Search

Zhongfeng Xingnao Decoction(ZFXN) has been utilized for treating intracerebral hemorrhage(ICH) in China, while the pharmacological mechanism of ZFXN remains unclear. Exploring the pharmacological roles of ZFXN is critical for guiding the treatment of cerebrovascular diseases. In this study, a rat model of ICH was constructed by injection of Ⅶ collagenase in the right caudate nucleus. SD rats were randomly assigned into five groups, and the neurological function of rats was evaluated based on the Bederson score. Magnetic resonance imaging(MRI) was used to assess the volume of ICH. Hematoxylin-eosin(HE) staining and transmission electron microscopy(TEM) were employed to observe the pathological and ultrastructural changes in the brain tissue. The levels of reactive oxygen species(ROS) were measured by flow cytometry. The immunofluorescence assay was employed to detect the expression of glutathione peroxidase 4(GPX4) in neurons surrounding the hematoma. Finally, Western blot was employed to determine the expression of ferroptosis-related proteins upstream frameshift 1(UPF1), ferroportin(FPN), acyl-CoA ligase 4(ACSL4), cyclooxyge-nase-2(COX-2), GPX4, NADPH oxidase 1(NOX1), and solute carrier family 7 member 11(SLC7A11) after ICH. Compared with the model(ICH) group, ZFXN treatment for 5 days attenuated neurological dysfunction, reduced the hematoma volume, and alleviated the pathological changes induced by ICH. Meanwhile, ZFXN lowered the levels of Fe~(2+) and oxidative stress and up-regulated the expression of proteins inhibiting ferroptosis. ZFXN improved the prognosis of ICH in rats by inhibiting neuronal ferroptosis, which provided a valuable guide for the clinical application of ZFXN. ZFXN may inhibit ferroptosis by promoting the expression of SLC7A11 and FPN.

This study aimed to explore the mechanism of Zhongfeng Xingnao Decoction(ZFXN) in intervening microcirculatory di-sorders in cerebral hemorrhage by network pharmacology and molecular docking techniques. The information on the components of ZFXN was obtained through the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform(TCMSP) database, and the predicted targets of chemical components were obtained from PubChem and SwissTargetPrediction. The relevant targets of cerebral hemorrhage and microcirculatory disorders were collected from the GeneCards database, and the common targets of the components and diseases were analyzed by the Database for Annotation, Visualization, and Integrated Discovery(DAVID) for Gene Ontology(GO) and Kyoto Encyclopedia of Genes and Genomes(KEGG) enrichment analyses. Visualization of the correlation network was carried out using Cytoscape software to further screen important chemical components for molecular docking prediction with disease targets. The animal experiment validation was performed using modified neurological severity score(mNSS), enzyme-linked immunosorbent assay(ELISA), quantitative real-time polymerase chain reaction(qRT-PCR), immunofluorescence, and Western blot to detect the effects of ZFXN intervention in mice with cerebral hemorrhage. The results showed that there were 31 chemical components and 856 targets in the four drugs contained in ZFXN, 173 targets for microcirculatory disorders in cerebral hemorrhage, and 57 common targets for diseases and components. The enrichment analysis showed that common targets were mainly involved in biological processes, such as cell proliferation and apoptosis, and signaling pathways, such as tumor pathway, viral infection, phosphoinositide-3-kinase/protein kinase B(PI3K/AKT) signaling pathway, and mitogen-activated protein kinase(MAPK) signaling pathway. Molecular docking results revealed that the common components β-sitosterol of Rhei Radix et Rhizoma, Notoginseng Radix et Rhizoma, and Ginseng Radix et Rhizoma Rubra showed good docking with proto-oncogene tyrosine-protein kinase(SRC), signal transducer and activator of transcription 3(STAT3), phosphoinositide-3-kinase catalytic alpha polypeptide gene(PIK3CA), recombinant protein tyrosine phosphatase non receptor type 11(PTPN11), AKT1, epidermal growth factor receptor(EGFR), calcium adhesion-associated protein beta 1(CTNNB1), vascular endothelial growth factor A(VEGFA), and tumor protein p53(TP53). Moreover, sennoside E of Rhei Radix et Rhizoma showed good docking with MAPK1. The results revealed that the ZFXN relieved the neural injury in mice with cerebral hemorrhage, decreased the expression of S100 calcium-binding protein B(S100β), neuron specific enolase(NSE), matrix metalloproteinase 9(MMP9), tumor necrosis factor α(TNF-α), interleukin 1β(IL-1β), SRC, EGFR, CTNNB1, VEGFA, TP53, glial fibrillary acidic protein(GFAP), and leukocyte differentiation antigen 86(CD86), and increased the expression of p-PI3K, p-AKT, and zona occludens 1(ZO-1). The results indicate that ZFXN may inhibit neuronal apoptosis and inflammatory response through PI3K/AKT/p53 pathway to protect the blood-brain barrier, thereby slowing down microcirculatory impairment in cerebral hemorrhage.

Objective: Early death (ED) characteristics and predictive factors analysis in patients with severe/very severe aplastic anemia (SAA/VSAA) treated with intensive immunosuppression therapy and establish an ED prediction model. Methods: The clinical data of 232 patients with SAA/VSAA treated with Antithymocyte immunoglobulin (ATG) at the Peking Union Medical College Hospital from August 2003 to August 2021 were collected. The characteristics and causes of ED within 90 days were analyzed retrospectively. Cox proportional hazards model was used to screen the ED risk factors and build a prediction model. Results: Only 19 patients (8.2% ) developed ED with a median time of 24 (3-85) days among the 232 patients with SAA/VSAA who received ATG treatment. The main cause of ED was infection (84.2% ) , followed by cerebral hemorrhage (10.5% ) . Multivariate analysis showed that VSAA ( HR =15.359, 95% CI 1.935-121.899, P =0.010) , fungal infection prevention by posaconazole ( HR =0.147, 95% CI 0.019-1.133, P =0.066) , lymphocyte count (LYM) ≤ 0.5×10(9)/L ( HR =3.386, 95% CI 1.123-10.206, P =0.030) , and PLT ≤ 5×10(9)/L ( HR =8.939, 95% CI 1.948-41.019, P =0.005) were ED's independent influencing factors. To build a clinical prediction model, VSAA, fungal infection prevention by posaconazole, LYM ≤ 0.5×10(9)/L, and PLT ≤ 5×10(9)/L were scored with 3, -2, 1, and 2, respectively. The integral model AUC=89.324 (95% CI 80.859-97.789) . The ED risk in patients with a score ≥ 3 was 23.1 (95% CI 5.3-100.2) times that in patients with a score<3. Conclusion: ED caused by infection and cerebral hemorrhage is an important challenge for SAA/VSAA to be treated with ATG. VSAA, LYM ≤ 0.5×10(9)/L, and PLT ≤ 5×10(9)/L patients who did not use posaconazole to prevent fungal infection had a high ED risk.

