Artificial intelligence using deep neural network learning for automatic location of the interscalene brachial plexus in ultrasound images.

BACKGROUND: Identifying the interscalene brachial plexus can be challenging during ultrasound-guided interscalene block. OBJECTIVE: We hypothesised that an algorithm based on deep learning could locate the interscalene brachial plexus in ultrasound images better than a nonexpert anaesthesiologist, thus possessing the potential to aid anaesthesiologists. DESIGN: Observational study. SETTING: A tertiary hospital in Shanghai, China. PATIENTS: Patients undergoing elective surgery. INTERVENTIONS: Ultrasound images at the interscalene level were collected from patients. Two independent image datasets were prepared to train and evaluate the deep learning model. Three senior anaesthesiologists who were experts in regional anaesthesia annotated the images. A deep convolutional neural network was developed, trained and optimised to locate the interscalene brachial plexus in the ultrasound images. Expert annotations on the datasets were regarded as an accurate baseline (ground truth). The test dataset was also annotated by five nonexpert anaesthesiologists. MAIN OUTCOME MEASURES: The primary outcome of the research was the distance between the lateral midpoints of the nerve sheath contours of the model predictions and ground truth. RESULTS: The data set was obtained from 1126 patients. The training dataset comprised 11 392 images from 1076 patients. The test dataset constituted 100 images from 50 patients. In the test dataset, the median [IQR] distance between the lateral midpoints of the nerve sheath contours of the model predictions and ground truth was 0.8 [0.4 to 2.9] mm: this was significantly shorter than that between nonexpert predictions and ground truth (3.4 mm [2.1 to 4.5] mm; P < 0.001). CONCLUSION: The proposed model was able to locate the interscalene brachial plexus in ultrasound images more accurately than nonexperts. TRIAL REGISTRATION: ClinicalTrials.gov (https://clinicaltrials.gov) identifier: NCT04183972.

Progress in the genetic studies of spermatogenesis abnormalities.

About 15% couples suffer from infertility, half of which are caused by male factors. Male infertility usually manifests as teratozoospermia, oligospermia and/or asthenospermia, of which the most severe form is azoospermia. In this review, we summarize the recent progress in the study of genetic factors involved in nonobstructive azoospermia and teratozoospermia, Recently, with the rapid development of high-throughput chips and sequencing technologies, many genetic factors of spermatogenesis have been discovered and analyzed. For the nonobstructive azoospermia, genome-wide association studies (GWAS) and high-throughput sequencing revealed many risk loci of nonobstructive azoospermia. For the teratozoospermia, the application of whole-exome sequencing (WES) revealed a series of disease-causing genes, greatly enriching our knowledge of teratozoospermia including multiple morphological abnormalities of the flagella (MMAF). The discovery of lots of disease genes helped the characterization of the pathological mechanisms of male infertility. Therefore, a comprehensive and in-depth understanding of genetic factors in spermatogenesis abnormalities will play important roles in the clinical diagnosis, treatment and genetic counseling of male infertility.

Resolution of migraine-like headache by coil embolization of a primitive trigeminal artery aneurysm.

OBJECTIVE: We report a rare case of migraine-like headache associated with an unruptured primitive trigeminal artery (PTA) aneurysm with a coincident finding of anterior cerebral artery (ACA) fenestration. We discuss the possible mechanism of the headache and review the relevant literature. CASE PRESENTATION: A 59-year-old woman was admitted with the chief complaint of episodes of pulsatile headache recurring over 3 months. The headaches were moderate to severe in intensity, located on the right side, sometimes triggered and aggravated by strenuous activity, and progressively accompanied by nausea. Headache episodes occurred three to six times per month and typically lasted for several hours each. Radiological examinations demonstrated the presence of a large right-side PTA aneurysm 23 × 18 × 17 mm in size, which was associated with an ACA fenestration. She was successfully treated with endovascular embolization, and postoperatively, her headaches were completely resolved. At follow-up 12 months after surgery, the patient reported complete resolution of her headache. DISCUSSION: Both primitive trigeminal artery aneurysm and fenestration of the cerebrovascular system are rare developmental anomalies. The PTA courses alongside and is in anatomical proximity to the trigeminal nerve. Therefore, PTA aneurysms are more likely to cause symptoms, due to compression of the trigeminal nerve. The trigeminovascular system has been implicated in the genesis of migraine headaches. We propose the high-velocity pulsatile flow through the aneurysm across the surface of the trigeminal nerve as the etiology of the migraine-like headaches. Endovascular embolization might be a preferred procedure for dealing with patients in this setting.

