Evolving Therapeutic Landscape of Intracerebral Hemorrhage: Emerging Cutting-Edge Advancements in Surgical Robots, Regenerative Medicine, and Neurorehabilitation Techniques.

Intracerebral hemorrhage (ICH) is the most serious form of stroke and has limited available therapeutic options. As knowledge on ICH rapidly develops, cutting-edge techniques in the fields of surgical robots, regenerative medicine, and neurorehabilitation may revolutionize ICH treatment. However, these new advances still must be translated into clinical practice. In this review, we examined several emerging therapeutic strategies and their major challenges in managing ICH, with a particular focus on innovative therapies involving robot-assisted minimally invasive surgery, stem cell transplantation, in situ neuronal reprogramming, and brain-computer interfaces. Despite the limited expansion of the drug armamentarium for ICH over the past few decades, the judicious selection of more efficacious therapeutic modalities and the exploration of multimodal combination therapies represent opportunities to improve patient prognoses after ICH.

An End-to-End Inclination State Monitoring Method for Collaborative Robotic Drilling Based on Resnet Neural Network.

The collaborative robot can complete various drilling tasks in complex processing environments thanks to the high flexibility, small size and high load ratio. However, the inherent weaknesses of low rigidity and variable rigidity in robots bring detrimental effects to surface quality and drilling efficiency. Effective online monitoring of the drilling quality is critical to achieve high performance robotic drilling. To this end, an end-to-end drilling-state monitoring framework is developed in this paper, where the drilling quality can be monitored through online-measured vibration signals. To evaluate the drilling effect, a Canny operator-based edge detection method is used to quantify the inclination state of robotic drilling, which provides the data labeling information. Then, a robotic drilling inclination state monitoring model is constructed based on the Resnet network to classify the drilling inclination states. With the aid of the training dataset labeled by different inclination states and the end-to-end training process, the relationship between the inclination states and vibration signals can be established. Finally, the proposed method is verified by collaborative robotic drilling experiments with different workpiece materials. The results show that the proposed method can effectively recognize the drilling inclination state with high accuracy for different workpiece materials, which demonstrates the effectiveness and applicability of this method.

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

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

Surgical Robotics for Intracerebral Hemorrhage Treatment: State of the Art and Future Directions.

Intracerebral hemorrhage (ICH) is a stroke subtype with high mortality and disability, and there are no proven medical treatments that can improve the functional outcome of ICH patients. Robot-assisted neurosurgery is a significant advancement in the development of minimally invasive surgery for ICH. This review encompasses the latest advances and future directions of surgical robots for ICH. First, three robotic systems for neurosurgery applied to ICH are illustrated. Second, the key technologies of robot-assisted surgery for ICH are introduced in aspects of stereotactic technique and navigation, the puncture instrument, and hematoma evacuation. Finally, the limitations of current surgical robots are summarized, and the possible development direction is discussed, which is named "multisensor fusion and intelligent aspiration control of minimally invasive surgical robot for ICH". It is expected that the new generation of surgical robots for ICH will facilitate quantitative, precise, individualized, standardized treatment strategies for ICH.

Triptolide induces the cell apoptosis of osteosarcoma cells through the TRAIL pathway.

Research on triptolide, a diterpenoid epoxide found in the Thunder God Vine Tripterygium wilfordii, has increased our knowledge of the pharmacology, pharmacokinetics, toxicology and clinical application of this agent. In the present study, we aimed to identify the effects of triptolide on the apoptosis of osteosarcoma cells and to evaluate the anti-proliferative action of this agent. MG-63 cells were treated either with various doses of triptolide (50, 100 or 200 nM) or DMSO for 6, 12 and 24 h. Treatment with triptolide effectively suppressed the cell viability and induced the apoptosis of osteosarcoma MG-63 cells as detected by MTT assay and flow cytometry, respectively. In addition, by using caspase-3, caspase-8 and caspase-9 activity assays and western blot analysis, the anticancer effects of triptolide against osteosarcoma growth were found to involve activation of the DR-5/p53/Bax/caspase-9/ caspase-3 signaling pathway and the DR-5/FADD/caspase-8/lysosomal/cathepsin B/caspase-3 signaling pathway in the MG-63 cells. An important factor in the anticancer effects of triptolide against osteosarcoma was TRAIL-DR-5. The data suggest that triptolide may be a potential novel chemotherapeutic agent for osteosarcoma and acts through the TRAIL-DR-5 signaling pathway.

