Objective To observe the expression of interleukin-1β (IL-1β) in blood serum after axonal injury in rats and investigate the effects of ciclosporin A (CsA) on it so as to discuss mechanism of CsA protecting neural function. Methods A total of 75 adult male SD rats were randomly divided into control group (Group A with 5 rats), only optic nerve stretch group (Group B with 35 rats) and stretch plus CsA treatment group (Group C with 35 rats). Stretch injury was induced in the right optic nerves of the rats in Group B and C. CsA at 20 mg/L was intraperitonealy injected in Group C immediately after stretch injury. Five animals from both Group B and Group C were killed at 1,3, 6, 12 hours and at days 1,3 and 7 after stretch injury or injection of CsA respectively. Morphological changes of optic nerves and retinal ganglion cells (RGCs) after stretch injury were examined under light microscope. In the mean- time, expression of IL-1β in the blood serum was observed by means of radioimmunoassay. Results (1) Histopathological observation showed lose of R GCs at day 3 and disarranged nerve fiber at day 7 after stretch injury of optic nerve in Group B, but significant amelioration of corresponding changes in Group C. (2) The expression of IL-1β in blood serum in Group B was significantly higher than that in Group A 3, 6, 12 hours and 1 day after injury. The expression of IL-1β reached peak at the 6th hour, then de- creased gradually and returned to the similar level of Group A after 3 days. The expression pattem of IL- 1 β in blood serum of Group C decreased more significantly at 3, 6, 12 hours and 1 day compared with that in Group B but was still higher than that of Group A at 6, 12 hours and 1 day. Conclusions The long-term and excessive expression of IL-1β may be involved in the secondary pathological changes after axonal injury. CsA exerts neuroprotective effect on injured axons mostly by attenuation of inflammation re- action after axonal injury.

Objective The purpose of this study is to explore the clinical value of CT angiography( CTA) in the diagnosis of multiple intracranial aneurysms.Methods The data of CTA and DSA from 74 patients with multiple intracra-nial aneurysms from July 2011 to March 2015 were reviewed retrospectively.Results One hundred seventy-seven aneu-rysms were detected by DSA, and 175 aneurysms were detected by CTA.Among the aneurysms identified by CTA, 4 aneu-rysms were false positive and the correct detection rate of CTA was 96.6%.One hundred sixty-five aneurysms identified by CTA were confirmed by DSA and the correct diagnostic rate of CTA was 96.5%.CTA failed to detect 6 aneurysms and mis-diagnosed 10 aneurysms.Conclusions The correct detection rate and diagnostic rate of CT angiography ( CTA) in multiple intracranial aneurysms is relatively high.But previous surgery, spasm of the vessels, the size and number of aneurysms, radiologists'experience can influence the accuracy of ( CTA) in the diagnosis of multiple intracranial aneurysms, indicating that we should combine CTA with DSA to avoid the misdiagnosis and missed diagnosis.

BACKGROUND: At present, traditional modalities of neuroimaging, such as CT and MRI, is very limited in the diagnosis and severity estimation of diffuse axonal injury (DAI).OBJECTIVE: To investigate the value of proton magnetic resonance spectroscopy (1HMRS) in the diagnosis and prognosis of DAI.DESIGN, TIME AND SETTING: Prospective clinical controlled observation. The study was performed at the Department of Neurosurgery, and Department of Radiology, First Affiliated Hospital of Chongqing Medical University between October 2002 and September 2007.PARTICIPANTS: A total of 63 subjects with traumatic brain injury were enrolled and divided into DAI group (n=27) and non-DAI group (n=36) according to the result of MRI. In addition, 20 healthy persons were served as control group.METHODS: Demographic and clinical data were recorded on admission and neuroimaging examinations including fluid attenuated inversion recovery were carried on according to carefully designed procedures, in addition, 1HMRS was performed and the data were analyzed in combination with clinical condition.MAIN OUTCOME MEASURES: The ratios of N-acetyl aspartate (NAA)/creatine (Cr) and creatine phosphate (Cr), Choline compound (Cho)/Cr, myoinositol (mlNs)/Cr, and glutamic acid (GIx)/Cr at genu and splenium of corpus cellosum, and basal ganglia were quantified using 1HMRS.RESULTS: Compared with control and non-DAI groups, DAI group had decreased NAA/Cr and increased Cho/Cr at genu and splenium of corpus callosum, and basal ganglia (P < 0.05- 0.01), as well as increased mlNs/Cr and Glx/Cr at genu and splenium of corpus cellosum (P < 0.05). Non-DAI group also showed decreased NAA/Cr at splenium and increased Cho/Cr at genu of corpus callosum compared with control group (P < 0.01), but the change degree was less than DAI group. A positive correlation between Cho/Cr at genu of corpus callosum and the peded of primary unconsciousness was identified in DAI group (r=0.824, P < 0.01). CONCLUSION: The 1HMRS indexes at genu and splenium of corpus callosum, and basal ganglia could serve as effective indexes for the diagnosis of DAI. The Cho/Cr could well reflect histological changes following injury and act as sensitive index to predict clinical injury.