Astaxanthin alleviates early brain injury following subarachnoid hemorrhage in rats: possible involvement of Akt/bad signaling.

Apoptosis has been proven to play a crucial role in early brain injury pathogenesis and to represent a target for the treatment of subarachnoid hemorrhage (SAH). Previously, we demonstrated that astaxanthin (ATX) administration markedly reduced neuronal apoptosis in the early period after SAH. However, the underlying molecular mechanisms remain obscure. In the present study, we tried to investigate whether ATX administration is associated with the phosphatidylinositol 3-kinase-Akt (PI3K/Akt) pathway, which can play an important role in the signaling of apoptosis. Our results showed that post-SAH treatment with ATX could cause a significant increase of phosphorylated Akt and Bad levels, along with a significant decrease of cleaved caspase-3 levels in the cortex after SAH. In addition to the reduced neuronal apoptosis, treatment with ATX could also significantly reduce secondary brain injury characterized by neurological dysfunction, cerebral edema and blood-brain barrier disruption. In contrast, the PI3K/Akt inhibitor, LY294002, could partially reverse the neuroprotection of ATX in the early period after SAH by downregulating ATX-induced activation of Akt/Bad and upregulating cleaved caspase-3 levels. These results provided the evidence that ATX could attenuate apoptosis in a rat SAH model, potentially, in part, through modulating the Akt/Bad pathway.

Hydrogen exerts neuroprotective effects after subarachnoid hemorrhage by attenuating neuronal ferroptosis and inhibiting neuroinflammation.

OBJECTIVE: Spontaneous subarachnoid hemorrhage (SAH), the third most common stroke subtype, is associated with high mortality and disability rates. Therefore, finding effective therapies to improve neurological function after SAH is critical. The objective of this study was to investigate the potential neuroprotective effects of hydrogen in the context of SAH, specifically, by examining its role in attenuating neuronal ferroptosis and inhibiting neuroinflammation, which are exacerbated by excess iron ions after SAH. METHODS: Mice were exposed to chambers containing 3% hydrogen, and cells were cultured in incubators containing 60% hydrogen. Neurological function in mice was assessed using behavioral scores. Protein changes were detected using western blotting. Inflammatory factors were detected using enzyme linked immunosorbent assay. Probes, electron microscopy, and related kits were employed to detect oxidative stress and ferroptosis. RESULTS: Hydrogen improved the motor function, sensory function, and cognitive ability of mice after SAH. Additionally, hydrogen facilitated Nuclear factor erythroid 2 -related factor 2 activation, upregulated Glutathione peroxidase 4, and inhibited Toll-like receptor 4, resulting in downregulation of inflammatory responses, attenuation of oxidative stress after SAH, and inhibition of neuronal ferroptosis. CONCLUSION: Hydrogen exerts neuroprotective effects by inhibiting neuronal ferroptosis and attenuating neuroinflammation after SAH.

Parent artery occlusion with Onyx for distal aneurysms of posterior inferior cerebellar artery: a single-centre experience in a series of 15 patients.

BACKGROUND: Aneurysms located at distal posterior inferior cerebellar artery (PICA) are rare. These aneurysms are difficult for surgical or endovascular treatment, especially for ruptured aneurysms. AIMS: To investigate the clinical and radiologic efficacy of parent artery occlusion (PAO) with embolic agent Onyx in the treatment of distal PICA aneurysm. MATERIALS AND METHODS: Case records of 15 consecutive patients with 15 ruptured distal PICA aneurysms treated with Onyx embolization were reviewed retrospectively. The follow-up ranged between 6 and 52 months. Cerebral angiography or cerebra computed tomography-angiogram (CTA) was performed for follow-up radiological study. Two aneurysms had origin from tonsillomedullary segment, nine from telovelotonsillar segments, and four from cortical segments. All patients were treated with Onyx to occlude aneurysm and proximal portion of vessel in front of aneurysm via endovascular approach. RESULTS: Aneurysm was occluded completely in every patient. One patient died because of intra-procedure haemorrhage. Fourteen patients had good recovery and the last follow-up Glasgow outcome scale was 5. Head CT scan was performed in every survived patient before discharge. CT in 3 patients revealed cerebellar infarctions but without any neurological deficits. None of the 14 patients had rebleeding or fresh neurologic deficits during the follow-up period. Aneurysmal recanalization had not been observed in any of the survived patients. CONCLUSIONS: Onyx occlusion of proximal parent artery and aneurysm in the treatment of distal PICA aneurysm is safe and effective according to this study. Morphology and location of aneurysm are important to decide the therapeutic strategy.

