Early acupuncture for traumatic intracerebral hematoma: a randomized controlled trial / 中国针灸

<p><b>OBJECTIVE</b>To observe the effect of early acupuncture intervention on brain edema in patients with traumatic intracerebral hematoma and explore its mechanism on the basis of conventional western medicine.</p><p><b>METHODS</b>With stratified block randomization, sixty-four patients with glasgow coma scale (GCS) of 6 to 12 were divided into an acupuncture combined with medicine group (a combination group) and a western medication group, 32 cases in each one. In the western medication group, dehydration to reduce intracranial pressure and nutritional nerves were given as the basic treatment. In the combination group, on the basis of the treatment as the western medication group, acupuncture was applied at Xuehai (SP 10), Taixi (KI 3), Fenglong (ST 40), Yinlingquan (SP 9), Zusanli (ST 36), etc. The treatment was given once every day, for 6 times as one course; there was an interval of 1 day between two courses; a total of 4 courses were required. GCS score and recovery time were recored before treatment and on the 7 th, 14 th and 28 th days. 90 days follow-up after treatment, the GOS was observed, and the mortality and effective survival rate were calculated. The Barthel index (BI) score was evaluated before treatment and on the 14th, 21st, 28th days and 90 days follow-up after treatment. Before treatment and 3rd, 7th, 14th, 21st, 28th days, cranial CT or MR scan was performed to calculate the brain edema index (BEI); Plasma interleukin-6 (6IL-6), neuropeptide Y (NPY) and nitric oxide (NO) were measured before treatment and on the 3rd, 7th and 14th days after treatment.</p><p><b>RESULTS</b>(1) The GCS scores increased gradually in the two groups during treatment, and there was significant difference between the 28th days and before treatment (both <0.05). There were no significant difference between the two groups about GCS score and average recovery time on the 28th days treatment (all >0.05). (2) The mortality rate of the combination group was 6.3% (2/32) on 90 days follow-up, 9.4% (3/32) in the western medication group (>0.05). The effective survival rate was 81.3% (26/32) in the combination group, which was higher than 59.4% (19/32) in the western medication group (<0.05). (3) The BI score was significantly higher than that before treatment on the 28th days and 90 days follow-up in the two groups (all <0.05), and the result in the combination group was superior to that in the western medication group (both <0.05). (4) The BEI decreased on the 14th, 21st and 28th days in the two groups (all <0.05), and on the 14th day, the BEI decreased more significantly in the combination group than that in the western medication group (<0.05). (5) The levels of IL-6, NPY and NO decreased on the 7th and 14th days in the two groups (all <0.05), and decreased more significantly in the combination group than that in the western medication group on the 7th day (<0.05).</p><p><b>CONCLUSION</b>On the basis of conventional western medicine, early acupuncture can reduce cerebral edema and improve the prognosis of patients, and acupuncture combined with medicine are superior to western medicine alone. Acupuncture mechanism may be related to reducing the expression of inflammatory response.</p>

Clinical efficacy of bevacizumab for the treatment of serious peritumorous brain edema / 中国肿瘤临床

Objective:To investigate the efficacy of bevacizumab on the treatment of serious peritumorous brain edema. Methods:A total of 16 patients with malignant brain tumors and serious peritumorous brain edema, (13 cases of lung cancer, 2 cases of breast can-cer, and 1 case of recurrent glioblastoma) were analyzed. Treatment with glucocorticoids, osmotic dehydration, and other convention-al approaches were not effective for these patients. Bevacizumab was administered at a dose of 5 mg/kg at least once every three or four weeks. The Karnofsky performance score (KPS) and the changes in cerebral edema symptoms, such as cerebral edema volume, tu-mor volume, edema index (EI), and changes in magnetic resonance imaging (MRI) were compared before and after treatment. The t-test and least-significant difference method were used to compare treatment groups. Results:All bevacizumab-treated patients had re-duced symptoms. The KPS after treatment was significantly higher than that before treatment (P<0.001). The cerebral edema vol-umes, tumor volumes, and EI of 16 patients were significantly decreased (P<0.05). Bevacizumab caused mild clinical side effects. Con-clusion:Preliminary results showed that treatment of serious peritumorous brain edema with bevacizumab was safe and effective.

