.001). Conclusions: PRx, DICP, RAP, and CPP could reflect intracranial changes in patients and were significantly correlated with the prognosis of the patients. Mean ICP, PRx, DICP20 mmHg × h, and RAP were negatively correlated with prognosis, while CPP was positively correlated with prognosis.
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Affiliation(s)
- Yongbo Yang
- Department of Neurosurgery, The Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China; (Y.Y.); (C.C.)
| | - Yuchun Pan
- Department of Neurosurgery, Nanjing Lishui People’s Hospital, Nanjing 211200, China;
| | - Chunlei Chen
- Department of Neurosurgery, The Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China; (Y.Y.); (C.C.)
| | - Penglai Zhao
- Department of Neurosurgery, The Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China; (Y.Y.); (C.C.)
- Correspondence: (P.Z.); (C.H.)
| | - Chunhua Hang
- Department of Neurosurgery, The Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China; (Y.Y.); (C.C.)
- Correspondence: (P.Z.); (C.H.)
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17
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Wu S, Wang H, Wang J, Hu F, Jiang W, Lei T, Shu K. Effect of Robot-Assisted Neuroendoscopic Hematoma Evacuation Combined Intracranial Pressure Monitoring for the Treatment of Hypertensive Intracerebral Hemorrhage. Front Neurol 2021; 12:722924. [PMID: 34925205 PMCID: PMC8674426 DOI: 10.3389/fneur.2021.722924] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 10/26/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: This study aimed to investigate the clinical efficacy of robot-assisted neuroendoscopic hematoma evacuation combined intracranial pressure (ICP) monitoring for the treatment of hypertensive intracerebral hemorrhage (HICH). Patients and Methods: A retrospective analysis of 53 patients with HICH undergoing neuroendoscopic hematoma evacuation in our department from January 2016 to December 2020 was performed. We divided the patients into two groups: the neuroendoscopic group (n = 32) and the robot-assisted neuroendoscopic combined ICP monitoring group (n = 21). Data on clinical characteristics, treatment effects, and outcomes were retrospectively reviewed and analyzed between these two groups. Results: The operation time of the procedure of the neuroendoscopic group was significantly longer than that of the robot-assisted neuroendoscopic combined ICP-monitoring group (mean time 153.8 ± 16.8 vs. 132.8 ± 15.7 min, P < 0.001). The intraoperative blood loss was significantly less in the robot-assisted neuroendoscopic combined ICP-monitoring group than in the neuroendoscopic group (215.4 ± 28.3 vs. 190.1 ± 25.6 ml, P = 0.001). However, the patients undergoing neuroendoscopic had a comparable hematoma clearance rate with those undergoing robot-assisted neuroendoscopic combined ICP monitoring (85.2 ± 4.8 vs. 89.2 ± 5.4%, P = 0.997). The complications rate was greater in the endoscopic group (25%) than in the robot-assisted neuroendoscopic combined ICP-monitoring group (9.5%) but without significant difference (P = 0.159). We also found that the dose of used mannitol was significantly less in the ICP monitoring group (615.2 ± 63.8 vs. 547.8 ± 65.3 ml, P < 0.001) and there was a significant difference in modified Rankin scale (mRS) score at discharge, patients with less mRS score in the robot-assisted neuroendoscopic combined ICP monitoring group than in the neuroendoscopic group (3.0 ± 1.0 vs. 3.8 ± 0.8, p = 0.011). Patients undergoing robot-assisted neuroendoscopic combined ICP monitoring had better 6-month functional outcomes, and there was a significant difference between the two groups (p = 0.004). Besides, multivariable analysis shows younger age, no complication, and robot-assisted neuroendoscopic combined ICP monitoring were predictors of 6-month favorable outcomes for the patients with HICH. Conclusion: Robot-assisted neuroendoscopic hematoma evacuation combined with ICP monitoring appears to be safer and more effective as compared to the neuroendoscopic hematoma evacuation in the treatment of HICH. Robot-assisted neuroendoscopic hematoma evacuation combined with ICP monitoring might improve the clinical effect and treatment outcomes of the patients with HICH.
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Affiliation(s)
- Shiqiang Wu
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Heping Wang
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Junwen Wang
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Feng Hu
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Jiang
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ting Lei
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kai Shu
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Qian TD, Zheng XF, Shi J, Ma T, You WY, Wu JH, Huang BS, Tao Y, Wang X, Song ZW, Li LX. L4-to-L4 nerve root transfer for hindlimb hemiplegia after hypertensive intracerebral hemorrhage. Neural Regen Res 2021; 17:1278-1285. [PMID: 34782572 PMCID: PMC8643034 DOI: 10.4103/1673-5374.327359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
There is no effective treatment for hemiplegia after hypertensive intracerebral hemorrhage. Considering that the branches of L4 nerve roots in the lumbar plexus root control the movement of the lower extremity anterior and posterior muscles, we investigated a potential method of nerve repair using the L4 nerve roots. Rat models of hindlimb hemiplegia after a hypertensive intracerebral hemorrhage were established by injecting autogenous blood into the posterior limb of internal capsule. The L4 nerve root on the healthy side of model rats was transferred and then anastomosed with the L4 nerve root on the affected side to drive the extensor and flexor muscles of the hindlimbs. We investigated whether this method can restore the flexible movement of the hindlimbs of paralyzed rats after hypertensive intracerebral hemorrhage. In a beam-walking test and ladder rung walking task, model rats exhibited an initial high number of slips, but improved in accuracy on the paretic side over time. At 17 weeks after surgery, rats gained approximately 58.2% accuracy from baseline performance and performed ankle motions on the paretic side. At 9 weeks after surgery, a retrograde tracing test showed a large number of fluoro-gold-labeled motoneurons in the left anterior horn of the spinal cord that supports the L4-to-L4 nerve roots. In addition, histological and ultramicrostructural findings showed axon regeneration of motoneurons in the anterior horn of the spinal cord. Electromyography and paw print analysis showed that denervated hindlimb muscles regained reliable innervation and walking coordination improved. These findings suggest that the L4-to-L4 nerve root transfer method for the treatment of hindlimb hemiplegia after hypertensive intracerebral hemorrhage can improve the locomotion of hindlimb major joints, particularly of the distal ankle. Findings from study support that the L4-to-L4 nerve root transfer method can effectively repair the hindlimb hemiplegia after hypertensive intracerebral hemorrhage. All animal experiments were approved by the Animal Ethics Committee of the First Affiliated Hospital of Nanjing Medical University (No. IACUC-1906009) in June 2019.
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Affiliation(s)
- Teng-Da Qian
- Department of Neurosurgery, Jintan Hospital, Affiliated Hospital of Jiangsu Vocational College of Medicine, Jintan, Jiangsu Province, China
| | - Xi-Feng Zheng
- Department of Gastroenterology, Jintan Hospital, Affiliated Hospital of Jiangsu Vocational College of Medicine, Jintan, Jiangsu Province, China
| | - Jing Shi
- Department of Neurosurgery, Changzhou First People's Hospital, Suzhou University, Changzhou, Jiangsu Province, China
| | - Tao Ma
- Department of Neurosurgery, Changzhou First People's Hospital, Suzhou University, Changzhou, Jiangsu Province, China
| | - Wei-Yan You
- Deparment of Neurobiology, Basic Medical College, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Jia-Huan Wu
- Deparment of Neurobiology, Basic Medical College, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Bao-Sheng Huang
- Department of Neurosurgery, Sir Run Run Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Yi Tao
- Department of Neurosurgery, Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Xi Wang
- Department of Neurosurgery, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Ze-Wu Song
- Department of Neurosurgery, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Li-Xin Li
- Department of Neurosurgery, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
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DU WQ, Jia M, Wang M, Zhang XY, Jiao WW, Chen Q, Lei L, Duan JY, Tong CG, Shen W, Liang X, Chen XZ, Wu DH, Zhang YL, Liao X. [Situation analysis of outcome indicators of randomized controlled trials of traditional Chinese medicine in treatment of hypertensive intracerebral hemorrhage in recent three years]. Zhongguo Zhong Yao Za Zhi 2021; 46:4601-4614. [PMID: 34581068 DOI: 10.19540/j.cnki.cjcmm.20210618.501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The study aims to analyze the outcome indicators of randomized controlled trial(RCT) of traditional Chinese medicine(TCM) in the treatment of hypertensive intracerebral hemorrhage(HICH) in recent three years, and thus provide suggestions for the future studies in this field. Four English databases, four Chinese databases and two online registration websites of clinical trials were searched. The RCTs published between January 2018 and September 2020 were screened. The risk of bias was assessed and outcome measures were classified. A total of 151 839 articles were retrieved, of which 44 RCTs were included for analysis after screening. The outcome measures of the included RCTs were classified into 7 categories, among which the symptoms/signs category showed the highest reporting rate. National Institute of Health stroke scale(72.73%) was the most frequently reported outcome indicator, while the vo-lume of intracerebral hemorrhage determined by computerized tomography(36.36%) was the most frequently reported lab test outcome. Most studies collect the outcomes at the end of treatment, while 9 studies reported long-term outcomes 3 months or more after onset. Compared with those of international clinical trials, the application of some of the outcomes was reasonable, focusing on patients' symptoms, quality of life and objective outcomes. However, there were still several problems: unclear primary and secondary outcome measures, insufficient attention to long-term prognosis, insufficient attention to social function, few TCM outcomes, lack of measurement blindness and the use of unreasonable composite outcomes. It is recommended that researchers should rationally design the outcome indicators of clinical trials and develop the core outcome set.