Peroxiredoxin 2 Is a Potential Objective Indicator for Severity and the Clinical Status of Subarachnoid Hemorrhage Patients.

Purpose: We have demonstrated that peroxiredoxin 2 (Prx2) released from lytic erythrocytes and damaged neurons into the subarachnoid space could activate microglia and then result in neuronal apoptosis. In this study, we tested the possibility of using Prx2 as an objective indicator for severity of the subarachnoid hemorrhage (SAH) and the clinical status of the patient. Materials and Methods: SAH patients were prospectively enrolled and followed up for 3 months. Cerebrospinal fluid (CSF) and blood samples were collected 0-3 and 5-7 days after SAH onset. The levels of Prx2 in the CSF and the blood were measured by an enzyme-linked immunosorbent assay (ELISA). We used Spearman's rank coefficient to assess the correlation between Prx2 and the clinical scores. Receiver operating characteristic (ROC) curves were used for Prx2 levels to predict the outcome of SAH by calculating the area under the curve (AUC). Unpaired Student's t-test was used to analyze the differences in continuous variables across cohorts. Results: Prx2 levels in the CSF increased after onset while those in the blood decreased. Existing data showed that Prx2 levels within 3 days in the CSF after SAH were positively correlated with the Hunt-Hess score (R = 0.761, P < 0.001). Patients with CVS had higher levels of Prx2 in their CSF within 5-7 days after onset. Prx2 levels in the CSF within 5-7 days can be used as a predictor of prognosis. The ratio of Prx2 in the CSF and the blood within 3 days of onset was positively correlated with the Hunt-Hess score and negatively correlated with Glasgow Outcome Scale (GOS; R = -0.605, P < 0.05). Conclusion: We found that the levels of Prx2 in the CSF and the ratio of Prx2 in the CSF and the blood within 3 days of onset can be used as a biomarker to detect the severity of the disease and the clinical status of the patient.

Efficacy of Liquid Embolic Agent Treatment in Hemorrhagic Peripheral Intracranial Aneurysms: A Single-Center Experience.

Objective: To evaluate the efficacy of liquid embolization agents for treating various hemorrhagic peripheral intracranial aneurysms. Methods: We retrospectively analyzed 38 patients who suffered from hemorrhagic peripheral intracranial aneurysms and were treated with liquid embolization agents. We used the modified Rankin scale for follow-up at 6 months postoperatively, and digital subtraction angiography follow-up was performed 6 months postoperatively. Results: Of the 38 patients (ten of simple peripheral intracranial aneurysms, six of Moyamoya disease (MMD), and 22 of arteriovenous malformation (AVM)), posterior circulation accounted for the most significant proportion (57.9%), followed by anterior circulation (21.1%) and intranidal aneurysms (21.1%). Intraoperative hemorrhage occurred in four cases, postoperative cerebral infarction occurred in four cases, two patients encountered microcatheter retention, and intraoperative thrombosis took place in the basilar artery of a patient with an arteriovenous malformation. A postoperative hemorrhage occurred in only one patient. At 6-month follow-up, 84.2% of patients had good prognosis outcomes, and 13.5% had poor outcomes. Conclusion: Liquid embolization agents are effective for hemorrhagic peripheral intracranial aneurysms; however, safety depends on the subtypes. For peripheral hemorrhagic aneurysms in MMD, the vessel architecture must be carefully evaluated before embolization.

[Endovascular treatment of intracranial major artery aneurysms associated with Moyamoya disease].