The prognosis of patients with spontaneous intracerebral hemorrhage (sICH) is poor. It is of great significance to improve the neurological function of these patients and make them return to society. However, to date, no treatment has been proved to significantly improve the neurological prognosis of sICH patients. The perihematomal edema (PHE) is a quantifiable marker of secondary brain injury (SBI) after ICH. It is associated with dysfunction of ion channels of vascular endothelial cells, inflammatory response induced-blood brain barrier dysfunction, and iron deposition caused by red blood cell degradation after ICH. Given that the space-occupying effect of PHE, the direct relation with SBI, long growth course and variable growth of PHE among individuals, interrupting the expansion of PHE has become a therapeutic target to improve neurological outcomes in ICH patients. Conducting an integrated and individualized strategy of critical care management and performing the corresponding pre-clinical and translational clinical research targeting the pathophysiological mechanism, nature course, and risk factors of PHE deserves further exploration.

To systematically review the efficacy and safety of Angong Niuhuang Pills in adjuvant treatment of cerebral hemorrhage. CNKI, VIP, Wanfang, CBM, PubMed, EMbase, Cochrane Library were retrieved to collect the randomized controlled trial(RCT) from the time of database establishment to November 2020. Two researchers screened out the literatures and extracted the data according to the inclusion and exclusion criteria. RevMan 5.3 software was used for Meta-analysis. A total of 13 RCTs were included, involving 1 196 patients with cerebral hemorrhage, with 599 in the treatment group and 597 in the control group, and all of them were treated with internal medicine. The results of Meta-analysis showed that compared with conventional therapy, the combined administration with Angong Niuhuang Pills could improve the effective rate in patients with cerebral hemorrhage(RR=1.25, 95%CI[1.18, 1.34], P&lt;0.000 01), the National Institutes of Health stroke scale(NIHSS)score(MD=-5.18, 95%CI[-8.12,-2.23], P=0.000 6) and Glasgow coma scale(GCS) score(MD=1.12, 95%CI[0.46, 1.78], P=0.000 9), activity of daily living(ADL)(MD=15.70, 95%CI[14.05, 17.36 ], P&lt;0.000 01), reduce the malondialdehyde(MDA)(MD=-1.73,95%CI[-2.81,-0.64],P=0.002), but with no statistically significant difference in hematoma volume changes between the two groups. In terms of safety, the combined administration with Angong Niuhuang Pills reduced the incidence of adverse reactions compared with the single administration of conventional therapy(RR=0.40, 95%CI[0.28, 0.57], P&lt;0.000 01), with no serious adverse events. The existing clinical study evidences show that Angong Niuhuang Pills had a good effect in adjuvant treatment of cerebral hemorrhage, and can improve the treatment efficacy, activity of daily living and symptoms of neurological deficits, and reduce oxidative stress, with a higher safety. However, the methodological quality of the included studies is not high, so the above conclusions still need to be verified with more high-quality studies.

To overview of systematic reviews/Meta-analysis of Xingnaojing Injection(XNJ) in the treatment of intracerebral hemorrhage(ICH). The systematic reviews concerning XNJ in the treatment of ICH were retrieved from four Chinese databases, four English databases, Chinese Clinical Trial Registry and ClinicalTrail.gov, with the retrieval time set from their inception to September 2020. Following the independent screening and data extraction by two researchers, a measurement tool to assess systematic evaluation 2(AMSTAR 2) and grades of recommendation, assessment, development and evaluation(GRADE) system were used to evaluate the metho-dological, reporting and evidence qualities of the 10 included systematic reviews. The results showed that XNJ was superior to the wes-tern medicine or conventional treatment in improving the effective rate and National Institutes of Health stroke scale(NIHSS) score, Barthel index(BI), and Glasgow coma scale(GCS) score and Chinese stroke scale(CSS) score, and reducing the mortality and cerebral hematoma volume, without inducing obvious adverse reactions. In general, the methodological, reporting and evidence qualities of the 10 included systematic reviews were poor. The AMSTAR 2 scores showed that key items No. 2 and No. 16 failed to meet the stan-dard, resulting in poor methodological quality. There was only one outcome indicator graded by GRADE as intermediate quality, 43% indicators as low quality, 42% indicators as extremely low quality, and none as high quality. These available evidences have suggested that the methodological, reporting and evidence qualities of the systematic evaluation concerning XNJ for the treatment of ICH need to be improved. Most evidences support that XNJ was better than the western medicine or conventional treatment in the treatment of ICH, but the methodological quality and the reliability of outcome indicators in relevant systematic review were low. More high-quality studies are still required for further verification.

Objective: To study the effect of different blood pressure control targets on hematoma enlargement and prognosis in patients within 48 h after hypertensive cerebral hemorrhage (HCH)., Methods: Between January, 2013 and July, 2016, 102 patients with HCH were randomized into group A (51 cases) and group B (51 cases) with different systolic blood pressure (SBP) control targets within 48 h. The patients in group A were given early active antihypertensive treatment with SBP control target of 130-140 mm Hg; those in group B received standard antihypertensive treatment with SBP control target of 170-180 mm Hg. The changes in the volume of hematomas and the patients' prognosis were compared between the two groups., Results: After 48 h of treatment, SBP, hematoma volume and the National Institutes of Health Stroke Scale (NIHSS) score were significantly lower and Glasgou Coma Scale (GCS) score was significantly higher in group A than in group B (P<0.01 or 0.05). After 30 days of treatment, the patients in group A showed significantly better indicators of treatment efficacy than those in group B (Z=2.331, P=0.020). The mortality rate was lower in group A than in group B, but the difference was not statistically significant (Χ 2 =2.772, P=0.096)., Conclusion: Early active antihypertensive treatment is safe and feasible in patients with HCH and can reduce the enlargement of the hematomas, alleviate deterioration of neurological function, and improve the prognosis of the patients.

Objective: To study the safety of using Chinese drugs for breaking blood expelling stasis (CDBBES) in hypertension patients with intracerebral hemorrhage within 6 h, and to observe whether they would result in hematoma enlargement., Methods: A prospective randomized double-blind controlled clinical study was employed. Totally 128 cerebral hemorrhage patients within 6 h were recruited from 8 research centers from October 2013 to March 2015, and finally 76 of them were included. These patients were assigned to 3 groups by simple random sampling, group A, B, and C. Patients in group A (26 cases) took whole CDBBES recipe (containing leeches and equivalent insects). Those in group B (25 cases) took CDBBES recipe (removing leech and gradfly). Those in group C (25 cases) took placebos. Medication lasted for 10 successive days. The hematoma enlargement rate within 24 h, the occurrence of adverse reactions and adverse events were observed. To guarantee the safety of this trial, an interim analysis of first level unblinding was used., Results: The hematoma enlargement rate was 11. 5% (3/26) in group A, 16. 0% (4/25) in group B, and 20. 0% (5/25) in group C. There was no statistical difference in the hematoma enlargement rate among the 3 groups (X² =0. 823, P =0. 682). Adverse reactions and adverse events occurred in 7 cases, 1 patient with acute myocardial infarction, 1 with chest op- pression and palpitation, 2 with diarrhea in group A. No patient had adverse reaction or adverse event in group B. And diarrhea occurred in 3 patients of group C., Conclusion: The interim analysis of first level unblinding showed that hematoma enlargement within 6 h was not resulted from using CDBBES.