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Affiliation(s)
- Wan-Qing DU
- Graduate School,Beijing University of Chinese Medicine Beijing 100029,China Center for Evidence-based Chinese Medicine,Institute of Basic Research in Clinical Medicine,China Academy of Chinese Medical Sciences Beijing 100700,China Xiyuan Hospital,China Academy of Chinese Medical Sciences Beijing 100091,China
| | - Min Jia
- Xiyuan Hospital,China Academy of Chinese Medical Sciences Beijing 100091,China
| | - Min Wang
- Graduate School,Beijing University of Chinese Medicine Beijing 100029,China
| | - Xin-Yang Zhang
- Graduate School,Beijing University of Chinese Medicine Beijing 100029,China
| | - Wei-Wei Jiao
- Xiyuan Hospital,China Academy of Chinese Medical Sciences Beijing 100091,China
| | - Qian Chen
- Graduate School,Beijing University of Chinese Medicine Beijing 100029,China
| | - Lin Lei
- Graduate School,Beijing University of Chinese Medicine Beijing 100029,China
| | - Jia-Yu Duan
- Graduate School,Beijing University of Chinese Medicine Beijing 100029,China
| | - Chen-Guang Tong
- Xiyuan Hospital,China Academy of Chinese Medical Sciences Beijing 100091,China
| | - Wei Shen
- Xiyuan Hospital,China Academy of Chinese Medical Sciences Beijing 100091,China
| | - Xiao Liang
- Xiyuan Hospital,China Academy of Chinese Medical Sciences Beijing 100091,China
| | - Xin-Zhi Chen
- the First Clinical Hospital of Jilin Academy of Chinese Medical Sciences Changchun 130021,China
| | - Da-Hua Wu
- Affiliated Hospital of Hunan Academy of Traditional Chinese Medicine Changsha 410006,China
| | - Yun-Ling Zhang
- Xiyuan Hospital,China Academy of Chinese Medical Sciences Beijing 100091,China
| | - Xing Liao
- Center for Evidence-based Chinese Medicine,Institute of Basic Research in Clinical Medicine,China Academy of Chinese Medical Sciences Beijing 100700,China
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20
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Wang M, Jia M, Zhang XY, DU WQ, Jiao WW, Chen Q, Lei L, Duan JY, Tong CG, Yang WM, Lyu ZG, Zhang YL, Liao X. [Systematic review and Meta-analysis of efficacy and safety of acupuncture therapy on hypertensive intracerebral hemorrhage]. Zhongguo Zhong Yao Za Zhi 2021; 46:4644-4653. [PMID: 34581072 DOI: 10.19540/j.cnki.cjcmm.20210429.501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
To systematically review the efficacy and safety of acupuncture combined with minimally invasive surgery or basic the-rapy in treating hypertensive intracerebral hemorrhage(HICH) patients compared with minimally invasive surgery or basic treatment. In this study, the four Chinese databases, the four English databases, Chinese Clinical Trial Registry and ClinicalTrail.gov, all above were systematically and comprehensively retrieved from the time of database establishment to September 10, 2020. Rando-mized controlled trials(RCTs) were screened out according to inclusion criteria and exclusion criteria established in advanced. The methodological quality of included studies was evaluated by the tool named "Cochrane bias risk assessment 6.1". Meta-analysis of the included studies was performed using RevMan 5.4, and the quality of outcome indicators was evaluated by the GRADE system. Finally, 17 studies were included, involving 1 852 patients with HICH, and the overall quality of the included studies was not high. According to Meta-analysis,(1)CSS score of the group of acupuncture combined with minimally invasive surgery or basic therapy was superior to the group of minimally invasive surgery or basic therapy(MD=-3.50,95%CI[-4.39,-2.61],P<0.000 01);(2)NIHSS score of the group of acupuncture combined with minimally invasive surgery or basic therapy was superior to the group of minimally invasive surgery or basic therapy(MD=-4.78,95%CI[-5.55,-4.00],P<0.000 01);(3)the cerebral hematoma volume of the group of acupuncture combined with minimally invasive surgery or basic therapy was superior to the group of minimally invasive surgery or basic therapy(MD=-4.44,95%CI[-5.83,-3.04],P<0.000 01);(4)ADL score of the group of acupuncture combined with minimally invasive surgery or basic therapy was superior to the group of minimally invasive surgery or basic therapy(MD=20.81,95%CI[17.25,24.37],P<0.000 01);(5)the GCS score of the group of acupuncture combined with minimally invasive surgery or basic therapy was superior to the group of minimally invasive surgery or basic therapy(MD=2.41,95%CI[1.90,2.91],P<0.000 01). The GRADE system showed an extremely low level of evidence for the above outcome indicators. Adverse reactions were mentioned only in two literatures, with no adverse reactions reported. The available evidence showed that acupuncture combined with minimally invasive surgery or basic therapy had a certain efficacy in patients of HICH compared with minimally invasive surgery or basic therapy. However, due to the high risk of bias in the included studies, its true efficacy needs to be verified by more high-quality studies in the future.
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Affiliation(s)
- Min Wang
- Graduate School,Beijing University of Chinese Medicine Beijing 100029,China Center for Evidence-based Chinese Medicine,Institute of Basic Research in Clinical Medicine,China Academy of Chinese Medical Sciences Beijing 100700,China
| | - Min Jia
- Xiyuan Hospital,China Academy of Chinese Medical Sciences Beijing 100091,China
| | - Xin-Yang Zhang
- Graduate School,Beijing University of Chinese Medicine Beijing 100029,China
| | - Wan-Qing DU
- Graduate School,Beijing University of Chinese Medicine Beijing 100029,China Xiyuan Hospital,China Academy of Chinese Medical Sciences Beijing 100091,China
| | - Wei-Wei Jiao
- Xiyuan Hospital,China Academy of Chinese Medical Sciences Beijing 100091,China
| | - Qian Chen
- Graduate School,Beijing University of Chinese Medicine Beijing 100029,China
| | - Lin Lei
- Graduate School,Beijing University of Chinese Medicine Beijing 100029,China
| | - Jia-Yu Duan
- Graduate School,Beijing University of Chinese Medicine Beijing 100029,China
| | - Chen-Guang Tong
- Xiyuan Hospital,China Academy of Chinese Medical Sciences Beijing 100091,China
| | - Wen-Ming Yang
- the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine Hefei 230031,China
| | - Zhi-Guo Lyu
- the Affiliated Hospital of Changchun University of Chinese Medicine Changchun 130021,China
| | - Yun-Ling Zhang
- Xiyuan Hospital,China Academy of Chinese Medical Sciences Beijing 100091,China
| | - Xing Liao
- Center for Evidence-based Chinese Medicine,Institute of Basic Research in Clinical Medicine,China Academy of Chinese Medical Sciences Beijing 100700,China
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21
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Song H, Men H, Song C, Feng H, Tan H, Zuo S. Low-molecular-weight heparin reduces the formation of lower limb deep venous thrombosis in patients with hypertensive intracerebral hemorrhage. Am J Transl Res 2021; 13:10509-10516. [PMID: 34650721 PMCID: PMC8507008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 06/04/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To demonstrate that low-molecular-weight heparin (LMWH) can reduce the formation of lower limb deep venous thrombosis (DVT) and improve the quality of life (QOL) of patients with hypertensive intracerebral hemorrhage (HICH). METHODS Totally, 98 patients with HICH were selected according to different treatment and intervention schemes. Patients receiving routine intracranial pressure reduction and blood pressure regulation intervention were included in group A (n=46) and those receiving LMWH calcium on the basis of treatment in group A were included in group B (n=52). The total effective rate of patients was compared between the two groups, and the prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen degradation product (FDP), D-dimer, and inflammatory factor levels as well as complications and QOL scores before and after treatment were recorded and compared. RESULTS The FDP and D-dimer showed an increasing trend in both groups after treatment, with the increase being significantly lower in group B than in group A (P<0.001). Serum tumor necrosis factor-α and interleukin-1β levels increased significantly in the two groups after treatment, with the increase being significantly lower in group B than in group A (P<0.05). Complications of pulmonary embolism, DVT, intracranial hemorrhage, and gastrointestinal hemorrhage were better in group B than in group A (P<0.05). In terms of QOL, physical and mental health, material life, and social functioning were significantly higher in patients of group B than for those in group A (P<0.001). CONCLUSIONS The application of LMWH in patients with HICH can reduce the formation of lower limb DVT.
