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1.
Crit Care Clin ; 39(1): 71-85, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36333038

RESUMO

Aneurysmal subarachnoid hemorrhage and intracerebral hemorrhage are devastating injuries causing significant morbidity and mortality. However, advancements made over decades have improved outcomes. This review summarizes a systematic approach to stabilize and treat these patient populations.


Assuntos
Isquemia Encefálica , Hemorragia Cerebral , Aneurisma Intracraniano , Hemorragia Subaracnóidea , Humanos , Isquemia Encefálica/etiologia , Isquemia Encefálica/terapia , Hemorragia Cerebral/etiologia , Hemorragia Cerebral/terapia , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/terapia , Hemorragia Subaracnóidea/etnologia , Hemorragia Subaracnóidea/terapia
2.
J Ethnopharmacol ; 301: 115816, 2023 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-36223845

RESUMO

ETHNOPHARMACOLOGICAL RELEVANCE: Di Dang decoction (DDD) is a prescription used for the treatment of cerebral hemorrhage. Its use is derived from the theory of typhoid fever, it has an obvious clinical effect and it has been used in the clinic for a long time. The results of early quantitative proteomics and targeted proteomics studies showed that the administration of high-dose DDD 7 days may regulate the expression of the proteins S100A8, S100A9, Col1a1 and Col1a2. The first 3 days after bleeding begins is the critical period for intervention, what occurs within approximately 3 days after AICH is unclear. AIM OF THE STUDY: To explore the effects of Di Dang decoction (DDD) on the Jak2/Stat5 signaling pathway and apoptosis-related gene expression in rats with acute hemorrhagic stroke via the oxidative stress response by proteomics to reveal its neuroprotective mechanism. MATERIALS AND METHODS: Ninety healthy Sprague-Dawley (SD) rats were randomly divided into the control, model, and low-, medium-, and high-dose DDD groups, with 18 rats in each group. An acute intracerebral hemorrhage (AICH) model was established by injecting autologous blood into the caudate nucleus. The low-, medium- and high-dose groups were intragastrically administered 0.15625 g/mL, 0.3125 g/mL and 0.625 g/mL DDD, respectively, for 1 or 3 days. The control and model groups were given the same amount of normal saline. Neurological deficits were evaluated by the modified neurological severity score (mNSS) test, brain water content was measured to assess brain tissue damage, and pathological changes in the lesion site were observed by hematoxylin and eosin (HE) staining. The cerebral cortex was selected for quantitative proteomics, and >1.2/1 and <1/1.2 were used as the thresholds for upregulated and downregulated proteins, respectively. KEGG pathway and Gene Ontology (GO) enrichment analyses of the differentially expressed proteins were conducted. The levels of the oxidative stress markers malondialdehyde (MDA), superoxide dismutase (SOD), and catalase (CAT) were measured by enzyme-linked immunosorbent assay (ELISA). Western blotting was used to assess p-Jak2, Jak2, p-Stat5, Stat5, Bax, Bcl-2, and Caspase-3 protein expression. RESULTS: Compared with the model group, the group treated with high-dose DDD for 3 days exhibited significant improvements in neurological defects, brain histopathology, and brain edema; reduced the level of MDA and significantly increased the levels of CAT and SOD; significantly decreased p-Jak2 and p-Stat5 protein expression and expression of the pro-apoptotic genes Bax and c-Caspase-3; and significantly increased expression of the anti-apoptotic gene Bcl-2 (all p<0.05). CONCLUSIONS: High-dose DDD administration for 3 days reduces the oxidative stress response, regulates the Jak2/Stat5 signaling pathway and inhibits apoptosis to exert a neuroprotective effect in rats with acute hemorrhagic stroke.


Assuntos
Acidente Vascular Cerebral Hemorrágico , Acidente Vascular Cerebral , Ratos , Animais , Caspase 3/metabolismo , Ratos Sprague-Dawley , Proteína X Associada a bcl-2/metabolismo , Fator de Transcrição STAT5/metabolismo , Proteômica , Estresse Oxidativo , Apoptose , Transdução de Sinais , Proteínas Proto-Oncogênicas c-bcl-2/metabolismo , Superóxido Dismutase/metabolismo , Hemorragia Cerebral/tratamento farmacológico , Janus Quinase 2/metabolismo
3.
Neuroimaging Clin N Am ; 33(1): 57-68, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36404047

RESUMO

The coronavirus disease (COVID-19) pandemic has impacted many lives globally. Neurologic manifestations have been observed among individuals at various stages and severity of the disease, the most common being stroke. Prompt identification of these neurologic diagnoses can affect patient management and prognosis. This article discusses the acute neuroradiological features typical of COVID-19, including cerebrovascular disease, intracerebral hemorrhage, leukoencephalopathy, and sensory neuropathies.


