Long-Term Follow-Up of Cerebral Amyloid Angiopathy-Associated Intracranial Hemorrhage Reveals a High Prevalence of Atrial Fibrillation

Goal: Cerebral amyloid angiopathy (CAA) is the second-most common cause of nontraumatic intracerebral hemorrhages (ICH), surpassed only by uncontrolled hypertension. We characterized the percentage, risk factors, and comorbidities of patients suffering from CAA-related ICH in relation to long-term outcomes. Material and Methods: We performed retrospective analyses and clinical follow-ups of individuals suffering from ICH who were directly admitted to neurosurgery between 2002 and 2016. Findings: Seventy-four of 174 (42%) spontaneous nontraumatic lobar ICH cases leastwise satisfied the modified Boston criteria definition for at least “possible CAA.” Females suffered a higher risk of CAA-caused ICH (42 of 74, 56.8%, P= .035). Atrial fibrillation as a major comorbidity was observed in 19 patients (25.7%). Recovery (decrease of modified Rankin scale [mRS]) was highest during hospitalization in the acute clinic. One-year mortality was as follows: 14 of 25 patients (56%) with probable CAA without supporting pathology, 6 of 18, and 8 of 31 patients with supporting pathology and possible CAA, respectively. Only 10 of 74 (13.6%) had favorable long-term outcomes (mRS ≤2). Increasing numbers of lobar hemorrhages, low initial Glasgow Coma Scale, and subarachnoid hemorrhage were significantly associated with poor survivability, whereas statins, antithrombotic agents, an intraventricular hemorrhage, and midline shift played seemingly minor roles. Conclusions: Symptomatic ICH is a serious stage in CAA progression with high mortality. The high incidence of concurrent atrial fibrillation in these patients may support data on more widespread vascular pathology in CAA.     

Applicability of NeuroTrend as a bedside monitor in the neuro ICU

Objective

To assess whether ICU caregivers can correctly read and interpret continuous EEG (cEEG) data displayed with the computer algorithm NeuroTrend (NT) with the main attention on seizure detection and determination of sedation depth.

脑电图反应性对急性重型脑伤患者预后的评估研究

目的探讨脑电图(EEG)反应性对急性重型脑伤患者预后的评估价值。方法选用数字化脑电监测系统,对66例急性重型脑伤患者在72小时内行EEG监测,将EEG的反应性和患者开始的GCS评分与其预后结果进行比较分析。结果EEG反应性对本组急性重型脑伤患者预后评估的准确率(95t45％)、敏感性(97．05％)、特异性(93．75％)均高于其GCS评分(71．21％,56．75％,89．65％);本组EEG反应性错误率为3．03％,低于其GCS评分错误率(4．55％)。结论EEG反应性对急性重型脑伤昏迷病人预后评估有较高的价值。     

Influence of renal compensatory hypertrophy on mitochondrial energetics and redox status

A reduction in functional renal mass is common in numerous renal diseases and aging. The remaining functional renal tissue undergoes compensatory growth primarily due to hypertrophy. This is associated with a series of physiological, morphological and biochemical changes similar to those observed after uninephrectomy. Previous work showed that compensatory renal cellular hypertrophy resulted in an increase in susceptibility to several drugs and environmental chemicals and appeared to be associated with oxidative stress. Compensatory renal cellular hypertrophy was also associated with increases in mitochondrial metabolic activity, uptake of glutathione (GSH) across renal plasma and mitochondrial inner membranes, and intracellular GSH concentrations. Based on these observations, we hypothesize that the morphological, physiological and biochemical changes in the hypertrophied kidney are associated with marked alterations in renal cellular energetics, redox status and renal function in vivo. In this study, we used a uninephrectomized (NPX) rat model to induce compensatory renal growth. Our results show alterations in renal physiological parameters consistent with modest renal injury, altered renal cellular energetics, upregulation of certain renal plasma membrane transporters, including some that have been observed to transport GSH, and evidence of increased oxidative stress in mitochondria from the remnant kidney of NPX rats. These studies provide additional insight into the molecular changes that occur in compensatory renal hypertrophy and should help in the development of novel therapeutic approaches for patients with reduced renal mass.     