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Affiliation(s)
- He Song
- Department of Neurosurgery, Shijiazhuang People's Hospital Shijiazhuang 050011, Hebei, China
| | - Huanli Men
- Department of Neurosurgery, Shijiazhuang People's Hospital Shijiazhuang 050011, Hebei, China
| | - Chunwang Song
- Department of Neurosurgery, Shijiazhuang People's Hospital Shijiazhuang 050011, Hebei, China
| | - Hongwei Feng
- Department of Neurosurgery, Shijiazhuang People's Hospital Shijiazhuang 050011, Hebei, China
| | - Haopeng Tan
- Department of Neurosurgery, Shijiazhuang People's Hospital Shijiazhuang 050011, Hebei, China
| | - Shuhao Zuo
- Department of Neurosurgery, Shijiazhuang People's Hospital Shijiazhuang 050011, Hebei, China
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22
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Lei L, Jia M, Liao X, Lu Y, Zhang YL, Liang X, Chen Q, Fu GJ. [Network Meta-analysis of oral or nasal feeding with Chinese patent medicine in treatment of hypertensive intracerebral hemorrhage]. Zhongguo Zhong Yao Za Zhi 2021; 46:2995-3006. [PMID: 34467689 DOI: 10.19540/j.cnki.cjcmm.20210326.502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The effect of oral or nasal feeding with Chinese patent medicine on hypertensive intracerebral hemorrhage was systematically evaluated by using the method of network Meta-analysis. Four Chinese databases(CNKI, VIP, Wanfang, CBM), three English databases(Medline, EMbase, Cochrane Library) and ClinicalTrials.gov were retrieved through computers. According to the inclusion criteria and exclusion criteria, randomized controlled trials(RCTs) of Chinese patent medicine combined with Western medicine in the treatment of hypertensive intracerebral hemorrhage were screened out according to the inclusion criteria and exclusion criteria. The Cochrane bias risk assessment tool was used to evaluate the quality of the included studies, and Stata 16.0 software was used to analyze the outcome indicators. A total of 3 888 literatures were retrieved, and 30 studies involving 6 kinds of Chinese patent medicines were finally included. The total sample size was 2 758 cases, including 1 401 cases in the treatment group and 1 357 cases in the control group. According to the results of network Meta-analysis,(1)in terms of improving the degree of nerve function defect, the order of Chinese patent medicines was conventional Western medicine combined with Xiaoyukang Capsules>combined with Tongxinluo Capsules>combined with Naoxuekang Oral Liquid>combined with Naoxueshu Oral Liquid>combined with Angong Niuhuang Pills>conventional Western medicine;(2)in terms of reducing the amount of residual cerebral hematoma, the order of Chinese patent medicines was conventional Western medicine combined with Naoxueshu Oral Liquid>combined Xiaoyukang Capsules>combined Naoxuekang Oral Liquid>conventional Western medicine;(3)in terms of improving ability of daily living, the order of Chinese patent medicines was conventional Western medicine combined with Shenzhi Huoxue Capsules>combined with Angong Niuhuang Pills>combined with Naoxueshu Oral Liquid>conventional Western medicine;(4)in terms of improving total effective rate, the order of Chinese patent medicines was conventional Western medicine combined with Naoxueshu Oral Liquid>combined with Xiaoyukang Capsules>combined with Angong Niuhuang Pills=combined with Naoxuekang Oral Liquid>combined Tongxinluo Capsules>conventional Western medicine treatment. The results showed that in addition to conventional Western medicine therapy, the combined use with Chinese patent medicine can improve the clinical efficacy in the treatment of hypertensive intracerebral hemorrhage. However, due to the differences in the number and quality of various Chinese patent medicines included in the studies, and the lack of direct comparison of Chinese patent medicines, the ranking results still need to be verified by multi center, large-sample-size randomized double-blind trials in the future, so as to provide more reliable evidence support for clinical drug use.
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Affiliation(s)
- Lin Lei
- Graduate School, Beijing University of Chinese Medicine Beijing 100029, China Center for Evidence-based Chinese Medicine, Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences Beijing 100700, China
| | - Min Jia
- Xiyuan Hospital, China Academy of Chinese Medical Sciences Beijing 100091, China
| | - Xing Liao
- Center for Evidence-based Chinese Medicine, Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences Beijing 100700, China
| | - Yan Lu
- Xiyuan Hospital, China Academy of Chinese Medical Sciences Beijing 100091, China
| | - Yun-Ling Zhang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences Beijing 100091, China
| | - Xiao Liang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences Beijing 100091, China
| | - Qian Chen
- Graduate School, Beijing University of Chinese Medicine Beijing 100029, China
| | - Guo-Jing Fu
- Graduate School, Beijing University of Chinese Medicine Beijing 100029, China
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23
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Duan JY, Liang X, Jia M, DU WQ, Wang M, Lei L, Chen Q, Jiao WW, Zhang XY, Zhang YL, Jin XL, Liao X. [Systematic review and Meta-analysis on efficacy and safety of Naoxueshu Oral Liquid in treatment of hypertensive intracerebral hemorrhage]. Zhongguo Zhong Yao Za Zhi 2021; 46:2984-2994. [PMID: 34467688 DOI: 10.19540/j.cnki.cjcmm.20210324.501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
To systematically review the efficacy and safety of Naoxueshu Oral Liquid in treatment of hypertensive intracerebral hemorrhage, four Chinese databases, four English databases, clinical trials registration center(ClinicalTrials.gov) and Chinese clinical trial registry were retrieved. The retrieval time was from the establishment of each database to September 9, 2020. According to the set criteria, the randomized controlled trial(RCT) of Naoxueshu Oral Liquid combined with conventional Western medicine was selected. The "Cochrane bias risk assessment" tool was used to evaluate the quality of the included studies. RevMan 5.4.1 was used to conduct Meta-analysis of the included studies and GRADE system was used to evaluate the evidence quality of the outcome indicators. Eleven studies were finally included, with a total sample size of 1 221 cases, 612 cases in the treatment group and 609 cases in the control group. Meta-analysis showed that Naoxueshu Oral Liquid combined with conventional Western medicine had no significant difference compare with conventional Western medicine in reducing National Institute of health stroke scale(NIHSS) after 2 weeks of treatment for hypertensive intracerebral hemorrhage(MD=-1.59,95%CI[-3.46,0.29],P=0.10), but was superior to conventional Western medicine after 30 d of treatment(MD=-1.16,95%CI [-1.39,-0.94],P<0.000 01). Naoxueshu Oral Liquid combined with conventional Western medicine was superior to conventional Western medicine in improving Glasgow coma scale(MD=1.00,95%CI[0,2.00],P=0.05) and reducing the incidence of secondary brain insults(RR=0.38,95%CI[0.24,0.59],P<0.000 1), but there was no significant difference in increasing Barthel index(MD=1.00,95%CI[-0.30,2.30],P=0.13). In terms of effective rate, studies using Guideline for clinical trials of new patent Chinese medicines, NHISS or Glasgow outcome scale(GOS) had shown that Naoxueshu Oral Liquid combined with conventional Western medicine was superior to conventional Western medicine(RR_(Guideline for clinical trials of new patent Chinese medicines)=1.27,95%CI[1.10,1.46],P=0.001;RR_(NHISS)=1.26,95%CI[1.13,1.40],P<0.000 1;RR_(GOS)=1.54,95%CI[1.22,1.93],P=0.000 2). In reduction of hematoma volume, Naoxueshu Oral Liquid combined with conventional Western medicine was superior to conventional Western medicine after 2 and 4 weeks of treatment(MD_(2 week)=-2.31,95%CI[-3.12,-1.49],P<0.000 01;MD_(4 week)=-2.04,95%CI[-2.41,-1.68],P<0.000 01). GRADE system showed that the evidence level of the above outcome indicators was low and extremely low. In terms of adverse reactions, two of the included studies reported mild adverse reactions, and the rest of studies were not mentioned, so this study was not able to make a positive evaluation of the safety of Naoxueshu Oral Liquid. This study showed that compared with conventional Western medicine, combined Naoxueshu Oral Liquid may be better for hypertensive intracerebral hemorrhage. However, due to the high bias risk in the included studies, more large-sample and high-quality RCTs are still needed in the future.