Assuntos
COVID-19 , Acidente Vascular Cerebral , Humanos , COVID-19/complicações , Hemorragia Cerebral , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico por imagem , Prognóstico
4.
Oxid Med Cell Longev ; 2022: 4564471, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35308167

RESUMO

The polarization of microglia is recognized as a crucial factor in reducing neuroinflammation and promoting hematoma clearance after intracerebral hemorrhage (ICH). Previous studies have revealed that redox components participate in the regulation of microglial polarization. Recently, the novel Nrf2 activator omaveloxolone (Omav) has been validated to improve neurological function in patients with neurodegenerative disorders by regulating antioxidant responses. In this study, we examined the efficacy of Omav in ICH. Omav significantly promoted Nrf2 nuclear accumulation and the expression of HO-1 and NQO1 in BV2 cells. In addition, both in vitro and in vivo experiments showed that Omav treatment inhibited M1-like activation and promoted the activation of the M2-like microglial phenotype. Omav inhibited OxyHb-induced ROS generation and preserved the function of mitochondria in BV2 cells. Intraperitoneal administration of Omav improved sensorimotor function in the ICH mouse model. Importantly, these effects were blocked by pretreatment with ML385, a selective inhibitor of Nrf2. Collectively, Omav modulated microglial polarization by activating Nrf2 and inhibiting ROS generation in ICH models, suggesting that it might be a promising drug candidate for the treatment of ICH.


Assuntos
Lesões Encefálicas , Microglia , Animais , Lesões Encefálicas/tratamento farmacológico , Hemorragia Cerebral/complicações , Hemorragia Cerebral/tratamento farmacológico , Hemorragia Cerebral/metabolismo , Humanos , Camundongos , Microglia/metabolismo , Fator 2 Relacionado a NF-E2/metabolismo , Fenótipo , Triterpenos
5.
Neurol India ; 70(5): 1840-1845, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36352576

RESUMO

Background: Intracerebral hemorrhage is a leading cause of death and disability worldwide. After intracerebral hemorrhage, cerebral blood flow (CBF) becomes extremely low approaching ischemic thresholds. Concurrently, CBF velocities become strongly correlated to CBF itself post-injury. Identification of such hemodynamic disturbances can be used to predict outcome immediately post-injury when indices are measured using transcranial doppler ultrasonography (TCD). TCD permits non-invasive assessment of different CBF velocities as well as pulsatility index (PI). Abnormal measurement of such indices is believed to correlate to poor outcome. Aim: To investigate the effect of cerebral hemodynamics after cranioplasty in decompressive craniectomy patients using pre and postoperative TCD. Materials and Methods: This study is a prospective study of 3 years duration undertaken on 64 patients. All the patients were evaluated by TCDbefore and after decompressive craniectomy.All patients were evaluated by transcranial Doppler (TCD) 1 week before and 7-15 days after cranioplasty. TCD results were obtained though trans-temporal approach. Results: Statistically significant differences between the values before and after craniectomy were detected in Peak Systolic Volume (PSV) for the Anterior Cerebral Artery (ACA) (P = 0.001), in PSV for the Middle Cerebral Artery (MCA) (P < 0.004), in Mean Bloodflow Velocity (MV) for the MCA (P < 0.003), and in PSV for the Posterior Cerebral artery (PCA) (P = 0.001) on the ipsilateral side. There were statistically significant differences between the values before and after cranioplasty in PSV for the PCA (P = 0.004), on contralateral side.After decompressive craniectomy, the PI values for the MCA decreased, on average, to 31+/- 33% of the pre-surgical value in the treated side and to 28+/- 31% on the opposite side. On the other hand, the mean PI values for the extracranial ICA reduced to 34+/- 21% of the initial values in the treated side, and to 21+/- 31% on the opposite side.Cranioplasty improved CBF velocities in all major intracrainal arteries, not only on the side of the lesion adjacent to the cranioplasty, but also in distant regions, such as in the contralateral hemisphere. Conclusion: Decompressive craniectomy significantly improves cerebral hemodynamics both on ipsilateral and contralateral cerebral hemispheres.Concomitantly, PI values on TCD decrease significantly postoperatively, mainly in the decompressed cerebral hemisphere, indicating reduction in cerebrovascular resistance. We conclude that cranioplasty improves neurological status and the mechanism of postoperative improvement of neurological status may be due to increased CBF velocity.