OBJECTIVE: To summarize the clinical experiences of treating intracranial aneurysms associated with Moyamoya disease by endovascular approach. METHODS: A total of 13 patients were admitted into our hospital because of subarachnoid hemorrhage. Cerebral angiography revealed the evidence of Moyamoya disease and intracranial aneurysms. Endovascular embolization was performed for these aneurysms with coils, balloon-assisted coils placement and stent plus coils. RESULTS: All operations were successful. Total occlusion was achieved in 11 patients and over 90% in 2. The patients recovered well with a patency of parent arteries. CONCLUSION: Endovascular therapy is a valid and suitable approach for the treatment of intracranial aneurysms associated with Moyamoya disease.

MiR-146a Ameliorates Hemoglobin-Induced Microglial Inflammatory Response via TLR4/IRAK1/TRAF6 Associated Pathways.

Microglial activation and sustained inflammation in the brain can lead to neuronal damage. Hence, limiting microglial activation and brain inflammation is a good therapeutic strategy for inflammatory-associated central nervous disease. MiR-146a is a promising therapeutic microRNA, since it can negatively regulate the inflammatory response. We thus investigated the expression changes of miR-146a after experimental induction of a subarachnoid hemorrhage (SAH) in vivo and in vitro, and we assessed the anti-inflammatory effects of miR-146a in microglial cells in vitro. Primary microglial cells were preincubated with miR-146a before hemoglobin (Hb) treatment. The results indicated that miR-146a decreased gene expression of Hb-induced pro-inflammatory cytokines (TNF-α and IL-1ß) and phenotype-related genes (iNOS and CD86) through IRAK1/TRAF6/NF-κB or MAPK signaling pathways, suggesting its pro-resolution activity in microglia. However, contrary to the LPS-induced microglia or macrophage activation model, we did not observe an elevation in miR-146a after activation. Overall, our findings demonstrated that miR-146a was involved in the regulation of brain inflammation and could be considered a novel therapeutic agent for treating brain inflammation.

Levels of Interleukin-1ß, Interleukin-18, and Tumor Necrosis Factor-α in Cerebrospinal Fluid of Aneurysmal Subarachnoid Hemorrhage Patients May Be Predictors of Early Brain Injury and Clinical Prognosis.

BACKGROUND: Aneurysmal subarachnoid hemorrhage (aSAH) is a severe cerebrovascular accident with high morbidity and mortality. The aim of this study is to investigate the relationship between level of inflammatory cytokines in cerebrospinal fluid (CSF) of aSAH patients, the severity of aSAH, and the outcome of aSAH patients. METHODS: aSAH patients were prospectively included and followed-up for 6 months. CSF samples were collected at 1-3, 4-6, and 7-9 days after aSAH onset. Levels of interleukin (IL)-1ß, IL-18, and tumor necrosis factor-α (TNF-α) in the CSF of aSAH patients were measured by enzyme-linked immunosorbent assay. RESULTS: Eighty-one aSAH patients were enrolled. The levels of IL-1ß, IL-18 and TNF-α in the CSF were especially higher in the group of aSAH patients with cerebral edema, cerebral vasospasm, and a high grade on Hunt-Hess scale, the high World Federation of Neurological Surgeons grades, and Fisher grade (P < 0.01). Higher levels of plasma C-reactive protein in the blood were correlated with poor outcome. The areas under the receiver operating characteristic curves for the levels of inflammatory cytokines in CSF were 0.85, 0.84, and 0.95, respectively. Clinical features (age, Hunt-Hess grade, etc.) were positively correlated with poor outcomes (P < 0.05). CONCLUSIONS: The levels of IL-1ß, IL-18, and TNF-α in CSF were elevated in aSAH patients and were positively associated with cerebral edema and acute hydrocephalus. Our findings suggest that CSF inflammatory cytokines might be biomarkers to assess severity and predict outcomes.

[On English translation of jun, chen, zuo and shi in science of prescription].

In this paper, English translation of JUN, CHEN, ZUO, and SHI in science of prescription of traditional Chinese medicine were discussed by hunting the headstream, analyzing and explaining their implication, discriminating and selecting the relative English terms.

Flat-detector computed tomography PBV map in the evaluation of presurgical embolization for hypervascular brain tumors.