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Affiliation(s)
- Jia-Yu Duan
- Graduate School,Beijing University of Chinese Medicine Beijing 100029,China Center for Evidence-based Chinese Medicine,Institute of Basic Research in Clinical Medicine,China Academy of Chinese Medical Sciences Beijing 100700,China
| | - Xiao Liang
- Xiyuan Hospital,China Academy of Chinese Medical Sciences Beijing 100091,China
| | - Min Jia
- Xiyuan Hospital,China Academy of Chinese Medical Sciences Beijing 100091,China
| | - Wan-Qing DU
- Graduate School,Beijing University of Chinese Medicine Beijing 100029,China
| | - Min Wang
- Graduate School,Beijing University of Chinese Medicine Beijing 100029,China
| | - Lin Lei
- Graduate School,Beijing University of Chinese Medicine Beijing 100029,China
| | - Qian Chen
- Graduate School,Beijing University of Chinese Medicine Beijing 100029,China
| | - Wei-Wei Jiao
- Xiyuan Hospital,China Academy of Chinese Medical Sciences Beijing 100091,China
| | - Xin-Yang Zhang
- Graduate School,Beijing University of Chinese Medicine Beijing 100029,China
| | - Yun-Ling Zhang
- Xiyuan Hospital,China Academy of Chinese Medical Sciences Beijing 100091,China
| | - Xiang-Lan Jin
- Dongfang Hospital,Beijing University of Chinese Medicine Beijing 100078,China
| | - Xing Liao
- Center for Evidence-based Chinese Medicine,Institute of Basic Research in Clinical Medicine,China Academy of Chinese Medical Sciences Beijing 100700,China
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24
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Wang Y, Yao W, Wang L, Xv D. The effect of butylphthalide injection on the cognitive function and the TLRs/NF-κB pathway in hypertensive intracerebral hemorrhage. Am J Transl Res 2021; 13:9578-9585. [PMID: 34540081 PMCID: PMC8430162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/30/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE This study explored and analyzed the effects of butylphthalide injection on the cognitive function and on the TLRs/NF-κB pathway in hypertensive intracerebral hemorrhage patients. METHODS A total of 115 patients admitted to our hospital with hypertensive intracerebral hemorrhages were recruited as the study cohort and randomly placed in the observation group (n=60) or the control group (n=55). In addition to the routine treatment administered in both groups, the control group was additionally administered oral nimodipine tablets, and the observation group was administered intravenous butylphthalide injections. Both groups were treated continuously for 14 days. Subsequently, the changes in the clinical efficacy, the NIHSS scores, the extremity motor function, the Fugl-Meyer scores, the blood-brain barrier (BBB) and the peripheral blood mononuclear cells (PBMCs), the TLR2, TLR9, and the NF-κB mRNA levels in the two groups before and after the treatment were compared, and any adverse reactions were observed. RESULTS The total effective rate in the observation group was significantly superior to the total effective rate in the control group (P<0.05). The post-treatment NIHSS scores in the two groups were dramatically lower (P<0.05), and the post-treatment scores in the observation group were significantly lower than they were in the control group (P<0.05). The post-treatment cerebral spinal fluid (CSF) albumin and BBB indexes in the two groups were decreased significantly compared to their pre-treatment levels (P<0.05), and the post-treatment indexes in the observation group were significantly lower than the post-treatment indexes in the control group (P<0.05). The post-treatment relative TLR2, TLR9, and NF-κB mRNA expressions in the two groups were apparently lower than their in pre-treatment levels (P<0.05), and the relative expressions in the observation group after the treatment were clearly lower than they were in the control group (P<0.05). CONCLUSION Butylphthalide injection has a high clinical efficacy in treating hypertensive intracerebral hemorrhages. The drug can effectively improve patients' cognitive functions, extremity motor functions, and BBB indexes, and its mechanism may connect with the expressive suppression of the TLRs/NF-κB signaling pathway. The treatment is safe and effective, so it is worthy of clinical promotion.
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Affiliation(s)
- Yuhui Wang
- Department of Pharmacy, People's Hospital of Anji Huzhou 313000, Zhejiang Province, China
| | - Wentao Yao
- Department of Pharmacy, People's Hospital of Anji Huzhou 313000, Zhejiang Province, China
| | - Li Wang
- Department of Pharmacy, People's Hospital of Anji Huzhou 313000, Zhejiang Province, China
| | - Dan Xv
- Department of Pharmacy, People's Hospital of Anji Huzhou 313000, Zhejiang Province, China
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25
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Wang G, Liu W, Li C, Wang H. Effect of minimally invasive surgery combined with intracranial pressure monitoring on neurological function recovery and quality of life in patients with hypertensive cerebral hemorrhage. Am J Transl Res 2021; 13:8076-8084. [PMID: 34377290 PMCID: PMC8340193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 04/03/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To explore the influence of minimally invasive surgery (MIS) combined with postoperative intracranial pressure (ICP) monitoring on Glasgow Outcome Scale (GOS) score and postoperative complications of hypertensive intracerebral hemorrhage (HICH). METHODS From January 2018 to January 2020, 106 patients with HICH admitted to Qingdao Municipal Hospital were divided into two groups according to different treatment methods. Among them, 56 cases in the research group received neuroendoscopy minimally invasive surgery (MIS) combined with ICP monitoring, while 50 cases in the control group received only neuroendoscopy MIS. Perioperative indexes, complication rate within 6 months after operation, GOS scores, and GOS grades 6 months after operation, Activities of Daily Living (ADL) scores before and 6 months after operation, and National Institute of Health stroke scale (NIHSS) scores before and 14 days after operation were compared between the two groups, and the quality of life of patients was evaluated in the two groups 6 months after operation. RESULTS Compared with the control group, the patients in the research group had notably better indexes of operation time, length of hospital stay, hematoma absorption time, intra-operative blood loss, and hematoma clearance rate, and notably lower incidence of postoperative complications. Moreover, the patients in the research group had markedly higher GOS and ADL scores at 6 months after operation, as well as markedly higher NIHSS score at 14 days after operation. CONCLUSION MIS combined with postoperative ICP monitoring can improve the prognosis of patients with HICH, reduce postoperative complications, and improve postoperative activities and quality of life.
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Affiliation(s)
- Guohua Wang
- Neurosurgery, Qingdao Municipal HospitalQingdao 266000, Shandong, China
| | - Wei Liu
- Neurosurgery, Affiliated Hospital of Qingdao University Medical CollegeQingdao 266000, Shandong, China
| | - Chuanfeng Li
- Neurosurgery, Qingdao Municipal HospitalQingdao 266000, Shandong, China
| | - Hong Wang
- Intensive Care Unit, Qingdao Fuwai Cardiovascular HospitalQingdao 266000, Shandong, China
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26
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Chen X, Hao Q, Yang SZ, Wang S, Zhao YL, Zhang D, Ye X, Wang H. Improvement in Midline Shift Is a Positive Prognostic Predictor for Malignant Middle Cerebral Artery Infarction Patients Undergoing Decompressive Craniectomy. Front Neurol 2021; 12:652827. [PMID: 34093400 PMCID: PMC8176305 DOI: 10.3389/fneur.2021.652827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/30/2021] [Indexed: 12/25/2022] Open
Abstract
Objective: The aim of this retrospective study is to evaluate the risk factors of malignant middle cerebral artery infarction (MMCAI) patients and explore an applicable prognostic predictor for MMCAI patients undergoing decompressive craniectomy (DC). Methods: Clinical data from the period 2012-2017 were retrospectively evaluated. Forty-three consecutive MMCAI patients undergoing DC were enrolled in this study. The 30-day mortality was assessed, and age, location, hypertension, pupil dilation, onset to operation duration, midline shift, and Glasgow Coma Scale (GCS) score were identified by univariate analysis and binary logistic regression. Results: In this retrospective study for DC patients, the 30-day mortality was 44.2%. In the univariate analysis, advanced age (≥60 years), right hemispheric location, hypertension, pupil dilation, shorter onset to operation duration (<48 h), improved midline shift (t = 4.214, p < 0.01), and lower pre-operation GCS score were significant predictors of death within 30 days. In binary logistic regression analysis, age [odds ratio (OR) = 1.141, 95% CI 1.011-1.287], the improvement of the midline shift (OR = 0.764, 95% CI 0.59-0.988), and pupillary dilation (OR = 15.10, 95% CI 1.374-165.954) were independent influencing factors. For the receiver operating characteristic (ROC) analysis of the relationship between post-operation outcomes and midline shift improvement, the area under the curve (AUC) was 0.844, and the cutoff point of midline shift improvement was 0.83 cm. Conclusion: Improved midline shift was a significant predictor of 30-day mortality. The improved midline shift of >0.83 cm indicated survival at 30 days.
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Affiliation(s)
- Xin Chen
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Qiang Hao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shu-Zhe Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shuo Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuan-Li Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Dong Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xun Ye
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hao Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Wu L, Liu J, Lai J, Meng L. Primary nursing intervention can improve the prognosis and postoperative quality of life of patients with hypertensive intracerebral hemorrhage undergoing minimally invasive surgery. Am J Transl Res 2021; 13:2955-2961. [PMID: 34017461 PMCID: PMC8129221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 11/22/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE This study aimed to explore the role of primary nursing in patients with hypertensive intracerebral hemorrhage (HICH) undergoing minimally invasive surgery. METHODS We randomly assigned 106 patients with HICH treated in our hospital to receive routine nursing (54 cases, group A) or primary nursing in addition to routine nursing (52 cases, group B). The scores of negative emotions, incidence of complications, quality of life, and prognosis of all patients were recorded. RESULTS The score of negative emotions and the incidence of complications were lower in group B than in group A (P < 0.05). The scores of quality of life and prognosis were higher in group B than in group A (P < 0.05). CONCLUSION Primary nursing intervention can improve the prognosis and postoperative quality of life of patients with HICH undergoing minimally invasive surgery.
