简介：ObjectivesToanalyzetheriskfactorsforrecurrenthemorrhageaftercraniotomyforhypertensivecerebralhemorrhage(HCH).MethodsClinicaldatafrom162HCHpatientswhounderwentsurgerywereretrospectivelyanalyzedforthecorrelationbetweenrecurrenthemorrhageandgender,age,durationofhypertension,historyofdiabetesmellitusandhypercholesterolemia,siteandvolumeofhemorrhageandpost-surgicalsystolicanddiastolicpressure.ResultsPost-surgicalrecurrenthemorrhagewasfoundin24patients.Withmulti-variateregressionanalysis,historyofdiabetes,long-termhypertensionandhigherpost-surgicalsystolicpressurewereprovedpositivelycorrelatedtotheincidenceofrecurrenthemorrhageaftercraniotomyforhypertensivecerebralhemorrhage(P<0.05).ConclusionsRiskfactorsforrecurrenthemorrhageaftercraniotomyforhypertensivecerebralhemorrhagearehistoryofdiabetes,long-termhypertensionandhigherpost-surgicalsystolicpressure.Patientswithdiabetesandhypertensionareathigherriskforcerebralhemorrhageorpost-surgicalrecurrenthemorrhage.Effectivecontrolonbloodpressureaftersurgerycanreducetheincidenceofrecurrenthemorrhageaftersurgeryforhypertensivecerebralhemorrhage.

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简介：AbstractPerimesencephalic subarachnoid hemorrhage (P-SAH) is a benign subset of subarachnoid hemorrhage. Only two cases of P-SAH during pregnancy have been reported in the literature. We describe a case of P-SAH detected at 29 weeks’ gestation, arose with severe bilateral frontal headache, neck rigidity, and vomiting. A diagnosis of P-SAH was confirmed on magnetic resonance angiography with no evidence of vascular malformation or bleeding sources and conservatively treated. Hemorrhage, vasospasm, and cerebellar edema observed on initial magnetic resonance angiography resolved after two months. The clinical course of P-SAH during pregnancy appears to be favorable. Our case shows for the first time in literature that magnetic resonance angiography is a valid diagnostic test for P-SAH during pregnancy that circumvents radiological risk associated with conventional imaging.

简介：AIM:Toevaluatetheeffectivenessofbariumimpactiontherapyforpatientswithcolonicdiverticularbleeding.METHODS:WereviewedtheclinicalchartsofpatientsinwhomtherapeuticbariumenemawasperformedforthecontrolofdiverticularbleedingbetweenAugust2010andMarch2012atYokohamaRosaiHospital.Twentypatientswereincludedinthereview,consistingof14menand6women.Themedianageofthepatientswas73.5years.Thedurationofthefollowupperiodrangedfrom1to19mo(median:9.8mo).Amongthe20patientswere11patientswhorequiredtheprocedureforre-bleedingduringhospitalization,6patientswhorequireditforre-bleedingthatdevelopedafterthepatientleftthehospital,and3patientswhorequiredtheprocedureforthepreventionofrebleeding.Barium(concentration:150w%/v%)wasadministeredpertherectum,andtheleadingedgeofthecontrastmediumwasfolloweduptothececumbyfluoroscopy.Afterconfirmationthattheascendingcolonandcecumwerefilledwithbarium,theenematubewaswithdrawn,andthepatient’spositionwaschangedevery20minfor3h.RESULTS:Twelvepatientsremainedfreeofrebleedingduringthefollow-upperiod(range:1-19mo)afterthetherapeuticbariumenema,including9menand3womenwithamedianageof72.0years.Re-bleedingoccurredin8patientsincluding5menand3womenwithamedianageof68.5years:4developedearlyre-bleeding,definedasre-bleedingthatoccurswithinoneweekaftertheprocedure,andtheremaining4developedlatere-bleeding.TheDFI(disease-freeinterval)decreased0.4for12mo.Onlyonepatientdevelopedacomplicationfromtherapeuticbariumenema(colonicperforation).CONCLUSION:Therapeuticbariumenemaiseffectiveforthecontrolofdiverticularhemorrhageincaseswheretheactivebleedingsitecannotbeidentifiedbycolonoscopy.

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简介：AbstractBackground:Dense exudate during the calcification of cerebral cysticercosis in basal subarachnoid space was easy to be misdiagnosed as subarachnoid hemorrhage (SAH); clinical evaluation and MRI can help differentiate SAH from pseudo-SAH.Case presentation:A case of ventricular expansion accompanied by high-density shadows in cisterna circinata cerebri was taken to the hospital for treatment due to sudden faint. This patient was diagnosed as subarachnoid hemorrhage according to computed tomography (CT) in another hospital. We believe that the high density in cisterna circinata cerebri was misdiagnosed as subarachnoid hemorrhage (SAH) 1 year ago. The main etiology of SAH is aneurysm; non-aneurysmal SAH associated with cerebral cysticercosis is extremely rare. Only 5 patients have been reported.Conclusion:This case indicated that although the specificity of CT for SAH is very high, the physicians should be aware of rare false positive findings, called pseudo-SAH.

