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Objective To investigate the relationship between serum mannan binding lectin(MBL),histi-dine rich glycoprotein(HRG),interleukin(IL)-23/IL-17 inflammatory axis and cerebral vasospasm(CVS)and prognosis in patients with aneurysmal subarachnoid hemorrhage(aSAH)after interventional emboliza-tion.Methods A total of 195 patients with aSAH who underwent interventional embolization treatment in the hospital from March 2019 to February 2022 were selected and were divided into no CVS group(126 cases),mild CVS group(18 cases),moderate CVS group(39 cases),and severe CVS group(12 cases)according to the occurrence and severity of CVS detected by digital subtraction angiography at the 4th postoperative day.The levels of serum MBL,HRG,IL-23 and IL-17 among the four groups before and 3 d after surgery were compared.The patients were followed up for 6 months and divided into good prognosis group(137 cases)and poor prognosis group(58 cases)according to their prognosis.Factors influencing poor prognosis in aSAH pa-tients were analyzed by multivariate Logistic regression model.The predictive value of serum MBL,HRG,IL-23,IL-17 levels and their combined application models for poor prognosis in patients with aSAH was analyzed by receiver operating characteristic(ROC)curve.Results The incidence rate of CVS after interventional em-bolization was 35.38%in 195 patients with aSAH.3 d after surgery,the serum levels of MBL,IL-23 and IL-17 in the mild,moderate,and severe CVS groups were higher than those in the no CVS group,those in the severe CVS group were higher than those in the moderate CVS group,those in the moderate CVS group were higher than those in the mild CVS group(P<0.05).The serum HRG levels in the mild,moderate,and severe CVS groups were lower than those in the non CVS group,those in the severe CVS group were lower than those in the moderate CVS group,those in the moderate CVS group were lower than those in the mild CVS group(P<0.05).3 d after surgery,the levels of serum MBL,IL-23 and IL-17 in the four groups were higher than that before surgery,while the levels of serum HRG were lower than that before surgery(P<0.05).The pro-portions of patients with aneurysm diameter≥6 mm,number of aneurysms>1,surgery time>24 h,Hunt-Hess grade Ⅲ/Ⅳ and postoperative CVS,and serum levels of MBL,IL-23,and IL-17 on the 3rd day after sur-gery in the good prognosis group were lower than those in the poor prognosis group,and serum HRG levels at 3 d after surgery in the good prognosis group were higher than that in the poor prognosis group(P<0.05).Multivariate Logistic regression analysis showed that aneurysm diameter≥6 mm,Hunt-Hess grade Ⅲ/Ⅳ and postoperative CVS,elevated serum levels of MBL,IL-23,and IL-17 and decreased HRG level at 3 d after sur-gery were independent risk factors for poor prognosis in aSAH patients(P<0.05).ROC results showed that serum levels of MBL,HRG,IL-23,and IL-17 at 3 d after surgery had certain predictive power for poor progno-sis in patients with aSAH.The predictive model with the combined application of four indicators had relatively high efficiency(the area under the curve was 0.853).Conclusion Elevated levels of MBL,IL-23,IL-17,and decreased HRG levels in aSAH patients after interventional embolization could increase the risk of CVS and are associated with poor prognosis in aSAH patients after interventional embolization.The above indicators have a certain predictive power for poor prognosis in aSAH patients.

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La ocurrencia de complicaciones afecta la evolución y ensombrece el pronóstico de los pacientes con hemorragia subaracnoidea espontánea. El estudio tuvo como objetivo determinar la incidencia de complicaciones neurológicas y no neurológicas en una serie de pacientes con hemorragia subaracnoidea espontánea. Se realizó un estudio observacional, descriptivo-correlacional y retrospectivo, que abarcó 96 pacientes con hemorragia subaracnoidea espontánea entre 2016 y 2021. Se determinó la frecuencia de distintas complicaciones neurológicas y no neurológicas, así como la relación entre la presencia de complicaciones neurológicas y otras variables mediante análisis bivariado (Odds Ratio y su intervalo de confianza). Entre los resultados se destacan que el 53% de los pacientes presentó algún tipo de complicación neurológica, lo cual predominó en los de 60 años o más (62% vs 45%), en la etiología aneurismática (54% vs 27%) y cuando el diagnóstico fue realizado en las primeras 48 horas de iniciados los síntomas (56% vs 43%). La frecuencia de pacientes complicados aumentó desde el grado I hasta el grado V de la escala de Hunt y Hess (OR 30,6[8,2;113]), al igual que en la escala de Fisher (OR 11,6[3,1;43,2]). La complicación neurológica más frecuente fue la hipertensión endocraneana (39%), mientras que la no neurológica fue la neumonía (24%). Se concluye que la serie de pacientes estuvo caracterizada por una elevada frecuencia de complicaciones neurológicas, entre las que predominó la hipertensión endocraneana. Se demostró evidente relación entre los peores grados de las escalas de Hunt y Hess e imagenológica de Fisher, obtenidos en la valoración del paciente al ingreso, y la mayor incidencia de complicaciones neurológicas.

