Abstract:Aim To explore the predictive value of CT blend sign and island sign combined with CT enhanced leakage sign in the early hematoma enlargement in patients with intracerebral hemorrhage(ICH). Methods Patients with blend sign and island sign hematoma enlargement risk factors in ICH baseline CT scan within 6 hours were scanned by CT enhanced arterial phase and delayed 3 min scan. The patients were divided into two groups according to the presence of leakage sign:leakage sign positive group and leakage sign negative group. The clinical data were collected and compared between groups, and the relationship with hematoma enlargement was analyzed. In addition, the influencing factors of early hematoma enlargement were analyzed by Logistic regression analysis, and the predictive value of early hematoma enlargement in ICH was evaluated.Results The admission GCS score of the group with positive leakage sign was significantly lower than that of the group with negative leakage sign(P＜0.05). The volume of hematoma in the group with positive leakage sign was significantly larger than that in the group with positive leakage sign. Logistic regression analysis showed that blend sign, island sign and leakage sign were the main risk factors for early hematoma enlargement. The sensitivity and specificity of blend sign and island sign combined with leakage sign in predicting early hematoma enlargement in acute ICH were 94.29% and 97.22%, respectively. Conclusion CT plain scan blend sign and island sign combined with CT enhanced leakage sign have high predictive value for early hematoma enlargement in ICH.

Abstract:Aim To explore the value of early blood pressure variability (BPV) in predicting the risk of symptomatic intracerebral hemorrhage (sICH) after intravenous thrombolysis (IVT) in acute ischemic stroke (AIS). Methods AIS patients were collected who received recombinant tissue plasminogen activator IVT within 4.5 hours of onset from 2012 to 2016 with complete clinical data. According to skull CT or MRI findings and NIHSS scores within 48 hours after IVT therapy, the patients were divided into sICH group (22 cases) and non-sICH group (157 cases). The differences of sICH risk factors between the two groups were analyzed by single factor t test, χ2 test and multivariate Logistic regression analysis. The 24-hour systolic blood pressure standard deviation (24hSBPsd) and 24-hour diastolic blood pressure standard deviation (24hDBPsd) were further divided into four groups in quartiles, with the lowest quartile group as the reference group, and the rest groups were compared with the reference group, respectively. Results Univariate analysis showed that age, fibrinogen (FIB), smoking history, 24hSBPsd and 24hDBPsd in sICH group were higher than those in non-sICH group (all P＜0.05). Multivariate Logistic regression analysis showed that age (OR 3.7,5% CI 1.089-8.920), smoking history (OR 2.3,5% CI 1.042-8.257) and 24hSBPsd (OR 4.5,5% CI 1.397-12.237) in sICH group were still higher than those in non-sICH group (all P＜0.05); There was no significant difference in FIB and 24hDBPsd between the two groups (P＞0.05). After adjusting for risk factors of age and smoking history, the risks of sICH in 24hSBPsd and 24hDBPsd of the highest quartile group were 10.882 times (95%CI 2.088-56.717) and 6.025 times (95%CI 1.550-23.417) higher than those of the lowest quartile group, respectively, and the differences were statistically sigificant (P＜0.05). Conclusion The higher the early BPV, the higher the risk of sICH after IVT, and the more obvious the influence of systolic blood pressure variability.

Abstract:Aim To investigate the correlation between homocysteine （Hcy）, cystatin C （Cys C） and patients with essential hypertension and hypertensive intracerebral hemorrhage. Methods Subjects were divided in to hypertensive intracerebral hemorrhage group （108 cases）, essential hypertension group （100 cases） and control group （100 cases）, and their cystatin C, homocysteine and total cholesterol （TC） and triglycerides （TG） were surveyed. Results The patients with hypertensive intracerebral hemorrhage and essential hypertension had higher levels of Hcy and Cys C than the control group （P<0.05）. The patients with hypertensive intracerebral hemorrhage had higher levels of Hcy and CysC than the essential hypertension group （P<0.05）. There was no correlation between Hcy and CysC with TC and TG （P>0.05）. Conclusion Cystatin C, Homocysteine determination have important significance to early prevention and treatment of hypertension and cerebral hemorrhage.

Abstract:Aim To investigate dynamic changes of water content and neuropetie Y(NPY) in intracerebral hemorrhagic(ICH) rats and the role that neuropetie Y plays in cerebral edema after hemorrage,and to evaluate the effect of aprotinin in reducing the content of cerebral edema and neuropetie Y.Methods Animal model was made by injecting self arterial blood into the caudate nucleus of rats.75 rats were randomly assigned to control group,cerebral hemorrhage group and aprotinin treated group.After the injection,the rats were sacrificed at 6 h,1 d,3 d,5 d,7 d respectively.Brain water content was determined by wet-dry weight,as the expression of neuropetie Y was detected by radioimmunoassay method over a time course ranging from 6 hours to 7 days.Results Brain water content and neuropetie Y increased after 6 hours of cerebral hemorrhage and reached its climax at the 3 days,then decreased at the 5 to the 7 days;Administration of aprotinin could reduce the content of brain edema and neuropetie Y.Conclusions Aprotinin can reduce neuropetie Y expression,thus can reduce cerebral edema after ICH.Aprotinin antagonist might be available for the therapy of cerebral edema after ICH.