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Affiliation(s)
- Liqian Wu
- Department of Nuclear Medicine, Tangshan Gongren HospitalTangshan 063000, Hebei Province, China
| | - Jing Liu
- Department of Neurosurgery, Tangshan Gongren HospitalTangshan 063000, Hebei Province, China
| | - Jing Lai
- Department of Nursing, The First People’s Hospital of Longquanyi DistrictChengdu 610010, Sichuan Province, China
| | - Libo Meng
- Second Intensive Care Unit, Fourth Affiliated Hospital of China Medical UniversityShenyang 110032, Liaoning Province, China
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28
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Li K, Ding X, Wang Q, Fan G, Guo W, Li C, Li M, Li Z. Low-Cost, Accurate, Effective Treatment of Hypertensive Cerebral Hemorrhage With Three-Dimensional Printing Technology. Front Neurol 2021; 12:608403. [PMID: 33716921 PMCID: PMC7947911 DOI: 10.3389/fneur.2021.608403] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 01/19/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Hypertensive intracerebral hemorrhage (HICH) is an acute, severe neurosurgical disease. Puncture drainage of the hematoma has gradually been accepted as a surgical treatment for HICH because of its minimally invasive nature. The precision of the puncture is extremely high because of particular physiological functions. This study was performed to explore the effect of a navigation mold created by three-dimensional printing (3DP) technology in the surgical treatment of HICH. Material and methods: We conducted a retrospective analysis of all consecutive patients with ICH treated with minimally invasive surgery using 3DP navigation or craniotomy to remove the hematoma through a small bone window at the Binzhou Medical University Hospital from June 2017 to March 2019. In total, 61 patients were treated with minimally invasive surgery using 3DP navigation (3DP group), and 67 patients were treated with craniotomy to remove the hematoma through a small bone window (craniotomy group). A comparative study of the two groups was conducted to assess the preoperative and postoperative conditions. Results: The duration of the surgery was significantly longer in the craniotomy group than in the 3DP group (3.27 ± 1.14 h vs. 1.52 ± 0.23 h). Postoperative complication rates were significantly lower in the 3DP group than in the craniotomy group (18.0 vs. 34.3%). Moreover, the rate of patients with a Glasgow Outcome Scale score ≥4 points was not statistically significantly different in the two groups. Conclusion: Minimally invasive surgery assisted by 3DP navigation to treat patients with HICH appears to be safe and effective. The 3DP technique may improve the individualization and accuracy of the surgery.
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Affiliation(s)
- Ke Li
- Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, China
| | - Xiangqian Ding
- Department of Neurosurgery, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Qingbo Wang
- Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, China
| | - Gangxian Fan
- Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, China
| | - Wei Guo
- Department of Neurology, Binzhou Medical University Hospital, Binzhou, China
| | - Chenglong Li
- Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, China
| | - Meng Li
- Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, China
| | - Zefu Li
- Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, China
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Yang F, Liu P, Huang S, Liu X, Gao X, Liu C, Chen L, Chen Y. Serum cystatin C was a marker of poststroke fatigue in hypertensive intracerebral hemorrhage. Brain Behav 2021; 11:e01969. [PMID: 33242234 PMCID: PMC7882160 DOI: 10.1002/brb3.1969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/29/2020] [Accepted: 11/02/2020] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION The relationship between poststroke fatigue (PSF) and serum Cystatin C (Cys-C) levels in hypertensive intracerebral hemorrhage (HICH) patients has not been determined. In this study, we investigated the association between serum Cys-C levels and PSF in HICH patients. METHODS A total of 125 patients with HICH were enrolled. Fatigue assessment was performed 6 months after HICH onset. The presence of PSF was defined as Fatigue Severity Scale (FSS) of 4 or more. Serum Cys-C levels were measured within 24 hr after admission. The correlation between FSS score and Cys-C level was analyzed by Spearman's correlation. Receiver operating characteristic (ROC) curves for PSF were calculated using Cys-C values. RESULTS Of enrolled 125 patients in the study, 36.0% who developed PSF were divided to the PSF group, which had higher Cys-C levels compared with the no-PSF group. There was significant positive correlation between FSS score and serum Cys-C level. Receiver operating characteristic curves for PSF revealed an area under the curve of 0.86 for Cys-C. High admission Cys-C (>0.75mg/L) yielded specificity of 93.7%, positive predictive value of 87.5%, and negative predictive value of 88.2%. In multivariate analysis, Cys-C increased by 1 mg/dl (0.1 mg/L), and the risk of PSF in patients increased by 2.55 times (odds ratio = 2.55, 95% CI: 1.65-3.95, p < .001). CONCLUSIONS High Cys-C levels have predictive value for PSF and can be used as one screening indicator for PSF occurrence.
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Affiliation(s)
- Fulan Yang
- Department of Neurology, Chongqing Emergency Medical Center, Chongqing University, Chongqing, China.,Department of Neurology, Clinical Medical College, Northern Jiangsu People's Hospital, Yangzhou University, Yangzhou, China
| | - Peipei Liu
- Department of Neurology, Clinical Medical College, Northern Jiangsu People's Hospital, Yangzhou University, Yangzhou, China
| | - Saiyu Huang
- Department of Neurology, The People's Hospital of Bozhou, Bozhou, China
| | - Xiaojie Liu
- Department of Neurology, Clinical Medical College, Northern Jiangsu People's Hospital, Yangzhou University, Yangzhou, China
| | - Xue Gao
- Department of Neurology, Clinical Medical College, Northern Jiangsu People's Hospital, Yangzhou University, Yangzhou, China
| | - Chunyin Liu
- Department of Neurology, Clinical Medical College, Northern Jiangsu People's Hospital, Yangzhou University, Yangzhou, China
| | - Lanlan Chen
- Department of Neurology, Clinical Medical College, Northern Jiangsu People's Hospital, Yangzhou University, Yangzhou, China
| | - Yingzhu Chen
- Department of Neurology, Clinical Medical College, Northern Jiangsu People's Hospital, Yangzhou University, Yangzhou, China
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Liu J, Cheng J, Zhou H, Deng C, Wang Z. Efficacy of minimally invasive surgery for the treatment of hypertensive intracerebral hemorrhage: A protocol of randomized controlled trial. Medicine (Baltimore) 2021; 100:e24213. [PMID: 33546039 PMCID: PMC7837866 DOI: 10.1097/md.0000000000024213] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 12/15/2020] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Hypertensive intracerebral hemorrhage (HICH) is the most serious complication of hypertension. Clearing intracranial hematoma as soon as possible, reducing brain cell edema, and controlling intracranial pressure could effectively reduce neuron damage, lower patient mortality, and improve patient prognosis. At present, minimally invasive surgery (MIS) has been widely used and plays an important role in the treatment of HICH. However, it is still in controversies about the choice of surgical treatment and medication treatment for HICH. Therefore, we try to conduct a randomized, controlled, prospective trial to observe the efficacy of MIS treatment against HICH compared with medication treatment. METHODS Patients will be randomly divided into treatment group and control group in a 1:1 ratio using the random number generator in Microsoft Excel. Stereotactic soft channel minimally invasive intracranial hematoma puncture and drainage treatment and medication treatment will be applied respectively. The outcomes of intracerebral hemorrhage volume, Glasgow coma scale, National Institutes of Health Stroke Scale will be recorded. CONCLUSIONS The findings of the study will be helpful for the choice of MIS and conservative treatment when treating HICH patients. TRIAL REGISTRATION OSF Registration number: DOI 10.17605/OSF.IO/ME6Y5.
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Balasa A, Ghiga D, Andone RS, Zahan AE, Florian IA, Chinezu R. Effects of Surgery on the 30-Day Survival Rate in Spontaneous Supratentorial Intracerebral Hemorrhage. Brain Sci 2020; 11:brainsci11010005. [PMID: 33374684 PMCID: PMC7822470 DOI: 10.3390/brainsci11010005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/13/2020] [Accepted: 12/21/2020] [Indexed: 12/19/2022] Open
Abstract
Background: Spontaneous intracerebral hemorrhage (ICH) is a severe form of stroke. The efficacy of surgery as ICH treatment is controversial. We sought to compare the 30-day postoperative mortality rate between patients with surgically and medically treated ICH; Methods: This prospective study enrolled patients consecutively diagnosed with ICH and treated between 2017 and 2019. Patients meeting the study surgical indications were assigned to either surgical or medical treatment. The relationship between Glasgow Coma Scale (GCS) score, age, ICH location, ICH volume, and 30-day mortality was analyzed. Results: A total of 174 ICH patients were enrolled in this study. Of these, 136 met the surgery criteria; 65 of these underwent surgery (Group A), and 71 received medical treatment (Group B). Age and ICH location did not modify mortality. Although surgery did not overall improve mortality some better postsurgical outcomes were observed among patients surgically treated with GCS scores of at least 10 points and ICH volumes between 30 to 50 mL; Conclusions: Despite achieving an immediate reduction in intracranial pressure, surgery seems to be advantageous only for patients with ICH volumes between 30 to 50 mL and GCS scores of 10 points or higher.
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Affiliation(s)
- Adrian Balasa
- Department of Neurosurgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology, 540142 Tîrgu Mureș, Romania;
- Department of Neurosurgery, Tîrgu Mureș Clinical Emergency County Hospital, 540136 Tîrgu Mureș, Romania
- Correspondence:
| | - Dana Ghiga
- Department of Medical Informatics and Biostatistics, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, 540142 Tîrgu Mureș, Romania;
| | - Razvan-Sebastian Andone
- Department of Neurology, Tîrgu Mureș Clinical Emergency County Hospital, 540136 Tîrgu Mureș, Romania;
| | - Ancuta Elena Zahan
- Department of Histology, George Emil Palade University of Medicine, Pharmacy, Science and Technology, 540142 Tîrgu Mureș, Romania;
| | - Ioan Alexandru Florian
- Department of Neurosurgery, Iuliu Haţieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
- Department of Neurosurgery, Cluj-Napoca Clinical Emergency County Hospital, 400006 Cluj-Napoca, Romania
| | - Rares Chinezu
- Department of Neurosurgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology, 540142 Tîrgu Mureș, Romania;
- Department of Neurosurgery, Tîrgu Mureș Clinical Emergency County Hospital, 540136 Tîrgu Mureș, Romania
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Gong W, Zhang S, Li X, Shi L. Dexmedetomidine is superior to midazolam for sedation and cerebral protection in postoperative hypertensive intracerebral hemorrhage patients: a retrospective study. J Int Med Res 2020; 48:300060520957554. [PMID: 32967514 PMCID: PMC7521051 DOI: 10.1177/0300060520957554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Dexmedetomidine has a good sedative effect and does not affect the judgment of the patient's consciousness level. However, its effectiveness for sedation and cerebral protection after craniotomy in hypertensive intracerebral hemorrhage (HICH) patients is unknown. METHODS A retrospective study of 164 postoperative HICH patients who underwent sedation with dexmedetomidine or midazolam was conducted. The Ramsay sedation score, mean arterial pressure (MAP), heart rate (HR), pulse oxygen saturation (SpO2), and respiratory rate were measured at the indicated time points. Human soluble protein-100β (S-100β) and neuron-specific enolase (NSE) levels were also compared between the two groups. RESULTS Dexmedetomidine treatment showed a significantly better effect than midazolam on decreasing the frequency of apparent agitation. The MAP and HR, but not the SpO2, were significantly decreased and lower than those in midazolam group. Detection of plasma S-100β and NSE proteins revealed a significant decrease in the dexmedetomidine group compared with the midazolam group. The 6-month follow-up evaluation indicated a significantly better prognosis of postoperative HICH patients treated with dexmedetomidine than for those treated with midazolam. CONCLUSIONS Dexmedetomidine is effective for sedation in postoperative HICH patients and may be beneficial for their outcome.