Objective: To evaluate the safety of intravenous thrombolysis (IVT) in cerebral microbleeds (CMBs) patients with prior antiplatelet therapy., Methods: Four hundred and forty nine patients with acute ischemic stroke aged (66.8 ± 12.9) years, including 298 males and 151 females, underwent susceptibility-weighted imaging (SWI) examination and MRI-guided IVT therapy between June 2009 and June 2015. The presence of CMBs, previous antiplatelet therapy, HT subtypes according to ECASS II criteria and functional outcome based on modified Rankin scale (mRS) at 3 months were analyzed in logistic regression model., Results: Total 934 CMBs were detected in 172 (38.3%) patients, among whom 63 (14.0%) previously received antiplatelet therapy. All patients received intravenous recombinant tissue-plasminogen activator (rt-PA) for thrombolysis with the onset-to needle time of (229.0 ± 103.7) min. The pretreatment National Institutes of Health Stroke Scale (NIHSS) score was 10 (IQR 5-15). Logistic regression analysis indicated that prior antiplatelet use increased neither risk of parenchymal hematoma (PH) (OR=0.809,95% CI:0.201-3.262, P=0.766) nor adverse functional outcome (OR=1.517, 95% CI:0.504-4.568, P=0.459) in patients with CMBs; while in patients with multiple CMBs (≥ 3) prior antiplatelet use increased risk of hemorrhagic transformation (OR=9.737, 95% CI: 1.364-69.494, P=0.023), but not adverse functional outcome (OR=1.697, 95% CI:0.275-10.487, P=0.569)., Conclusion: The study indicates that in patients with CMBs, thrombolytic therapy should not be excluded due to the prior use of antiplatelet; however, the larger prospective studies are needed in future for patients with multiple CMBs.

Objective: To investigate the effects of herbs capable of activating blood circulation or inducing diuresis on the expressions of tumor necrosis factor-alpha (TNF-alpha), nuclear factor-kappaB (NF-kappaB), and aquaporin-4 (AQP-4) in rats with intracerebral hemorrhage (ICH), and to study their possible mechanisms., Methods: The ICH rat model was established by injecting autologous arterial blood into the right caudate nucleus. The 168 male rats were randomly divided into four groups, the sham-operative group, the model group, the blood activating group, and the diuresis inducing group, 42 in each group. Chinese compound decoction (consisting of 0.2 g rhubarb, 0.02 g leech, and 0.3 g notoginseng in each milliliter decoction) was given to rats in the blood activating group by gastrogavage at the dose of 10 mL/kg, once daily. Chinese compound decoction (consisting of 0.2 g poria, 0.2 g water plantain tuber, and 0.2 g acori graninei in each milliliter decoction) was given to rats in the diuresis inducing group by gastrogavage at the dose of 10 mL/kg, once daily. 4.0 mL/kg normal saline was given to rats in the model group and the sham-operative group by gastrogavage, once daily. A series of brain samples were obtained on the 1st, 3rd, and 5th day, respectively. The mRNA and protein expressions of TNFalpha, NF-kappaB p65, and AQP-4 were determined by immunohistochemical staining and Real-time fluorescent quantitative PCR respectively., Results: After ICH, TNF-alpha, NF-KB, and AQP-4 protein positive cells in the brain tissue and their protein and mRNA expressions significantly increased in rats of the model group at each time point when compared with the sham-operative group (P < 0.01, P < 0.05). The gene and protein expressions of TNF-alpha and AQP-4 significantly decreased in the blood activating group and the diuresis inducing group at each time point when compared with the model group (PP < 0.05). The expression of NF-kappaB p65 in the blood activating group obviously decreased when compared with the model group (P < 0.05), but there was no statistical difference in the NF-KB expression when compared with the diuresis inducing group (P > 0.05). Compared with the model group, the water content of the brain tissue decreased to some degree in the blood activating group and the diuresis inducing group at each time point. There was statistical difference between the blood activating group and the diuresis inducing group (P < 0.05)., Conclusions: Chinese herbs capable of activating blood circulation or inducing diuresis could inhibit the release of TNF-alpha, down-regulate the expression of AQP-4, and alleviate the brain edema around hematoma. But the action strength and the effect links were different.

Objective: To investigate the protective effect and mechanism of baicalin on nerve tissue in rat with intracerebral hemorrhage (ICH)., Methods: Rats were randomly divided into five groups: the sham-operated group, the ICH model group, and the three baicalin treated groups treated respectively with small, medium and large doses of baicalin. ICH rat model was established by injecting collagenase VII into caudate nucleus. Baicalin was given by peritoneal injection to the baicalin treated groups, and saline was given to the other two groups once a day started from 2 h after modeling. Animals were sacrificed in batches on the 1st, 3rd, 5th and 10th day of treatment to take their brains for detecting protease-activated receptor-1 (PAR-1) expression and cell apoptosis in brain tissue surrounding hematoma by Western blot and TUNEL method, respectively. And the water content of brain was estimated by dry-wet weight method., Results: Compared with the model group, the PAR-1 expression and TUNEL-positive cells were significantly reduced in the baicalin treated groups; and brain edema was also significantly reduced (P<0.01)., Conclusions: The up-regulated PAR-1 expression after ICH in rats might play an important role in inducing cell apoptosis and brain edema. Baicalin shows significant protective effect on ICH rats, which may be related to its effects in inhibiting PAR-1 expression and decreasing apoptosis cells, so as to reduce brain edema.

Objective: To observe the effects of polydatin on dynamic changes of excitatory amino acids in cerebrospinal fluid and water content of brain tissue of cerebral hemorrhage rats. And to discuss the therapeutic action and mechanisms of polydatin on brain hemorrhagic injured rats., Method: A quantitative determination method of Asp and Glu was established by microdialysis-HPLC. The cerebral hemorrhage model in rats was induced by local injection of type VII collagenase. The dynamic changes of Asp and Glu in cerebrospinal fluid were observed on 0, 6, 12, 24, 36, 48, 60, 72, 84, 96, 108 h of cerebral hemorrhage rats, and then the water content of brain tissue was detected., Result: The content of Asp and Glu increased rapidly within 24 h after cerebral hemorrhage, and to the highest in 24 h, then decreased gradually. Compared with the cerebral hemorrhage model group, the content of Asp and Glu increased slowly in polydatin group, and there were significant differences in 12-72 h and 6-84 h (P < 0.01, P < 0.05), but there was no significant difference after 84 h and 96 h. Compared with sham group, water content of brain tissue significantly higher in model group, while significantly lower (P < 0.01) in polydatin group., Conclusion: Polydatin can inhibit increasing content of Asp and Glu in cerebrospinal fluid dynamics, and significantly inhibit cerebral edema of cerebral hemorrhage rats. It shows that the mechanisms of anti-cerebral hemorrhage injury of polydatin may be related to increasing of excitatory amino acids after cerebral hemorrhage.

