OBJECTIVETo study the background patterns and sleep-wake cycles (SWC) on amplitude-integrated electroencephalography (aEEG) in preterm infants with different grades of periventricular-intraventricular hemorrhage (PIVH).

METHODSFifty-six preterm infants with a gestational age between 25 and 33 weeks who were diagnosed with PIVH and 31 gestational age-matched normal preterm without ICH were enrolled. According to Papile staging criteria, the infants with PIVH were subdivided into mild group (grades I and II) and moderate-severe group (grades III and IV). The results of the aEEG were compared between groups.

RESULTSThe moderate-severe PIVH group showed a decreased continuity of the voltage, an increased loss rate of SWC, and a lower aEEG score than the mild PIVH and control groups (P<0.017). There were no significant differences in these parameters between the mild PIVH and control groups.

CONCLUSIONSThe changes of background patterns and SWCs may be associated with the severity of PIVH in preterm infants.

Cerebral Hemorrhage ; physiopathology ; Electroencephalography ; Female ; Humans ; Infant, Newborn ; Infant, Premature ; Male ; Sleep ; physiology

We studied three patients with spontaneous mesencephalic hemorrhages. All presented with some degree of impaired consciousness and abnormal ocular movements. One patient had a convergence-retraction nystagmus with a unilateral hemorrhage confined to the dorsal midbrain. Another patient showed left third nerve palsy due to a unilateral hemorrhage that involved ventral midbrain. The third patient revealed left internuclear ophthalmoplegia with ataxia due to a pinpoint hemorrhage in the tegmentum of the left midbrain. The patients survived and major neurologic deficits recovered, but abnormal ocular movements persisted.
Adult ; Cerebral Hemorrhage/*physiopathology/radiography ; Humans ; Male ; Mesencephalon ; Middle Aged ; Tomography, X-Ray Computed

OBJECTIVETo evaluate the application value of percutaneous endoscopic gastrostomy (PEG) for home nutrition support in patients with stroke and post-traumatic brain.

METHODSWe retrospectively analyzed the clinical data of the 16 patients with stroke and post-traumatic brain, including cerebral infarction (n = 9), cerebral hemorrhage ( n = 5), subarachnoid hemorrhage (n = 1), and cerebral trauma (n = 1). All these patients underwent PEG in our hospital because they were not able to be orally fed.

RESULTSThe weight, triceps skinfold thickness, mid-upper arm muscle circumference, and serum albumin, hemoglobin, and lympholeukocyte cell counts 30, 60, and 120 days after hospital discharge were significantly higher than those at hospital discharge (P <0.05 or P <0.01). The NIHSS scores 30, 60, and 120 days after hospital discharge were 14.0 +/- 1.3, 14.0 +/- 1.1, and 3.0 +/- 1.2, respectively, which were significantly lower than 16.0 +/- 1.2 at hospital discharge (all P <0.05). Complications included gastric contents retention (n = 1), backstreaming (n = 1), aspirated pneumonia (n = 1), and intra-cushion syndrome (n = 1).

CONCLUSIONSPEG for home nutrition support is useful for the treatment of patients with stroke and post-traumatic brain with dysphagia and malnutrition after long-term coma. It can help to avoid the deterioration of nutritional status and improve the quality of life.

Adult ; Aged ; Aged, 80 and over ; Cerebral Hemorrhage ; physiopathology ; Cerebral Infarction ; physiopathology ; Enteral Nutrition ; methods ; Female ; Gastroscopy ; adverse effects ; methods ; Gastrostomy ; adverse effects ; methods ; Hemoglobins ; metabolism ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Serum Albumin ; metabolism ; Stroke ; physiopathology ; Subarachnoid Hemorrhage ; physiopathology

OBJECTIVETo observe the effects of cross electro-nape-acupuncture on reflex remodeling of airway protective reflex cough in patients with tracheotomy after cerebral hemorrhage.