Toluene effects on oxidative stress in brain regions of young-adult, middle-age, and senescent Brown Norway rats

The influence of aging on susceptibility to environmental contaminants is not well understood. To extend knowledge in this area, we examined effects in rat brain of the volatile organic compound, toluene. The objective was to test whether oxidative stress (OS) plays a role in the adverse effects caused by toluene exposure, and if so, if effects are age-dependent. OS parameters were selected to measure the production of reactive oxygen species (NADPH Quinone oxidoreductase 1 (NQO1), NADH Ubiquinone reductase (UBIQ-RD)), antioxidant homeostasis (total antioxidant substances (TAS), superoxide dismutase (SOD), γ-glutamylcysteine synthetase (γ-GCS), glutathione transferase (GST), glutathione peroxidase (GPX), glutathione reductase (GRD)), and oxidative damage (total aconitase and protein carbonyls). In this study, Brown Norway rats (4, 12, and 24 months) were dosed orally with toluene (0, 0.65 or 1 g/kg) in corn oil. Four hours later, frontal cortex, cerebellum, striatum, and hippocampus were dissected, quick frozen on dry ice, and stored at − 80 °C until analysis. Some parameters of OS were found to increase with age in select brain regions. Toluene exposure also resulted in increased OS in select brain regions. For example, an increase in NQO1 activity was seen in frontal cortex and cerebellum of 4 and 12 month old rats following toluene exposure, but only in the hippocampus of 24 month old rats. Similarly, age and toluene effects on glutathione enzymes were varied and brain-region specific. Markers of oxidative damage reflected changes in oxidative stress. Total aconitase activity was increased by toluene in frontal cortex and cerebellum at 12 and 24 months, respectively. Protein carbonyls in both brain regions and in all age groups were increased by toluene, but step-down analyses indicated toluene effects were statistically significant only in 12 month old rats. These results indicate changes in OS parameters with age and toluene exposure resulted in oxidative damage in frontal cortex and cerebellum of 12 month old rats. Although increases in oxidative damage are associated with increases in horizontal motor activity in older rats, further research is warranted to determine if these changes in OS parameters are related to neurobehavioral and neurophysiological effects of toluene in animal models of aging.     

颅脑外伤应激性血糖水平与病情转归的相关性分析

目的探讨颅脑外伤应激性血糖水平与患者病情转归的关系。方法对87例颅脑外伤患者应激性血糖水平与病情转归的关系进行回顾性研究,病情严重程度按格拉斯哥昏迷（GCS）评分分组,测定患者入院后次日晨或手术前的空腹血糖浓度并进行统计学分析。结果血糖水平与GCS评分有很大的关联,GCS（13～15分）组的血糖浓度为5.7±2.5mmol/L,预后全部恢复良好;GCS（8～12分）组的血糖浓度为7.6±3.0mmol/L,其预后恢复良好者有25例,植物生存者6例,死亡5例;GCS（≤7分）组的血糖浓度为10.1±3.6mmol/L,其预后植物生存者5例,死亡10例;GCS评分越低血糖水平越高（p〈0.05）,其病情转归越差。结论颅脑外伤应激性血糖水平与病情转归有着明显的关系,血糖越高,病情转归越差。     