Assuntos
Craniectomia Descompressiva , Humanos , Craniectomia Descompressiva/métodos , Estudos Prospectivos , Ultrassonografia Doppler Transcraniana , Circulação Cerebrovascular/fisiologia , Hemodinâmica , Hemorragia Cerebral , Velocidade do Fluxo Sanguíneo
8.
PLoS One ; 17(11): e0277296, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36383604

RESUMO

BACKGROUND: Chinese populations have been reported higher incidence of all strokes and intracerebral hemorrhage. However, few large-scale studies have evaluated changes of stroke epidemiology in the 21st century. METHODS: We explored the rates of incidence of all first-ever strokes, subtypes, and 1-month case fatality by using data from the Taiwan National Health Insurance Research Database since 2004. Also, we investigated sex differences in stroke. Time-trend analysis was performed for incidence and case fatality rates of all strokes and subtypes in both sexes. RESULTS: The age-adjusted incidence of all strokes per 100,000 person-years decreased by 16%, from 251 (95% confidence interval [CI] 249-253) in 2004 to 210 (95% CI 209-212) in 2011 (p<0.001); it was always higher in Chinese men than in women. Among pathological subtypes, the incidence of intracerebral hemorrhage markedly decreased by 26% over the years (p<0.001), while that of ischemic stroke slightly decreased by 8%. However, when stratified by sex, the incidence of ischemic stroke decreased significantly in only women, not in men (men: p = 0.399, women: p = 0.004). Regarding the incidence of subarachnoid hemorrhage, it remained unchanged. Furthermore, the rate of 1-month case fatality decreased significantly for all strokes in both sexes (p<0.001). CONCLUSIONS: In Taiwan, the incidence rate of first-ever stroke decreased in both Chinese men and women in the early 21st century. Men had a higher incidence rate than women. Furthermore, a marked decrease was noted in the incidence of intracerebral hemorrhage, while a slight decrease was noted in that of ischemic stroke; however, the decreased incidence of ischemic stroke was significant in only women.


Assuntos
Isquemia Encefálica , AVC Isquêmico , Acidente Vascular Cerebral , Feminino , Humanos , Masculino , Incidência , Isquemia Encefálica/epidemiologia , Caracteres Sexuais , Taiwan/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Hemorragia Cerebral/epidemiologia
9.
Neurology ; 99(19): e2137-e2148, 2022 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-36344278

RESUMO

BACKGROUND AND OBJECTIVES: Prestroke physical activity may protect the brain from severe consequences of stroke. However, previous studies on this subject included mainly ischemic stroke cases, and the association between prestroke physical activity and outcomes after intracerebral hemorrhage is uncertain. Therefore, we sought to examine the associations between prestroke physical activity, stroke severity, and all-cause mortality after intracerebral hemorrhage in comparison with ischemic stroke. METHODS: This was a longitudinal, register-based cohort study. All adult patients with intracerebral hemorrhage or ischemic stroke admitted to 3 stroke units in Gothenburg, Sweden, between November 1, 2014, and June 30, 2019, were screened for inclusion. Physical activity was defined as light physical activity ≥4 h/wk or moderate physical activity ≥2 h/wk the year before stroke. Stroke severity was assessed on admission using the NIH Stroke Scale. All-cause mortality rates were followed up to 7 years, from the time of incident stroke until death or censoring. Ordinal logit models and Cox proportional hazards models were used to estimate adjusted associations of prestroke physical activity. RESULTS: We included 763 patients with intracerebral hemorrhage and 4,425 with ischemic stroke. Prestroke physical activity was associated with less severe strokes by an adjusted odds ratio of 3.57 (99% CI 2.35-5.47) for intracerebral hemorrhages and 1.92 (99% CI 1.59-2.33) for ischemic strokes. During a median follow-up of 4.7 (interquartile range 3.5-5.9) years, 48.5% of patients with intracerebral hemorrhage died, compared with 37.5% with ischemic stroke. Prestroke physical activity was associated with decreased short-term mortality (0-30 days) by an adjusted hazard ratio of 0.30 (99% CI 0.17-0.54) after intracerebral hemorrhage and 0.22 (99% CI 0.13-0.37) after ischemic stroke. Prestroke physical activity was further associated with decreased long-term mortality (30 days-2 years) by an adjusted hazard ratio of 0.40 (99% CI 0.21-0.77) after intracerebral hemorrhage and 0.49 (99% CI 0.38-0.62) after ischemic stroke. DISCUSSION: Prestroke physical activity was associated with decreased stroke severity and all-cause mortality after intracerebral hemorrhage and ischemic stroke, independent of other risk factors. Based on current knowledge, health care professionals should promote physical activity as part of primary stroke prevention.