The occurrence of complications affects the evolution and darkens the prognosis of patients with spontaneous subarachnoid hemorrhage. The objective was to determine the incidence of neurological and non-neurological complications in a series of patients with spontaneous subarachnoid hemorrhage. An observational, descriptive-correlational and retrospective study of 96 patients with spontaneous subarachnoid hemorrhage between 2016 and 2021 was carried out. The frequency of different neurological and non-neurological complications was determined, as well as the relationship between the presence of neurological complications and other variables through analysis. bivariate (Odds Ratio and its confidence interval). Among the results it is found that 53% of the patients presented some type of neurological complication, which prevailed in those 60 years of age or older (62% vs 45%), in aneurysmal etiology (54% vs 27%) and when the diagnosis was made. in the first 48 hours of the onset of symptoms (56% vs 43%). The frequency of complicated patients increased from grade I to grade V on the Hunt and Hess scale (OR 30.6[8.2;113]), the same as on the Fisher scale (OR 11.6[3 ,1;43,2]). The most frequent neurological complication was intracranial hypertension (39%), while the non-neurological one was pneumonia (24%). It is concluded that the series of patients was characterized by a high frequency of neurological complications, among which intracranial hypertension predominated. An evident relationship was demonstrated between the worst grades on the Hunt and Hess and Fisher imaging scales, obtained in the patient's assessment on admission, and the higher incidence of neurological complications.

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OBJECTIVES@#Subarachnoid hemorrhage (SAH) is a serious cerebrovascular disease. Early brain injury (EBI) and cerebral vasospasm are the main reasons for poor prognosis of SAH patients. The specific inhibitor of histone deacetylase 6 (HDAC6), tubastatin A (TubA), has been proved to have a definite neuroprotective effect on a variety of animal models of acute and chronic central nervous system diseases. However, the neuroprotective effect of TubA on SAH remains unclear. This study aims to investigate the expression and localization of HDAC6 in the early stage of SAH, and to evaluate the protective effects of TubA on EBI and cerebral vasospasm after SAH and the underlying mechanisms.@*METHODS@#Adult male SD rats were treated with modified internal carotid artery puncture to establish SAH model. In the first part of the experiment, rats were randomly divided into 6 groups: a sham group, a SAH-3 h group, a SAH-6 h group, a SAH-12 h group, a SAH-24 h group, and a SAH-48 h group. At 3, 6, 12, and 24 h after SAH modeling, the injured cerebral cortex of rats in each group was taken for Western blotting to detect the expression of HDAC6. In addition, the distribution of HDAC6 in the cerebral cortex of the injured side was measured by immunofluorescence double staining in SAH-24 h group rats. In the second part, rats were randomly divided into 4 groups: a sham group, a SAH group, a SAH+TubAL group (giving 25 mg/kg TubA), and a SAH+TubAH group (giving 40 mg/kg TubA). At 24 h after modeling, the injured cerebral cortex tissue was taken for Western blotting to detect the expression levels of HDAC6, endothelial nitric oxide synthase (eNOS), and inducible nitric oxide synthase (iNOS), terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling (TUNEL) staining to detect apoptosis, and hematoxylin and eosin (HE) staining to detect the diameter of middle cerebral artery.@*RESULTS@#The protein expression of HDAC6 began to increase at 6 h after SAH (P<0.05), peaked at 24 h (P<0.001), and decreased at 48 h, but there was still a difference compared with the sham group (P<0.05). HDAC6 is mainly expressed in the cytoplasm of the neurons. Compared with the sham group, the neurological score was decreased significantly and brain water content was increased significantly in the SAH group (both P<0.01). Compared with the SAH group, the neurological score was increased significantly and brain water content was decreased significantly in the SAH+TubAH group (both P<0.05), while the improvement of the above indexes was not significant in the SAH+TubAL group (both P>0.05). Compared with the sham group, the expression of eNOS was significantly decreased (P<0.01) and the expressions of iNOS and HDAC6 were significantly increased (P<0.05 and P<0.01, respectively) in the SAH group. Compared with the SAH group, the expression of eNOS was significantly increased, and iNOS and HDAC6 were significantly decreased in the SAH+TubA group (all P<0.05). Compared with the SAH group, the number of TUNEL positive cells was significantly decreased and the diameter of middle cerebral artery was significantly increased in the SAH+TubA group (both P<0.05) .@*CONCLUSIONS@#HDAC6 is mainly expressed in neurons and is up-regulated in the cerebral cortex at the early stage of SAH. TubA has protective effects on EBI and cerebral vasospasm in SAH rats by reducing brain edema and cell apoptosis in the early stage of SAH. In addition, its effect of reducing cerebral vasospasm may be related to regulating the expression of eNOS and iNOS.