Objective Analyze the risk factors associated with severe subarachnoid hemorrhage(SAH)and rebleeding in small intracranial aneurysms.Methods From July 2014 to January 2020,patients with SAH caused by small ruptured intracranial aneurysms admitted to the Neurosurgery Department of the First Affiliated Hospital,Chongqing Medical University were retrospectively and continuously included.Small intracranial aneurysms refer to intracranial aneurysms with a maximum diameter of less than 5 mm.Baseline data and clinical data of patients were collected,including age,gender,past history(hypertension,diabetes,coronary heart disease),smoking history,drinking history,admission Glasgow coma scale(GCS)score and Hunt-Hess grade.Patient imaging data were collected to clarify the characteristics of aneurysms,including the number of aneurysms(single or multiple),the shape of SAH responsible aneurysms(irregular aneurysms with subcapsular,polycystic,or lobulated aneurysms),and their location(anterior communicating artery,posterior communicating artery,middle cerebral artery,anterior cerebral artery,internal carotid artery,and posterior circulation).Based on the CT images of the head at admission,the distribution of SAH in patients was determined.The modified Fisher grading system was used to classify SAH into 1-4 levels,and the Hijdra score was used to assess the bleeding volume of SAH in patients.The treatment methods of patients(interventional embolization,clipping)were collected.All patients were grouped according to the modified Fisher classification,with grades 1-2 being the minor SAH group and grades 3-4 being the massive SAH group.Baseline data and clinical data and aneurysm characteristics were compared between minor SAH group and massive SAH group.Multiple Logistic regression analysis was conducted using the modified Fisher grades 3-4 as the dependent variable,and factors with P＜0.1 in baseline data that may affect SAH bleeding volume as independent variables,the risk factors associated with the massive SAH in small ruptured intracranial aneurysms were analyzed.New bleeding visible on preoperative CT of the patient,with or without neurological deterioration,is defined as rebleeding.All patients are divided into rebleeding group and non-rebleeding group based on the occurrence of rebleeding.Baseline data and aneurysm characteristics between patients with rebleeding and those without rebleeding were compared.Multivariate Logistic regression analysis was conducted with rebleeding as the dependent variable,and factors with P＜0.1 in baseline data and aneurysm characteristics were used as independent variables,the risk factors associated with rebleeding in small aneurysms were analyzed.Results A total of 363 SAH patients with small ruptured aneurysms were included in this study,including 103 males and 260 females;age range from 25 to 85 years old,with an average age of(55±11)years.According to the modified Fisher classification,there were 198 cases in the massive SAH group and 165 cases in the minor SAH group.Compared with patients in the minor SAH group,patients in the massive SAH group were older(P=0.011),with a higher proportion of males,concomitant hypertension,and smoking history(all P＜0.05).The proportion of admitted Hunt Hess grade Ⅳ to V was higher(26.3％vs.2.4％,P＜0.01),the GCS score was lower([13.1±1.8]points vs.[13.9±0.8]points,P＜0.01),and the Hijdra score was higher([19.7±5.4]points vs.[8.4±2.6]points,P＜0.01).There was no statistically significant difference in the number of aneurysms and the location and morphology of responsible aneurysms between the massive and minor SAH groups(all P＞0.05).According to whether patients experienced rebleeding before surgery,there were 30 cases in the rebleeding group and 333 cases in the non-rebleeding group.Compared with the non-rebleeding group,patients in the rebleeding group had a higher proportion of concomitant hypertension(83.3％vs.49.2％,P＜0.01)and a higher proportion of admitted Hunt Hess grades Ⅳ-V(43.3％vs.12.9％,P＜0.01),lower GCS scores(12[9,14]points vs.14[13,14]points,P＜0.01),and higher Hijdra scores(18[9,26]points vs.14[9,18]points,P=0.024).There was no statistically significant difference in the number of aneurysms,responsible aneurysm morphology,and location between the rebleeding group and the non-rebleeding group(all P＞0.05).There was no statistically significant difference between the coiling and clipping in the two group(both P＞0.05).Multiple Logistic regression analysis was conducted using modified Fisher grading 3-4 and rebleeding as dependent variables respectively.The results showed that age(OR,1.027,95％CI 1.006-1.049,P=0.012)and hypertension(OR,1.858,95％CI 1.196-2.886,P=0.006)were independent risk factors associated with massive SAH in small ruptured aneurysms.Hypertension(OR,3.775,95％CI 1.371-10.391,P=0.010)and lower GCS score(OR,0.677,95％CI 0.561-0.816,P＜0.01)were independent risk factors associated with rebleeding in small ruptured aneurysms.Conclusions Older age and concomitant hypertension are risk factors associated with massive SAH in patients with small ruptured aneurysms.Coexisting hypertension and lower GCS score are risk factors associated with rebleeding in patients with small ruptured aneurysms.

Subarachnoid hemorrhage (SAH) is the third common type of stroke in the world,and its mortality and disability rates have declined over the past few decades due to the advances in neuroimaging technology and endovascular interventional therapy and promotion of healthy physical examination,but long-term neurological deficits and cognitive impairment of the patients have not significantly improved,which may be related to the white matter injury (WMI) after SAH.Little attention has been paid to WMI after SAH in the past,which may be an important reason for the poor prognosis of the patients with SAH.The neuroin-flammation response is an important pathophysiological process after SAH,and the neuroinflammation after SAH can aggravate WMI.This article reviews the relationship between neuroinflammation and WMI after SAH in order to deepen the understanding of its effects on cognitive function after SAH.