Objective: To investigate the effects of Liangxue Tongyu Formula (LXTYF), a compound traditional Chinese herbal medicine, on brain edema in rats with intracerebral hemorrhage and to explore the mechanism., Methods: Intracerebral hemorrhage was induced by using the intrastriatal autologous blood injection. Rats were randomized into sham-operated (SO) group, intracerebral hemorrhage (ICH) group and LXTYF group. Rats in the LXTYF group were intragastrically administered with LXTYF every day while the other two groups were given normal saline. Brain water content was determined at 24, 48, 72, and 120 h after intracerebral hemorrhage. Matrix metalloproteinase-9 (MMP-9) level, and MMP-9 and tissue inhibitor of metalloproteinase-1 (TIMP-1) mRNA expressions in perihematoma area were detected by gelatin zymography and fluorescence quantitative real-time polymerase chain reaction at the four time points, respectively., Results: Water content in the ICH group was highly elevated after intracerebral hemorrhage, and reached to the peak at 72 h. Compared with the ICH group, the LXTYF group had lower water contents at 48, 72 and 120 h after intracerebral hemorrhage (P<0.01). The difference in water content between the LXTYF and SO groups was significant only at 72 h (P<0.01). Although the pro-MMP-9 level and MMP-9 activity in the LXTYF and ICH groups were enhanced, they were still lower in the LXTYF group than in the ICH group (P<0.01 for 24, 48, 72 and 120 h, respectively). And there was no significant difference in them between the LXTYF group and the SO group at 120 h. Meanwhile, MMP-9 mRNA expressions were increased in the ICH and LXTYF groups, but the levels in the LXTYF group were significantly lower (P<0.01 for 48, 72 and 120 h, respectively) than those in the ICH group. Also, TIMP-1 mRNA expressions at 24, 48, 72 and 120 h after intracerebral hemorrhage were up-regulated in the LXTYF group, and there were significant differences in TIMP-1 expressions between the LXTYF group and ICH group after intracerebral hemorrhage (P<0.01)., Conclusion: Liangxue Tongyu Formula ameliorates brain edema in rats after intracerebral hemorrhage by inhibiting MMP-9 expression and activity and up-regulating TIMP-1.

Objective: To investigate the protective effect of procyanidins on cerebral injury in rat model of cerebral hemorrhage (ICH) and it's possible mechanisms. METHEOD: Fifty-four health Sprague-Dawley rats were divided into six groups randomly: sham operation group, model group of intracerebral hemorrhage, treatment group-administrate with procyanidins of low (50 mg x kg(-1)), middle (100 mg x kg(-1)) and high(200 mg x kg(-1)) dose, and positive control group-administrate with nimodipine (10 mg x kg(-1)). Intragastric administration procyanidins to rats of each treatment groups once a day, lasting two weeks and once again at one hour before operation. The sham-operation group and intracerebral hemorrhage group was administrated with Sodium Chloride of the equal volume. On the brain stereotaxic apparatus, the rat intracerebral hemorrhage model was established by injecting collagenase with microinjector into the brain caudate nucleus which was located according to the brain stereotaxic atlas. Symptoms of neurological handicap of rats with ICH was evaluated by measurement of Bederson score at 4, 8, 12, 24 hour after operation respectively. Twenty-four hours after operation, make the blood serum of rats ready to measure the level of creatine kinase (CK) and lactate dehydrogenase (LDH), and the brain homogenate was prepared to detect the activity of superoxide dismutase (SOD) and the content of malondialdehyde (MDA) in rat's brain tissues. The content of water in rat's brain was observed by Dry-weight method, the brain tissue pathomorphology was observed with electron microscope., Result: In procyanidins groups (50, 100, 200 mg x kg(-1)), the neurological behavioral score, Brain Water Content (BWC) and the level of CK, LDH were significantly lower than those in ICH group (P < 0.05, P < 0.01), whereas the activity of SOD was higher than that in ICH group (P < 0.05). Meanwhile, procyanidins (100, 200 mg x kg(-1)) degrade the content of MDA in brain homogenate. In addition, changes of histopathology in procyanidin groups at every doses was better than ICH group., Conclusion: Procyanidins can protect rats with cerebral hemorrhage, and the protective effect may be result from improving lipid peroxidation and reducing free radicals to generate.

Objective: To investigate the occurrence of delayed neuronal degeneration, activation of microglia and nuclear factor-kappa B after rat intracerebral hemorrhage (ICH) and the possible role of iron., Methods: ICH model was induced by infusion of autologous whole blood into the right basal ganglia. To evaluate the possible role of iron on delayed neuron loss, an iron model by injection of FeCl(2) into hippocampus was also set up. Degeneration of neurons and the activation of microglia and NF-kappa B were detected., Result: Both whole blood and iron caused neuron degeneration for at least 14 days were revealed by Fluoro-jade C staining. Consistently, activated microglia and NF-kappa B positive cells were also observed in the peri-hematoma area and the ipsilateral hippocampus., Conclusion: The iron may participate in the delayed neuron injury followed ICH; the activated microglia and NF-kappa B may be involved in the process of delayed neuronal injury.

Objective: To study the effects of xijiao dihuang decoction on the expressions of Bcl-2 and caspase-3 protein positive cells in brain tissue, TNF-alpha and IL-6 in blood after acute intracerebral hemorrhage in rat., Method: The experimental ICH model was established by injection of non-heparinized autologous arterial blood into the right basal ganglia. Immunohistochemistry and radioimmunity methods were used to detect expressions of Bcl-2 and caspase-3 protein positive cells in brain tissue, TNF-alpha and IL-6 in blood., Result: After ICH, caspase-3 protein positive cells in brain tissue, TNF-alpha and IL-6 in blood increased obviously in the model group, caspase-3 protein positive cells, TNF-alpha and IL-6 were significantly reduced by treatment with Xijiao Dihuang decoction, on the contrary, Bcl-2 protein positive cells in brain tissue increased markedly., Conclusion: Xijiao Dihuang decoction can pretect nerve cell by reducing the expression of caspase-3, TNF-alpha and IL-6, increasing the expression of Bcl-2 after ICH in hemorrhagic brain damage.

Objective: To evaluate the clinical application value of sodium ferulate for intracerebral hemorrhage in early stage., Method: Sixty patients with cerebral hemorrhage in basal ganglia onset within 24 h were randomly divided into two groups. The two groups showed no evident differences in age, hematoma volume and edema volume, computerized tomography number, and Chinese Stroke Scale. Both groups were given basic treatment with dehydrating, cytidine diphosphocholine, controlling blood pressure, blood sugar and complicating diseases, while the observation group added the treatment of sodium ferulate intravenous drip after 24 h. The hematoma volume, edema volume, and computerized tomographynumber were examined in the 1st day and 14th day, Chinese Stroke Scale in the 1st day, 14th day and 28th day, and the level of serum endothelin in the 1, 3, 5, 7, 14th day., Result: After treatment, edema volume and computerized tomography number in the observation group were lower than those in the control group (P < 0.01, P < 0.05). Patients' recovery of neural function were markedly improved in the observation group better than that in the control group (P < 0.05), and also the therapeutic effectiveness (P < 0.05). The serum endothelin level of the 60 patients showed higher significantly than the healthy group in 24 h after hemorrhage (P < 0.01). The control group kept higher in 14 days (P < 0.05), while the observation group showed declined significantly in the 3rd day and close to the healthy group, and lower than the healthy group in the 14th day (P < 0.05)., Conclusion: With the basic medical therapy, applying sodium ferulate can effectually improve the resolution of the haematoma, reduce the peripheral edema, and enhance the recovery of neural function for the patients with intracerebral hemorrhage in early stag. The therapeutic effectiveness of adding sodium ferulate in patients with intracerebral hemorrhage in early stage is better than that of the basic medical therapy in most of the fields as the above. No evident effect on secondary hemorrhage, or harmful impact on heart, liver and kidney function was found.

