An early neuroprotective effect of atorvastatin against subarachnoid hemorrhage

Atorvastatin has been shown to reduce early brain edema and neuronal death after subarachnoid hemorrhage,but its mechanism is not clear.In this study,rat models of subarachnoid hemorrhage were established by autologous blood injection in the cisterna magna.Rat models were intragastrically administered 20 mg/kg atorvastatin 24 hours before subarachnoid hemorrhage,12 and 36 hours after subarachnoid hemorrhage.Compared with the controls,atorvastatin treatment demonstrated that at 72 hours after subarachnoid hemorrhage,neurological function had clearly improved;brain edema was remarkably relieved;cell apoptosis was markedly reduced in the cerebral cortex of rats;the number of autophagy-related protein Beclin-1-positive cells and the expression levels of Beclin-1 and LC3 were increased compared with subarachnoid hemorrhage only.The ultrastructural damage of neurons in the temporal lobe was also noticeably alleviated.The similarities between the effects of atorvastatin and rapamycin were seen in all the measured outcomes of subarachnoid hemorrhage.However,these were contrary to the results of 3-methyladenine injection,which inhibits the signaling pathway of autophagy.These findings indicate that atorvastatin plays an early neuroprotective role in subarachnoid hemorrhage by activating autophagy.The experimental protocol was approved by the Animal Ethics Committee of Anhui Medical University,China(904 Hospital of Joint Logistic Support Force of PLA;approval No.YXLL-2017-09)on February 22,2017.

Gut microbiota dysbiosis in preeclampsia patients in the second and third trimesters

Background:Preeclampsia(PE)is a serious complication that affects maternal and perinatal outcomes.However,the mechanisms have not been fully explained.This study was designed to analyze longitudinal gut microbiota alterations in pregnant women with and without PE in the second(T2)and third trimesters(T3).Methods:In this nested case-control study,which was conducted at Nanjing Maternity and Child Health Care Hospital,fecal samples from 25 PE patients(25 fecal samples obtained in T2 and 15 fecal samples obtained in T3)and 25 matched healthy controls(25 fecal samples obtained in T2 and 22 fecal samples obtained in T3)were collected,and the microbiota were analyzed using 16S rRNA gene sequencing.The diversity and composition of the microbiota of PE cases and controls were compared.Results:No significant differences in diversity were found between the PE and control groups(P>0.05).In the control group,from T2 to T3,the relative abundances of Proteobacteria(median[Q1,Q3]:2.25%[1.24%,3.30%]vs.0.64%[0.20%,1.20%],Z=-3.880,P<0.05),and Tenericutes(median[Q1,Q3]:0.12%[0.03%,3.10%]vs.0.03%[0.02%,0.17%],Z=-2.369,P<0.05)decreased significantly.In the PE group,the relative abundance of Bacteroidetes in T2 was lower than in T3(median[Q1,Q3]:18.16%[12.99%,30.46%]vs.31.09%[19.89%,46.06%],Z=-2.417,P<0.05).In T2,the relative abundances of mircrobiota showed no significant differences between the PE group and the control group.However,in T3,the relative abundance of Firmicutes was significantly lower in the PE group than in the control group(mean±standard deviation:60.62%±15.17%vs.75.57%±11.53%,t=-3.405,P<0.05).The relative abundances of Bacteroidetes,Proteobacteria,and Enterobacteriaceae were significantly higher in the PE group than in the control group(median[Q1,Q3]:31.09%[19.89%,46.06%]vs.18.24%[12.90%,32.04%],Z=-2.537,P<0.05;1.52%[1.05%,2.61%]vs.0.64%[0.20%,1.20%],Z=-3.310,P<0.05;0.75%[0.20%,1.00%]vs.0.01%[0.004%,0.023%],Z=-4.152,P<0.05).Linear discriminant analysis combined effect size measurements analysis showed that the relative abundances of the phylum Bacteroidetes,class Bacteroidia and order Bacteroidales were increased in the PE group,while those of the phylum Firmicutes,the class Clostridia,the order Clostridiales,and the genus unidentified Lachnospiraceae were decreased in the PE group;and these differences were identified as taxonomic biomarkers of PE in T3.Conclusion:From T2 to T3,there was an obvious alteration in the gut microbiota.The gut microbiota of PE patients in T3 was significantly different from that of the control group.

Lung-protective Ventilation in Patients with Brain Injury： A Multicenter Cross-sectional Study and Questionnaire Survey in China

Background： Over the years, the mechanical ventilation （MV） strategy has changed worldwide. The aim of the present study was to describe the ventilation practices, particularly lung-protective ventilation （LPV）, among brain-injured patients in China. Methods： This study was a multicenter, 1-day, cross-sectional study in 47 Intensive Care Units （ICUs） across China. Mechanically ventilated patients （18 years and older） with brain injury in a participating ICU during the time of the study, including traumatic brain injury, stroke, postoperation with intracranial tumor, hypoxic-ischemic encephalopathy, intracranial infection, and idiopathic epilepsy, were enrolled. Demographic data, primary diagnoses, indications for MV, MV modes and settings, and prognoses on the 60th day were collected. Multivariable logistic analysis was used to assess factors that might affect the use of LPV. Results： A total of 104 patients were enrolled in the present study, 87 （83.7%） of whom were identified with severe brain injury based on a Glasgow Coma Scale 〈8 points. Synchronized intermittent mandatory ventilation （SIMV） was the most frequent ventilator mode, accounting for 46.2% of the entire cohort. The median tidal volume was set to 8.0 ml/kg （interquartile range [IQR], 7.0-8.9 ml/kg） of the predicted body weight; 50 （48.1%） patients received LPV. The median positive end-expiratory pressure （PEEP） was set to 5 cmH20 （IQR, 5-5 cmH20）. No PEEP values were higher than 10 cmH20. Compared with partially mandatory ventilation, supportive and spontaneous ventilation practices were associated with LPV. There were no significant differences in mortality and MV duration between patients subjected to LPV and those were not. Conclusions： Among brain-injured patients in China, SIMV was the most frequent ventilation mode. Nearly one-half of the brain-injured patients received LPV. Patients under supportive and spontaneous ventilation were more likely to receive LPV.