脑蛛网膜下腔出血优秀课件.ppt
脑蛛网膜下腔出血第1页，本讲稿共21页OutlinenIntroduction;nResearch purposes;nMaterial and method;nResult and Discussion;nEvaluation and outlook;nConclusion.第2页，本讲稿共21页ReferencesnCahill W J,Calvert J H,Z Hang JH,et al.Mechanisms of early brain injury after subarachnoid hemorrhage J .J Cereb Blood Flow Metab,2006,26(11):1341-1353nE.Koniewska,R.Michalik et al.Mechanisms of vascular dysfunction after subarachnoid hemorrhage J.J.Physiology and Pharmacology,2006,57,11,145.160nWesterm Aier T,Jauss a,Eriskat J,et al.Time-course of cerebral perfusion and tissue oxygenation in the first 6 h after experimental subarachnoid hemorrhage in rats J .J Cereb Blood Flow Metab,2009,29(4):771-779nBenjamin Friedrich,et al.Experimental subarachnoid hemorrhage causes early and long-lasting microarterial constriction and microthrombosis:an in-vivo microscopy study.J C ereb Flow Metab.2012,32(3):447-455nIshikawa Mami;Kusaka Gen;Yamaguchi Noriyuki.Platelet and leukocyte adhesion in the microvascularture at the cerebral surface immediately after subarachnoid hemorrhage,J.Neurosurgery,2009,64(3):546-553nDaniel Z,Muhammad F.et al.Delayed ischemia after subarachnoid hemorrhage:result of vasospasm alone or a broader J,J.Vasc Med 2007 12:243第3页，本讲稿共21页Introductionn nSubarachnoid Hemorrhage(SAH):Subarachnoid Hemorrhage(SAH):nA subtype of stroke with a particularly high morbidity and mortality.n nEarly Brain Injury(EBI):Early Brain Injury(EBI):nOccurs within 72h after the initial bleed;nNo effective treatment is available;nMechanisms have recently started to be understood.第4页，本讲稿共21页 CAHILL W J,CALVERT J H,Z HANG JH,et al.Mechanisms of early brain injury after subarachnoid hemorrhage J .J CerebBlood Flow Metab,2006,26(11):1341-1353第5页，本讲稿共21页E.KONIEWSKA,R.MICHALIK et al.MECHANISMS OF VASCULAR DYSFUNCTION AFTER SUBARACHNOID HEMORRHAGE JJ.PHYSIOLOGY AND PHARMACOLOGY 2006,57,Suppl 11,145.160第6页，本讲稿共21页 WESTERM AIER T,JAUSS A,ERISKAT J,et al.Time-course of cerebral perfusion and tissue oxygenation in the first 6 h after experimental subarachnoid hemorrhage in rats J .J Cereb Blood Flow Metab,2009,29(4):771-779第7页，本讲稿共21页Research purposesCPP independent Investigate in vivoAlterations on microcirculation?Whether/When/Where/What/HowRelationship withmicrothrombiEarly perfusion deficits CBFreduction第8页，本讲稿共21页Material and Method nCWp model;nCranial window;nIntravital fluorescence microscopy.第9页，本讲稿共21页nMicrovascular Constriction:nNumerous constricted arterioles were observed,in contract to venules;nDistribution of severity changed over time.Result-1Benjamin Friedrich,et al.Experimental subarachnoid hemorrhage causes early and long-lasting microarterial constriction and microthrombosis:an in-vivo microscopy study.J C ereb Flow Metab.2012,32(3):447-455第10页，本讲稿共21页Result 1nMicrovascular Constriction:nNumerous constricted arterioles were observed,in contract to venules;nDistribution of severity changed over time.nThe smallest arterioles are most severely affected by microvasospasm.Benjamin Friedrich,et al.Experimental subarachnoid hemorrhage causes early and long-lasting microarterial constriction and microthrombosis:an in-vivo microscopy study.J C ereb Flow Metab.2012,32(3):447-455第11页，本讲稿共21页Result-1nMicrothrombi:nArteriolar constrictions occur first and then trigger microthrombosis;nThe severity of constriction was positively correlated with the frequency of micro-thrombiBenjamin Friedrich,et al.Experimental subarachnoid hemorrhage causes early and long-lasting microarterial constriction and microthrombosis:an in-vivo microscopy study.J C ereb Flow Metab.2012,32(3):447-455第12页，本讲稿共21页SummarynLong-lasting hemodynamic alterations at the microcirculatory level may be an important mechanism for the development of early post hemorrhagic ischemia.第13页，本讲稿共21页 P-selectin and ApocyninP-selectin Platelet-Leukocyte rolling and adhesionEndothelialLeukocyteadhesion Platelet-Endothelialadhesionnon-P-selectin60%40%blockerPlatelet P-selectin Endothelial P-selectinLeukocyte PSGL-1NAD(P)H oxidase Apocynin第14页，本讲稿共21页Result-2nPlatelet-leukocyte-endothelial cell interactions were observed mainly in the postcapillary venules immediately after SAH.nTreatment with P-selectin-blocking antibody before SAH reduced rolling and adherent platelets almost to baseline levels.nTreatment with apocynin before SAH reduced platelet adhesion by one half.Ishikawa Mami;Kusaka Gen;Yamaguchi Noriyuki.Platelet and leukocyte adhesion in the microvascularture at the cerebral surface immediately after subarachnoid hemorrhage,J.Neurosurgery,2009 第15页，本讲稿共21页 DiscussionP-selectin Platelet-Leukocyte rolling and adhesionEndothelialLeukocyteadhesion Platelet-Endothelialadhesionnon-P-selectin60%40%blockerPlatelet P-selectin;Endothelial P-selectinLeukocyte PSGL-1NAD(P)H oxidase ApocyninApocynin第16页，本讲稿共21页SummarynP-selectin and NAD(P)H oxidase participate in the early microvascular responses to SAH.第17页，本讲稿共21页EvaluationnAdvantages:nProvide Morphological evidence;nHelp verify mechanisms;nIn vivo;nDynamic changes at early time;nMicrocirculation;nRetained dura mater;nLimitations:nsuperficial structures only;ndecompression craniectomy;ndetailed molecular mechanisms;第18页，本讲稿共21页OutlooknThe distinct events occur in micro-arterioles and micro-venules?nwhich pathways play a dominant role?nOther potential roles in the induction of microcirculation deficit?nCombine with molecular biology study?nSecret hidden behind the phenomenon.Daniel Z,Muhammad F.et al.Delayed ischemia after subarachnoid hemorrhage:result of vasospasm alone or a broader J,J.Vasc Med 2007 12:243第19页，本讲稿共21页ConclusionnIn-vivo fluorescence microscopy study plays an important role in observing morphological changes as well as cell-interactions at the microcirculatory level at early time after SAH.nIt might be used in a broader and deeper field combining with molecular biology study,creating an effective way to understand microcirculation deficit caused by SAH,thus help us to reduce the mortality of EBI.第20页，本讲稿共21页nThanks for your attention!第21页，本讲稿共21页