简介：AbstractWith the widespread adoption of advanced tourniquets, the mortality rate of limb wound hemorrhage has decreased significantly, and non-compressible torso hemorrhage has gradually occupied the leading position of potentially preventable death, both in military and civilian circumstances. With the emergence of novel hemostatic devices and materials, strategies for the management of non-compressible torso hemorrhage have changed significantly. This review summarizes the current treatment strategies and types of equipment for non-compressible torso hemorrhage and suggests future research directions, hoping to provide a comprehensive review for the medical personnel and researchers engaging in this field.

简介：Intracerebralhemorrhage(ICH)isthemostseverecerebrovasculardisease,whichrepresentsaleadingcauseofdeathanddisabilityindevelopedcountries.However,therapeuticoptionsarelimited,soismandatorytoinvestigaterepairingprocessesafterstrokeinordertodevelopnewtherapeuticstrategiesabletopromotebrainrepairprocesses.TherapeuticangiogenesisandvasculogenesisholdpromisetoimproveoutcomeofICHpatients.Inthisregard,circulatingendothelialprogenitorcells(EPCs)haverecentlybeensuggestedtobeamarkerofvascularriskandendothelialfunction.Moreover,EPClevelshavebeenassociatedwithgoodneurologicalandfunctionaloutcomeaswellasreducedresidualhematomavolumeinICHpatients.Finally,experimentalandclinicalstudiesindicatethatEPCmightmediateendothelialcellregenerationandneovascularization.Therefore,EPC-basedtherapycouldbeanexcellenttherapeuticoptioninICH.Inthismini-review,wediscussthepresentstatusofknowledgeaboutthepossibletherapeuticroleofEPCsinICH,molecularmechanisms,andthefutureperspectivesandstrategiesfortheiruseinclinicalpractice.

简介：Gastrointestinalmetastasisfromprimarylungcancerisrare.Inthepresentstudy,wereportthecaseofa78-year-oldmalewhowasadmittedtotheemergencydepartmentwithacutebleedingofthedigestivetract.Duringevaluation,hewasfoundtohavelungadenocarcinomametastasisinthesmallbowelleadingtohemorrhage.Ajejunumwedgeresectionwascarriedoutandbleedingwascontrolled.However,2monthsaftertheoperation,thepatientthedfromseverepulmonaryinfection.Wealsoreviewthepublishedliteratureofprimarylungcancerwithgastrointestinalmetastasis.

简介：Inthepresentpaper,theauthorsreviewrecentadvancesinclinicalandexperimentalstudiesonacupuncturetreatmentofcerebralhemorrhage(CH).Regardingclinicalstudies,theresuscitation-inducingneedlingmaneuver,andmainpointsofShuigou(水沟GV26),Baihui(百会GV20)andscalp-pointsMotorArea(MS6),SensoryArea(MS7),etc.areofteninvolved.Concerningexperimentalstudies,theunderlyingmechanismsofacupunctureofGV-26+'Neiguan'(内关PC6),GV-20,GV-26+GV-20,etc.inimprovingacuteCHareintroduced.Inaword,acupuncturetherapyworkswellinimprovingclinicalsymptomsandsignsofCHpatients,andacupuncturestimulationinducedameiliorationofcerebralbloodflow,favorablemodulationofsomebioactivesubstancesasexcitatoryandinhibitoryaminoacids,endothelin,CGRP,heatshockprotein70,etc.andneuro-endocrine-immunenetworkmaycontributetotheeffectofacupunctureonCH.Inaddition,acupuncturecombinedwithmedicineandearlierapplicationofacupuncturetherapyintheacutestageofCHarerecommendedinclinicalpractice.

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简介：Objective:Toassessthecardiovascularabnormalitiesinpatientswithspontaneoussubarachnoidhemorrhage(SAH).Methods:AllpatientsadmittedtoourinstitutionwithaprimarydiagnosisofspontaneousSAHandhadatransthoracicechocardiogram(TTE)performedfrom1stofJuly2011until30thofMay2014wereenrolled.Results:Outof2058patientsadmittedtoourinstitutionwithadiagnosisofSAH,overathreeyearperiod,only244patients(12%)hadTTEperformedduringtheindexhospitalization.Inthisselectedcohort,themeanagewas59yearsand66%ofpatientswerefemale.ElevatedtroponinTwasnoticedin37%ofpatientsandQTcprolongationwasthecommonestECGabnormalityoccurringin49%ofthepatients.Thirtyninepatients(16%)hadarestingsegmentalwallmotionabnormalityontheTTE,includingfivepatientswithapicalballooning.In-hospitalmortalitywas15.6%(38patients).Conclusion:CardiovascularabnormalitiesinselectedpatientswithSAHwhohadcardiacultrasoundarerelativelycommon;howevertheincidenceofventricularballooningislow.InordertoattainthecorrectincidenceofcardiovascularabnormalitiesinSAHpatients,allpatientsadmittedwithSAHshouldundergoTTEandhaveECGandcardiacmarkerscheckedduringtheirhospitalization.

