Objective To evaluate the diagnosis and emergency surgical treatment of ruptured intracerebral aneurysms (RIAs) accompanied with intracerebral hematomas (ICH).Methods A retrospective study was performed on the clinical data of 23 patients ofICH following RIAs,admitted to our hospital from May 2009 to September 2013.CTA was performed in 17 patients and cranial CT in 6 before the operation.The emergent operations were performed in all the patients within 24 hours of aneurysm rupture; pterion approach was adopted to clip the arterial aneurysm and clear intracerebral hematoma.Results According to Glasgow outcome scale (GOS) scores,4 recovered well,6 were mildly disabled,8 were severely disabled and 5 died.After follow-up for 3.3 years in 15 patients,no further bleeding occurred.Eight aneurysms were re-checked by CTA,7 aneurysms were completely clipped and 1 aneurysm had residual neck.Conclusions Preoperative CTA is essential for the correct diagnosis of ICHs due to RIA.The curative effect of the emergent operation can improve the survival rate and prognosis of patients with RIA accompanied with ICH.

Disturbance of macrophage-associated lipid metabolism plays a key role in atherosclerosis. Crosstalk between autophagy deficiency and inflammation response in foam cells (FCs) through epigenetic regulation is still poorly understood. Here, we demonstrate that in macrophages, oxidized low-density lipoprotein (ox-LDL) leads to abnormal crosstalk between autophagy and inflammation, thereby causing aberrant lipid metabolism mediated through a dysfunctional transcription factor EB (TFEB)-P300-bromodomain-containing protein 4 (BRD4) axis. ox-LDL led to macrophage autophagy deficiency along with TFEB cytoplasmic accumulation and increased reactive oxygen species generation. This activated P300 promoted BRD4 binding on the promoter regions of inflammatory genes, consequently contributing to inflammation with atherogenesis. Particularly, ox-LDL activated BRD4-dependent super-enhancer associated with liquid-liquid phase separation (LLPS) on the regulatory regions of inflammatory genes. Curcumin (Cur) prominently restored FCs autophagy by promoting TFEB nuclear translocation, optimizing lipid catabolism, and reducing inflammation. The consequences of P300 and BRD4 on super-enhancer formation and inflammatory response in FCs could be prevented by Cur. Furthermore, the anti-atherogenesis effect of Cur was inhibited by macrophage-specific Brd4 overexpression or Tfeb knock-out in Apoe knock-out mice via bone marrow transplantation. The findings identify a novel TFEB-P300-BRD4 axis and establish a new epigenetic paradigm by which Cur regulates autophagy, inhibits inflammation, and decreases lipid content.