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Aneurysmal subarachnoid hemorrhage: long-term trends in incidence and survival in Olmsted County, Minnesota.

动脉瘤性蛛网膜下腔出血: 明尼苏达州奥姆斯特德县发病率和生存率的长期趋势。

  • 影响因子:3.00
  • DOI:10.3171/2019.12.JNS192468
  • 作者列表:"Giordan E","Graffeo CS","Rabinstein AA","Brown RD","Rocca WA","Chamberlain AM","Lanzino G
  • 发表时间:2020-02-21
Abstract

OBJECTIVE:Recent population-based and hospital cohort studies have reported a decreasing incidence of aneurysmal subarachnoid hemorrhage (aSAH) and declining aSAH-associated case-fatality rates. Principal drivers of these trends are debated, but improvements in smoking cessation and hypertension control may be critical factors. METHODS:The population-based medical records linkage system of the Rochester Epidemiological Project was used to document aSAH incidence and 30-day case fatality rates during a 20-year study period (1996-2016) in Olmsted County, Minnesota. Incidence rates in the study period were compared with data from a previous Olmsted County study concerning aSAH incidence from 1965 to 1995 and with regional trends in tobacco use. RESULTS:One hundred nineteen incident cases of aSAH were included. The median age at hemorrhage was 59 years (range 16-94 years), and 74 patients were female (62.2%). The overall average annual aSAH incidence rate was 4.2/100,000 person-years (P-Y). The aSAH incidence rate decreased from 5.7/100,000 in 1996 to 3.5/100,000 P-Y in 2011-2016. The overall aSAH-associated 30-day case-fatality rate was 21.9% and declined by approximately 0.5% annually. An accelerated decline in the fatality rate (0.9%/year) was observed from 2006-2016. Smoking among adult Olmsted County residents decreased from 20.4% in 2000 to 9.1% in 2018. CONCLUSIONS:A decline in the incidence of aSAH and 30-day case-fatality rate from 1996 to 2016 was observed, as well as an accelerated decline of the fatality rate from 2006 to 2016. These findings confirm and extend the trends reported by prior studies in the same population. The decrease in aSAH in the years studied paralleled a noticeable reduction in the population smoking rates.

摘要

目的: 最近基于人群和医院队列研究报道动脉瘤性蛛网膜下腔出血 (aSAH) 的发生率降低,aSAH 相关病死率下降。这些趋势的主要驱动因素存在争议,但戒烟和高血压控制的改善可能是关键因素。 方法: 在 20 年研究期间 (1996-2016),使用 Rochester 流行病学项目的基于人群的病历链接系统记录 aSAH 发病率和 30 天病死率在明尼苏达州奥姆斯特德县。将研究期间的发病率与之前 Olmsted 县 1965年 1995年关于 aSAH 发病率的研究数据以及烟草使用的区域趋势进行比较。 结果: 纳入 119 例 aSAH 病例。出血的中位年龄为 59 岁 (范围 16-94 岁),74 例患者为女性 (62.2%)。总体平均年 aSAH 发病率为 4.2/100,000 人年 (P-Y)。ASAH 发病率从 1996年的 5.7/100,000 下降到 3.5/100,000 P-Y 在 2011-2016。总体 aSAH 相关 30 天病死率为 21.9%,每年下降约 0.5%。观察到病死率从 0.9%-2006 加速下降 (2016/年)。Olmsted 县成年居民吸烟率从 2000年的 20.4% 下降到 2018年的 9.1%。 结论: 观察到 aSAH 发生率和 30 天病死率 (1996年至 2016年) 下降,病死率 (2006年至 2016年) 加速下降。这些发现证实并扩展了同一人群中先前研究报告的趋势。研究年份中 aSAH 的减少与人群吸烟率的显著降低平行。

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影响因子:2.57
发表时间:2020-01-06
DOI:10.1007/s12031-019-01474-x
作者列表:["Cheng, Xiao","Yang, Ying-Lin","Li, Wei-Han","Liu, Man","Zhang, Shan-Shan","Wang, Yue-Hua","Du, Guan-Hua"]

METHODS:Cerebral ischemia-reperfusion (I/R) is characterized by initial transient cerebral ischemia followed by reperfusion. Various pathophysiological processes are involved in brain injury and functional recovery during cerebral I/R. There are few studies on dynamic metabolic process after cerebral I/R. The present study was to observe dynamic alteration of brain injury, functional recovery, and metabolites after cerebral I/R in rats and discover potential metabolic markers. The cerebral I/R model was established by middle cerebral artery occlusion (MCAO) for 90 min, following reperfusion in rats. The results of cerebral infarction area, cerebral edema, and behavior test showed that there were dynamic changes in brain injury and functional recovery at different periods after cerebral I/R. Further analysis showed that the brain injury was severe on the first day of cerebral I/R, and there was a significant functional recovery from the 7th day of cerebral I/R, followed by an aggravation trend of brain injury from the days 7 to 28. Furthermore, Matrix-assisted laser desorption ionization mass spectrometry imaging analysis showed that the expression of ATP, glucose, and citric acid on 7th day was the highest during cerebral I/R, which indicated that energy metabolism and oxidative phosphorylation played important roles during cerebral I/R. In addition, the untargeted metabolomic results showed that the level of isocitric acid, the ratio of oxyglutaric acid/glutamic acid, and the level of pyruvic acid associated with the TCA cycle were also the highest on the 7th day during cerebral I/R, which indicated that the transient spontaneous recovery of ischemic brain on the 7th day after ischemia-reperfusion might be related to oxidative phosphorylation and energy metabolism in the brain in this period. In conclusion, the results suggest that some small molecule metabolites participate in the brain injury and functional recovery during cerebral I/R, which is of great significance to the development of therapeutic drugs and diagnostic markers.

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影响因子:2.75
发表时间:2020-01-01
DOI:10.1007/s00702-019-02124-7
作者列表:["Wang, Xiaodong","Shi, Cunxian","Pan, Hongxia","Meng, Xiaowen","Ji, Fuhai"]

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