Arterial spin labeling for moyamoya angiopathy: A preoperative and postoperative evaluation method.

Objectives: Studies have shown that arterial spin labeling (ASL) effectively replaces traditional MRI perfusion imaging for detecting cerebral blood flow (CBF) in patients with Moyamoya angiopathy (MMA). However, there are few reports on the relationship between neovascularization and cerebral perfusion in patients with MMA. The aim of this study is to investigate the effects of neovascularization on cerebral perfusion with MMA after bypass surgery. Methods: We selected patients with MMA in the Department of Neurosurgery between September 2019 and August 2021 and enrolled them based on the inclusion and exclusion criteria. ASL imaging was used to monitor the baseline CBF level before surgery and determine the changes in cerebral vessels at postoperative 1 week and 6 months, respectively. The Alberta stroke grade, modified Rankin Scale (mRS), and digital subtraction angiography images were used to evaluate the effect of postoperative CBF status and prognosis. Ninety hemispheres from 51 patients were included in this study. There were no significant differences in the baseline data of the enrolled patients. At 1 week and 6 months post-surgery, the CBF state in the operation area was significantly changed compared with that at baseline (P < 0.05). The preoperative Alberta score (t = 2.714, P = 0.013) and preoperative mRS score (t = 6.678, P < 0.001) correlated with postoperative neovascularization. Conclusion: ASL is an effective method for detecting CBF and plays an important role in the long-term follow-up of patients with MMA. Combined cerebral revascularization significantly improves CBF in the operation area both in the short and long terms. Patients with lower preoperative Alberta scores and higher mRS scores were more likely to benefit from combined cerebral revascularization surgery. However, regardless of the type of patient, CBF reconstruction can effectively improve prognosis.

Optimization strategy for anesthesia in patients with moyamoya disease undergoing revascularization: scalp nerve block combined with general anesthesia / 中华麻醉学杂志

Objective:To evaluate the efficacy of scalp nerve block combined with general anesthesia in optimizing anesthesia in the patients with moyamoya disease undergoing revascularization.Methods:A total of 154 patients with moyamoya disease, aged 18-64 yr, of American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ, undergoing elective revascularization, were divided into 2 groups ( n=77 each) using a random nunber table method: scalp nerve block combined with general anesthesia group (GN group) and general anaesthesia group (G group). Anesthesia was induced with intravenous midazolam 0.05 mg/kg, sufentanil 0.5-1.0 μg/kg, rocuronium 0.6 mg/kg and etomidate 0.2-0.3 mg/kg.After the patients were tracheally intubated after anesthesia induction, ipsilateral scalp nerve block (2 ml for supraorbital nerve block, 2 ml for supratrochlear nerve block; 3 ml for auriculotemporal nerve block, 3 ml for greater occipital nerve block, 3 ml for less occipital nerve block) was performed with 0.5% ropivacaine in GN group.The equal volume of normal saline was locally injected in G group.Anesthesia was maintained by inhalation of sevoflurane and intravenous infusion of remifentanil 0.05-0.10 μg·kg -1·min -1 and cisatracurium 0.1 mg·kg -1·h -1.The consumption of intraoperative remifentanil, requirement for postoperative rescue analgesia, nausea and vomiting, length of postoperative hospital stay, and early neurological complications were recorded.The modified Rankin Scale scores were evaluated before operation, at discharge and at 6 months after operation. Results:Compared with G group, the consumption of intraoperative remifentanil and requirement for postoperative rescue analgesia were significantly decreased ( P<0.05), and no significant change was found in the incidence of postoperative nausea and vomiting, incidence of neurological complications, length of postoperative hospital stay, and modified Rankin Scale scores at each time point in GN group ( P>0.05). Conclusions:Scalp nerve block combined with general anesthesia can increase the perioperative analgesic efficacy and is helpful in achieving a low-opioid anesthesia mode when used in the patients with moyamoya disease undergoing revascularization.

Establishment and application of the one-stop multi-mode stroke rescue platform / 中华医院管理杂志

Stroke rescue features strong time sensitivity and high complexity. Minimizing the time of consumption in pre-hospital and in-hospital stroke rescue is key to improve stroke rescue efficiency and reduce the disability rate. In December 2017, a tertiary hospital launched the construction of a one-stop stroke rescue platform. This platform was centered on " multi-mode image fusion operating room" , operating as a one-stop rescue mode integrating emergency admission, imaging examination, intravenous thrombolytic therapy, mechanical thrombolytic therapy, postoperative evaluation, and so on. The seamless convergence workflow of pre-hospital, in-hospital and post-hospital could effectively optimize the physical rescue pathway. In order to ensure the efficient and orderly operation of the platform, the hospital adopted such measures as multidisciplinary integration, pre-hospital and in-hospital integration construction, and regional stroke care network. Since its operation in September 2019, the platform has treated more than 1 000 patients by December 2021. The application of the platform had effectively improved the efficiency of stroke rescue, led the development of regional stroke rescue system, and provided the reference for raising the stroke rescue capacity and management level in China.

Gas-liquid mass transfer characteristics of aviation fuel scrubbing in an aircraft fuel tank.