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Objective The combined detection of serum angiopoietin-like protein 8(ANGPTL8)and Vascular cell adhesion molecule-1(VCAM-1)levels was analyzed for the predictive value of cerebral vasospasm(CVS)after intracranial aneurysm embolization.Methods A total of 196 patients who underwent intracranial aneurysm embolization in our hospital from March 2019-March 2022 were selected as the study subjects,99 patients with CVS were in the CVS group,and 97 patients without CVS were in the non CVS group.Serum ANGPTL8 and VCAM-1 levels were detected by ELISA;the correlation between serum ANGPTL8 and VCAM-1 levels was analyzed by Pearson method,Logistic regression was used to analyze the influencing factors of CVS in patients undergoing intracranial aneurysm embolization;ROC curve was used to analyze the serum levels of ANGPTL8 and VCAM-1 to predict the cutoff value of CVS in patients undergoing intracranial aneurysm embolization;four grid table method was used to analyze the predictive value of ANGPTL8,VCAM-1 and their combination on the occurrence of CVS in patients undergoing intracranial aneurysm embolization.Results The differences between CVS and non-CVS groups were statistically significant in hypertension,Hunt-Hess grade,and Glasgow coma(GCS)scores(P＜0.05).The serum ANGPTL8 and VCAM-1 levels in the CVS group were significantly higher than those in the non-CVS group(P＜0.05).There was a positive correlation between serum ANGPTL8 and VCAM-1(r=0.468,P＜0.05).Multivariate analysis showed that high level of ANGPTL8(OR=3.652,95％CI:1.434-9.302),high level of VCAM-1(OR=2.619,95％CI:1.212-5.658),Hunt Hess grade Ⅲ-Ⅳ(OR=1.927,95％CI:1.104-3.362),GCS score of 3-8(OR=2.813,95％CI:1.257-6.295)were independent risk factors for CVS in patients undergoing intracranial aneurysm embolization.The AUC of serum ANGPTL8 level in predicting CVS in patients undergoing intracranial aneurysm embolization was 0.844,and the cut-off value was 189.233 U/L;the AUC of serum VCAM-1 level in predicting CVS in patients undergoing intracranial aneurysm embolization was 0.795,and the cutoff value was 17.984 mg/L.The accuracy,sensitivity and specificity of the combined prediction for CVS were 89.81％,93.94％and 85.57％,respectively,which were obviously higher than those of the single prediction.Conclusion The serum levels of ANGPTL8 and VCAM-1 in CVS group are obviously higher than those in non CVS group.The combination of the two has a high predictive value for CVS after intracranial aneurysm embolization.

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Objective:To investigate the clinical value of hematoma volume estimated by 3D-Slicer in predicting symptomatic cerebral vasospasm (sCVS) after aneurysmal subarachnoid hemorrhage (aSAH).Methods:CT images on admission of 84 aSAH patients, admitted to our hospital from January 2018 to June 2021, were collected. The hematoma volume of these patients was measured by 3D-Slicer (3D-Slicer hematoma volume). Patients were divided into sCVS group and non-sCVS group according to the occurrence of postoperative sCVS. The differences of 3D-Slicer hematoma volume, Fisher grading scale and modified Fisher grading scale between the two groups were compared by statistical methods, and the independent risk factors for sCVS after aSAH were screened. The differences of 3D-Slicer hematoma volume among patients with different Fisher grading scale or modified Fisher grading scale were compared.Results:There was no significant difference in Fisher grading scale and modified Fisher grading scale between sCVS group and non-SCVS group ( P>0.05), but the 3D-Slicer hematoma volume in sCVS group was significantly larger than that in non-SCVS group ( P<0.05). 3D-Slicer hematoma volume ( OR=1.061, 95%CI: 1.004-1.120, P=0.034) was independent risk factors for sCVS after aSAH. The comparison of 3D-Slicer hematoma volume among patients with different Fisher grading scale or modified Fisher grading scale showed statistical difference ( P<0.05). Conclusion:As compared with Fisher grading scale and modified Fisher grading scale, the hematoma volume measured by 3D-Slicer has more advantage in predicting sCVS after aSAH.