METHODSWith the method of completely random design, according to treatment order, 60 patients who received tracheotomy after cerebral hemorrhage accompanied with cough reflex difficulty were randomly divided into a cross electro-nape-acupuncture group and an acupuncture group, 30 cases in each group. Both groups were treated with basic treatment, including anti-inflammation, eliminating phlegm, improving cerebral metabolism and so on. The acupuncture group was treated with acupuncture at Yifeng (TE 17), Fengchi (GB 20), Lianquan (CV 23), Baihui (GV 20), Touwei (ST 8), Dicang (ST 4) through Jiache (ST 6), Hegu (LI 4), Quchi (LI 11), and motor area on the affected side, and the needles were retained for 30 min. Based on the treatment of acupuncture group, the cross electro-nape-acupuncture group was additionally treated with cross electro-nape-acupuncture (continuous wave) for 30 min per treatment. The treatment was both given twice a day from Monday to Friday and once a day on Saturday and Sun day for 4 weeks. Tracheostomy cough reflex grading score (TCRGS) and clinical pulmonary infection score (CPIS) were observed before and after treatment in the two groups, and the clinical efficacy of two groups was evaluated.

RESULTSCompared before the treatment, TCRGS and CPIS were both reduced in two groups (both P < 0.01); after treatment, there were significant differences of TCRGS and CPIS between two groups (both P < 0.01), indicating cross electro-nape-acupuncture group was superior to acupuncture group. Regarding the effects of cough reflex remodeling, the cured and markedly effective rate was 96.7% (29/30) in the cross electro-nape-acupuncture group, which was significantly different from 55.2% (16/29) in the acupuncture group (P < 0.01).

CONCLUSIONCross electro-nape-acupuncture could effectively improve the remodeling of cough reflex and promote the recovery of lung infection in patients with tracheotomy after cerebral hemorrhage, leading to an increased quality of life.

Acupuncture Points ; Aged ; Cerebral Hemorrhage ; physiopathology ; surgery ; therapy ; Cough ; physiopathology ; Electroacupuncture ; Female ; Humans ; Male ; Middle Aged ; Reflex ; Tracheotomy

OBJECTIVETo explore the therapeutic effect of acupuncture for hypertensive cerebral hemorrhage at the early stage.

METHODSFifty-four cases of small-amount cerebral hemorrhage were randomized into an acupuncture group and a conventional treatment group, 27 cases in each one. In the conventional treatment group, special care, oxygen therapy, nerve nutrition and symptomatic support were applied. In necessary, dehydrant and hypotensive drugs were prescribed for antihypertension, or surgery was given. In the acupuncture group, on the basis of the treatment as the control group, acupuncture was applied at Quchi (LI 11), Neiguan (PC 6), Zusanli (ST 36), Sanyinjiao (SP 6) and Taichong (LR 3). Acupuncture was given at the admission, 4 h, 6 h and 12 h after disease onset respectively. Blood pressure was monitored in the whole procedure. 6 h and 24 h after disease onset, the cranial CT was re-examined. Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), hematoma volume and neurological deficit score were compared at different time points between the two groups.

RESULTS(1) Blood pressure: from the admission to 12 h after disease onset, SBP, DBP and MAP were increased apparently in the conventional treatment group and increased slightly in the acupuncture group. The differences in SBP [(164.3 +/- 21.6) mmHg vs (158.6 +/- 21.5) mmHg] and MAP [(113.4 +/- 4.9) mmHg vs (106.7 +/- 6.1) mmHg] were significant between the two groups (both P < 0.05). From 12 h to 24 h after disease onset, compared with the conventional treatment group, SBP and MAP were decreased apparently in the acupuncture group [(147.3 +/- 21.6) mmHg vs (158.4 +/- 23.5) mmHg, (97.2 +/- 5.3) mmHg vs (106.6 +/- 5.1) mmHg, both P < 0.05)]. (2) Hematoma volume: from the admission to 6 h after disease onset, the volume was increased by (4.15 +/- 0.73) mL in the convertional treatment group and (2.67 +/- 0.33) mL in the acupuncture group, indicating the significant difference in comparison (P < 0.05). From the admission to 24 h after disease onset, it was increased by (5.57 +/- 1.26) mL in the convertional treatment group and (3.14 +/- 1.18) mL in the acupuncture group, indicating the significant difference in comparison (P < 0.05). (3) Neurological deficit score: the score was increasing gradually in first 3 days after disease onset in the two groups. The score (38.39 +/- 6.84) in the acupuncture group on the first day was different significantly as compared with that (42.37 +/- 7.46) in the conventional treatment group (P < 0.05). On the 10th days, the score (24.68 +/- 5.42) in the acupuncture group was different significantly from that (29.74 +/- 7.36) in the convertional treatment group (P < 0.05).

