Risk factors and emergency management of intraprocedural re-rupture of ruptured intracranial aneurysms / 中华神经医学杂志

Objective To study the risk factors of intraprocedural re-rupture (IPR) of ruptured intracranial aneurysms, and the emergency management on this event and its efficacy. Methods The clinical data of 236 patients with ruptured intracranial aneurysms, admitted to our hospital from 2005 to 2009 and treated with embolization, were retrospectively analyzed; non-conditional logistic regression analysis was performed to analyze the risk factors of IPR of ruptured intracranial aneurysms. And the emergency management of IPR and its efficacy were concluded in 16 patients with IPR. Results The risk factors of IPR of ruptured intracranial aneurysms included small aneurysms with a diameter smaller than or equaling to 3.0 mm (OR=6.353, 95% CI: 1.266-31.894, P=0.025), aneurysms at distal part of Al and M1 segment of the anterior cerebral artery or middle cerebral artery (OR=35.449, 95% CI:3.053-411.642, P=0.004), atherosclerosis (OR=5.961, 95% CI: 1.215-29.260, P=0.028), mild vasospasm (OR=13.048, 95% CI: 1.220-139.574, P=0.034) and severe vasospasm (OR=14.826, 95% CI:1.871-117.488, P=0.011). Immediate reversal of heparin anticoagulation with protamine sulfate and rapid completion of coiling were performed in 16 patients (6.78%) occurred IPR. Emergent external ventricular drainage was performed in 12 patients having above Hunt-Hess grade Ⅲ:6 patients died; 1 was under persistent vegetative state and 9 fully recovered. Conclusion Small aneurysms, atherosclerosis,cerebral vasospasm and aneurysms at the distal part of Al or M1 segment may easily lead to IPR of ruptured intracranial aneurysms. Rapid completion of coiling combined with immediate reversal of heparin anticoagulation, and emergent external ventricular drainage performed in severe patients are confirmed to be the keys, which can decrease the death rate and improve the prognosis.

Effects of xuefuzhuyu injection on expression and activation of NF-кB in rat brain tissue after traumatic brain injury / 中华神经医学杂志

Objective To investigate the effects of xuefuzhuyu injection on the expressions of the nuclear factor-кB(NF-кB)and inhibitor-кBα(1-кBα)in rat brain tissue after traumatic brain injury.Methods Eighty SD rats were randomly divided into sham-operative(n=20), model(n=20),hexadecadrol-treated(n=120)and xuefuzhuyu-treated(n=20)groups.Traumatic brain injury models were induced by free-fall.Sham-operative and model groups received intraperitoneal injection of 0.1 mL/(kg·d)normal saline;dexamethasone-treated group and xuefuzhuyu-treated group received intraperitoneal injection of 0.1 mg/(kg·d)dexamethasone and 4 mL/(kg·d)xuefuzhuyu injection immediately after the successful model inducement,respectively, and then, heir brain tissue samples were obtained at 6,24,48 and 96 h. Immunohistochemistry was employed to detect the protein expressions of NF-кB P65 and I-кBα in the traumatic brain tissue,and HE staining was performed to observe the brain structure.Results Increased protein expression of NF-кB P65 and decreased protein expression of I-кBα in the model group were found as compared to those in the sham-operative group at all time points(P<0.05);dexamethasone-treated and xuefuzhuyu-treated groups showed significantly lower protein expression of NF-кB and higher protein expression of I-кBα than the model group at all time points(P<0.05)and the effect of xuefuzhuyu injection was better than that of dexamethasone.The expressions of NF-кB and I-кBα were negatively correlated in the model group(r=-0.876.P=0.000). Conclusion Secondary injury caused by traumatic brain injury can be relieved by inhibiting the activation of NF-кB and increasing the expression of I-кBα, which are exactly the effects of xuefuzhuyu injection and dexamethasone,and xuefuzhuyu injection works better than dexamethasone.