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Affiliation(s)
- Weiyi Gong
- Department of Neurosurgery, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, P.R. China
| | - Shuguang Zhang
- Department of Neurosurgery, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, P.R. China
| | - Xiaoliang Li
- Department of Neurosurgery, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, P.R. China
| | - Lei Shi
- Department of Neurosurgery, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, P.R. China
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Mao JL, Xu YG, Luo YC, Zhang GZ, Liang M, Hu YF, Shen CS. [Keyhole Approach Endoscopic Surgery versus Stereotactic Aspiration plus Urokinase in Treating Basal Ganglia Hypertensive Intracerebral Hemorrhage]. Zhongguo Yi Xue Ke Xue Yuan Xue Bao 2020; 42:513-520. [PMID: 32895104 DOI: 10.3881/j.issn.1000-503x.12591] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective To compare the short-and long-term effect of two minimal invasive surgical therapies including keyhole approach endoscopic surgery(KAES)and stereotactic aspiration plus urokinase(SAU)in treating basal ganglia hypertensive intracerebral hemorrhage(hICH). Methods The clinical data of 117 hICH patients(63 received KAES and 54 received SAU)were retrospectively analyzed.The operation time,blood loss during surgery,and drainage time were compared between two groups.The residual hematoma volume,hematoma clearance rate(HCR),Glasgow coma scale(GCS)score,and National Institute of Health Stroke Scale(NIHSS)score were recorded at baseline and in the ultra-early stage,early stage,and sub-early stage after surgery.The 30-day mortality and serious adverse events were assessed and the 6-month modified Rankin scale(mRS)score was rated.Results Baseline data showed no significant difference between these two groups.Compared with the SAU group,the KAES group had significantly longer operation time,more intraoperative blood loss,and shorter drainage time(all P<0.001).In the ultra-early stage after surgery,HCR was significantly higher in the KAES group(P<0.001),whereas in the early and sub-early stage,HCR showed no significant differences(all P>0.05).In the ultra-early and early stage,the GCS and NIHSS scores showed no significant differences between two groups(all P>0.05),whereas in the sub-early stage,the NIHSS score was better in the SAU group(P=0.034).The 30-day mortality and incidences of serious adverse events showed no significant difference(all P>0.05).The good recovery(mRS≤3)at 6-months follow-up showed no significant difference between the two groups(P=0.413).Conclusions Both KAES and SAU are safe and effective in treating basal ganglia hICH.In the ultra-early stage after surgery,KAES achieves better residual hematoma volume and HCR,and patients undergoing SAU quickly catch up.The short-and long-term effectiveness of SAU is comparable or even superior to KAES.
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Zhao XH, Zhang SZ, Feng J, Li ZZ, Ma ZL. Efficacy of neuroendoscopic surgery versus craniotomy for supratentorial hypertensive intracerebral hemorrhage: A meta-analysis of randomized controlled trials. Brain Behav 2019; 9:e01471. [PMID: 31743631 PMCID: PMC6908893 DOI: 10.1002/brb3.1471] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 09/22/2019] [Accepted: 10/15/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Hypertensive cerebral hemorrhage (HCH) is a potentially life-threatening neurological condition with an extremely high morbidity and mortality. In recent years, neuroendoscopy has been used to treat intracerebral hemorrhage (ICH). However, the choice of neuroendoscopic surgery versus craniotomy for patients with intracerebral hemorrhages is controversial. AIM We conducted this meta-analysis to assess the efficacy of neuroendoscopic surgery compared with craniotomy in patients with supratentorial hypertensive ICH. METHODS A systematic electronic search was conducted of online electronic databases: PubMed, Embase, and the Cochrane Library updated on December 2017. The meta-analysis only included randomized controlled studies. RESULTS Three randomized controlled trials met our inclusion criteria. The pooled analysis of death showed that neuroendoscopic surgery decreased the rate of death when compared with craniotomy (RR = 0.58, 95% CI 0.26-1.29; p = .18). The pooled result of complications indicated that neuroendoscopic surgery has a tendency toward lower complications (RR = 0.37, 95% CI 0.28-0.49; p < .001). CONCLUSIONS Our results suggested that neuroendoscopic surgery has lower complications, but no superior advantages in morbidity rates. Since the advantage of neuroendoscopic surgery has been performed in some area, the continuation of multi-center comparative investigation with craniotomy may be necessary. Moreover, some efforts need to be taken in selecting appropriate patients with different treatments.
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Affiliation(s)
- Xu-Hui Zhao
- Department of Neurosurgery, Xingtai People's Hospital, Xingtai, China
| | - Su-Zhen Zhang
- Clinical Laboratory, Xingtai People's Hospital, Xingtai, China
| | - Jin Feng
- Department of Neurosurgery, The Frist Hospital of Xingtai, Xingtai, China
| | - Zhen-Zhong Li
- Department of Neurosurgery, Xingtai People's Hospital, Xingtai, China
| | - Zeng-Lu Ma
- Department of Neurosurgery, Xingtai People's Hospital, Xingtai, China
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Nam TM, Kim YZ. A Meta-analysis for Evaluating Efficacy of Neuroendoscopic Surgery versus Craniotomy for Supratentorial Hypertensive Intracerebral Hemorrhage. J Cerebrovasc Endovasc Neurosurg 2019; 21:11-17. [PMID: 31832382 PMCID: PMC6901811 DOI: 10.7461/jcen.2019.21.1.11] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 03/26/2019] [Accepted: 03/28/2019] [Indexed: 12/22/2022] Open
Abstract
Objective Hypertensive intracerebral hemorrhage is a potentially life-threatening neurological deficit with the highest morbidity and mortality. In recent years, neuroendoscopy has been used to treat intracerebral hemorrhages (ICHs). However, the choice of neuroendoscopic surgery or craniotomy for patients with ICHs is controversial. The objective of this meta-analysis was to assess the efficacy of neuroendoscopic surgery compared to craniotomy in patients with supratentorial hypertensive ICH. Materials and Methods A systematic electronic search was performed using online electronic databases such as Pubmed, Embase, and Cochrane library updated on December 2017. The meta-analysis was performed by only including studies designed as randomized controlled trials. Results Three randomized controlled trials met our inclusion criteria. Pooled analysis of death showed that neuroendoscopic surgery decreased the rate of death compared to craniotomy (RR=0.58, 95% CI: 0.26-1.29; P=0.18). Pooled results of complications showed that neuroendoscopic surgery tended to have fewer complications than craniotomy had (RR=0.37, 95% CI: 0.28-0.49; P < 0.0001). Conclusion Although the presenting analyses suggest that neuroendoscopic surgery should have fewer complications than craniotomy dose, it had no superior advantage in morbidity rate definitely. Therefore, it may be necessary for the neurosurgeons to select best optimal patients for individual treatment.
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Affiliation(s)
- Taek Min Nam
- Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea
| | - Young Zoon Kim
- Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea
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Zhang X, Zhou S, Zhang Q, Fu X, Wu Y, Liu J, Liang B, Yang Z, Wang X. Stereotactic aspiration for hypertensive intracerebral haemorrhage in a Chinese population: a retrospective cohort study. Stroke Vasc Neurol 2019; 4:14-21. [PMID: 31105974 PMCID: PMC6475080 DOI: 10.1136/svn-2018-000200] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 02/09/2019] [Accepted: 02/13/2019] [Indexed: 12/31/2022] Open
Abstract
Objective We aimed to compare the therapeutic effects of stereotactic aspiration and best medical management in patients who developed supratentorial hypertensive intracerebral haemorrhage (HICH) with a volume of haemorrhage between 20 and 40 mL. Methods The clinical data of 220 patients with supratentorial HICH with a volume between 20 and 40 mL were retrospectively analysed. Among them, 142 received stereotactic aspiration surgery (stereotactic aspiration group) and 78 received best medical management (conservative group). All were followed up for 6 months. Multivariate logistic regression and Kaplan-Meier survival curves were used to compare the outcome between the two groups. Results The rebleeding rate was lower in the group that had stereotactic aspiration when compared with the group with medical treatment (6 [4.2%] vs 9 [11.5%], χ2=4.364, p=0.037). After 6 months, although the mortality rate did not differ significantly between the two groups (8 cases [5.6%] vs 10 cases [12.8%], χ2=3.461, p=0.063), the rate of a favourable outcome was higher in the group who received stereotactic aspiration (χ2=15.870, p=0.000). Logistic regression identified that medical treatment (OR=1.64, p=0.000) was an independent risk factor for an unfavourable outcome. The Kaplan-Meier curves indicated that the median favourable outcome time in the stereotactic aspiration group was 59.5 days compared with that in the medically treated group (87.0 days). The log-rank test indicated that the prognosis at 6 months was better for those treated with stereotactic haematoma aspiration (χ2=29.866, p=0.000). However, the 6-month survival rate was similar between the two groups (χ2=3.253, p=0.068). Conclusions Stereotactic haematoma aspiration significantly improved the quality of life, although did not effectively reduce the rate of mortality. When selected appropriately, patients with HICH may benefit from this type of surgical intervention.
