Intracerebral hemorrhage (ICH) remains a common and debilitating form of stroke. This neurological emergency must be diagnosed and treated rapidly yet effectively. In this article, we review the medical, surgical, repair, and regenerative treatment options for managing ICH. Topics of focus include the management of blood pressure, intracranial pressure, coagulopathy, and intraventricular hemorrhage, as well as the role of surgery, regeneration, rehabilitation, and secondary prevention. Results of various phase II and III trials are incorporated. In summary, ICH patients should undergo rapid evaluation with neuroimaging, and early interventions should include systolic blood pressure control in the range of 140 mmHg, correction of coagulopathy if indicated, and assessment for surgical intervention. ICH patients should be managed in dedicated neurosurgical intensive care or stroke units where continuous monitoring of neurological status and evaluation for neurological deterioration is rapidly possible. Extravasation of hematoma may be helpful in patients with intraventricular extension of ICH. The goal of care is to reduce mortality and enable multimodal rehabilitative therapy.
Genomic aberrations comprise hallmarks of multiple myeloma (MM), a plasma cell malignancy with an overall poor prognosis. MM is heterogeneous and has different molecularly-defined subtypes according to varying clinical and pathological features. Hyperdiploidy or non-hyperdiploidy has usually been identified as early initiating genetic events that can be followed by secondary aberrations, including copy number changes, secondary translocations, and different epigenetic modifications, which cause immortalization of plasma cell and disease progression. Even though recent advances in drug discovery have offered new perspectives of treatment, MM remains incurable. However, understanding the molecular complexity of MM would allow patients to get precision treatment. Our review focuses on current evidence in myeloma biology with special attention to genomic and molecular variations.
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