脑蛛网膜下腔出血精选文档.ppt

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1、脑蛛网膜下腔出血本讲稿第一页，共二十一页OutlinenIntroduction;nResearch purposes;nMaterial and method;nResult and Discussion;nEvaluation and outlook;nConclusion.本讲稿第二页，共二十一页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

2、(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 subarach

3、noid 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 Ge

4、n;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 M

5、ed 2007 12:243本讲稿第三页，共二十一页IntroductionnSubarachnoid Hemorrhage(SAH):nA subtype of stroke with a particularly high morbidity and mortality.nEarly Brain Injury(EBI):nOccurs within 72h after the initial bleed;nNo effective treatment is available;nMechanisms have recently started to be understood.本讲稿第四页

6、，共二十一页 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本讲稿第五页，共二十一页E.KONIEWSKA,R.MICHALIK et al.MECHANISMS OF VASCULAR DYSFUNCTION AFTER SUBARACHNOID HEMORRHAGE JJ.PHYSIOLOGY AND PHARMACOLOGY 2006,5

7、7,Suppl 11,145.160本讲稿第六页，共二十一页 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本讲稿第七页，共二十一页Research purposesCPP independent Investigate in

8、 vivoAlterations on microcirculation?Whether/When/Where/What/HowRelationship withmicrothrombiEarly perfusion deficits CBFreduction本讲稿第八页，共二十一页Material and Method nCWp model;nCranial window;nIntravital fluorescence microscopy.本讲稿第九页，共二十一页nMicrovascular Constriction:nNumerous constricted arterioles we

9、re 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本讲稿第十页，共

10、二十一页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 a

11、nd long-lasting microarterial constriction and microthrombosis:an in-vivo microscopy study.J C ereb Flow Metab.2012,32(3):447-455本讲稿第十一页，共二十一页Result-1nMicrothrombi:nArteriolar constrictions occur first and then trigger microthrombosis;nThe severity of constriction was positively correlated with the

12、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本讲稿第十二页，共二十一页SummarynLong-lasting hemodynamic alterations at the micr

13、ocirculatory level may be an important mechanism for the development of early post hemorrhagic ischemia.本讲稿第十三页，共二十一页 P-selectin and ApocyninP-selectin Platelet-Leukocyte rolling and adhesionEndothelialLeukocyteadhesion Platelet-Endothelialadhesionnon-P-selectin60%40%blockerPlatelet P-selectin Endot

14、helial P-selectinLeukocyte PSGL-1NAD(P)H oxidase Apocynin本讲稿第十四页，共二十一页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 almos

15、t 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 本讲稿第十五页，共二十一页 Disc

16、ussionP-selectin Platelet-Leukocyte rolling and adhesionEndothelialLeukocyteadhesion Platelet-Endothelialadhesionnon-P-selectin60%40%blockerPlatelet P-selectin;Endothelial P-selectinLeukocyte PSGL-1NAD(P)H oxidase ApocyninApocynin本讲稿第十六页，共二十一页SummarynP-selectin and NAD(P)H oxidase participate in the

17、 early microvascular responses to SAH.本讲稿第十七页，共二十一页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 mec

18、hanisms;本讲稿第十八页，共二十一页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.D

19、elayed ischemia after subarachnoid hemorrhage:result of vasospasm alone or a broader J,J.Vasc Med 2007 12:243本讲稿第十九页，共二十一页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.本讲稿第二十页，共二十一页nThanks for your attention!本讲稿第二十一页，共二十一页