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Affiliation(s)
- Xuyang Zhang
- Department of Neurosurgery, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shaolong Zhou
- Department of Neurosurgery, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qiang Zhang
- Department of Radiation Oncology and Comprehensive Cancer Center, The University of Michigan, Ann Arbor, Michigan, USA
| | - Xudong Fu
- Department of Neurosurgery, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuehui Wu
- Department of Neurosurgery, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jiasheng Liu
- Department of Neurosurgery, Neihuang People's Hospital, Neihuang, China
| | - Bo Liang
- Department of Neurosurgery, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhuo Yang
- Department of Neurosurgery, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xinjun Wang
- Department of Neurosurgery, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Sun S, Li Y, Zhang H, Wang X, She L, Yan Z, Lu G. The effect of mannitol in the early stage of supratentorial hypertensive intracerebral hemorrhage: a systematic review and meta-analysis. World Neurosurg 2018; 124:S1878-8750(18)32818-3. [PMID: 30576817 DOI: 10.1016/j.wneu.2018.11.249] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 11/28/2018] [Accepted: 11/30/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Mannitol has been widely applied as a priority drug in the clinical treatment for brain edema and increased intracranial pressure (ICP) after intracerebral hemorrhage (ICH). However, no consensus on the efficacy and safety of mannitol has been achieved. Our meta-analysis was conducted to assess the effect of mannitol in the early stage of supratentorial hypertensive intracerebral hemorrhage (HICH) and provided a treatment reference for clinicians. METHOD All relevant studies on mannitol treatment of supratentorial HICH were identified from the databases including PubMed, EMBASE, Cochrane Library, VIP, CNKI and Wan Fang. Our outcome measures included the incidence of hematoma enlargement, the neurological function improvement rate, mortality and the incidence of aggravated brain edema. The subgroup analysis was performed to explore the impact of study type, year of publication, intervention time and dose on the outcome measures. Publication bias was assessed by the funnel plot. RESULTS Thirty-four studies consisting of 3627 patients with supratentorial HICH were included in this study (range from 2000 to 2018). Significant statistical difference was found between mannitol and non-mannitol group in terms of all the outcome measures, including the incidence of hematoma enlargement (p < 0.00001), the neurological function improvement rate (p < 0.00001), mortality (p < 0.00001) and the incidence of aggravated cerebral edema (p = 0.0002). In subgroup analysis, the results showed study type and intervention time did not significantly affect the outcome measures. No significant statistical difference was found in the subgroups of publication time (after 2010) (p = 0.08) and half-dose of mannitol (p = 0.20) on mortality. In addition, the further analysis showed whatever the dose (250ml and 125ml) and intervention time (<24h, <12h, <6h) was, mannitol could lead to the hematoma enlargement. CONCLUSION For patients without obvious symptoms of intracranial hypertension or cerebral palsy, it is not recommended to use mannitol routinely in the early stage of supratentorial HICH. More high-quality trials should be included to confirm our conclusion and to ascertain the best time and dose of mannitol to use.
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Affiliation(s)
- Shuwen Sun
- Department of Neurosurgery, The Clinical Medical College of Yangzhou University, 225001, Yangzhou, China
| | - Yuping Li
- Department of Neurosurgery, The Clinical Medical College of Yangzhou University, 225001, Yangzhou, China
| | - Hengzhu Zhang
- Department of Neurosurgery, The Clinical Medical College of Yangzhou University, 225001, Yangzhou, China.
| | - Xiaodong Wang
- Department of Neurosurgery, The Clinical Medical College of Yangzhou University, 225001, Yangzhou, China
| | - Lei She
- Department of Neurosurgery, The Clinical Medical College of Yangzhou University, 225001, Yangzhou, China
| | - Zhengcun Yan
- Department of Neurosurgery, The Clinical Medical College of Yangzhou University, 225001, Yangzhou, China
| | - Guangyu Lu
- Yangzhou University, 225001, Yangzhou, China
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Luan L, Li M, Sui H, Li G, Pan W. Efficacies of minimally invasive puncture and small bone window craniotomy for hypertensive intracerebral hemorrhage, evaluation of motor-evoked potentials and comparison of postoperative rehemorrhage between the two methods. Exp Ther Med 2018; 17:1256-1261. [PMID: 30680000 PMCID: PMC6327651 DOI: 10.3892/etm.2018.7094] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 11/05/2018] [Indexed: 02/07/2023] Open
Abstract
Application value of the minimally invasive puncture and small bone window craniotomy in hypertensive intracerebral hemorrhage was investigated to explore the effects of the above treatment methods on motor-evoked potentials (MEPs) and postoperative rehemorrhage. Patients with hypertensive intracerebral hemorrhage who were admitted to Chengyang People's Hospital from March 2016 to December 2017 were selected and randomly divided into the minimally invasive group (n=40) and the craniotomy group (n=40). The minimally invasive group was treated with minimally invasive puncture and drainage for hematomas, while the craniotomy group received small bone window craniotomy for evacuation of hematomas. The clinical efficacy was compared between the two groups. At 28 days after operation, the Chinese scale of clinical neurological deficit of stroke patients (CSS) score in the minimally invasive group was lower than that in the craniotomy group (p<0.05). At 28 days after operation, the S-100β level in the minimally invasive group was lower than that in the craniotomy group (p<0.05). At 1 week after operation, 35 patients in the minimally invasive group were able to elicit MEP waveforms, and only 7 patients in the craniotomy group were able to elicit positive waveforms. At 2 weeks after operation, 40 patients in the minimally invasive group and 20 patients in the craniotomy group could elicit MEP waveforms, and the incubation period, central motor conduction time and amplitude in the former were significantly better than those in the latter (p<0.05). The operation time and length of hospital stay were shorter with more total expenses of hospitalization in the minimally invasive group compared to those in the craniotomy group (p<0.05). Compared with small bone window craniotomy, minimally invasive puncture can reduce serum S-100β level. Its advantages are obvious, so it is worthy of promotion and application.
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Affiliation(s)
- Lei Luan
- Department of Neurosurgery, Chengyang People's Hospital, Qingdao, Shandong 266109, P.R. China
| | - Maolei Li
- Department of Neurosurgery, Chengyang People's Hospital, Qingdao, Shandong 266109, P.R. China
| | - Hang Sui
- Department of Neurosurgery, Chengyang People's Hospital, Qingdao, Shandong 266109, P.R. China
| | - Guoliang Li
- Department of Neurosurgery, Chengyang People's Hospital, Qingdao, Shandong 266109, P.R. China
| | - Wenyong Pan
- Department of Neurosurgery, Chengyang People's Hospital, Qingdao, Shandong 266109, P.R. China
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Abstract
BACKGROUND In recent years, neuroendoscopy has been used as a method for treating intracerebral hemorrhages (ICHs). However, the efficacy and safety of neuroendoscopic surgery is still controversial compared with that of craniotomy. Our aim was to compare the outcomes of neuroendoscopic surgery and craniotomy in patients with supratentorial hypertensive ICH using a meta-analysis. METHODS We searched on PubMed, EMBASE, and Cochrane Central Register of Controlled Trials to identify relevant studies in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Quality of eligible studies was evaluated and the related data were extracted by 2 reviewers independently. This study assessed clinical outcomes, evacuation rates, complications, operation time, and hospital stay for patients who underwent neuroendoscopic surgery (NE group) or craniotomy (craniotomy group). RESULTS Meta-analysis included 1327 subjects from verified studies of acceptable quality. There was no significant heterogeneity between the included studies based on clinical outcomes. Compared with craniotomy, neuroendoscopic surgery significantly improved clinical outcomes in both randomized controlled studies (RCTs) group (relative risk: 0.62; 95% confidence interval [CI], 0.47-0.81, P < .001) and non-RCTs group (relative risk: 0.84; 95% CI: 0.75-0.95, P = .005); decreased the rate of death (relative risk: 0.53; 95% CI, 0.37-0.76, P < .001) in non-RCTs group but not in RCTs group (relative risk: 0.58; 95% CI, 0.26-1.29, P = .18); increased evacuation rates in non-RCTs group (standard mean differences: 0.75; 95% CI, 0.24-1.26, P = .004) and had a tendency of higher evacuation rates in RCTs group (standard mean differences: 1.34; 95% CI, 0.01-2.68, P = .05); reduced the total risk of complications in non-RCTs group (relative risk: 0.45; 95% CI, 0.25-0.83, P = .01) and RCTs group (relative risk: 0.37; 95% CI, 0.28-0.49, P < .001); reduced the operation time in non-RCTs group (standard mean differences: 3.26; 95% CI: 1.20-5.33, P < .001) and RCTs group (standard mean differences: 4.37; 95% CI: 3.32-5.41, P < .001). CONCLUSIONS Our results suggested that the NE group showed better clinical outcomes than the craniotomy group for patients with supratentorial hypertensive ICH. Moreover, the patients who underwent neuroendoscopy had a higher evacuation rate, lower risk of complications, and shorter operation time compared with those that underwent a craniotomy.