Assuntos
AVC Isquêmico , Acidente Vascular Cerebral , Adulto , Humanos , Estudos de Coortes , Hemorragia Cerebral , Fatores de Risco , Exercício Físico
11.
Medicine (Baltimore) ; 101(44): e31415, 2022 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-36343042

RESUMO

Previous studies have shown that mean corpuscular volume (MCV) levels are associated with the prognosis of patients with cardiovascular disease. However, the relationship between MCV levels and mortality in patients with intracerebral hemorrhage (ICH) remains unclear. Patients with ICH were extracted from the Medical Information Mart for Intensive Care-III database. The primary outcome measure was 30-day mortality. Multivariate Cox regression analysis was used to investigate the relationship between MCV at admission and 30-day mortality in ICH patients. We enrolled 1100 patients with ICH. After adjustment for potential confounders, we found that a 1 unit increase in MCV (fl) was associated with a 3% increase in 30-day mortality (HR = 1.03, 95% CI = 1.01-1.05, P = .0015). High MCV (MCV ≥ 92 fl) compared with the low MCV group (MCV < 87 fl) showed a 46% increase of 30-day mortality (HR = 1.46, 95% CI = 1.10-1.92 P = .008). In subgroups analysis's the results remained stable. We demonstrated that MCV at admission was positively associated with 30-day mortality. The Kaplan-Meier (KM) method was used to plot survival curves of three groups with different admission MCV levels.


Assuntos
Hemorragia Cerebral , Índices de Eritrócitos , Humanos , Prognóstico , Análise Multivariada , Estudos Retrospectivos
12.
Semin Pediatr Neurol ; 43: 101001, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36344021

RESUMO

Pediatric hemorrhagic stroke (HS) accounts for a large proportion of childhood strokes, 1 of the top 10 causes of pediatric deaths. Morbidity and mortality lead to significant socio-economic and psychosocial burdens. To understand published data on recognizing and managing children with HS, we conducted a systematic review of the literature presented here. We searched PubMed, Embase, CINAHL and the Cochrane Library databases limited to English language and included 174 studies, most conducted in the USA (52%). Terminology used interchangeably for HS included intraparenchymal/intracranial hemorrhage, spontaneous ICH, and cerebrovascular accident (CVA). Key assessments informing prognosis and management included clinical scoring (Glasgow coma scale), and neuroimaging. HS etiologies reported were systemic coagulopathy (genetic, acquired pathologic, or iatrogenic), or focal cerebrovascular lesions (brain arteriovenous malformations, cavernous malformations, aneurysms, or tumor vascularity). Several scales were used to measure outcome: Glasgow outcome score (GOS), Kings outcome score for head injury (KOSCHI), modified Rankin scale (mRS) and pediatric stroke outcome measure (PSOM). Most studies described treatments of at-risk lesions. Few studies described neurocritical care management including raised ICP, seizures, vasospasm, or blood pressure. Predictors of poor outcome included ethnicity, comorbidity, location of bleed, and hematoma >2% of total brain volume. Motor and cognitive outcomes followed independent patterns. Few studies reported on cognitive outcomes, rehabilitation, and transition of care models. Interdisciplinary approach to managing HS is urgently needed, informed by larger cohort studies targeting key clinical question (eg development of a field-guide for the clinician managing patients with HS that is reproducible internationally).