Objective: To investigate the effects of Xiehuo Bushen Decoction (XHBSD), a compound Chinese herbal medicine, on the survival and differentiation of transplanted neural stem cells (NSCs) in brains of rats with intracerebral hemorrhage, and to explore the mechanism of Xiehuo Bushen formula in promoting the survival of transplanted NSCs., Methods: NSCs separated from hippocampuses of neonatal SD rats were cultured. Sixty-five panel reactive antibody (PRA) positive SD rats were selected by lymphocytotoxicity methods. The PRA positive rats were made into intracerebral hemorrhagic model and divided into three groups: cerebral hemorrhage group (n=15), NSCs transplanted group (n=25) and XHBSD group (n=25). XHBSD was orally administered after 5-bromodeoxyuridine (BrdU)-marked NSCs were transplanted in brains of rats with intracerebral hemorrhage in the XHBSD group. Rats in the other two groups were administered distilled water. The expressions of interferon gamma (IFN-gamma) and interleukin-4 (IL-4) mRNAs were measured by reverse transcription polymerase chain reaction (RT-PCR); the numbers of BrdU and 200 kD neurofilament (NF200) positive cells were detected by double-labeling immunofluorescence method., Results: The expression of IFN-gamma mRNA was down-regulated significantly in the XHBSD group, but the expression of IL-4 mRNA was up-regulated significantly (P<0.05). The numbers of BrdU and NF200 positive cells were also increased remarkably in the XHBSD group., Conclusion: XHBSD can promote the survival and differentiation of transplanted NSCs, which may be related to inducing the expression of IL-4 mRNA and inhibiting the expression of IFN-gamma mRNA.

Objective: To investigate the mechanisms of Buyang Huanwu Decoction (BYHWD) by observing its effects on expressions of angiopoietin-1 (Ang-1) and the endothelial-specific receptor tyrosine kinase (Tie-2) mRNA in damaged region of rats' brain after intracerebral hemorrhage (ICH)., Methods: One hundred and sixty Sprague-Dawley rats were randomly divided into four groups, 10 in the normal control group, 60 in the sham-operative group, 60 in the ICH model group, and 30 in the BYHWD-treated group. The ICH model was established by injecting collagenase type VII 0.5 U stereotaxically into right globus pallidus. Animals in the BYHWD-treated group were administered orally with BYHWD, while animals in the sham-operative group and the ICH model group were administered orally with equal volume distilled water, and those in the normal control group drank water freely. The positional variations of the expression of Ang-1 and Tie-2 in the sham-operative group and the model group were assayed by immunohistochemistry on dayl, 4, 7, 14, 21 and 28 after modeling, in the meantime, the dynamic changes of Ang-1 and Tie-2 mRNA expressions in all groups were assayed by reverse transcription-polymerase chain reaction (RT-PCR)., Results: No significant expression of Ang-1 and Tie-2 in brain of rats in the normal or the sham-operative group was found during the experiment. In the model group, the Ang-1 and Tie-2 positive micrangio-segments appeared at the edge of clot on day 1 to day 4, they gradually penetrated to hematoma area from day 7; with Ang-1 and Tie-2 mRNA expressed from day 1, but very weak until day 4, showing no significant difference to that on day 1; thereafter, they increased gradually, and reached the peak on day 28 (P <0.05). While the two expressions in the BYHWD treated group reached the peak on day 21, and from day 7 to day 28, they were all significantly higher than those in ICH model group at the corresponding time points (P <0.01)., Conclusion: BYHWD can promote the up-regulation of Ang-1 and Tie-2mRNA expressions in brain of intracerebral hemorrhagic rats, which might accelerate the angiogenesis in the reconstruction of microvascular network in the damaged zone, and thus facilitating the repairing of damaged tissue.

Objective: To explore the most effective daily dose and use method of mannitol in reducing intracranial pressure in patients with cerebral hemorrhage in acute stage., Methods: One hundred and eighteen cerebral hemorrhage patients with elevated intracranial pressure, 74 males and 44 females, aged (58 +/- 11) (33-80), that had undergone cranial CT scanning to calculate the volume of hemorrhage, were divided into 4 groups treated with 20% mannitol 125 ml: 32 cases treated q 4 h, 35 cases treated q 6 h, 25 cases treated q 8 h, and 26 cases treated q 12 h. The everyday doses of mannitol were recorded. Intracranial pressure was monitored daily by NIP-200 noninvasive intracranial pressure apparatus. The difference between the very day and that of the last day (effect of decreasing intracranial pressure per day) was calculated. Multivariate regression analysis was conducted., Results: The average saturation dosage of mannitol was 750-6000 (3504 +/- 1085) ml, the time from the hospitalization till the saturation dosage was 1-8 (4.5 +/- 1.5) d. The average intracranial pressure at admission was 330-698 (486 +/- 93) mm H2O, the average intracranial pressure when mannitol reached the saturation dosage was 160-378 (253 +/- 52) mm H2O. The effect of reduction of intracranial pressure was not associated with age (P > 0.05). The effects of reducing intracranial pressure in the 1st, 2nd, 3rd, and 4th day were associated with the volume of hematoma and mannitol doses (all P < 0.01). Best effects of reducing the intracranial pressure in the 1st, 2nd, 3rd, and 4th day could be reached when 20% mannitol 125 ml was used every 4 hours., Conclusions: Mannitol use every 4 hours per day has evident effect of reducing the intracranial pressure in the 1st, 2nd, 3rd, and 4th day, then mannitol should be used temporarily according to the intracranial pressure after the 5th day. Mannitol should not be used for more than 8 days.

Objective: To study the effects and possible mechanisms of TCM treatment for purging fire, removing toxic substance, relieving stagnation and eliminating phlegm on cytoplasmic free calcium ([Ca2+]i) and intercellular adhesion molecule-1 (ICAM-1) in rats with intracerebral hemorrhage (ICH)., Methods: Adult SD rats were randomly divided into six groups: the normal group, the operated group, the model group, the Naoqing Decoction (NQD) low- and high-dose groups, and the Qingkailing Injection (QKL) group. ICH model was induced by injecting collagenase into right caudate nucleus, level of [Ca2+]i was determined by fluorescent tracing assay, and the expression of ICAM-1 was determined using immunohistochemical technique., Results: High- and low-dose of NQD and QKL could significantly antagonize the collagenase injection induced increase of [Ca2+]i (P < 0.01), inhibit the expression of ICAM-1 and shorten its sustainable time., Conclusion: NQD plays a role in protecting neuron by inhibiting calcium overload, regulating cytokines network, and inhibiting inflammatory reaction through postponing the release of cytokines and inflammatory mediators.