BACKGROUND: Preoperative embolization of hypervascular brain tumors is frequently used to minimize intraoperative bleeding. OBJECTIVE: To explore the efficacy of embolization using flat-detector CT (FDCT) parenchymal blood volume (PBV) maps before and after the intervention. MATERIALS AND METHODS: Twenty-five patients with hypervascular brain tumors prospectively received pre- and postprocedural FDCT PBV scans using a biplane system under a protocol approved by the institutional research ethics committee. Semiquantitative analysis, based on region of interest measurements of the pre- and post-embolization PBV maps, operating time, and blood loss, was performed to assess the feasibility of PBV maps in detecting the perfusion deficit and to evaluate the efficacy of embolization. RESULTS: Preoperative embolization was successful in 18 patients. The relative PBV decreased significantly from 3.98±1.41 before embolization to 2.10±2.00 after embolization. Seventeen patients underwent surgical removal of tumors 24 hours after embolization. The post-embolic tumor perfusion index correlated significantly with blood loss (ρ=0.55) and operating time (ρ=0.60). CONCLUSIONS: FDCT PBV mapping is a useful method for evaluating the perfusion of hypervascular brain tumors and the efficacy of embolization. It can be used as a supplement to CT perfusion, MRI, and DSA in the evaluation of tumor embolization.

[Influence of Biological Activated Carbon on Simultaneous Nitrification and Denitrification in Inflow with Different C/N Ratios].

Influence of biological activated carbon (BAC) on simultaneous nitrification and denitrification (SND) in inflow with different C/N ratios was investigated with continuous operation of BAC reactor and SBR. Methanol was added as carbon source and the inflow C/N ratio was set to 3, 5, 8 and 10 to run for about 120 cycles, under conditions of indoor temperature (15-27℃), initial DO 2-3mg·L-1. The TN removal efficiency and stability of two reactors were compared. The results showed that, BAC reactor had a higher TN removal efficiency than SBR at different C/N ratios. TN removal rate of BAC reactor was 44.88%, 58.07% and 66.64%, when the C/N ratio was 3, 5 and 8 respectively. After increasing the C/N ratio to 10, the BAC reactor could maintain TN removal rate of 63.65%, but the SBR showed sludge bulking. BAC provided various DO environments for microorganisms in a vessel, which was beneficial to SND. BAC could reduce the influence of excessive carbon source on the nitrification system, enlarge the application range and improve the stability of reactor at different C/N ratios, and increase the nitrogen removal capacity of organic matter. BAC provided condition for efficient nitrogen removal.

Inflammasome Proteins in Cerebrospinal Fluid of Patients with Subarachnoid Hemorrhage are Biomarkers of Early Brain Injury and Functional Outcome.

BACKGROUND: Aneurysmal subarachnoid hemorrhage (SAH) remains a devastating disease with significant morbidity and mortality. To date, clinical variables are still used to evaluate injury severity and prognosis. This study was designed to investigate the role of cerebrospinal fluid (CSF) inflammasome proteins as laboratory-based biomarkers of brain injury severity and outcome in SAH patients. METHODS: Ten control patients and 24 SAH patients were prospectively enrolled in this study. CSF samples were collected within 72 hours after SAH. Levels of inflammasome proteins in the CSF, including NLRP1, ASC, and caspase-1 were analyzed. RESULTS: Immunoblot analysis exhibited that levels of NLRP1, ASC and caspase-1 were elevated in the CSF of SAH patients (P < 0.0001, P = 0.0178, and P < 0.0001, respectively). In the group of SAH patients, these inflammasome proteins were significantly higher in the patients with cerebral edema on computed tomographic scans (P = 0.0002, P = 0.0005, and P = 0.0004, respectively), and in the patients with acute hydrocephalus (P = 0.0009, P = 0.00017, and P = 0.0016, respectively). Higher levels of inflammasome proteins were associated with severe SAH and poor outcome 3 months after the SAH. High level of NLRP1 was the independent risk factor of poor outcome after SAH (P = 0.049, odds ratio = 1.730). CONCLUSIONS: Inflammasome proteins are potential biomarkers to assess early brain injury and to predict functional outcome after SAH.

Onyx Embolization for Tentorial Dural Arteriovenous Fistula with Pial Arterial Supply: Case Series and Analysis of Complications.