Assuntos
Acidente Vascular Cerebral Hemorrágico , Acidente Vascular Cerebral , Criança , Humanos , Prognóstico , Avaliação de Resultados em Cuidados de Saúde , Encéfalo , Convulsões , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia , Hemorragia Cerebral
13.
BMJ Open ; 12(11): e061241, 2022 11 02.
Artigo em Inglês | MEDLINE | ID: mdl-36323476

RESUMO

OBJECTIVES: Previous studies suggested an inverse association between lipoprotein cholesterols and bleeding risk, while limited data were available about the predictive value of lipoproteins on intracerebral haemorrhage (ICH). Our recent research series showed that higher non-high-density lipoprotein cholesterol (non-HDLC) was an independent predictor of favourable 3-month outcome in ICH patients, we thus aimed to further investigate the association between non-HDLC levels and 1-year functional outcomes after ICH. DESIGN: Prospective multicentre cohort study. SETTING: 13 hospitals in Beijing, China. PARTICIPANTS: A total of 666 ICH patients were included between December 2014 and September 2016. METHODS: Non-HDLC was calculated by subtracting HDL-C from total cholesterol. Patients were then grouped by non-HDLC levels into three categories: <3.4 mmol/L, 3.4-4.2 mmol/L and ≥4.2 mmol/L. Both the univariate and multivariate logistic regressions were used to assess the association between non-HDLC levels and 1-year unfavourable functional outcomes (modified Rankin Scale ≥3) in ICH patients. Moreover, sensitivity analysis was performed in ICH patients without statin use after admission. RESULTS: There were 33.5% (223/666) ICH patients identified with unfavourable functional outcomes at 1-year follow-up. In the univariate analysis, patients who achieved non-HDLC levels above 4.2 mmol/L had a 49% decreased risk of 1-year poor prognosis (OR 0.51, 95% CI 0.33 to 0.81). However, non-HDLC did not retain its independent prognostic value in multivariate analysis, the fully adjusted OR values were 1.00 (reference), 1.06 (0.63, 1.79) and 0.83 (0.45, 1.54) from the lowest to the highest non-HDLC group. Moreover, statin use after ICH onset made no difference to the long-term prognosis. CONCLUSIONS: Non-HDLC was not an independent predictor for 1-year functional outcome in ICH patients, irrespective of poststroke statin use. The predictive value of well-recognised confounding factors was more dominant than non-HDLC on long-term prognosis.


Assuntos
Inibidores de Hidroximetilglutaril-CoA Redutases , Humanos , Hemorragia Cerebral/epidemiologia , Colesterol , Estudos de Coortes , Hospitais , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Lipoproteínas , Prognóstico , Estudos Prospectivos , Fatores de Risco , Pequim/epidemiologia
14.
Biol Pharm Bull ; 45(11): 1699-1705, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36328505

RESUMO

Hydrogen sulfide and polysulfides are increasingly recognized as bioactive signaling molecules to produce various actions and regulate (patho)physiological processes. Here we examined the effects of sodium sulfide (Na2S) and sodium trisulfide (Na2S3) on an experimental model of intracerebral hemorrhage (ICH) in mice. Na2S or Na2S3 (25 µmol/kg, intraperitoneally (i.p.)) was administered 30 min before ICH induction by intrastriatal injection of collagenase. We found that Na2S significantly ameliorated sensorimotor functions of mice after ICH. Histopathological examinations revealed that Na2S inhibited neuron loss in the striatum, prevented axon degeneration in the internal capsule, and ameliorated axonal transport dysfunction in the striatum and the cerebral cortex where the edge of hematoma was located. Although Na2S did not suppress accumulation of activated microglia/macrophages in the peri-hematoma region, it suppressed ICH-induced upregulation of inflammatory mediators such as C-X-C motif ligand 2. On the other hand, Na2S3 did not ameliorate ICH-induced sensorimotor dysfunction. Although the effect of Na2S3 on several parameters such as axon degeneration and axonal transport dysfunction was comparable to that of Na2S, Na2S3 did not significantly inhibit neuron loss and upregulation of inflammatory mediators. These results suggest that the regulation of multiple pathological events is involved in the effect of Na2S leading to amelioration of neurological symptoms associated with ICH.