Onodera's Prognostic Nutritional Index as a Risk Factor for Mortality in Peritoneal Dialysis Patients

The aim of this study was to evaluate the clinical relevance and usefulness of the Onodera's prognostic nutritional index (OPNI) as a prognostic and nutritional indicator in peritoneal dialysis (PD) patients. Patients were divided into 3 groups based on the initial OPNI score: group A (n = 186, 45). Group A was associated with a higher grade according to the Davies risk index than the other groups. Serum creatinine and albumin levels, total lymphocyte count, and fat mass increased with an increase in OPNI. According to the edema index, the correlation coefficient for OPNI was -0.284 and for serum albumin was -0.322. Similarly, according to the C-reactive protein (CRP), the correlation coefficient for OPNI was -0.117 and for serum albumin was -0.169. Multivariate analysis adjusted for age, Davies risk index, CRP, and edema index revealed that the hazard ratios for low OPNI, serum albumin, and CRP were 1.672 (P = 0.003), 1.308 (P = 0.130), and 1.349 (P = 0.083), respectively. Our results demonstrate that the OPNI is a simple method that can be used for predicting the nutritional status and clinical outcome in PD patients.

Onodera's Prognostic Nutritional Index as a Risk Factor for Mortality in Peritoneal Dialysis Patients

The aim of this study was to evaluate the clinical relevance and usefulness of the Onodera's prognostic nutritional index (OPNI) as a prognostic and nutritional indicator in peritoneal dialysis (PD) patients. Patients were divided into 3 groups based on the initial OPNI score: group A (n = 186, 45). Group A was associated with a higher grade according to the Davies risk index than the other groups. Serum creatinine and albumin levels, total lymphocyte count, and fat mass increased with an increase in OPNI. According to the edema index, the correlation coefficient for OPNI was -0.284 and for serum albumin was -0.322. Similarly, according to the C-reactive protein (CRP), the correlation coefficient for OPNI was -0.117 and for serum albumin was -0.169. Multivariate analysis adjusted for age, Davies risk index, CRP, and edema index revealed that the hazard ratios for low OPNI, serum albumin, and CRP were 1.672 (P = 0.003), 1.308 (P = 0.130), and 1.349 (P = 0.083), respectively. Our results demonstrate that the OPNI is a simple method that can be used for predicting the nutritional status and clinical outcome in PD patients.

Involvement of nitric oxide pathways in neurogenic pulmonary edema induced by vagotomy

OBJECTIVE: The objective of this study was to evaluate the involvement of peripheral nitric oxide (NO) in vagotomy-induced pulmonary edema by verifying whether the nitric oxide synthases (NOS), constitutive (cNOS) and inducible (iNOS), participate in this mechanism. INTRODUCTION: It has been proposed that vagotomy induces neurogenic pulmonary edema or intensifies the edema of other etiologies. METHODS: Control and vagotomized rats were pretreated with 0.3 mg/kg, 3.0 mg/kg or 39.0 mg/kg of L-NAME, or with 5.0 mg/kg, 10.0 mg/kg or 20.0 mg/kg of aminoguanidine. All animals were observed for 120 minutes. After the animals' death, the trachea was catheterized in order to observe tracheal fluid and to classify the severity of pulmonary edema. The lungs were removed and weighed to evaluate pulmonary weight gain and edema index. RESULTS: Vagotomy promoted pulmonary edema as edema was significantly higher than in the control. This effect was modified by treatment with L-NAME. The highest dose, 39.0 mg/kg, reduced the edema and prolonged the survival of the animals, while at the lowest dose, 0.3 mg/kg, the edema and reduced survival rates were maintained. Aminoguanidine, regardless of the dose inhibited the development of the edema. Its effect was similar to that observed when the highest dose of L-NAME was administered. It may be that the non-selective blockade of cNOS by the highest dose of L-NAME also inhibited the iNOS pathway. CONCLUSION: Our data suggest that iNOS could be directly involved in pulmonary edema induced by vagotomy and cNOS appears to participate as a protector mechanism.

