Interactions between rat cortico-striatal slice cultures and neutrophil-like HL60 cells under thrombin challenge: Toward elucidation of pathological events in intracerebral hemorrhage

Neutrophils constitute the major population of infiltrating leukocytes after stroke including intracerebral hemorrhage (ICH), and these cells may exhibit pro-inflammatory and anti-inflammatory phenotypes depending on the external stimuli. Here we constructed an experimental system to evaluate how the properties of neutrophils were influenced by the injured brain tissues. HL60 cells differentiated into neutrophils were added to the culture medium of neonatal rat cortico-striatal slices maintained at liquid–air interface. Thrombin was applied to the cultures to mimic the pathogenic events associated with ICH. HL60 cells responded to thrombin by increasing mRNA expression of pro-inflammatory IL-1β and anti-inflammatory IL-10 with a different time course. Co-presence of cortico-striatal slice cultures significantly enhanced IL-1β mRNA expression, whereas attenuated IL-10 mRNA expression, in HL60 cells. Toll-like receptor 4 (TLR4) agonist lipopolysaccharide synergistically enhanced IL-1β mRNA expression with thrombin, and TLR4 inhibitor TAK-242 abolished thrombin-induced IL-1β mRNA expression in the presence of slice cultures. On the other hand, thrombin-induced cell death in cortico-striatal cultures was attenuated by the presence of HL60 cells. This experimental system may provide a unique platform to elucidate complex cell-to-tissue interactions during ICH pathogenesis.     

桃红四物汤联合银杏酮酯滴丸治疗老年出血性玻璃体混浊的临床疗效研究

目的:探究桃红四物汤联合银杏酮酯滴丸治疗老年出血性玻璃体混浊的临床疗效。方法:收集2016年12月-2018年12月我院收治的老年出血性玻璃体混浊患者67例,共67眼,根据随机对照表分为对照组和试验组,其中试验组34例,对照组33例,对照组予以银杏酮酯滴丸;试验组在对照组的基础上联用桃红四物汤。两组均服用30 d。治疗结束后对比分析两组患者临床疗效、出血吸收时间、血液流变学及视网膜中央动脉血流动力学。结果:治疗后两组患者高切全血粘度、低切全血粘度、纤维蛋白原、阻力指数(Resistance Index,RI)低于治疗前,收缩期峰值速度(Peak Systolic Velocity,PSV)、舒张末期血流速度(End Diastolic Velocity,EDV)高于治疗前,差异具有统计学意义(P<0.05);治疗后试验组临床总有效率、PSV、EDV高于对照组,出血吸收时间、高切全血粘度、低切全血粘度、纤维蛋白原、RI低于对照组,差异具有统计学意义(P<0.05)。结论:桃红四物汤联合银杏酮酯滴丸治疗老年出血性玻璃体混浊临床疗效显著,适宜临床应用推广。     

基于GTWR模型的陕西省HFRS发病影响因素分析

目的 针对陕西省2005-2018年肾综合征出血热发病率和影响因素数据建立时空地理加权回归模型（geographically and temporally weighted regression，GTWR），探究各因素对肾综合征出血热发病的影响。方法 借助主成分分析获取主要影响因素，进行聚类和异常值分析以更好地解释模型结果，通过对比不同模型拟合优度，确定使用GTWR模型进行分析，获取回归系数分布变化情况。结果 陕西省2005-2018年肾综合征出血热高发疫区有北移趋势，主要受自然气候和社会经济活动影响，且影响程度时空分布不均衡。结论 GTWR模型对陕西省肾综合征出血热发病率的影响因素分析比较合理，反映出自然条件的限制和人类活动强度的改变，会导致各因素对出血热发病率的影响程度产生差异。     

CT与MRI对脑梗死后出血性转变的诊断价值

目的探讨CT与MRI在脑梗死后出血性转变(HT)中的诊断价值。方法对2011-01—2014-04我院收治的45例HT患者的临床资料进行回顾性分析,对CT与MRI的检查结果进行对比。结果45例患者中,脑内血肿34例(75.6%),脑梗死病灶内片状、斑点状或条状出血11例(24.4%)。其中大面积脑梗死继发出血24例(53.3%),中等面积继发出血15例(33.3%),小面积脑梗死继发出血6例(13.3%);CT检出HT 10例(22.2%),MRI检出45例(100%),差异有统计学意义(P0.05);在对不同部位的HT检查中,CT检出幕上出血9例(20.0%),幕下出血1例(2.2%);MRI检出幕上出血39例(86.7%),幕下出血6例(13.3%)。MRI对幕上及幕下出血的检出率均优于CT(P0.05)。结论在HT的诊断中,MRI比CT更加准确和敏感,在判断出血时间、指导临床治疗以及预后判断中具有重要意义。     