Dissolved oxygen evolving from aviation fuel leads to an increase in the oxygen concentration in an inert aircraft fuel tank ullage that may increase the flammability of the tank. Aviation fuel scrubbing with nitrogen-enriched air (NEA) can largely reduce the amount of dissolved oxygen and counteract the adverse effect of oxygen evolution. The gas-liquid mass transfer characteristics of aviation fuel scrubbing are investigated using the computational fluid dynamics method, which is verified experimentally. The effects of the NEA bubble diameter, NEA superficial velocity and fuel load on oxygen transfer between NEA and aviation fuel are discussed. Findings from this work indicate that the descent rate of the average dissolved oxygen concentration, gas holdup distribution and volumetric mass transfer coefficient increase with increasing NEA superficial velocity but decrease with increasing bubble diameter and fuel load. When the bubble diameter varies from 1 to 4 mm, the maximum change of descent rate of dissolved oxygen concentration is 18.46%, the gas holdup is 8.73%, the oxygen volumetric mass transfer coefficient is 81.45%. When the NEA superficial velocities varies from 0.04 to 0.10 m/s, the maximum change of descent rate of dissolved oxygen concentration is 146.77%, the gas holdup is 77.14%, the oxygen volumetric mass transfer coefficient is 175.38%. When the fuel load varies from 35 to 80%, the maximum change of descent rate of dissolved oxygen concentration is 21.15%, the gas holdup is 49.54%, the oxygen volumetric mass transfer coefficient is 44.57%. These results provide a better understanding of the gas and liquid mass transfer characteristics of aviation fuel scrubbing in aircraft fuel tanks and can promote the optimal design of fuel scrubbing inerting systems.

Impact of blood pressure changes in cerebral blood perfusion of patients with ischemic Moyamoya disease evaluated by SPECT.

Our aim was to determine the impact of targeted blood pressure modifications on cerebral blood flow in ischemic moyamoya disease patients assessed by single-photon emission computed tomography (SPECT). From March to September 2018, we prospectively collected data of 154 moyamoya disease patients and selected 40 patients with ischemic moyamoya disease. All patients underwent in-hospital blood pressure monitoring to determine the mean arterial pressure baseline values. The study cohort was subdivided into two subgroups: (1) Group A or relative high blood pressure (RHBP) with an induced mean arterial pressure 10-20% higher than baseline and (2) Group B or relative low blood pressure (RLBP) including patients with mean arterial pressure 10-20% lower than baseline. All patients underwent initial SPECT study on admission-day, and on the following day, every subgroup underwent a second SPECT study under their respective targeted blood pressure values. In general, RHBP patients showed an increment in perfusion of 10.13% (SD 2.94%), whereas RLBP patients showed a reduction of perfusion of 12.19% (SD 2.68%). Cerebral blood flow of moyamoya disease patients is susceptible to small blood pressure changes, and cerebral autoregulation might be affected due to short dynamic blood pressure modifications.

Clinical analysis of 36 cases with whirlpool acute epidural hematoma / 中国基层医药

Objective To analyze the clinical features and prognosis of patients with acute epidural hematoma in the whirlpool sign.Methods 36 cases of CT scan showed a whirlpool sign of acute subdural hematoma patients were selected as the observation group.During the same time period,50 acute epidural hematoma patients without the whirlpool sign were selected as the control group.All patients received operation treatment.The Glasgow coma score (GCS),amount of hemorrhage and prognosis were compared between the two groups.Results The preoperative GCS score of the observation group was significantly lower than that of the control group (P ＜ 0.05).In the operation,the blood loss of the observation group was significantly increased compared with the control group (t =3.232,3.164,P ＜ 0.05).Control group CT evaluation of preoperative and intraoperative measurement had no significant difference(P ＞0.05).In the observation group,11 patients died,the mortality rate was 30.5％ (11/36).In the control group,6 patients died,the mortality rate was 12.0％ (6/50),the difference between the two groups was statistically significant (x2 =4.134,P ＜ 0.05).The patients were followed up for 6 months,the excellent and good rate of ADL score in observation group was 64.0％,which was significantly lower than 84.1％ in the control group (x2 =3.989,P ＜ 0.05).Conclusion Acute epidural hematoma patients with thewhirlpool signshowed progressive disease,high mortality,poor prognosis,and active countermeasures should be taken.

Clinical Research On Fast Track Surgery in Neurosurgery / 中国神经精神疾病杂志

Objective To investigate the feasibility and effectiveness of fast track surgery (FTS) in neurosurgery. Methods One hundred fifteen patients who underwent neurosurgery surgery in Henan Province People's Hospital from June 2012 to March 2014 were enrolled in this study. All the patients were divided into FTS group (62 cases) and the tra?ditional operation group (53 cases). The clinical index, postoperative hospital stay and hospitalization cost were compared between the two groups. Results The clinical index were significantly lower in FTS group than in traditional operation group (P<0.05). Length of hospital stay (days) and hospitalization cost of FTS group were significantly shorter and lower in FTS group compared with traditonal operation group (8±1 vs. 11±2 days and RMB 4.58 ±0.75 vs. 5.78 ±0.64 ten thou?sand, respectively) (P<0.05). Conclusion FTS in neurosurgery operation is an all-new concept for surgery which can ef?fectively reduce postoperative complications, shorten length of hospital stay, decrease hospitalization cost and promote postoperative recovery.