Assuntos
Hemorragia Cerebral , Microglia , Camundongos , Animais , Hemorragia Cerebral/tratamento farmacológico , Modelos Teóricos , Hematoma/complicações , Mediadores da Inflamação/farmacologia
15.
Artigo em Inglês | MEDLINE | ID: mdl-36361190

RESUMO

Patients with mild traumatic brain injury (MTBI) with intracerebral hemorrhage (ICH), particularly those at higher risk of having ICH progression, are typically prescribed a second head Computer Tomography (CT) scan to monitor the disease development. This study aimed to evaluate the role of a repeat head CT in MTBI patients at a higher risk of ICH progression by comparing the intervention rate between patients with and without ICH progression. METHODS: 192 patients with MTBI and ICH were treated between November 2019 to December 2020 at a single level II trauma center. The Glasgow Coma Scale (GCS) was used to classify MTBI, and initial head CT was performed according to the Canadian CT head rule. Patients with a higher risk of ICH progression, including the elderly (≥65 years old), patients on antiplatelets or anticoagulants, or patients with an initial head CT that revealed EDH, contusional bleeding, or SDH > 5 mm, and multiple ICH underwent a repeat head CT within 12 to 24 h later. Data regarding types of intervention, length of stay in the hospital, and outcome were collected. The risk of further neurological deterioration and readmission rates were compared between these two groups. All patients were followed up in the clinic after one month or contacted via phone if they did not return. RESULTS: 189 patients underwent scheduled repeated head CT, 18% had radiological intracranial bleed progression, and 82% had no changes. There were no statistically significant differences in terms of intervention rate, risk of neurological deterioration in the future, or readmission between them. CONCLUSION: Repeat head CT in mild TBI patients with no neurological deterioration is not recommended, even in patients with a higher risk of ICH progression.


Assuntos
Concussão Encefálica , Humanos , Idoso , Canadá , Tomografia Computadorizada por Raios X/métodos , Hemorragia Cerebral/diagnóstico por imagem , Computadores , Encéfalo , Estudos Retrospectivos
16.
J Stroke Cerebrovasc Dis ; 31(12): 106861, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36323169

RESUMO

OBJECTIVES: This study aimed to determine the impact of the approval of prothrombin complex concentrates on the treatment of vitamin K antagonist-related intracerebral hemorrhage. MATERIALS AND METHODS: We retrospectively studied all patients with vitamin K antagonist-related intracerebral hemorrhage treated with prothrombin complex concentrate at our institutes between January 2010 and June 2021. Before approval, prothrombin complex concentrate was administered as either 500 or 1000 IU at the physician's discretion (previous dose group). After approval, we adopted the manufacturer's recommended regimen (recommended dose group). The primary outcome was post-administration international normalized ratio. Secondary outcomes were the amount of prothrombin complex concentrate administered and proportion of post-administration international normalized ratio <1.5, hematoma expansion, thrombotic events within 30 days, modified Rankin scale 0-3 at discharge, and in-hospital mortality. RESULTS: Thirty-two and 19 patients in the previous and recommended dose groups, respectively, were included. The post-administration international normalized ratio significantly differed between groups. The prothrombin complex concentrate dose and proportion of patients achieving post-administration international normalized ratio <1.5 were significantly higher in the recommended dose group than in the previous dose group (1500 IU vs. 500 IU, p<0.001 and 100% vs. 68%, p = 0.008). The proportions of hematoma expansion, thromboembolic events, modified Rankin scale 0-3, and mortality did not differ between groups. CONCLUSION: After prothrombin complex concentrate approval, prothrombin time-international normalized ratio correction was more effective with a significant increase in the prothrombin complex concentrates dose for vitamin K antagonist-associated intracerebral hemorrhage; however, there was no apparent difference in clinical outcomes.


Assuntos
Protrombina , Vitamina K , Humanos , Estudos Retrospectivos , Protrombina/uso terapêutico , Fatores de Coagulação Sanguínea/efeitos adversos , Anticoagulantes/efeitos adversos , Coeficiente Internacional Normatizado , Hemorragia Cerebral/induzido quimicamente , Hemorragia Cerebral/tratamento farmacológico , Hematoma/tratamento farmacológico , Fibrinolíticos/uso terapêutico
17.
Zhongguo Dang Dai Er Ke Za Zhi ; 24(11): 1195-1201, 2022 Nov 15.
Artigo em Chinês | MEDLINE | ID: mdl-36398543

