From vasospasm to early brain injury: new frontiers in subarachnoid haemorrhage research.

INTRODUCTION: Delayed vasospasm has traditionally been considered the most important determinant of poor outcome after subarachnoid haemorrhage (SAH). Consequently, most of the research and therapies are directed towards reducing the incidence of vasospasm (VSP). To date, however, clinical trials based on this strategy have not delivered a definitive treatment for preventing or reducing brain injury after SAH. This fact has caused a paradigm shift in research, which now focuses on early brain injury (EBI) occurring in the first 72 hours after SAH. It has also changed the idea of VSP's role in brain damage, and suggests the need for re-evaluating the pathophysiological process of SAH. DEVELOPMENT: This review examines the current state of knowledge on the pathophysiological mechanisms associated with EBI and summarises the diagnostic options currently available. CONCLUSION: It seems that the research approach needs to be changed so that investigators will focus on prevention of EBI, reduction of secondary brain complications and ultimately, the optimisation neurological outcome.

[Effects of competitive physical exercise on neuroendocrine response and interleukin-6 liberation in children]. / Repercusión del ejercicio físico competitivo en la respuesta neuroendocrina y liberación de interleuquina-6 en niños.

OBJECTIVE: The purpose of this study was to evaluate the effects of physical activity on the secretion of cortisol, melatonin and interleukin-6 (IL-6) in children. PATIENTS AND METHODS: A controlled prospective study was carried out. Based on anthropometrical measurements and physical examination, which excluded those with an organic pathology or that were further than one standard deviation from the 50th percentile, 74 male children aged 6 or 7 years were included in this study. Forty-one children from a public school (PS) and 33 children from a soccer sport school (SS) were selected and asked to perform three different physical activities. A score was made to evaluate their performance and both before and after physical activity salivary samples were obtained to measure cortisol, melatonin and IL-6 concentrations. RESULTS: The children in the SS group had a better global physical performance score than those from the PS. There were no statistically significant differences in biochemical parameters between the two groups before and after exercise. There was a rise in the cortisol, melatonin and IL-6 levels after physical activity in both groups. The increment in melatonin levels after exercise was significantly higher in the SS group. There was a strong positive correlation between the rise of cortisol and IL-6 levels after exercise. CONCLUSIONS: In our study, controlled physical competitive activity in children 6 or 7 years of age showed no negative repercussion on cortisol secretion or in the liberation of IL-6.

Del vasoespasmo a la lesión cerebral precoz: una nueva frontera en la investigación de la hemorragia subaracnoidea / From vasospasm to early brain injury: new frontiers in subarachnoid haemorrhage research

Introducción: El vasoespasmo (VSP) ha sido tradicionalmente considerado como el principal determinante de mal pronóstico tras sufrir una hemorragia subaracnoidea (HSA). Como consecuencia, la mayoría de las líneas de investigación y los tratamientos están dirigidos hacia la reducción de la incidencia de dicho VSP. Hasta la fecha, sin embargo, los resultados de los ensayos clínicos basados en esta estrategia no se han traducido en un tratamiento definitivo capaz de prevenir o mejorarla lesión cerebraltras unaHSA. Este hecho ha provocado un cambio de paradigma en el interés investigativo, focalizándolo hacia la lesión cerebral precoz (LCP), que se produce en las primeras 72 h tras la HSA. Así mismo, ha modificado la visión que se tenía de la responsabilidad del VSP sobre el dano˜ cerebral y sugiere la necesidad de una re-evaluación del proceso fisiopatológico de la HSA. Desarrollo: Esta revisión examina el estado actual del conocimiento de los mecanismos fisiopatológicos relacionados con la LCP y resume las opciones diagnósticas disponibles en la actualidad. Conclusión: Parece necesario cambiar la dirección en la investigación de esta enfermedad, centrándose en la prevención de la LCP, la reducción de las complicaciones cerebrales secundarias y en última instancia, la optitimización de los resultados neurológicos (AU)

Introduction: Delayed vasospasm has traditionally been considered the mostimportant determinant of poor outcome after subarachnoid haemorrhage (SAH). Consequently, most of the research and therapies are directed towards reducing the incidence of vasospasm (VSP). To date, however, clinical trials based on this strategy have not delivered a definitive treatment for preventing or reducing brain injury after SAH. This fact has caused a paradigm shift in research, which now focuses on early brain injury (EBI) occurring in the first 72hours after SAH. It has also changed the idea of VSP’s role in brain damage, and suggests the need for re-evaluating the pathophysiological process of SAH. Development: This review examines the current state of knowledge on the pathophysiological mechanisms associated with EBI and summarises the diagnostic options currently available. Conclusion: It seems that the research approach needs to be changed so that investigators will focus on prevention of EBI,reduction of secondary brain complications and ultimately,the optimisation neurological outcome (AU)