简介：AbstractBackground:Recent advances in surgical and neuroprotective strategies could effectively manage the pathophysiological progression of subarachnoid hemorrhage (SAH). However, pulmonary dysfunction frequently occurs in SAH patients with an increased risk of unsatisfactory outcomes. Based on the similar microvascular structures in the blood-air barrier and blood-brain barrier and possible brain-lung crosstalks, we believe that pericytes may be involved in both neurological and pulmonary dysfunction after SAH.Methods:In our experiments, platelet-derived growth factor B (PDGF-B) retention motif knockout (PDGF-Bret/ret) mice and adeno-associated virus PDGF-B were employed to show the involvement of pericyte deficiency and PDGF-B expression. Neurological score, SAH grade, hematoxylin-eosin staining, and PaO2/FiO2 ratio analysis were performed to evaluate the neurological deficits and pulmonary functions in endovascular perforation SAH models at 24 h after surgery, as well as western blotting and immunofluorescence staining for underlying molecular expressions.Results:We found that neonatal PDGF-Bret/ret mice exhibited pulmonary atelectasis 12 h after birth. Further investigation showed a decrease in PaO2/FiO2 and lung-specific surfactant proteins in adult PDGF-Bret/ret mice. These dysfunctions were much worse than those in wild-type mice at 24 h after SAH. PDGF-B overexpression alleviated pulmonary dysfunction after SAH.Conclusions:These results suggested pulmonary dysfunction after SAH and the pivotal role of PDGF-B signaling for the pathophysiological process and future therapeutic targets of pulmonary injury treatment after SAH. Further studies are needed for pathophysiological investigations and translational studies on pulmonary injuries after SAH.

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简介：BACKGROUND:Recentstudieshaveindicatedthatblood-brainbarrier(BBB)disruptionfollowingsu-barachnoidhemorrhage(SAH)significantlycorrelateswiththedevelopmentofbraininjuryandpoorprognosisofpatientssubjectedtoSAH.OBJECTIVE:ToinvestigatebothfunctionalandstructuralchangesrelatedtoBBBinvariousphasesafterSAHinratsthroughquantitativeandqualitativemethods.DESIGN,TIMEANDSETTING:Thisexperiment,acompletelyrandomizeddesignandcontrolledex-periment,wasperformedattheDepartmentofNeurosurgery,theSecondAffiliatedHospitalofChongqingUniversityofMedicalSciencesfromJune2006toMarch2007.MATERIALS:Atotalof128female,healthy,Sprague-Dawleyratswereselectedforthisstudy.Mainreagentsandinstruments:EvansBluedye(SigmaCompany,USA),fluorescencespectrophotometer(ShimadzuCompany,Japan),andtransmissionelectronmicroscope(OlympusCompany,Japan).METHODS:Theincluded128ratswererandomlydividedintotwogroups:sham-operatedgroup(n=16)andSAHgroup(n=112).RatsintheSAHgroupweredividedintosevensubgroups:6,12,24,36,48,60,and72hoursafterSAH(16ratsforeachtimepoint).ExperimentalSAHwasinducedbybloodinjectionintothepre-chiasmaticcistern(300μL).Thesham-operatedgroupreceivedanequivalentvolumeofnormalsalinesolution(300μL)injectedintothesubarachnoidspace.MAINOUTCOMEMEASURES:Braintissuewatercontentwasdeterminedbythewet-drymethod.BBBpermeabilityinthecerebralcortexwasdeterminedbyEvansBluedyeandfluorescentspectrophotometer.TheultrastructuralchangesinBBBwereobservedwithtransmissionelectronmicroscope.RESULTS:Comparedwiththesham-operatedgroup,SAHinducedasignificantincreaseinbrainwatercontentbetween24and60hours(F=888.32,P<0.05).Brainwatercontentincreasedtoamaximumby36hoursafterSAH,normalizingby72hours.EvansBluecontentinthecerebralcortexofSAHgroupratsbegantoincreaseby24hoursafterSAH,pea

简介：Clinicaloutcomesarepositivelyassociatedwithhematomaabsorption.Themonocyte-macrophagescavengerreceptor,CD163,playsanimportantroleinthemetabolismofhemoglobin,andasolubleformofCD163ispresentinplasmaandothertissuefluids;therefore,wespeculatedthatserumCD163affectshematomaabsorptionafterintracerebralhemorrhage.Patientswithintracerebralhemorrhageweredividedintohigh-andlow-levelgroupsaccordingtotheaverageCD163level(1,977.79±832.91ng/mL).Comparedwiththehigh-levelgroup,thelow-levelgrouphadasignificantlyslowerhematomaabsorptionrate,andsignificantlyincreasedNationalInstitutesofHealthStrokeScalescoresandmodifiedRankinScalescores.TheseresultssuggestthatCD163promoteshematomaabsorptionandtherecoveryofneurologicalfunctioninpatientswithintracerebralhemorrhage.