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@#Spontaneous subarachnoid haemorrhage (SAH) is a significant cause of stroke and may lead to severe neurological deficit or death. It is also associated with high morbidity and mortality for patients despite optimal medical and surgical treatment. Based on the World Health Organization the annual incidence of spontaneous SAH varies in different regions of the world between 2.0-22.5 per 100,000 populations with Finland and Japan having the highest incidence and South and Central America with lowest incidence.1

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Objective:To investigate the relations of serum hypoxia inducible factor 2α (HIF-2α) and miR-21 expressions with cerebral vasospasm in patients with aneurysmal subarachnoid hemorrhage (aSAH) after interventional embolization.Methods:One hundred and seventy-four patients with aSAH underwent interventional embolization in our hospital from October 2017 to June 2019 were prospectively selected. DSA examination was performed 4 d after surgery, and severity of cerebral vasospasm was evaluated. Enzyme-linked immunosorbent assay was used to detect the level of serum HIF-2α and reverse transcription-PCR was employed to detect the serum miR-21 expression before and 3 and 7 d after interventional embolization. The clinical data and changes of serum HIF-2α and miR-21 expressions in patients with different degrees of cerebral vasospasm were compared. Correlation analysis was performed to analyze the relation of HIF-2α expression with miR-21 expression 3 and 7 d after interventional embolization. Receiver operating characteristics curve was used to analyze the diagnostic values of serum HIF-2α and miR-21 levels in cerebral vasospasm 3 d after interventional embolization.Results:There were 100 patients without vasospasm, and 20, 38 and 16 patients with mild, moderate and severe cerebral vasospasm, respectively. The serum levels of HIF-2α and miR-21 in patients with mild, moderate and severe cerebral vasospasm increased successively 3 and 7 d after interventional embolization, with significant differences ( P<0.05). Positive correlation was noted between expressions of HIF-2α and miR-21 in serum 3 and 7 d after interventional embolization ( P<0.05). Area under the curve (AUC) of HIF-2α in diagnosis of cerebral vasospasm was 0.748 ( 95%CI: 0.615-0.883, P=0.000) 3 d after interventional embolization. AUC of serum miR-21 level in diagnosis of cerebral vasospasm was 0.715 ( 95%CI: 0.590-0.842, P=0.000). AUC of serum HIF-2α combined with miR-21 in diagnosis of cerebral vasospasm was 0.893 ( 95%CI: 0.792-0.985, P=0.000). When diagnostic critical points of HIF-2α and miR-21 were 82.75 pg/mL and 1.15, the sensitivity, accuracy and negative predictive value of HIF-2α combined with miR-21 in the diagnosis of cerebral vasospasm were higher than those of HIF-2α or miR-21 alone. Conclusion:The expressions of serum HIF-2α and miR-21 in patients with aSAH after interventional embolization can effectively predict the occurrence of cerebral vasospasm, and may be involved in the occurrence and development of cerebral vasospasm.

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Objective To investigate the effect of salvinorin A (SA) on alleviating cerebral vasospasm (CVS) after subarachnoid hemorrhage (SAH). Methods The SAH models were established by endovascular perforation method. Adult male SD rats (n = 91) were randomly divided into the sham group (sham), SAH model group (SAH), control group (SAH+DMSO) and drug administration group (SAH + SA). SA and DMSO were diluted with saline, and injected intraperitoneally at hour 24, hour 48 and hour 72 after SAH. At hour 72 after SAH, the neurological score was evaluated. The diameter and wall thickness of the internal carotid artery were observed through HE staining. Endothelin 1 (ET-1) ELISA kit and nitric oxide (NO) kit were used to observe the ET-1 concentration and NO content on the blood vessels of Willis circle. The expression of phosphorglated PI3K (p-PI3K), PI3K, phosphorylated Akt (p-Akt), Akt and endothelial nitric oxide synthase (eNOS) proteins were detected by Western blotting and the location of eNOS protein was observed by immunofluorescent staining. Results At hour 72 after SAH, SA could increase the neurological score, increase the vessel diameter and reduce the wall thickness of internal carotid artery. SA could reduce the ET-1 concentration and increase NO content in the blood vessels of Willis circle at hour 72 after SAH. SA could increase the ratio of p-PI3K/PI3K, p-Akt/Akt and the expression of eNOS proteins, which could be inhibited by PI3K inhibitor wortmannin and eNOS inhibitor L-NAME. eNOS expressed in vascular endothelial cells was detected by the immunofluorescence staining. Conclusion SA can alleviate CVS after SAH through PI3K/Akt/eNOS pathway.