Management of post-puncture bleeding after neurointerventional procedures performed with a large-bore sheath introducer

Various adjunctive techniques for neurointerventional procedures require a large-bore sheath introducer, but there is concern that this could result in more puncture site hemorrhagic complications despite using a vascular closure device. The purpose of this study was to assess the relationship between use of large-bore sheath introducer and post-procedural complications. Between January 2016 and April 2018, 126 neurointerventional procedures were performed in our hospital using 8 or 9 Fr sheath introducer in size and the Angio-Seal STS PLUS (St. Jude Medical, Minnetonka, USA). Hemorrhagic complications were defined as obvious swelling or bleeding at the puncture site or as extravascular bleeding detected by ultrasonography or contrast-enhanced computed tomography. The procedures were divided into a group with post-puncture bleeding (group B, n = 21) and a group without bleeding (group N, n = 105). Risk factors were compared between the groups according to the incidence of post-puncture bleeding. In addition, we assessed the outcome and approach to hemostasis in the procedures with bleeding. In result, hemorrhagic complications occurred in 21 procedures (17%), and pseudoaneurysm was detected in 4 procedures (3.2%). In 20 of group B (16%), manual compression was performed for an average of 36.4 min. One patient (0.79%) required surgical angioplasty. Risk factors for bleeding were not significantly different between the two groups. None of the patients with bleeding showed a decrease on the modified Rankin Scale. In conclusion, use of a large-bore sheath introducer may increase the incidence of post-puncture bleeding, but the outcome of this complication is acceptable.     

骨髓腔穿刺输液在院外创伤失血性休克患者抢救中的应用效果

目的比较通过骨髓腔输液与常规静脉输液对于院外创伤失血性休克患者抢救应用效果。方法选取2017年7月-2018年7月北京急救中心中区分中心院外救治的创伤失血性性休克患者100例随机分骨髓腔穿刺组(IO,n=50)和常规静脉穿刺组(IV,n=50)。分别应用骨髄腔穿刺或常规静脉穿刺进行快速补液治疗。比较建立补液通道所用的时间,一次性穿刺成功率,现场救后生存率及不良反应。结果骨髓腔穿刺组建立有效补液通道时间明显比常规辞脉穿刺组短(P<0.05),骨髓腔穿刺组一次穿刺成功率明显高于常规静脉穿刺组(P<0.05),骨疏腔穿刺组现场救后生存率明显高于常规静脉穿刺组(P<0.05),骨髓腔穿刺组发生液体渗漏的患者明显少于常规静脉穿刺组(P<0.05)。结论常规静脉穿刺对救治环境和患者自身条件有一定的要求,院外现场急救因其特殊性有时难以保证常规静脉穿刺的顺利进行。采用骨髓腔穿刺建立补液通路具有操作简单、快捷,输液通路穩定性高,方便及时给予抢救药物,可为创伤失血性休克患者的抢救争取宝贵的时间。骨髓腔穿刺具有一次穿刺成功率高,操作时间短,不良反应少等优点,值得在院外现场抢救中推广应用。     

Management of patients suffering from hemorrhagic intracranial metastases: Propositions to help the neurosurgeon in emergency situations based on a literature review

