OBJECTIVETo explore the role of CD4(+)CD25(+) regulatory T cells (Treg) in the occurrence of spontaneous subarachnoid hemorrhage (SAH).

METHODSFifteen patients with spontaneous SAH, 15 with traumatic SAH, and 15 with headache without organic pathologies as confirmed by lumbar puncture (control group) were examined with flow cytometry for Treg in the peripheral blood and cerebrospinal fluid and intracellular cytokine interleukin-10 (IL-10) and transforming growth factor beta1 (TGF-β1) levels. The Glasgow score (GCS), neurological deficit score (NIHSS), headache, visual analog scale (VAS) and hospitalization time were compared between the two SAH groups.

RESULTSSpontaneous SAH patients showed significantly lowered peripheral blood Treg, IL-10, and TGF-β1 in the cerebrospinal fluid compared with the patients with traumatic SAH and the control group (P<0.05), and the 3 measurements were comparable between the latter two groups (P>0.05). After administration of treatment, of Treg content in spontaneous SAH patients increased progressively and became comparable with those in the other two groups at the third and fourth lumbar punctures. Spontaneous SAH patients showed significantly lower GCS, NIHSS, and VAS with shorter hospital stay than the traumatic SAH patients. Correlation analysis showed that Treg, IL-10 and TGF-β1 were all inversely correlated with NIHSS, VAS, and duration of hospitalization but positively correlated with GCS (the absolute r values were all greater than 0.6, P<0.05).

CONCLUSIONTreg deficiency can be an important mechanism for the occurrence of spontaneous SAH, and a higher level of Treg indicates a better outcome of the patients.

Adult ; CD4 Lymphocyte Count ; Case-Control Studies ; Female ; Flow Cytometry ; Humans ; Interleukin-10 ; cerebrospinal fluid ; Interleukin-2 Receptor alpha Subunit ; Male ; Middle Aged ; Subarachnoid Hemorrhage ; cerebrospinal fluid ; metabolism ; T-Lymphocytes, Regulatory ; metabolism ; Transforming Growth Factor beta1 ; cerebrospinal fluid

Objective:To analyze the safety and efficacy of left atrial appendage closure(LAAC)with Watchman in patients ≥85 years with atrial fibrillation(AF).Methods:515 elderly patients with atrial fibrillation, including 73 patients aged 85 years or older(85~91), who had undergone Watchman LAAC at Zhoupu Hospital affiliated to Shanghai Health Medical College from August 2016 to December 2020, were retrospectively analyzed.Of those ≥85 years, 44(60.3%)with transesophageal echocardiography records were assigned to the elderly group.Fifty-three patients aged 60 to 65 were selected as the control group.Differences in baseline data, intraoperative conditions, antithrombotic treatment plans and 1-year follow-up prognosis were compared between the two groups.Results:Compared with the control group, there was no difference in AF types, history of ischemic stroke/transient ischaemic attack(all P>0.05), but there were higher incidences of coronary heart disease and renal insufficiency, more severe heart failure, higher CHA 2DS 2-VASC(6.0±1.5 vs.3.6±1.5), HAS-BLED(3.2±1.2 vs.2.3±1.3)scores( t values were 7.682 and 3.871, respectively, P<0.05), and a lower one-stop surgery rate(6 cases or 13.6% vs. 27 cases or 50.9%, χ2=10.517, P<0.05)in the advanced age group.There was no difference in the diameter of the Watchman device, rate of device replacement, compression percentage and residual flow between the two groups during the perioperative period.The incidences of device-related thrombosis were 4.5%(2/44)and 3.8%(2/53)for the advanced age group and the control group, respectively, but the difference was not statistically significant( P>0.05). During the 12-month follow-up, there were no cases of ischemic stroke or intracerebral hemorrhage.Three died of heart failure and 1 died of cancer. Conclusions:LAAC with Watchman is safe and effective for patients over 85 years with AF, but the decision on the procedure should be based on careful assessment of patients' cardiac and renal function and general health.