Objective: To investigate the protective effect and mechanism of Naoningkang Granule (NG), a Chinese medicinal preparation formulated for clearing heat and detoxication, on brain tissue in intracerebral hemorrhagic (ICH) rats., Methods: Rats were randomly divided into 5 groups: the sham operated group, the model group and the high-, medium- and low-dose NG groups. Collagenase VII was injected into caudate nucleus to induce rat model of ICH, corresponding dosage of NG was started to give to the 3 NG groups by gastrogavage 2 h after modeling, and saline of equal volume was given to the other 2 groups instead. The brain tissue of rats was taken in batches at the 3rd and 7th day for pathomorphological observation using HE stain, and detection of thrombin receptor-1 (PAR-1) expression and nerve cell apoptosis in the peripheral tissue of hemorrhagic brain with immunohistochemistry and TUNEL assay, as well as for measurement of water content in brain tissue by wet-to-dry weight method., Results: PAR-1 expression elevated in the model rats. As compared with the model group, the pathomorphological changes significantly improved, PAR-1 expression decreased, apoptotic cells re-duced and brain edema alleviated in the 3 NG groups., Conclusion: Overexpression of PAR-1 in the brain tissue might mediate the nerve cell apoptosis and brain edema in ICH rats. The mechanism of NG in protecting hemor-rhagic brain tissue might be related with its actions in inhibiting the post-cerebral high PAR-1 expression to re-duce cell apoptosis and relieve brain edema.

Objective: To observe the effect of Panax notoginseng saponins (PNS) on serum content of neuronal specific enolase (NSE) and function recovery in patients with cerebral hemorrhage (CH) for exploring the therapeutic action of PNS in treating CH., Methods: Fifty CH patients with their course of disease not more than 5 days were randomly assigned to two groups, 27 in the PNS group and 23 in the control group, all were treated with conventional treatment, while PNS was given additionally to the PNS group. The serum levels of NSE before and after treatment were determined by electrochemiluminescence, and the recovery of patients, including their neuro-function deficit and daily living activity, was assessed according to scoring by the National Institute of Health Stroke Scale (NIHSS) and Barthel Index (BI) respectively., Results: Before treatment, the difference between the two groups in serum NSE content and scores of NIHSS and BI was insignificant (P > 0.05). However, after 3 weeks of treatment, the level of NSE and score of NIHSS were significantly lower, while score of BI was significantly higher in the PNS group than those in the control group respectively (all P < 0.01). In the PNS group, the level of NSE showed a positive correlation with the score of NIHSS (r = 0.757, P < 0.05), and a negative correlation with the score of BI (r = - 0.803, P < 0.05)., Conclusion: PNS can effectively protect the neuron and promote functional rehabilitation in patients after CH.

Objective: To observe the effect and safety of a comprehensive protocol of integrated Chinese and Western medicine (ICWM) in treating acute intracerebral hemorrhage (AICH)., Methods: A multi-center, single blinded, random and control clinical trial was adopted with 404 patients with AICH, they were divided into the treatment group (199 cases) treated with ICWM protocol, and the control group (205 cases) treated with Western medicine plus placebo, and AICH related indexes were assessed after treatment., Results: Compared with the control group, the neurological deficit score (National Institute of Health Stroke Scale, NIHSS) determined on the 28th and the 90th day after treatment was ameliorated in the treatment group (P < 0.01). Moreover, the 90th day assessment showed that the mortality and severe disability rate was lower (BI < 75) (P <0.05), the complete rehabilitation and mild disability rate (BI > or = 95, P < 0.05), and the sociability rate (Functional Assessment Questionnaire, FAQ) were higher (P < 0.01) in the treatment group than those in the control group. The incidence of adverse reaction was 5.53%, manifested as non-infective diarrhea., Conclusion: The ICWM protocol used in this study may improve neural function and quality of life of AICH patients, and reduce the mortality and severe disability rate in those after 90 days' treatment, with only non-infective diarrhea as the adverse reaction.

Objective: To observe the effect of Dahuang Zhechong Pill (DZP) on the content of amino acids in hippocampal tissue of model rats of ischemic cerebral hemorrhage (ICH)., Methods: Collagenase and heparin were injected into caudate nucleus to establish ICH rat model. The content of glutamic acid (Glu), aspartic acid (Asp) and gamma-aminobutyric acid (GABA) in hippocampal tissue was detected by anti-phase high-performance liquid chromatographic fluorimetry to observe the effect of DZP on the content of amino acids in brain tissue., Results: Three days after modeling, the content of Glu, Asp and GABA was significantly higher in the model group than those in the sham-operation and the normal control group (P < 0.05), for Glu 15.2926 +/- 4.2429 micromol/g vs 8.0057 +/- 1.1227 micromol/g and 8.5040 +/- 1.7794 micromol/g, for Asp 3.6384 +/- 3.1021 micromol/g vs 1.4986 +/- 0.4174 micromol/g and 1.2669 +/- 0.4695 micromol/g, and for GABA 0.3859 +/- 0.1846 micromol/g vs 0.1829 +/- 0.04665 micromol/g and 0.1770 +/- 0.0472 micromol/g. The content of Glu (9.0550 +/- 1.7195 micromol/g), Asp (1.8085 +/- 0.6862 micromol/g) and GABA (0.1993 +/- 0.0424 micromol/g) in hippocampal tissue in the DZP group was reduced significantly, as compared with that in the model group (P <0.05)., Conclusion: DZP could reduce the release of excitatory amino acids (EAA-Glu, ASP) to balance EAA/inhibitory amino acid (IAA), so as to relieve ICH-induced brain injury.

Domestic and overseas literature of clinical and experimental study in recent years concerning treatment of intracerebral hemorrhage (ICH) by active ingredients of single Chinese drug was reviewed, and the therapeutic mechanism, acting pathways and clinical effect of these ingredients were also explored in this paper.

Objective: To investigate the effects of Tongfu Huoxue decoction on experimental intracelebral hemorrhage and the associated machenisms., Method: The cerebral hemorrhage model in rats was induced by local injection of type VII collagenase and they were randomly divided into four groups. The treated groups were treated with Naoxuekang and Tongfu Huoxue decoction. The control groups were only treated with water. The changes of neurological defect were observed. The content of brain water, MDA, NO and the activity of SOD were measured., Result: The cerebral hemorrhage rats showed hemiplegia, and the hemorrhage brains showed celebral edema, higher quotient of brain and content of brain water, suggesting the hemorrhage model was established successfully. After the treatment of Tongfu Huoxue decoction, the hemorrhage rats showed smaller hemorrhage volume, the brain tissue from the hemorrhage rats had lower MDA content and the quotient of brain, and also had higher activity of SOD and content of NO., Conclusion: Tongfu Huoxue decoction has treatment effects on cerebral hemorrhage.

Objective: To investigate the mechanism of rhubarb in regulating aquaporin-4 in rats with blood-brain barrier damage after acute cerebral hemorrhage (CH)., Methods: CH model was induced by stereospecific injection of auto-blood into caudate nucleus of rats, and the brain water content and neurological defect were detected to evaluate cerebral edema and neurological defect level. Also, the blood-brain barrier damage was observed by Evan's blue staining; the changes of blood-brain barrier tight junction and astrocyte end feet at different time points were observed with electron microscope; and the AQP-4 mRNA and protein expression were measured with RT-PCR and Western blot., Results: Rhubarb showed effects in reducing cerebral edema. Evan's blue result indicated the blood-brain barrier was evidently damaged at the 12th hour after CH, with blood-brain barrier tight junction damaged and astrocyte end feet process swelled obviously, but these changes could be relieved by rhubarb. The AQP-4 mRNA and protein expression in rats increased significantly 24 hrs after modeling (P < 0.05) and reached the peak value at 72 hrs, and decreased gradually after then. Rhubarb also showed inhibiting transcription and translation of AQP-4 gene., Conclusion: Rhubarb could alleviate cerebral edema via reducing blood-brain barrier tight junction damage and astrocyte end feet process swelling, which might be realized by the inhibition on transcription and translation of AQP-4 gene.