IntroductionBrain metastases are the most common intracranial neoplasm in adult patients, and one of the fearsome complications proves to be intratumoral hemorrhage. The neurosurgical management of patients harboring a bleeding brain metastasis is not fully established and there is still today an ongoing debate on the optimal management of these patients. The aim of this article is to provide the neurosurgeons with practical tools to assist in their decision-making process in the management of BMs.MethodsWe conducted a literature review of the relevant Pubmed, Cochrane, and Google scholar-indexed articles published between 2000 and 2019. The following key words were entered in the Pubmed search engine: [metastasis], [metastases], [brain metastases], [brain metastasis], [hemorrhage], [hematoma], [blood clot], [intracerebral hemorrhage], [intracranial hemorrhage]. The review was performed in accordance with the PRISMA recommendations.ResultsBased on PubMed, Cochrane, and Google scholar, 459 articles were retained, 392 were then removed because of their non-adequacy with the topic and, 9 articles were removed because they were not written in English language. So, 58 articles were analyzed. Radiological evaluation is crucial, but few traps exist. The frequency of overall brain tumor-related with intracranial hematoma is 7.2%, with a higher frequency for secondary tumors. The local recurrence rate after resection of a hemorrhagic metastasis seems to be better probably because of an easier “en bloc” resection thanks to the hematoma. An atypical presentation is reported in up to 4% in patients with chronic or acute subdural hematoma. Patients with subarachnoid hemorrhage and epidural hematoma are rare. A clear-cut correlation between the incidence of bleeding event in brain mets and prior stereotactic radiosurgery was not established.ConclusionThe current literature pertaining to the neurosurgical management of acute bleeding in brain metastasis is scant and the level of evidence remains low (experts ‘opinions; class C). Herein we suggest a flowchart to assist in dealing with those difficult patients.     

白茅根治疗肾综合征出血热急性肾功能衰竭效果分析

目的分析研究白茅根治疗肾综合征出血热急性肾功能衰竭患者的临床效果。方法本次研究资料均随机选自本院接收治疗的肾综合征出血热急性肾功能衰竭患者,共102例,手术时间为2013年5月—2016年5月期间。对102例患者采用随机数字抽取表法进行分组,分别为西医西药治疗组和中医白茅根治疗组。西医西药治疗组采用支持治疗及利尿等,中医白茅根治疗组在此基础上采用以白茅根为主的中药治疗,对两组患者的治疗效果、出血情况、尿闭情况、休克情况、肾功能及生化指标变化等进行比较。结果中医白茅根治疗组患者治疗总有效率为92.16%,西医西药治疗组患者治疗总有效率为70.59%,中医白茅根治疗组治疗效果更好,数据比较差异具有统计学意义(P0.05);中医白茅根治疗组患者出血、尿闭及休克情况均显著低于西医西药治疗组,数据比较差异具有统计学意义(P0.05);中医白茅根治疗组血浆尿素氮、血肌酐、丙氨酸转氨酶及天冬氨酸转氨酶等均显著低于西医西药治疗组,数据比较差异具有统计学意义(P0.05)。结论白茅根治疗肾综合征出血热急性肾功能衰竭患者疗效显著,能够有效缩短出血时间,改善患者肾功能等,值得在临床上推广应用。     

右美托咪定减轻失血性休克/复苏大鼠急性肾损伤

目的:研究右美托咪定对失血性休克/复苏(HS/R)大鼠急性肾损伤的影响。方法:健康雄性Wistar大鼠32只,随机分为4组:生理盐水对照组(NS组)、右美托咪定组(D组)、HS/R组和HS/R+D组。容量复苏后6 h处死动物,采集血和肾组织标本。检测各组血清中肌酐和尿素氮的浓度;检测各组大鼠肾组织中丙二醛(MDA)含量、超氧化物歧化酶(SOD)活性、肿瘤坏死因子α(TNF-α)含量和白细胞介素1β(IL-1β)含量;Western blot法检测肾组织血红素加氧酶1(HO-1)和核因子κB(NF-κB)的表达;HE染色观察肾组织病理学改变。结果:与NS组比较,HS/R组MDA含量升高,SOD活性降低(P0.05);与HS/R组比较,HS/R+D组MDA含量降低,SOD活性升高(P0.05)。与NS组比较,HS/R组TNF-α和IL-1β含量升高(P0.05);与HS/R组比较,HS/R+D组TNF-α和IL-1β含量降低(P0.05)。与NS组比较,HS/R组肾组织NF-κB表达升高;与HS组比较,HS/R+D组肾组织NF-κB表达降低(P0.05)。与NS组比较,HS/R组肾组织HO-1表达升高;与HS/R组比较,HS/R+D组HO-1表达进一步升高(P0.05)。肾组织病理学检查可见,右美托咪定治疗可明显减轻肾细胞变性、坏死及炎性细胞浸润程度。结论:右美托咪定可减轻HS/R大鼠急性肾损伤,其作用机制可能与上调HO-1表达及抑制NF-κB表达有关。