OBJECTIVE: We describe treatment with Onyx embolization in a series of cases of tentorial dural arteriovenous fistula (DAVF) with pial arterial supply. The aim of this study was to analyze the cause of intraoperative hemorrhage and to explore therapeutic strategies. METHODS: Retrospective review was performed of 53 consecutive patients with DAVF treated by Onyx embolization between February 2009 and December 2014. Tentorial DAVF with pial arterial supply was diagnosed in 6 patients (2 women and 4 men; mean age, 47.3 years ± 10.2), and transarterial Onyx embolization was performed in these patients. Fisher exact test was used to analyze differences of incidence of procedure-related complications. RESULTS: Intraoperative hemorrhage occurred in 2 of 6 patients with pial arterial supply. One patient died as a result of hemorrhage, and the other patient survived after craniotomy. The incidence of complications for these 6 patients (2 of 6; 33.3%) was significantly higher (P = 0.0309) compared with patients with DAVF without pial arterial supply (1 of 47; 2.1%). CONCLUSIONS: Pial arterial supply may be a risk factor for intraoperative hemorrhage during transarterial embolization of DAVF through dural feeders. Identification of pial feeders and early superselective occlusion of such feeders are important for safe management.

The influence of subarachnoid hemorrhage on neurons: an animal model.

Subarachnoid hemorrhage (SAH) has considerable mortality and morbidity, but the pathophysiologic mechanism is not entirely clear. Following SAH, blood or its lysate enters the subarachnoid space. This study examined how blood lysate influences the vulnerable brain following SAH. Heparinized hemolysate was slowly injected into the cisterna magna of 10 female rabbits, while a control group of 10 rabbits received a similar injection of heparinized isotonic sodium chloride solution without hemolysate. The basilar artery and brain tissue were excised after perfusion fixation. The degree of cerebral vasospasm was evaluated by measuring the cross-sectional area of the basilar artery, and brain damage was investigated by TUNEL staining. In the SAH group, the apoptosis index of neuronal cells located at the base of the temporal lobe averaged 26% (range = 3 to 56%), which was significantly higher than the corresponding apoptosis index in the control group (mean 0.5%, range = 0 to 4%, p <0.001). The mean cross-sectional area of the basilar artery in the SAH group did not differ significantly from that in the control group. These results suggest that SAH induces apoptosis of neuronal cells by a mechanism that is independent of cerebral vasospasm.

Astaxanthin reduces matrix metalloproteinase-9 expression and activity in the brain after experimental subarachnoid hemorrhage in rats.

We have previously shown that astaxanthin (ATX) reduces the blood-brain barrier (BBB) disruption and neurovascular dysfunction following subarachnoid hemorrhage (SAH) insults. However, the underlying mechanisms remain unclear. It is known that the matrix metalloproteinases (MMPs), especially matrix metalloproteinase-9 (MMP-9) plays a crucial role in the pathogenesis of secondary brain injury after SAH. And ATX has the ability to regulate MMP-9 in other models. Herein, we investigated whether ATX could ameliorate MMP-9 activation and expression in a rat model of SAH. A total of 144 rats were randomly divided into the following groups: control group (n=36), SAH group (n=36), SAH+vehicle group (n=36), and SAH+ATX group (n=36). The SAH model was induced by injection of 0.3 ml autologous blood into the prechiasmatic cistern. ATX (20 µl of 0.1 mmol) or vehicle was administered intracerebroventricularly 30 min after SAH induction. Mortality, neurological function, brain edema and blood-brain barrier (BBB) permeability were measured at 24 and 72 h after SAH. Biochemical and zymographic methods were used to analyze MMP-9 expression and activity in brain samples. Immunohistochemistry and terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL) staining were also evaluated at 24h. Our data indicated that ATX could significantly reduce the expression and activity of MMP-9, leading to the amelioration of brain edema, BBB impairment, neurological deficits and TUNEL-positive cells at 24h but not 72 h after SAH. The ATX-mediated down-regulation of MMP-9 was correlated with the decreased levels of IL-1ß, TNF-α, oxidative stress, activated microglia and infiltrating neutrophils. These results suggest that the neurovascular protection of ATX in SAH is partly associated with the inhibition of MMP-9 expression and activity.