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Abstract Background: Aneurysmal subarachnoid hemorrhage is an important cause of premature death and disability worldwide. Magnesium sulphate is shown to have a neuroprotective effect and it reverses cerebral vasospasm. Milrinone is also used in the treatment of cerebral vasospasm. The aim of the present study was to compare the effect of prophylactic magnesium sulphate and milrinone on the incidence of cerebral vasospasm after subarachnoid hemorrhage. Methods: The study included 90 patients with aneurysmal subarachnoid hemorrhage classified randomly (by simple randomization) into two groups: magnesium sulphate was given as an infusion of 500 mg.day-1 without loading dose for 21 days. Group B: milrinone was given as an infusion of 0.5 µg.kg-1.min-1 without loading dose for 21 days. The cerebral vasospasm was diagnosed by mean cerebral blood flow velocity in the involved cerebral artery (mean flow velocity ≥ 120 cm.s-1), neurological deterioration by Glasgow coma scale, or angiography (the decrease in diameter of the involved cerebral artery >25%). Results: The mean cerebral blood flow velocity decreased significantly in the magnesium group compared to milrinone group through Day 7, Day 14 and Day 21 (p < 0.001). The incidence of cerebral vasospasm decreased significantly with magnesium compared to milrinone (p = 0.007). The Glasgow coma scale significantly improved in the magnesium group compared to milrinone group through Day 7, Day 14 and Day 21 (p = 0.036, p = 0.012, p = 0.016, respectively). The incidence of hypotension was higher with milrinone than magnesium (p = 0.012). Conclusions: The incidence of cerebral vasospasm after aneurysmal subarachnoid hemorrhage was significantly lower and Glasgow coma scale significantly better with magnesium when compared to milrinone. Milrinone was associated with a higher incidence of hypotension and requirement for dopamine and norepinephrine when compared to magnesium.

Resumo Justificativa: A hemorragia subaracnoidea por aneurisma é uma importante causa de morte prematura e de incapacidade em todo o mundo. O sulfato de magnésio mostra um efeito neuroprotetor e reverte o vasoespasmo cerebral. A milrinona também é usada no tratamento de vasoespasmo cerebral. O objetivo do presente estudo foi comparar o efeito profilático do sulfato de magnésio e da milrinona sobre a incidência de vasoespasmo cerebral após hemorragia subaracnoidea. Métodos: O estudo incluiu 90 pacientes com hemorragia subaracnoidea por aneurisma randomicamente distribuídos (randomização simples) em dois grupos: sulfato de magnésio foi administrado em infusão de 500 mg.dia-1 sem dose de ataque durante 21 dias. O Grupo B recebeu milrinona em infusão de 0,5 µg.kg-1·min-1 sem dose de ataque durante 21 dias. O vasoespasmo cerebral foi diagnosticado pela velocidade média do fluxo sanguíneo cerebral na artéria cerebral envolvida (velocidade média do fluxo ≥ 120 cm.s-1), a deterioração neurológica por escala de coma de Glasgow ou angiografia (diminuição do diâmetro da artéria cerebral envolvida > 25%). Resultados: A velocidade média do fluxo sanguíneo cerebral diminuiu significativamente no grupo magnésio em comparação com o grupo milrinona nos dias 7, 14 e 21 (p < 0,001). A incidência de vasoespasmo cerebral diminuiu significativamente com o magnésio em comparação com milrinona (p = 0,007). A escala de coma de Glasgow melhorou significativamente no grupo magnésio em comparação com o grupo milrinona nos dias 7, 14 e 21 (p = 0,036, p = 0,012, p = 0,016, respectivamente). A incidência de hipotensão foi maior com milrinona do que com magnésio (p = 0,012). Conclusões: A incidência de vasoespasmo cerebral após hemorragia subaracnoidea por aneurisma foi significativamente menor e a escala de coma de Glasgow significativamente melhor com magnésio em comparação com milrinona. A milrinona foi associada a uma maior incidência de hipotensão e necessidade de dopamina e norepinefrina em comparação com o magnésio.

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Subarachnoid hemorrhage (SAH) accounts for about 5% of all stroke patients, with high disability and mortality. Secondary cerebral vasospasm (CVS) after SAH interrupts cerebral blood flow to important parts of the brain, and then causes cerebral ischemia, which is one of the major complications of the disability and mortality. CVS usually occurring 3 to 12 days after SAH and lasted for an average of two weeks. The mechanism of CVS after SAH is very complex, and it is a process involving multiple factors and links, including hemolysis products, imbalance of vasodilator and vasoconstrictors, inflammation, activation of signal cascade reaction, apoptosis and expression of related genes. The treatment of CVS after SAH is divided into interventional therapy and drug therapy. Effective prediction, prevention, and treatment of CVS will significantly improve survival and quality of life after SAH. This article briefly reviews progress of the research on the mechanism and treatment of cerebral vasospasm after SAH.