Peritumoral Brain Edema in Meningiomas : Correlation of Radiologic and Pathologic Features

OBJECTIVE: The primary objective of this study was to perform a retrospective evaluation of the radiological and pathological features influencing the formation of peritumoral brain edema (PTBE) in meningiomas. METHODS: The magnetic resonance imaging (MRI) and pathology data for 86 patients with meningiomas, who underwent surgery at our institution between September 2003 and March 2009, were examined. We evaluated predictive factors related to peritumoral edema including gender, tumor volume, shape of tumor margin, presence of arachnoid plane, the signal intensity (SI) of the tumor in T2-weighted image (T2WI), the WHO histological classification (GI, GII/GIII) and the Ki-67 antigen labeling index (LI). The edema-tumor volume ratio was calculated as the edema index (EI) and was used to evaluate peritumoral edema. RESULTS: Gender (p=0.809) and pathological finding (p=0.084) were not statistically significantly associated with peritumoral edema by univariate analysis. Tumor volume was not correlated with the volume of peritumoral edema. By univariate analysis, three radiological features, and one pathological finding, were associated with PTBE of statistical significance: shape of tumor margin (p=0.001), presence of arachnoid plane (p=0.001), high SI of tumor in T2WI (p=0.001), and Ki-67 antigen LI (p=0.049). These results suggest that irregular tumor margins, hyperintensity in T2WI, absence of arachnoid plane on the MRI, and high Ki-67 LI can be important predictive factors that influence the formation of peritumoral edema in meningiomas. By multivariate analysis, only SI of the tumor in T2WI was statistically significantly associated with peritumoral edema. CONCLUSION: Results of this study indicate that irregular tumor margin, hyperintensity in T2WI, absence of arachnoid plane on the MRI, and high Ki-67 LI may be important predictive factors influencing the formation of peritumoral edema in meningiomas.

Effect of High-dose Methylprenisolone Pulse Treatment on Peritumor Edema Induced by Supratentorial Brain Tumors / 中国康复理论与实践

@#Objective To observe the clinical efficacy and adverse reactions of high-dose methylprednisolone pulse treatment on peritumoral edema induced by supratentorial brain tumors.Methods Thirty-five patients with supratentorial brain tumors and peritumoral edema were treated with methylprednisolone pulse therapy before surgery and the edema index of every patient was calculated by MRI examinations before and after methylprednisolone treatment.Results After methylprednisolone pulse therapy, the edema indexes of the light, medium and severe edema patients reduced by 1.79%, 8.81% and 12.02% respectively. The edema indexes of the medium and serious patients were significantly lower than that before treatment ( P<0.01). But the edema index of the light edema patients was not significantly different with that before treatment ( P>0.05).Conclusion High-dose methylprednisolone pulse therapy has an obvious effect on medium and serious peritumoral edema induced by supratentorial brain tumors and has no serious adverse reactions.

Factors Influencing the Development of Peritumoral Brain Edema in Menigiomas

In a series of 43 patients with intracranial meningioma, we retrospectively analysed factors influencing the development of peritumoral brain edema(PTBE). The extent of this was measured by the Edema Index(EI), obtained from the size of the meningioma and associated PTBE on a T2-weighted magnetic resonance image. We evaluated the relationship between EI and certain factors that may play a role in the development of PTBE ; namely age, size, location, and histology of the tumor, and its vascular supply(intrinsic cerebral artery or meningeal artery). Tumors in the frontal and sphenoid ridge regions tended to be associated with more extensive PTBE than these in the parietal, occipital, and infratentorial regions(p<0.05). In particular, the extent of infratentorial meningioma-associated PTBE tended to be slight. Histologically, PTBE associated with meningotheliomatous and transitional meningiomas tended to be more extensive than that associated with the fibroblastic meningiomas(p<0.05). On angiography, it was seen that for meningiomas supplied by intrinsic cerebral artery(internal carotid or veterbral artery only, or in conjunction with the meningeal artery), correlation with severe PTBE was higher than for those supplied by the meningeal artery only(p<0.05). We concluded, therefore, that location, histology, and vascular supply from the intrinsic cerebral arteries were the factors influencing PTBE.