RESUMO

OBJECTIVES: To investigate the influence of early-stage hypotension defined as mean arterial pressure (MAP)0.05).The univariate analysis showed that the poor short-term prognosis was related to birth of cesarean section, gestational age, an Apgar score of ≤ 5 at 5 minutes, use of vasoactive drugs within 72 hours, mechanical ventilation within 72 hours, and hypotension under the two definitions (P<0.05).The multivariate logistic regression showed that hypotension based on either definition was not an independent risk factor for poor prognosis (P>0.05). CONCLUSIONS: Hypotension based on either definition is not an independent risk factor for short-term poor prognosis in preterm infants with a gestational age of <32 weeks. Hypotension defined by MAP<30 mmHg might be more sensitive than that defined by MAP

Assuntos
Hipotensão , Recém-Nascido Prematuro , Lactente , Criança , Recém-Nascido , Humanos , Gravidez , Feminino , Idade Gestacional , Estudos Prospectivos , Cesárea , Hipotensão/etiologia , Prognóstico , Hemorragia Cerebral
18.
Front Immunol ; 13: 945860, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36389834

RESUMO

Intracerebral hemorrhage (ICH) is the most common subtype of hemorrhagic stroke. After ICH, blood components extravasate from vessels into the brain, activating immune cells and causing them to release a series of inflammatory mediators. Immune cells, together with inflammatory mediators, lead to neuroinflammation in the perihematomal region and the whole brain, and neuroinflammation is closely related to secondary brain injury as well as functional recovery of the brain. Despite recent progress in understanding the pathophysiology of ICH, there is still no effective treatment for this disease. MicroRNAs (miRNAs) are non-coding RNAs 17-25 nucleotides in length that are generated naturally in the human body. They bind complementarily to messenger RNAs and suppress translation, thus regulating gene expression at the post-transcriptional level. They have been found to regulate the pathophysiological process of ICH, particularly the neuroinflammatory cascade. Multiple preclinical studies have shown that manipulating the expression and activity of miRNAs can modulate immune cell activities, influence neuroinflammatory responses, and ultimately affect neurological functions after ICH. This implicates the potentially crucial roles of miRNAs in post-ICH neuroinflammation and indicates the possibility of applying miRNA-based therapeutics for this disease. Thus, this review aims to address the pathophysiological roles and molecular underpinnings of miRNAs in the regulation of neuroinflammation after ICH. With a more sophisticated understanding of ICH and miRNAs, it is possible to translate these findings into new pharmacological therapies for ICH.


Assuntos
MicroRNAs , Humanos , MicroRNAs/genética , MicroRNAs/uso terapêutico , Doenças Neuroinflamatórias , Hemorragia Cerebral/genética , Hemorragia Cerebral/terapia , Inflamação , Mediadores da Inflamação/metabolismo
20.
Cell Rep ; 41(8): 111709, 2022 Nov 22.
Artigo em Inglês | MEDLINE | ID: mdl-36417884

RESUMO

The function of fibroblasts in intracerebral hemorrhage (ICH) remains elusive. By targeting Col1α1, a fibroblast-specific marker, we generate mice with ablated Col1α1+ fibroblasts. These mutants show exacerbated blood-brain barrier (BBB) damage, enlarged injury volume, and worse neurological function, highlighting a beneficial role of Col1α1+ fibroblasts in ICH. Echoing these findings, fibroblasts significantly decrease endothelial permeability in an in vitro ICH model. Next, we demonstrate that fibroblasts promote BBB integrity in ICH mainly via up-regulating tight junction proteins without affecting transcytosis-associated proteins, indicating a paracellular rather than transcellular mechanism. A subsequent mechanistic study reveals that the BBB-protective effect of fibroblasts is partially mediated by TIMP metallopeptidase inhibitor 2 (TIMP2). Furthermore, we find that exogenous TIMP2 attenuates BBB disruption in these mutants after ICH. These results suggest that Col1α1+ fibroblasts repair BBB damage in ICH via the paracellular pathway in a TIMP2-dependent manner, and that Col1α1+ fibroblasts and TIMP2 may be targeted in ICH treatment.


Assuntos
Barreira Hematoencefálica , Lesões Encefálicas , Animais , Camundongos , Barreira Hematoencefálica/metabolismo , Hemorragia Cerebral/metabolismo , Transporte Biológico , Fibroblastos/metabolismo
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