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Objective:To investigate the molecular mechanism of Buyang Huanwu Tang in improving cerebral vasospasm after subarachnoid hemorrhage. Method:Eighty male Sprague-Dawley rats were randomly divided into sham operation group, model group, Buyang Huanwu Tang low and high dose (13, 26 g·kg-1·d-1) group. According to 10 mL·kg-1, the drug was administered twice a day for 7 days. The subarachnoid hemorrhage model was made by double occipital pool injection method. The neurological function scores of rats in each group were evaluated at 1, 3, 5 and 7 days. The diameter of basilar artery was measured by hematoxylin-eosin (HE)staining. The expressions of phosphp-phosphoinositide 3-kinases(p-PI3K), phosphp-protein kinase B(p-Akt),endothelial nitric oxide synthase(eNOS) and neuronal nitric oxide synthase(nNOS) protein in basilar artery brain tissue were detected by Western blot. The expression of nitric oxide(NO) and endothelin-1(ET-1) in rat cerebrospinal fluid was detected by enzyme-linked immunosorbent assay (ELISA). Result:Compared with sham operation group, the neurological function scores of the model group were significantly decreased (PPPPP-1·d-1) increased the neurological function scores 3 to 5 days after treatment, and the basilar artery diameter was significant increased (PPPPPPPPPConclusion:The protective effect of Buyang Huanwu Tang on cerebral vasospasm after subarachnoid hemorrhage may be related to up-regulation of p-PI3K, p-Akt and eNOS expression in PI3K/Akt/eNOS signaling pathway, thereby increasing NO production.

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Objective To explore the effect of hypertonic saline combined with magnesium sulfate on severe craniocerebral injury.Methods Patients with severe craniocerebral injury admitted to our hospital from September 2017 to February 2019 were selected prospectively.With the informed consent of the patients' families,the patients were divided into control group and experimental group according to the random number table.Patients in the two groups accepted intracranial pressure monitoring;patients in the experimental group additionally accepted magnesium sulfate combined with hypertonic saline for a continuous use of 7 d.Incidences of high intracranial pressure,epilepsy,low intracranial perfusion,cerebral vasospasm,cerebral infarction,and intracranial pressure rebound,total mannitol dosages one week after injury,serum neuron specific enolase (NSE) level,and Glasgow outcome scale (GOS) scores and mortality rate 3 months after injury were analyzed and compared between the two groups.Results A total of 93 patients were enrolled;47 were into the control group and 46 into the experimental group.There were no significant differences in age,gender,Glasgow coma scale (GCS) scores and NSE levels at admission,and percentages of patients accepted craniotomy evacuation of hematoma or bone flap decompression between the two groups (P＞0.05).As compared with those in the control group,the total mannitol dosage one week after injury and serum NSE concentration were significantly lower,and GOS scores 3 months after injury in the experimental group were significantly higher(P＜0.05).Patients in the experimental group had significantly lower incidences of high intracranial pressure,cerebral vasospasm and intracranial pressure rebound as compared with patients in the control group (P＜0.05).Conclusion Hypertonic saline combined with magnesium sulfate can improve the prognoses of severe craniocerebral injury;it has few side effects and is cheap;it might be an effective cerebral protective agent.

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Objective To investigate the occurrence status quo and related factors of cerebral vasospasm after cerebral ruptured aneurysms embolization.Methods Sixty-six patients withruptured cerebral aneurysms undergoing embolization treatment were selected as the research subjects,and conducted routine aneurysm embolization treatment.The cerebral vasospasm occurrence rate during hospitalization period was statistically calculated,and the related factors of cerebral vasospasm after cerebral aneurysm rupture embolization were analyzed.Results The cerebral vasospasm occurrence rate was 22.73 ％.Age,body mass index (BMI),hypertension rate,smoking history,aneurysms number,Fisher grade,Hunt-Hess grade,operation timing and Glasgow coma index (GCS) had statistically significant difference between the patients with and without cerebral vasospasm (P＜0.05).The related factors of cerebral vasospasm after embolization of ruptured aneurysms were age,hypertension,smoking history,number of aneurysms,Fisher grade,Hunt-Hess grade,operation timing and GCS index.Conclusion The cerebral vasospasm rate after embolization of ruptured aneurysms is high,and related to age,hypertension,smoking history,number of aneurysms,Fisher grade,Hunt-Hess grade,operation timing and GCS index.