Abstract:Aim To investigate the expression of protein kinase C(PKC) isoenzyme and apoptosis in rats following intralcerebral hemorrhage,and the intervention effect of hirudin.Methods Animal model was made by injecting self arterial blood into the caudate nucleus of rats.75 rats were randomly assigned to control group,cerebral hemorrhage group and aprotinin treated group.After the injection,the rats were sacrificed at 6 h,1 d,3 d,6 d,10 d respectively.The expression of PKC isoenzyme was measured by immunohistochemistry method,and apoptosis detected with TUNEL method over a time course ranging from 6 hours to 10 days.Results Compared with the control group,the level of PKC isoenzyme increased after 6 hours of intralcerebral hemorrhage and reached its climax at the 3 day,then decreased at the 6 day and come back to the normal standard at the 10 day.Administration of aprotinin could reduce the expression and the level of apoptosis.Conclusions The expression of protein kinase C isoenzyme and apoptosis were up-regulated in rats following intralcerebral hemorrhage;Aprotinin can reduce the level of apoptosis;the inhibited expression of PKC isoenzyme may be involved in the mechanisms.

Abstract:Aim To investigate the expression of interleukin-2(IL-2),interleukin-8(IL-8) and their relations with cerebral water content in rats following intralcerebral hemorrhage. Methods The rats were infused with autologous fresh blood taken from rat femoral artery into the right caudate nucleus IL-2 and IL-8 in the perihematoma and were determined with radioimmnoassay method over a time course ranging from 6 hours to 10 days.The brain water content was measured by dry-wet weight method. Result Compared with those in the control group,the levels of IL-2 in the perihematoma within 1 day after intracerebral hemorrhage(ICH) were significantly lower,slightly lower at 3-day point and highest at 6-day point,then gradually decreased;the levels of IL-8 in the perihematoma within 6 hours after ICH were not significantly different,highest in 1-day point and 3-day point,and gradually reduced to the normal level at 6-day point;the contents of edema in the perihematoma within 1 day slightly reduced,were highest at 3-day point,then gradually decreased and reached the normal levels at 6 days. Conclusion IL-2 may benefit to decrease the formation and development of brain edema, accelerate the extinction of brain edema and facilitate the recovery of nervous system function;there was immunoreaction conducted by IL-8 which led to damage after ICH,and IL-8 may be related to the produce and development of brain edema.

Abstract:Aim To investigate the expression of matrix metalloproteinase-9 (MMP-9) and matrix metalloproteinase-2 (MMP-2) in rats following intracerebral hemorrhage(ICH). Methods ICH model was produced by stereotactically infusing 75 μL autologous fresh blood taken from rat femoral artery into the left caudate nucleus. The expression of MMP-2 and MMP-9 was detected by zymogram analysis over a time course ranging from 6 hours to 15 days. Results The expression of MMP-2 and MMP-9 in the hemorrhage site increased progressively over time after ICH. After 6 hours, significant (p<0.05) MMP-9 activity reached maximum levels by 24 hours (p<0.01), then persisted for 3 days at this level and returned based level (zero) by 15 days. MMP-2 was significantly (p<0.05) increased by 24 hours and was maximum after 5 days following ICH. Conclusions These results demonstrated that early increased MMP-9 expression was a significant responses to ICH; MMP-2 may contribute to brain tissue repairing.

Abstract:Aim To observe the expression of vascular endothelial growth factor (VEGF) and matrix metalloproteinase-9(MMP-9) in rat brain tissue in the border zone of the hematoma and explore the relationship among the expression of VEGF,MMP-9 and sodium aescinate after intracerebral hemorrhage(ICH). Methods 85 heath SD rats were divided randomly for: intracerebral hemorrhage model group(20),sodium aescinate treatment group A(20),sodium aescinate treatment group B(20),sham-operated group(20) and,normal contral group(5).Rat model of ICH was established by injection of physiological saline containing collagenase into the right caudate nucleus.Before and after interefered with sodium aescinate,the immunohistochemical methods were used to examine the expression of VEGF,MMP-9 in rat brain tissue at 6 h,24 h,48 h,and 96 h on ICH respectively. Results The amount of VEGF and MMP-9 were markedly increased at 6 h,respectively 12.67±1.50 and 9.27±1.28 and reached the hightest on 24～96 h in the border zone after ICH(p<0.01).There was a positive correlation with the expression of VEGF and MMP-9 after 6～96 h on ICH,coefficient correlation is 0.479(p<0.01).The expression of VEGF and MMP-9 were inhibited transparently in sodium aescinate treatment group A and sodium aescinate treatment group B,especially in the latter and there was a negative dose-effect relationship,coefficient of determination is 0.107 and 0.083. Conclusions 1.The upregulated expression of VEGF might induce the expression of MMP-9 in the border zone after ICH in rats.2.The antiencephaledema effects of sodium aescinate maybe related to change of the suppression of VEGF and MMP-9.