Definite therapeutic effect has obtained by TCM in treating acute cerebral hemorrhage (ACH) according the TCM theory of "blood circulating outside the vessels is the stasis" using breaking stagnant and eliminating blood stasis (Poxue Zhuyu) method, but no material involving the natural development of stoke in superacue stage (0 - 4 hrs after onset of the disease) being presented so far. It has been proved by randomized, double-blinded multi-centeric clinical trials that recombinant activated factor VII (rF VII a) could decreased the morbidity and disability of patients suffered from ACH, suggesting that use hemostasis treatment in ACH during superacu stage should be stressed, and the drugs for Poxue Zhuyu should be used cautiously in the period of 0 - 4 hrs after onset. The hemorrhagic disorder could be eliminated by using drugs for Poxue Zhuyu and other medicines in rational combination.

Objective: To evaluate the clinical effect of Tianhuang Huoxue Tongluo Decoction (THTD) in treating acute hemorrhagic stroke., Methods: Seventy-two patients were randomly divided into the treated group (n = 32) and the control group (n = 40), they were treated with conventional Western medicine treatment and to the patients in the treated group, THTD was given additionally starting from the 6th day of disease for 30 days., Results: Comparison of the neurofunction deficit scoring on the 15th day and the 30th day after treatment was significantly different in both group (P < 0.05). The markedly improving rate in the treated group was 71.88%, which was better than that in the control group (55.00%, P < 0.05), and no relaptic hemorrhage or secondary infarction case was found in the treated group., Conclusion: THTD may have bi-directional regulation on coagulation mechanism and fibrinolysis promoting mechanism, thus to benefit the resolving and absorption of hematoma in stroke patients, which plays important role in preventing relapse and secondary infarction, raising the cure rate, reducing mortality and disability rate.

Objective: To explore the protective mechanisms of the traditional Chinese medicine complex Naoyian granule (NYA) on intracerebral hemorrhagic (ICH)., Methods: ICH rat models were established by stereotaxically injecting 0.4 U type VII collagenase into the right globus pallidus (GP), the expression of IL-6mRNA and protein were investigated by in situ hybridization and Western blotting., Results: In the NYA group the IL-6 mRNA level was higher than that of the model group on 4 - 7 d and the IL-6 protein level was remarkably higher than that of the model group on 6 h - 7 d after ICH injury (P <0.01)., Conclusion: Up-regulating the expression of IL-6 protein, and stabilizing the increasing expression of IL-6 mRNA and protein may be the protective mechanisms of NYA.

Objective: To observe the effects of Pinggan Xifeng decoction (PGXFD) on the change of mitochondrial membrane potential (MMP) after intracerebral hemorrhage (ICH) injury in rat brain and to explore the mechanism of PGXF decoction in the treatment of ICH., Methods: VII type collagenase was stereotaxically injected into the globas pallidus of rats and spectrofluorometer was used to detect the fluorescence value of mitochondrial suspension. The neurobehavioral scores were used to evaluate the neurological defect., Results: Neurological function defects were seen after ICH in rats and PGXFD decreased the neurological grades. The MMP of rats with ICH was reduced significantly 4 hours after the operation, peaking at 1 d and was higher at 3 d and 7 d than that of the sham group . MMP in the PGXFD group was obviously higher than that in the control group at 1 d, 3 d, and 7 d., Conclusion: MMP decreased in rats suffering from ICH. PGXFD can markedly depress the decreation of MMP.

Objective: To probe into the influence of mannitol on early enlargement of hematoma in hypertensive cerebral hemorrhage, and to discuss how to use mannitol correctly., Methods: 93 patients with hypertensive supratentorial non-thalamic cerebral hemorrhage and light intracranial hypertension, and with less than 30 ml of hematoma volume determined by cranial CT within 6 h after the onset were randomly divided into a group in which mannitol was used (n = 46) or a group in which mannitol was not used (n = 47) within 24 h. Cranial CT was redone at 48 h. If the volume of hematoma increased by 33%, it was named early enlargement of hematoma. The influence of using mannitol within 24 h after the onset on early enlargement of hematoma was analyzed., Results: 14(14/46) patients in the group in which mannitol was used within 24 h after the onset had early enlargement of hematoma, yet 4(4/47) patients in the group without mannitol had hematoma enlargement. There was significant difference between them (P < 0.01). No significant difference was seen between the integral of nerve function defect in the two groups when CT was done at the first time (P > 0.05). When CT was redone, the integral of nerve function defect in the group with mannitol used within 24 h was markedly higher than that in the group without mannitol (P < 0.05). 5(5/46) patients died in the former group and 1(1/47) in the latter., Conclusion: Improper use of mannitol within 24 h after the onset may increase the incidence of early enlargement of hematoma in patients with hypertensive cerebral hemorrhage, and exacerbate the patient's condition. For patients with hypertensive cerebral hemorrhage with light intracranial hypertension, especialy those within 24 h after the onset, mannitol should not be used blindly, in case that it enlarges the hematoma and exacerbates patient's condition.

Objective: To assess the effect of Salviae miltiorrhiza (SM) injection in the treatment of hypertensive cerebral hemorrhage (HCH)., Methods: Fifty-one cases (age 50-78 years, 61.2 years on average) of HCH were randomly divided into three groups (SM + cytosine diphosphate-choline (CDP-C) group and para-aminomethyl benzoic acid (PAMBA) + CDP-C group as treated group, CDP-C group as control group) to observe the outcome of the clinical treatment, hematoma absorbability and changes of ADP-platelet agglutination rate (Pag), prothrombin time(PT) and function of the liver and kidney., Results: The rate of good result (GR) and moderate disability (MD) in SM group was 85.71% with the method of Glasgow outcome score (GOS), others were 47.06% and 61.54% separately, they have significant difference, P < 0.05. Among them, SM group had best result. Compared the rate of hematoma absorbability of SM group with that of PAMBA, CDP-C groups, the difference was significant, P < 0.05. It did not affect the platelet coagulative function in SM group., Conclusion: SM injection could effectively improve the condition of patients with HCH, and without any side effect. It is worthwhile to be used in the clinical practice.

Objective: To study the mechanism of Huanyuan injection in treating acute intracerebral hemorrhage., Methods: Forty-five patients were divided into Huanyuan group and mannitol group who were treated with Huanyuan injection and mannitol intravenously for two weeks respectively. Meanwhile, the two groups were also treated with vitamin C, potassium chloride, etc, intravenously. Plasma endothelin (ET) and calcitonin gene-related peptide (CGRP) levels were determined before and after treatment., Results: After treatment for two weeks, changes of plasma ET and CGRP in mannitol group was insignificant (P > 0.05). Compared with the two treated group, There was obvious significance in plasma ET levels and CGRP content (P < 0.05)., Conclusion: Therapeutic mechanism of Huanyuan injection in treating acute intracerebral hemorrhage were correlated to reduce plasma ET and raise the CGRP levels.