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Objective To investigate the value of cerebrospinal fluid drainage after aneurysm clipping in patients with intracranial aneurysm complicated with subarachnoid hemorrhage .Methods 84 intracranial aneurysms patients with subarachnoid hemorrhage were selected ,and they were randomly divided into study group (n =42) and control group (n =42).The control group used simple suture after aneurysm clipping ,the study group was given lumbar cistern drainage by implementation of the dural suture tube after aneurysm clipping .Before and after hydro-cephalus and cerebral vasospasm ,treatment changes of serum insulin-like growth factor 1 (IGF-1) and soluble vascular cell adhesion molecule-1 (sVCAM-1) levels were compared between the two groups .Results The incidence rate of hydrocephalus of the study gruop was 4.8%,which was significantly lower than the 14.3% of the control group (χ2 =9.743,P <0.05).The incidence rate of cerebral vasospasm of the study group was 7.1%,which was significantly lower than 19.0% of the control group (χ2 =11.802,P <0.05).The incidence rates of intracranial infection,cerebrospinal fluid leakage and other complications between the two groups had no statistically significant differences (χ2 =2.074,2.125,all P >0.05).The serum levels of IGF-1 and sVCAM-1 between the two groups had no statistically significant differences before operation (t =0.417,0.603,all P >0.05).At the 8th day after oper-ation,the serum levels of sVCAM-1 and IGF-1 of the study group were significantly lower than those of the control group (t =7.335,6.856,all P <0.05).Conclusion After aneurysm clipping,the lumbar cistern drainage tube drainage is beneficial to reduce hydrocephalus and cerebral vasospasm incidence ,inhibit the expression of serum IGF-1,sVCAM-1,with less adverse reactions,it is worthy of application.

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One of the majority reasons for mortality and morbidity in children is cerebral vasospasm secondary to intracranial hemorrhage(CVSIH).CVSIH prevented and treated by nimodipine in adult patients have been widely reported in China and abroad,but only limited reports in children.We aimed to describe the mechanism and diagnosis of CVSIH in children,and also the mechanism,efficacy and safety of nimodipine.

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An 8-month old female presented with spontaneous subarachnoid hemorrhage and was treated successfully with endovascular coil embolization of the ruptured aneurysm. Transcranial Doppler ultrasound performed four days later demonstrated middle cerebral artery (MCA) velocities greater than 350 cm/sec on the right and greater than 200 cm/sec on the left, despite medical management. The patient demonstrated no focal neurological deficits, though examination was limited by our patient's sedation and intubation. Angiography revealed severe vasospasm of the supraclinoid internal carotid and MCA territories, bilaterally. The vasospasm was refractory to the administration of intra-arterial verapamil. Balloon angioplasty was attempted, but the device could not be advanced safely due to the small size of the patient's vessels and the stiffness of the device. A microcatheter (0.0165" diameter) was advanced over a J-shaped soft microwire (0.014" diameter) to perform mechanical angioplasty in the internal carotid artery and MCA vessels bilaterally. Dramatic improvement was seen angiographically and on transcranial Doppler, and no complications were seen.

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Therapeutic hypothermia (TH) improves the neurological outcome in patients after cardiac arrest and neonatal hypoxic brain injury. We studied the safety and feasibility of mild TH in patients with poor-grade subarachnoid hemorrhage (SAH) after successful treatment. Patients were allocated randomly to either the TH group (34.5°C) or control group after successful clipping or coil embolization. Eleven patients received TH for 48 hours followed by 48 hours of slow rewarming. Vasospasm, delayed cerebral ischemia (DCI), functional outcome, mortality, and safety profiles were compared between groups. We enrolled 22 patients with poor-grade SAH (Hunt & Hess Scale 4, 5 and modified Fisher Scale 3, 4). In the TH group, 10 of 11 (90.9%) patients had a core body temperature of 95% of the 48-hour treatment period. Fewer patients in the TH than control group (n = 11, each) had symptomatic vasospasms (18.1% vs. 36.4%, respectively) and DCI (36.3% vs. 45.6%, respectively), but these differences were not statistically significant. At 3 months, 54.5% of the TH group had a good-to-moderate functional outcome (0–3 on the modified Rankin Scale [mRS]) compared with 9.0% in the control group (P = 0.089). Mortality at 1 month was 36.3% in the control group compared with 0.0% in the TH group (P = 0.090). Mild TH is feasible and can be safely used in patients with poor-grade SAH. Additionally, it may reduce the risk of vasospasm and DCI, improving the functional outcomes and reducing mortality. A larger randomized controlled trial is warranted.