Increased cerebrospinal fluid concentrations of asymmetric dimethylarginine correlate with adverse clinical outcome in subarachnoid hemorrhage patients.

Elevated cerebrospinal fluid (CSF) concentrations of asymmetric dimethylarginine (ADMA), an endogenous inhibitor of nitric oxide synthase, have been found in patients with subarachnoid hemorrhage (SAH). In addition, CSF levels of ADMA are associated with the severity of vasospasm. However, the relation between CSF ADMA levels and the clinical outcome of SAH patients is still unclear. We hypothesized that elevated ADMA levels in CSF might be related to the clinical outcome of SAH patients. CSF ADMA levels were measured in 20 SAH patients at days 3-5, days 7-9 and days 12-14 after SAH onset using high-performance liquid chromatography. Cerebral vasospasm was assessed by transcranial Doppler ultra sonography. Clinical outcome at 2year follow-up was evaluated using the Karnofsky Performance Status scale (KPS). CSF ADMA concentrations in all SAH patients were significantly increased at days 3-5 (p=0.002) after SAH, peaked on days 7-9 (p<0.001) and remained elevated until days 12-14 (p<0.001). In subgroup analysis, significant increases of CSF ADMA levels were found in patients both with and without vasospasm. The KPS scores significantly correlated with CSF levels of ADMA at days 7-9 (correlation coefficient=-0.55, p=0.012; 95% confidence interval -0.80 to -0.14). Binary logistic regression analysis indicated that higher ADMA level at days 7-9 predicted a poor clinical outcome at 2year follow-up after SAH (odds ratio=1.722, p=0.039, 95% confidence interval 1.029 to 2.882). ADMA may be directly involved in the pathological process and future adverse prognosis of SAH.

[Effects of acupuncture at "Zusanli" (ST 36) on eosinophil apoptosis and related gene expression in rats with asthma].

OBJECTIVE: To observed efficacy differences of acupuncture at "Zusanli" (ST 36) in rats with asthma and asthma with spleen-deficency, so as to investigate the therapeutic mechanism. METHODS: Sixty SD rats were randomly divided into 5 groups according to their weight, named as an asthma with spleen-deficency group (group A), an acupuncture on asthma with spleen-deficency group (group B), an asthma group (group C), an acupuncture on asthma group (group D) and a control group. The rat models with spleen-deficiency in the first two groups were set up by TCM, then the rats of asthma model in the first four groups were induced by egg albumin, but the control group was treated by the same dose of saline. The group B and the group D were both treated with acupuncture at "Zusanli" (ST 36), once each day for 8 days, and the other groups remained unhandled. The mRNA expressions of Fas and Bcl-2 in the lung tissues were detected by hybridization in situ and apoptosis was detected by TUNEL (terminal dexynucleotidyl transferase-mediated dutp nick end labeling). RESULTS: Compared with the control group, in both the group A and the group C, the expression of Fas mRNA significantly decreased, but the expression of Bcl-2 mRNA significantly increased (all P < 0.01), and eosinophils (EOS) counts significantly increased, but EOS apoptosis rate significantly decreased (all P < 0.01). Compared with the group C, in the group A, the expressions of Fas mRNA significantly decreased, but the expressions of Bcl-2 mRNA and EOS counts significantly increased (all P < 0.01). At the same time, compared with the corresponding asthma groups, in both acupuncture groups, Fas mRNA expression obviously increased, Bcl-2 mRNA expression was significantly reduced (all P < 0.01), EOS counts remarkably decreased and EOS apoptosis rate significantly increased (all P < 0.01). There were no significant differences in the expressions of Fas mRNA and Bcl-2 mRNA between the two acupuncture groups (both P > 0.05), but compared with group B,in the group D, EOS counts significantly decreased and EOS apoptosis rate significantly increased (both P < 0.01). CONCLUSION: Acupuncture at "Zusanli" (ST 36) can regulate the disorders of Fas mRNA and Bcl-2 mRNA expression in the state of both asthma and asthma with spleen-deficency, promote EOS apoptosis so as to inhibit the development of inflammatory reaction of asthma, showing that acupuncture at "Zusanli" (ST 36) has certain advantages on regulation of related gene of EOS in asthma with spleen-deficency.