序贯性机械通气治疗COPD所致严重呼吸衰竭治疗切换点时间窗的研究

目的探索早期拔管改换无创机械通气策略的技术可行性并评价其治疗效果。方法选择接受气管插管和机械通气的慢性阻塞性肺疾病（COPD）病例36例,随机分为治疗组20例和对照组16例,治疗组20例以同步间歇强制通气十压力支持通气（SIMV＋PSV）方式行机械通气,待＂改良GCS评分达15分标准＂稳定2h窗口期出现,此时拔除气管导管,改用经鼻面罩压力支持通气十呼气末正压（PSV＋PEEP）通气,以后渐减PSV水平直至脱离呼吸机。对照组16例待肺部感染明显控制时判为＂肺部感染控制窗＂出现,此时拔除气管导管,改无创通气直至脱离呼吸机。动态观察两组病例机械通气前通气及氧合指标,两组接受有创机械通气时间、总机械通气时间、总住院时间、重新插管率、VAP发生例数。结果治疗组与对照组的治疗前各指标相仿（P〉0.05）;两组有创通气时间分别为（3.2±1.1）和（5.4±2.3）d,P〈0.05;呼吸机相关肺炎发生例数分别为0和3例,P〈0.05;住院时间分别为（17士3）和（21士5）d,P〈0.05。结论对COPD合并呼吸衰竭插管上机病例,以＂改良GCS评分达15分标准＂窗口期为时机,早期拔管改用经鼻面罩无创通气可以显著改善治疗效果。     

早期针刺治疗对高血压脑出血微创术后患者意识状态影响临床观察

[目的]观察针刺治疗对高血压脑出血微创术后患者意识状态的影响。[方法]将研究对象随机分为微创术后常规治疗加针刺组(命名为治疗组,下同)患者20例、微创术后常规治疗组(命名为对照组,下同)患者20例。分别评定两组入院时、入院第4天、第10天、第20天、第30天的格拉斯哥昏迷量表(GCS)积分情况。[结果]治疗组与对照组GCS评分第30天时比较差异有统计学意义(P<0.01),两组间第30天时间相点与第4天时间相点GCS积分差值比较差异有统计学意义(P<0.01)。[结论]早期针刺治疗对高血压脑出血微创术后患者具有较好的促醒作用。     

Changes in concentration of cerebrospinal fluid components in patients with traumatic brain injury

Brain injury, like other central nervous system pathologies, causes changes in the composition of the cerebrospinal fluid (CSF). In this study, changes in the concentration of small molecules of the CSF, which are in the minimal micromolar concentration, were observed and monitored using high-resolution proton (NMR) spectroscopy. Twenty-two patients with isolated traumatic brain injuries (TBI) and 15 patients making up the control group were recruited for the study. CSF samples were collected by lumbar puncture from the lumbar subarachnoid space in the patients just before commencement of therapy and on the first, third, seventh and fourteenth days of therapy at the ICU. Forty-four signals of the NMR spectra and NO concentration of the CSF samples were analyzed. The analysis shows that the amino acid and organic acid concentrations change during the therapy and mostly are higher than in the control group. Significant differences in concentration of the analyzed CSF components between the TBI patients and the control group have been noted. The rate of the lactate to pyruvate conversion increased because the L/P ratio showed no significant differences between the TBI group and the control group, while the concentrations of both components were significantly higher in the TBI patients than in the control group. Citrulline, arginine and nitric oxide concentrations were the focus of the analysis. Citrulline concentration changes overlapped NO changes from 0 until 3rd day of therapy, while for the remaining days of observation the NO concentration stabilized at the control level, whereas citrulline concentration significantly decreased.     

Can diffusion tensor imaging predict motor power affection after moderate traumatic brain injury?

Objective

To determine whether commissural and projection fibers fractional anisotropy (FA) abnormalities can help in the prediction of long-term outcome of motor power affection after moderately severe traumatic brain injury (TBI).

Methods

MRI protocol included diffusion tensor imaging (DTI) and was performed for 32 patients with moderate TBI and 32 matched control subjects. Regions of interests were applied in the FA maps in the corpus callosum, internal capsules posterior limb, and cerebral peduncles. Results were compared in patients with motor power affection and patients without motor power affection to the control group.

Results

All patients had FA values lower than the control group with significance differences in the corpus callosum. Patient group with weakness had FA values lower than the control groups with significance differences in the posterior limb of the left internal capsules (p = 0.001) and left cerebral peduncles (p < 0.001). Significant differences were found when comparing the posterior limb of the left internal capsule (p = 0.002) and left cerebral peduncle (p = 0.022) to the right side in the weakness group.

Conclusion

FA values measured in the acute stage provided information about associated and projectional fibers disruptions, which have a prognostic value about motor power affection.