CONCLUSIONThere is no peak of blood pressure rising, and the continuous hemorrhagic volume is less in 24 h and neurological deficit score is improved in the acupuncture group. Acupuncture brings the positive significance in the treatment of cerebral hemorrhage at the early stage.

Acupuncture Therapy ; Adult ; Aged ; Blood Pressure ; Cerebral Hemorrhage ; physiopathology ; therapy ; Female ; Hematoma ; physiopathology ; therapy ; Humans ; Male ; Middle Aged

Cerebral Hemorrhage ; pathology ; physiopathology ; Child ; Child, Preschool ; Female ; Heart Defects, Congenital ; pathology ; physiopathology ; Hemodynamics ; physiology ; Humans ; Infant ; Male ; Risk Factors ; Stroke ; pathology ; physiopathology ; Vascular Malformations ; pathology ; physiopathology

OBJECTIVESponsored by the Subspecialty Group of Neonatology of Pediatric Society, China Medical Association, more than 10 large-scale hospitals participated in the near two-year multicenter investigation for Brain Injuries in Premature Infants in China. The present study presents the follow-up results of 147 premature infants with brain injuries from 6 Third Class A Level hospitals.

METHODSAll premature infants with intraventricular hemorrhage (IVH) or periventricular leukomalacia (PVL) diagnosed in the early neonatal period in the 6 hospitals were followed-up between January 2005 and August 2006. Based on the synthetic results of physical development, examination of nervous system, intelligence tests and cranial ultrasound, the premature infants with brain injuries were classified as normal development, marginal development and retarded development.

RESULTSOne hundred and forty-seven premature infants with brain injuries from the 6 hospitals consisted of 141 cases of IVH and 36 cases of PVL (30 cases having IVH and PVL). Based on the synthetic follow-up results, 51.4% of premature infants with brain injuries were generally assessed as normal development, 38.4% as marginal development and 10.7% as retarded development. Among them, delayed growth in head circumference, height and weight was 13.4%; the occurrence frequency of cerebral paralysis (CP) was 7.1% in PVL grade I, 28.6% in PVL grade II and 100% in PVL grade III; 12.7% showed retarded development of intelligence; and 30% presented post-injurious changes on cranial sonography.

CONCLUSIONSThe data of the multicenter follow-up can basically reflect the short-term prognosis of premature infants with brain injuries in major big cities of China. About 10% of them have retarded physical, motor-and mental developments. The long-term regular follow-up study is expected for more premature infants with brain injuries, and behavioral sequelae of brain injuries which may occur in peri-school age and adolescence should be paid particularly close attention.

Cerebral Hemorrhage ; complications ; physiopathology ; Cerebral Palsy ; etiology ; Echoencephalography ; Follow-Up Studies ; Humans ; Infant, Newborn ; Infant, Premature ; Intelligence ; Leukomalacia, Periventricular ; complications ; physiopathology

BACKGROUNDEndothelin-1 (ET-1) has deleterious effects on water homeostasis, cerebral edema, and blood-brain barrier (BBB) integrity. Highly expressed ET-1 was observed after intracerebral hemorrhage (ICH); however, ET-1 changes and their relationship with BBB disruption within 24 hours of ICH have not been thoroughly investigated. The aim of the present study was to observe the changes in perihematomal ET-1 levels in various phases of ICH and their correlation with the BBB integrity in a rabbit model of ICH.