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Objective To investigate the genetic association between endothelin receptor type A(EDNRA)gene polymor-phism and delayed cerebral vasospasm(DCVS)in patients with aneurysmal subarachnoid hemorrhage(aSAH).Methods 133 aSAH patients from January 2015 to January 2017 were recruited to participate in the study.According to whether com-bined with DCVS,they were divided into the DCVS group(78 cases)and the control group(55 cases).Genotype was deter-mined by polymerase chain reaction-restriction fragment length polymorphism combined with DNA direct sequencing tech-nique for the polymorphism of the EDNRA gene.Results Samples of DCVS group and control group both were consistent with Hardy-Weinberg's law of inheritance(χ2=0.295,P=0.863;χ2=0.652,P=0.722).There were significant differ-ences of EDNRA gene rs5335 polymorphism between DCVS group and control group,under allele model(χ2=4.213,P=0.040)and the dominant model(χ2=4.790,P=0.029).However,there was no difference of EDNRA gene polymorphism between DCVS group and control group under recessive model(χ2=1.299,P=0.254).Multivariate Logistic regression a-nalysis showed that allele C was protective factor of DCVS for aSAH patients(OR=0.572,95%CI 0.401~0.872,P=0.021).Conclusion For aSAH patients,EDNRA gene rs5335 polymorphism may closely related to DCVS.

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Objective To assess the clinical effects of individual nursing in the prevention of cerebral va-sospasm(CVS)in perioperative intracranial aneurysm intervention based on the therapy use of ligustrazine. Meth-ods Patients who suffered intracranial aneurysm from January 2014 to June 2017 in our hospital were divided into two groups randomly.Normal nursing was applied in the control group,while individual nursing was used for the ex-perimental group. Ligustrazine was used in both groups. Results A total of 56 patients were included in this re-search,28 for the control group,and 28 for the other group.Most patients recovered well and discharged regularly. The incidence rate of CVS in the experimental group(3.57%)was significant lower than that in the control group (28.57%)(P<0.05).Conclusions Based on the fact that individual nursing could lower the incidence of CVS of patients who suffered intracranial aneurysms when ligustrazine was used,it is one of the most important way to pro-mote the recovery as well as lower the mortality rate of patients.

ABSTRACT

Objective·To observe the degree of cerebral vasospasm (CVS) after subarachnoid hemorrhage (SAH) at different time points, and to investigate the effects of ethyl pyruvate (EP) on CVS following SAH and its mechanism. Methods·Fifty healthy SD rats were randomly divided into five groups i.e. sham group, SAH-3 d group, SAH-5 d group, SAH-7 d group and SAH-9 d group (n=10 in each group). Sham group was built by double cisternal injection with 0.3 mL saline each time, and SAH group was built by double cisternal injection with 0.3 mL autologous blood each time. The neurological function and degree of CVS were observed. Another forty-eight healthy SD rats were randomly divided into three groups i.e. sham+saline (equal volume) group, SAH+saline (equal volume) group and SAH+EP [100 mg/(kg·d)] group (n=16 in each group). The neurological function, degree of CVS and cell apoptosis of basilar artery were observed on day 7. The expressions of p-Akt, Bax, Bcl-2 and cleaved caspase-3 were also observed on day 7. Results·CVS significantly increased on day 3, decreased on day 5, and then significantly increased to top level on day 7, and gradually decreased on day 9. Compared with sham+saline group, the neurological scores were significantly decreased in SAH+saline group on day 7. Compared with sham+saline group, CVS and cell apoptosis of basilar artery were significantly increased in SAH+saline group on day 7. Compared with sham+saline group, the expressions of Bax and cleaved caspase-3 were significantly up-regulated, while the expressions of p-Akt and Bcl-2 were significantly down-regulated in SAH+saline group on day 7. Compared with SAH+saline group, the neurological scores significantly increased in SAH+EP group on day 7. Compared with SAH+saline group, CVS and cell apoptosis of basilar artery significantly decreased in SAH+EP group on day 7. Compared with SAH+saline group, the expressions of Bax and cleaved caspase-3 were significantly down-regulated, while the expressions of p-Akt and Bcl-2 were significantly up-regulated in SAH+EP group on day 7. Conclusion·The double hemorrhage model rat has most severely CVS on day 7. EP can attenuate vasospasm after SAH, and its mechanism may be associated with inhibition of cell apoptosis. PI3K/Akt signaling pathway may be involved, which may provide a novel therapeutic target for CVS.