In order to investigate the efficacy mechanism of Nao Yi-an(NYA) granule on acute cerebral hemorrhage(ACH), 38 cases of ACH were treated with NYA granule(NYA group) or with Western Medicine (WM group). The contents of their plasmal NE, E, and DA before and after treatments were observed. The results showed that the contents of the plasmal NE, E and DA increase remarkably, compared with those of normal control group(P < 0.01), and accompanied by the increase of volume of hemorrhage or the gravity of the disease. After treatment, the contents of the plasmal NE, E and DA in NYA group are notably lower than those before the treatment(P < 0.01), but in WM group, they are not significantly lower than those before the treatment(P > 0.05), and they are strikingly lower in NYA group than in WM group. It is indicated that the NYA group can effectively decrease the contents of plasmal NE, E and DA, to remove cerebrovascular spasm, to relieve cerebral edema, to improve microcirculation of brain tissue, to increase blood and energy supplies, anticerebral secondary ischemia and hypoxia and improve the clinical effects.

Aim: To explore the protective effect and its mechanism of the traditional Chinese medicine complex, naoyi-an granule(NYAG), on intracerebral hemorrhage(ICH) in rats., Methods: Collagenase-induced ICH rats were used. Inducible nitric oxide synthase(iNOS) activity of ischemic cerebral cortex surrounding the intracerebral hematoma was assayed by monitoring the conversion of L-3H-arginine to L-3H-citrulline. Pathologic changes in the same area were observed with transmission electron microscope on the 2nd day, the 4th day and the 7th day after ICH., Results: The iNOS activities of NYA-treated group decreased remarkably(P < 0.01) compared with those of the saline-treated group. Ultrastructural observation also indicated that NYAG ameliorated the brain edema, cell degeneration and necrosis., Conclusions: The inhibitory effect of NYAG on iNOS activity may be related to its protection against ischemic brain injury secondary to ICH.

The effects of Nao Yi-an granule(Chinese medicine group, CMG) and western medicine (western medicine group, WMG) on hemorheological indexes and red cell deformability(RCD) were investigated in 40 patients with hemorrhagic stroke. The results showed that whole blood relative viscosity(high and low shear), whole blood reduced viscosity(high shear), plasma relative viscosity and RCD were significantly elevated before the treatment in both group than those of the control group(P < 0.01). After the treatment, the above indexes were lower in CMG than before the treatment and also lower in CMG than in WMG(P < 0.01). It is indicated that the Nao Yi-an granule is obviously superior to western medicine on the decrease of blood viscosity, increase of RCD, improvement of blood perfusion of brain tissue, protection of brain tissue and improved clinical in patients with hemorrhagic stroke.

Objective: To observe the effect of "Qingkailing" (QKL) on cerebral hematoma., Methods: The experimental cerebral hematoma models were produced by injecting autogenous clot in the rabbit. The influences of QKL on blood gas, brain index, contents of water, sodium, potassium, calcium, magnesium in brain tissues and changes of cerebrovascular permeability, histomorphology at the third day, seventh day, fourteenth day after cerebral hematoma were observed., Results: In the pathological group brain index and contents of water, sodium, calcium of brain tissue, ventilation of lung were increased progressively, cerebrovascular permeability were raised obviously, especially in the side of hematoma (right brain). After the forming of cerebral hematoma cerebral edema was reduced, brain index, contents of water, sodium, calcium in brain tissue and cerebrovascular permeability, hyperventilation were all less than pathological group and close to the control group., Conclusion: QKL was advantageous in the treatment of encephal edema induced by experimental cerebral hematoma.

The alteration of renal function after initiation of mannitol infusion were monitored in 20 patients with cerebrovascular accident to evaluate whether mannitol has nephrotoxicity effects. Serum creatinine and urea nitrogen were increased after initiation of mannitol infusion, but hadn't reached stagistical significance. Urinary and serum alpha 1-microglobulin, beta 2-microglobulin and urinary NAG, gamma-GT were significantly increased after 5-10 days successive infusion of mannitol (P < 0.05). The results suggest that the acute nephrotoxicity effect of mannitol should not be ignored.

Fifty-one patients of cerebral hemorrhage were observed on controlled study which were treated with the Zhu-Yu Hua-Tan Decoction (ZYHTD) and Western medicine. The results revealed that ZYHTD could reduce the serum IgG (P < 0.05), and lymphocyte transformation rate (P < 0.05). Meanwhile, the patient's health condition of treated group was better than the control group in the fields of eliminating brain hematoma, evaluating patients condition score in TCM and compromised neurologic function (P < 0.05). It is assumed that there is positive significance in anti-inflammatory effect and promoting the absorption of brain hematoma in the acute phase of cerebral hemorrhage.

The effect of integrated Chinese medicine (ICM) on the convalescent of acute cerebral hemorrhage patients were observed. The results showd that the effect of patients treated with ICM was better than that treated with Western medicine alone on the aspects of absorption of brain hemetoma, elimination of encephaledema and recovery of neural function (P < 0.05, 0.01). It suggested that early application of integrated Chinese medicine is very helpful in rehabilitation of cerebral hemorrhage patients.

The 120 patients with acute cerebral hemorrhage were divided into two groups: tested group and control group. The tested group were treated with Zhong Feng I oral liquor (acute stage), Zhong Feng II oral liquor (convalescent stage) and Western medicine, the control group were treated with Western medicine alone. The results showed that: the course of acute stage, and the time for restoring consciousness and the time for eliminating high intracranial pressure were shorter in tested group than those in control group; The mortality and rate of causing disability lowered. The rate of intracranial hemorrhage absorption was promoted in tested group (81.67%) than that in control group (58.37%), P < 0.01; The efficacy in various aspects was superior than that of control.

42 cases of hypertensive encephalorrhagia (HER) were randomly divided into two groups. All cases received treatment within three days after the attack, group I received current conventional treatment as control, group II took 100ml Naoxuenin (NXN) oral liquid with conventional treatment. Effects were evaluated after 14-day treatment. Results indicated that NXN had direct therapeutic effect or/and synergistic effect on HER in acute phase, the mortality was significantly lowered (P < 0.05) and the recovery of nerve function speeded up in group II. And NXN displayed similar effect on different Syndromes and Types of the acute phase of HER (P > 0.05). Analysis of results of hemorheological examination of pre- and post-treatment suggested that NXN could improve the microcirculation and prevent the high hemo-viscosity syndrome caused by dehydration therapy.

Based on the analysis of heritable autoregulatory functions and adaptive developments which occur long course of in response to inner and outer environment, FCMCK therapy was first designed to mobilize the autoregulatory system and resist the stress of acute hemorrhagic cerebral stroke. In this paper, 44 cases of acute hemorrhagic cerebral stroke were treated with FCMCK therapy, with another 44 cases treated with mannitol as control. The result showed that the mortality rate of the treated group was 4.5% (2/44), significantly lower than that of the control (47.7%, 21/44, P less than 0.01). FCMCK therapy in acute hemorrhagic cerebral stroke has the following advantages: 1) effectiveness in maintenance of adequate blood pressure; 2) effectiveness in reduction of cardiac arrhythmias and other complications; 3) i.v. drip of Ca and repeated use of digitalis shows atoxic effect; and 4) respiratory failure improves without stopping i.v. drip of Mg. The mechanism of FCMCK therapy is briefly discussed by the authors.