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Xu X, Chen X, Li F, Zheng X, Wang Q, Sun G, Zhang J, Xu B. Effectiveness of endoscopic surgery for supratentorial hypertensive intracerebral hemorrhage: a comparison with craniotomy. J Neurosurg 2017; 128:553-559. [PMID: 28387618 DOI: 10.3171/2016.10.jns161589] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The goal of this study was to investigate the effectiveness and practicality of endoscopic surgery for treatment of supratentorial hypertensive intracerebral hemorrhage (HICH) compared with traditional craniotomy. METHODS The authors retrospectively analyzed 151 consecutive patients who were operated on for treatment of supratentorial HICH between January 2009 and June 2014 in the Department of Neurosurgery at Chinese PLA General Hospital. Patients were separated into an endoscopy group (82 cases) and a craniotomy group (69 cases), depending on the surgery they received. The hematoma evacuation rate was calculated using 3D Slicer software to measure the hematoma volume. Comparisons of operative time, intraoperative blood loss, Glasgow Coma Scale score 1 week after surgery, hospitalization time, and modified Rankin Scale score 6 months after surgery were also made between these groups. RESULTS There was no statistically significant difference in preoperative data between the endoscopy group and the craniotomy group (p > 0.05). The hematoma evacuation rate was 90.5% ± 6.5% in the endoscopy group and 82.3% ± 8.6% in the craniotomy group, which was statistically significant (p < 0.01). The operative time was 1.6 ± 0.7 hours in the endoscopy group and 5.2 ± 1.8 hours in the craniotomy group (p < 0.01). The intraoperative blood loss was 91.4 ± 93.1 ml in the endoscopy group and 605.6 ± 602.3 ml in the craniotomy group (p < 0.01). The 1-week postoperative Glasgow Coma Scale score was 11.5 ± 2.9 in the endoscopy group and 8.3 ± 3.8 in the craniotomy group (p < 0.01). The hospital stay was 11.6 ± 6.9 days in the endoscopy group and 13.2 ± 7.9 days in the craniotomy group (p < 0.05). The mean modified Rankin Scale score 6 months after surgery was 3.2 ± 1.5 in the endoscopy group and 4.1 ± 1.9 in the craniotomy group (p < 0.01). Patients had better recovery in the endoscopy group than in the craniotomy group. Data are expressed as the mean ± SD. CONCLUSIONS Compared with traditional craniotomy, endoscopic surgery was more effective, less invasive, and may have improved the prognoses of patients with supratentorial HICH. Endoscopic surgery is a promising method for treatment of supratentorial HICH. With the development of endoscope technology, endoscopic evacuation will become more widely used in the clinic. Prospective randomized controlled trials are needed.
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Ding R, Lin C, Wei S, Zhang N, Tang L, Lin Y, Chen Z, Xie T, Chen X, Feng Y, Wu L. Therapeutic Benefits of Mesenchymal Stromal Cells in a Rat Model of Hemoglobin-Induced Hypertensive Intracerebral Hemorrhage. Mol Cells 2017; 40:133-142. [PMID: 28190323 PMCID: PMC5339504 DOI: 10.14348/molcells.2017.2251] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 12/29/2016] [Accepted: 01/09/2017] [Indexed: 12/31/2022] Open
Abstract
Previous studies have shown that bone marrow mesenchymal stromal cell (MSC) transplantation significantly improves the recovery of neurological function in a rat model of intracerebral hemorrhage. Potential repair mechanisms involve anti-inflammation, anti-apoptosis and angiogenesis. However, few studies have focused on the effects of MSCs on inducible nitric oxide synthase (iNOS) expression and subsequent peroxynitrite formation after hypertensive intracerebral hemorrhage (HICH). In this study, MSCs were transplanted intracerebrally into rats 6 hours after HICH. The modified neurological severity score and the modified limb placing test were used to measure behavioral outcomes. Blood-brain barrier disruption and neuronal loss were measured by zonula occludens-1 (ZO-1) and neuronal nucleus (NeuN) expression, respectively. Concomitant edema formation was evaluated by H&E staining and brain water content. The effect of MSCs treatment on neuroinflammation was analyzed by immunohistochemical analysis or polymerase chain reaction of CD68, Iba1, iNOS expression and subsequent peroxynitrite formation, and by an enzyme-linked immunosorbent assay of pro-inflammatory factors (IL-1β and TNF-α). The MSCs-treated HICH group showed better performance on behavioral scores and lower brain water content compared to controls. Moreover, the MSC injection increased NeuN and ZO-1 expression measured by immunochemistry/immunofluorescence. Furthermore, MSCs reduced not only levels of CD68, Iba1 and pro-inflammatory factors, but it also inhibited iNOS expression and peroxynitrite formation in perihematomal regions. The results suggest that intracerebral administration of MSCs accelerates neurological function recovery in HICH rats. This may result from the ability of MSCs to suppress inflammation, at least in part, by inhibiting iNOS expression and subsequent peroxynitrite formation.
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Affiliation(s)
- Rui Ding
- Department of Neurosurgery, Jingmen No. 1 People’s Hospital, Jingmen 448000, Hubei,
China
| | - Chunnan Lin
- Department of Neurosurgery, Maoming People’s Hospital, Maoming 525000, Guangdong,
China
| | - ShanShan Wei
- Department of Hematology, Jingmen No. 1 People’s Hospital, Jingmen 448000, Hubei,
China
| | - Naichong Zhang
- Department of Neurosurgery, Maoming People’s Hospital, Maoming 525000, Guangdong,
China
| | - Liangang Tang
- Department of Neurosurgery, Maoming People’s Hospital, Maoming 525000, Guangdong,
China
| | - Yumao Lin
- Department of Neurosurgery, Maoming People’s Hospital, Maoming 525000, Guangdong,
China
| | - Zhijun Chen
- Department of Neurosurgery, Jingmen No. 1 People’s Hospital, Jingmen 448000, Hubei,
China
| | - Teng Xie
- Department of Neurosurgery, Jingmen No. 1 People’s Hospital, Jingmen 448000, Hubei,
China
| | - XiaoWei Chen
- Department of Neurosurgery, Jingmen No. 1 People’s Hospital, Jingmen 448000, Hubei,
China
| | - Yu Feng
- Department of Neurosurgery, Jingmen No. 1 People’s Hospital, Jingmen 448000, Hubei,
China
| | - LiHua Wu
- Department of Neurosurgery, Jingmen No. 1 People’s Hospital, Jingmen 448000, Hubei,
China
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Li JY, Yuan LX, Zhang GM, Zhou L, Gao Y, Li QB, Chen C. Activating blood circulation to remove stasis treatment of hypertensive intracerebral hemorrhage: A multi-center prospective randomized open-label blinded-endpoint trial. Chin J Integr Med 2016; 22:328-34. [PMID: 27338955 DOI: 10.1007/s11655-016-2467-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To investigate the efficacy and safety of the Chinese herbal therapeutic regimen of activating blood circulation (TRABC) in treatment of hypertensive intracerebral hemorrhage (HICH). METHODS This was a multi-center prospective randomized open-label blinded-endpoint (PROBE) trial with HICH admitted to 12 hospitals. Totally 240 participants were randomized to the treatment group treated with TRABC in addition to conventional Western treatment or the control group with conventional Western treatment equally for 3 months. Primary outcome was degree of disability as measured by modified Rankin Scale (mRS). Secondary outcomes were the absorption of hematoma and edema, National Institutes of Health Stroke Scale (NIHSS) scores and patient-reported outcome measures for stroke and Barthel activities of daily living index. Adverse events and mortality were also recorded. RESULTS After 3 months of treatment, the rate of mRS 0-1 and mRS 0-2 in the treatment group was 72.5% and 80.4%, respectively, and in the control group 48.1% and 63.9%, respectively, with a significant difference between groups (P<0.01). Hematoma volume decreased significantly at day 7 of treatment in the treatment group than the control group (P=0.038). Average Barthel scores in the treatment group after treatment was 89.11±19.93, and in the control group 82.18±24.02 (P=0.003). NIHSS scores of the two groups after treatment decreased significantly compared with before treatment (P=0.001). Patient-reported outcomes in the treatment group were lower than the control group at day 21 and 3 months of treatment (P<0.05). There were 4 deaths, 2 in each group, and 11 adverse events, 6 in the treatment group and 5 in the control group. CONCLUSION The integrative therapy combined TRABC with conventional Western treatment for HICH could promote hematoma absorption thus minimize neurologic impairment, without increasing intracerebral hematoma expansion and re-bleeding.
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