METHODSTwenty-five rabbits (3.2-4.3 kg body weight) were randomly divided into a normal control group (five rabbits) and a model group (20 rabbits). Animals in the model group were equally divided into four subgroups (five rabbits each to be sacrificed at 6, 12, 18, and 24 hours following ICH establishment). An ICH model was prepared in the model group by infusing autologous arterial blood into the rabbit brain. ET-1 expression in perihematomal brain tissues was determined using immunohistochemistry and color image analysis, and the permeability of the BBB was assayed using the Evan's Blue (EB) method. A repeated measures analysis of variance was used to make comparisons of the ET-1 and EB content across the entire time series.

RESULTSThe number of perihematomal endothelial cells with ET-1 positive expressions following 6, 12, 18, and 24 hours ICH model establishment was 9.32, 13.05, 15.90, and 20.44, respectively, but as low as 6.67 in the control group. The average transmittance of ET-1-positive cell bodies at 6, 12, 18, and 24 hours after ICH was 99.10, 97.40, 85.70, and 80.80, respectively, but 100.12 in the control group. These data reveal that the expression of ET-1 was significantly increased at 6, 12, 18, and 24 hours after ICH compared with the control group, and a marked decrease in the average transmittance of ET-1-positive cell bodies was noted (P < 0.05). Similarly, the perihematomal EB content at 6, 12, 18, and 24 hours after ICH was 29.39 ± 1.16, 32.20 ± 0.73, 33.63 ± 1.08, and 35.26 ± 1.12, respectively, in the model group and 28.06 ± 0.80 in the control group. The results indicate that a significant increase in the EB content in the model group was observed compared with that of the control group (P < 0.05). Moreover, a positive correlation between the number of ET-1-positive endothelial cells and BBB permeability was observed (r = 0.883, P < 0.05).

CONCLUSIONSHigh levels of ET-1 are closely associated with BBB disruption. ET-1 may play an important role in the pathogenesis of secondary brain injury after ICH.

Animals ; Blood-Brain Barrier ; metabolism ; physiopathology ; Brain ; metabolism ; physiopathology ; Cerebral Hemorrhage ; metabolism ; physiopathology ; Disease Models, Animal ; Endothelin-1 ; metabolism ; Immunohistochemistry ; Male ; Rabbits

Acupuncture Points ; Animals ; Brain ; pathology ; physiopathology ; Brain Edema ; etiology ; pathology ; physiopathology ; Cerebral Hemorrhage ; chemically induced ; pathology ; physiopathology ; Collagenases ; Electroacupuncture ; Heparin ; Male ; Rats ; Rats, Sprague-Dawley

OBJECTIVETo investigate neuron regeneration of aged rats after intracerebral hemorrhage(ICH).

METHODSICH model was induced by intracerebral infusion of 100microL autologous blood in adult and aged (3 and 18 m of age, respectively) male Sprague-Dawley (SD) rats. Doublecortin(DCX), polysialylated neural cell adhesion protein(PSA-NCAM) and Bromodeoxyuridine (Brdu) in brain tissue were detected by Western blot analysis and immunohistochemical examination.

RESULTIn aged rats, DCX levels in the ipsilateral basal ganglia and subventricular zone started to increase at 7d after ICH, peaked at 14 d [(670+/-145)% of controls, P<0.01]. Most DCX positive cells in ipsilateral striatum were BrdU positive. Though DCX content in ipsilateral basal ganglia [(2560+/-758) pixels]of ICH aged rats was much higher than that of aged rat controls [(450+/-97)pixels, P<0.01], it was still lower than that in adult rats.

CONCLUSIONThe results demonstrate that neuron regeneration occurs in subventricular zone in the aged rats following intracerebral hemorrhage(ICH).

Age Factors ; Animals ; Cerebral Hemorrhage ; physiopathology ; Male ; Nerve Regeneration ; physiology ; Neuronal Plasticity ; physiology ; Neurons ; physiology ; Rats ; Rats, Sprague-Dawley