Inhibiting wear particles-induced osteolysis with naringin.

PURPOSE: The purpose of this study was to determine the effects of naringin on osteoclastogenesis and osteolysis both in vitro and in vivo. METHODS: In this research osteoclasts were generated from mouse bone marrow monocytes with the receptor activator of NF-КB ligand and the macrophage colony stimulating factor. Naringin, at a concentration of 1, 10, 50, and 100 µg/mL, was respectively added to the medium. Seven days later, the osteoclasts were determined through tartrate-resistant acid phosphatase (TRAP) staining. Mature osteoclasts were isolated from newborn rabbits and cultured for three days on bone slices. Naringin at a concentration of 1, 10, 50, and 100 µg/mL was respectively added to the medium. The resorption bone slices were quantified, and the area was calculated after toluidine blue and Mayer-hematoxylin staining. Polymethyl methacrylate (PMMA) particles were implanted on the calvariae of C57BL/J6 mice. Naringin, at a dose of 50 µg/kg and 100 µg/kg, was respectively given intraperitoneally for seven. Seven days later, the calvariae were removed and processed for pathological analysis. RESULTS: The result indicated that naringin treatment effectively inhibited in vitro osteoclastogenesis and inhibited mature osteoclasts. In vivo data indicated that naringin strongly inhibited PMMA-induced osteolysis. CONCLUSION: Naringin can effectively inhibit osteoclastogenesis and suppress wear particles-induced osteolysis and might be useful in the treatment or prevention of wear particles-induced osteolysis and aseptic loosening for its effect on osteoclast generation and function.

[Case-control study on bone setting manipulation for the treatment of over degree II supination-eversion fractures of ankle joint].

OBJECTIVE: To explore therapeutic effects of bone setting manipulation for the treatment of over degree II supination-eversion fractures of ankle,and analyze manipulative reduction mechanism. METHODS: From 2005 to 2008, 95 patients with over degree II supination-eversion fractures of ankle were treated respectively by manipulation and operation. There were 43 cases [11 males and 32 females with an average age of (44.95 +/- 12.65) years] in manipulation group, and 2 cases were degree II, 11 cases were degree III, and 30 cases were degree IV. There were 52 cases [21 males and 31 females with an average age of (39.96 +/- 13.28) years] in operative group,and 6 cases were degree II, 18 cases were degree III, and 28 cases were degree IV. Bone setting manipulation and hard splint external fixation were applied to manipulative group. Operative reduction internal fixation was performed in operative group. X-ray was used to evaluate reduction of fracture before and after treatment, 2 months after treatment. Ankle joint function was evaluated according to Olerud-Molander scoring system after 6 months treatment. RESULTS: All patients were followed up with good reduction. Three cases occurred wound complication in operative group, but not in manipulative group. In manipulation group, 19 cases got excellent results, 20 cases good and 4 cases fair; while in operative group, 30 cases got excellent results, 20 cases good and 2 cases poor. There were no significant differences in fracture reduction and ankle joint function recovery between two groups (P > 0.05). Efficacy of operative treatment was better than that of manipulative treatment at degree IV fracture (P < 0.05). CONCLUSION: Bone setting manipulation is a good method for treating supination-eversion ankle joint fractures, which has advantages of simple and safe operation, reliable efficacy. For ankle join fracture at degree IV, manipulative reduction should be adopted earlier, and operative treatment also necessary

[Treatment of Barton fractures with external fixation with paper splints].

OBJECTIVE: To study the control of instability of paper splints for the treatment of Barton fractures. METHODS: From 1998 to 2007, 30 patients with Barton fractures were treated with manual reduction and external fixation with paper splints. Among the patients, 20 patients were male and 10 patients were female, ranging in age from 20 to 68 years, averaged 45.3 years. The course of the disease ranged from 1 to 15 hours, with a mean of 4.2 h. All the patients had a history of trauma. The X-rays showed palm-side distal radius fractures, fractured fragments displacing toward proximal palm and the radius bone sudislocating toward the palm. Anderson assessment method was adopted. RESULTS: All the patients were followed up ranging from 0.5 to 2 years (12.3 months on average). When clinical healing, the X-ray showed good position in 26 cases, and the fractured fragments on the palm side displaced 1 to 2.5 mm toward palm in 4 cases. Final results : the motion range and function of wrist and forearm recovered completely in 24 patients; the motion range and function of wrist and forearm were limited slightly without hindering daily life in 6 patients. According to Anderson assessment method, 24 patients got an excellent result and 6 good. CONCLUSION: This fixation method possesed such advantages as improving hematoma absorption, reinforcing fixation on the basis of original fixation at any time without pressure sore and necrosis, safe and effective.

