Clinical diagnosis of cerebral vasospasm after subarachnoid hemorrhage by using transcranial Doppler sonography.

OBJECTIVE: To investigate the diagnosis of cerebral vasospasm (CVS) after subarachnoid hemorrhage (SAH) by transcranial Doppler (TCD) sonography. PATIENTS AND METHODS: 90 patients with SAH admitted to the Department of Neurosurgery of Weifang People's Hospital from January 2016 to December 2016 were selected. TCD and digital subtraction angiography (DSA) were used to diagnose the prevalence of CVS in patients. The severity of disease was evaluated (improved-Fisher grading). Correlations between neurological status (Hunt-Hess grading) and the prevalence of CVS were analyzed. It turned out that the prevalence of CVS was 87.78% detected by DSA and was 83.33% detected by TCD, no significant difference was found between them (p > 0.05). RESULTS: The results of TCD showed that the gender, age, smoking, alcoholism, and history of hypertension had no significant correlations with the prevalence of CVS (p > 0.05). Blood flow velocity of patients was significantly higher at 4-6 days after the occurrence of SAH compared with the level at 1-3 days, reached the peak at 7-9 days, and decreased at 10-12 days after occurrence. Significant differences in the severity of the disease were found between patients with different improved-Fisher grades and different Hunt-Hess grades (p < 0.05). The prevalence of CVS was significantly increased after SAH (p < 0.05). CONCLUSIONS: TCD can dynamically detect the blood flow velocity of SAH patients, and can be used for the prediction and diagnosis of CVS after SAH.

Expression of Nrf2-Keap1-ARE signal pathway in traumatic lung injury and functional study.

OBJECTIVE: Traumatic lung injury (TLI) can cause inflammation and oxidative stress, or even leads to acute respiratory distress syndrome (ARDS) and death. Nuclear factor erythroid-2 related factor 2 (Nrf2)-Kelch-like ECH-associated protein 1 (Keap1)-antioxidant response element (ARE) signal pathway participates in disease occurrence and progression via regulating inflammatory and oxidative stress response, but with its expression and functional roles in TLI largely unknown. MATERIALS AND METHODS: Wistar rats were randomly divided into control group, TLI group by crushing method, and Nrf2 activation group which received Nrf2 specific agonist sulforaphane 30 min before TLI treatment. Artery blood gas (ABG), wet/dry mass ratio (W/D) of lung tissues, myeloid peroxidase (MPO) and superoxide dismutase (SOD) activity of lung tissue were analyzed. Keap1 and ARE mRNA levels were tested by Real-time PCR, while Nrf2 protein was measured by Western blot. Inflammatory factors including tumor necrosis factor-α (TNF-α) and interleukin-2 (IL-2) were quantified by enzyme-linked immunosorbent assay (ELISA). RESULTS: TLI model had lower ABG or SOD, higher W/D ratio, MPO value, elevated expressions of TNF-α, IL-2, and Keap1, plus decreased Nrf2 and ARE expression (p<0.05). Nrf2 activation significantly improved ABG, decreased W/D ratio and MPO value, enhanced SOD activity, decreased TNF-α and IL-2 secretion, suppressed Keap1 expression, and facilitated Nrf2 and ARE expressions (p<0.05). CONCLUSIONS: Nrf2-Keap1-ARE signal pathway can improve TLI-related pathology via modulating oxidative stress response and suppressing inflammation.

Risk factors for early-onset ventilator-associated pneumonia in aneurysmal subarachnoid hemorrhage patients

This study aimed to investigate the risk factors related to ventilator-acquired pneumonia (VAP) in aneurysmal subarachnoid hemorrhage (SAH) patients. From January 2011 to December 2015, a single-center retrospective study including 200 SAH patients requiring mechanical ventilation (MV) ≥48 h was performed. The clinical data of these patients were collected and analyzed. The age range of the patients were 41-63 and 72 (36%) were male. The Glasgow coma scale score range was 5-15 and the Simplified Acute Physiology Score II range was 31-52. One hundred and forty-eight (74%) patients had a World Federation of Neurosurgeons (WNFS) score ≥III. Aneurysm was secured with an endovascular coiling procedure in 168 (84%) patients and 94 (47%) patients presented VAP. Male gender (OR=2.25, 95%CI=1.15-4.45), use of mannitol (OR=3.02, 95%CI=1.53-5.94) and enteral feeding above 20 kcal·kg−1·day−1 (OR=2.90, 95%CI=1.26-6.67) after day 7 were independent factors for VAP. Patients with early-onset VAP had a longer duration of sedation (P=0.03), MV (P=0.001) and ICU length of stay (P=0.003) and a worse Glasgow Outcome Scale score (P<0.001), but did not have a higher death rate.