[Manual reduction of 90 degree bending elbow and external fixation with paper splint for treatment of type I capitellum fractures].

OBJECTIVE: To study the operation points of manual reduction for treatment of capitellum fractures of type I and analyze the characteristics of fixation with paper splint. METHODS: From April 2000 to February 2008, 27 cases with capitellum fractures of type I were treated by manual reduction of 90 degrees bending elbow and external fixation with paper splint, included 23 males and 4 females aged from 5 to 14 years old (means 8.9 years) with the course from 1 to 23 hours (averaged 5.4 hours). Before treatment all the wounded elbows were swollen and malfunctioned, the X-ray film showed that the fracture fragments of capitellum were separated and upside down displaced in varying degrees. During reduction, the correct restoration point was found and the reduction was correct, continuous and steady, and coordinated the passive movement of forearm and elbow joint, and the 90 degrees bending elbow was fixed by paper splint. All the patients were assessed according to JOA elbow joint function assessment method. RESULTS: All 27 patients were followed-up for from 6 months to 2 years (averaged 17 months). All the elbow joints were painless, the movement and functions were normal, the elbow joints were stable. After reduction, no complication was found. There were 25 cases with the fracture site reaches or nearly reaches healing of anatomical counterparts, only 2 cases with slight cubitus valgus deformity. According to JOA score 25 cases gained 100 scores and 2 cases gained 97 scores. CONCLUSION: This method has advantage of strong stability, high success rate, firm and easy fixation, without pressure sore and necrosis.

[Effect of zhenggu powder ([Chinese characters: see text]) on the inflammatory cell factor of soft tissue in experimental acute injury].

OBJECTIVE: To probe the recovery mechanism of Zhenggu powder (ZGP) on acute soft tissue injury in cell levels. METHODS: Forty rabbits which established animal model of acute soft tissue injury with hammer hitting,were divided randomly into normal group (A), model group (B), vaseline group (C)and ZGP group (D). Injured part was applied external drug daily after model was made. All animals were killed after using drug for 4 days. The local tissue of injured part was taken pathologic study, and was measured the content of IL-1beta, IL-6, TNFalpha by ELISA method and TXB2, 6-keto-PGF1alpha by RIA method. RESULTS: Muscular tissue of group A was normal. But that of group B and C was aberrant,such as swelling and broken of muscular fiber or infiltration of inflammatory cell. Such histological change of group D was lightly and hyperplasia of blood vessel was found. The contents of IL-1beta, TNFalpha, TXB2 and TXB2/6-keto-PGF1alpha in group D were lower than that of group B and group C. On the contrary, the contents of 6-keto-PGF1alpha in the group D were higher than that of group B and group C. The difference of content of IL-6 between groups was not obvious. CONCLUSION: ZGP could promote not only the dilution and the transportation of inflammatory cell factors,but also the repair and the regeneration of the injured tissue structures. The therapeutic effect of ZGP was not relative to IL-6.

[Comparison of the therapeutical effectiveness between paper splint adduction fixation and plaster abduction fixation in Bennett fracture].

OBJECTIVE: To study and compare the difference on the therapeutical effectiveness between paper splint adduction fixation and plaster abduction fixation in Bennett fracture. METHODS: In the study, seventy outpatient were selected from October 2005 to April 2007, and devided into two groups randomly involving experiment group (35 cases with paper splint adduction fixation) and control group (35 cases with plaster abduction fixation). After the fracture clinical healed and removed fixation, the patients had been followed up 6 months. At the 6th, 8th, 12th, 16th, 20th, 24th week after fracture, the fracture hand had been scored and compared according to Gabriele's score system. RESULTS: At the 8th, 12th, 16th and 20th week, the excellent rate of experiment group was higher than control group, there was significant difference (P<0.05) At 6th week and 24th week there was no significant difference (P>0.05). At 8th, 12th, 16th, 20th and 24th week, the functional score of experiment group was higher than control group, there was significant difference (P<0.05); At 6th week there was no significant difference (P>0.05). CONCLUSION: The paper splint adduction fixation could promote recovery of the hand function in Bennett fracture. In addition, the paper splint adduction fixation is comfortable to recipient. It could be spreaded in clinic as a effective fixation method.