Sepsis and delayed cerebral ischemia are associated and have a cumulative effect on poor functional outcome in aneurysmal subarachnoid hemorrhage.

Objective: Although sepsis and delayed cerebral ischemia (DCI) are severe complications in patients with aneurysmal subarachnoid hemorrhage (aSAH) and share pathophysiological features, their interrelation and additive effect on functional outcome is uncertain. We investigated the association between sepsis and DCI and their cumulative effect on functional outcome in patients with aSAH using current sepsis-3 definition. Methods: Patients admitted to our hospital between 11/2014 and 11/2018 for aSAH were retrospectively analyzed. The main explanatory variable was sepsis, diagnosed using sepsis-3 criteria. Endpoints were DCI and functional outcome at hospital discharge (modified Rankin Scale (mRS) 0-3 vs. 4-6). Propensity score matching (PSM) and multivariable logistic regressions were performed. Results: Of 238 patients with aSAH, 55 (23.1%) developed sepsis and 74 (31.1%) DCI. After PSM, aSAH patients with sepsis displayed significantly worse functional outcome (p < 0.01) and longer ICU stay (p = 0.046). Sepsis was independently associated with DCI (OR = 2.46, 95%CI: 1.28-4.72, p < 0.01). However, after exclusion of patients who developed sepsis before (OR = 1.59, 95%CI: 0.78-3.24, p = 0.21) or after DCI (OR = 0.85, 95%CI: 0.37-1.95, p = 0.70) this statistical association did not remain. Good functional outcome gradually decreased from 56.3% (76/135) in patients with neither sepsis nor DCI, to 43.8% (21/48) in those with no sepsis but DCI, to 34.5% (10/29) with sepsis but no DCI and to 7.7% (2/26) in patients with both sepsis and DCI. Conclusion: Our study demonstrates a strong association between sepsis, DCI and functional outcome in patients with aSAH and suggests a complex interplay resulting in a cumulative effect towards poor functional outcome, which warrants further studies.

Comparative Analyses of the Impact of Different Criteria for Sepsis Diagnosis on Outcome in Patients with Spontaneous Subarachnoid Hemorrhage.

Data on sepsis in patients with a subarachnoid hemorrhage (SAH) are scarce. We assessed the impact of different sepsis criteria on the outcome in an SAH cohort. Adult patients admitted to our ICU with a spontaneous SAH between 11/2014 and 11/2018 were retrospectively included. In patients developing an infection, different criteria for sepsis diagnosis (Sepsis-1, Sepsis-3_original, Sepsis-3_modified accounting for SAH-specific therapy, alternative sepsis criteria compiled of consensus conferences) were applied and their impact on functional outcome using the modified Rankin Scale (mRS) on hospital discharge and in-hospital mortality was evaluated. Of 270 SAH patients, 129 (48%) developed an infection. Depending on the underlying criteria, the incidence of sepsis and septic shock ranged between 21-46% and 9-39%. In multivariate logistic regression, the Sepsis-1 criteria were not associated with the outcome. The Sepsis-3 criteria were not associated with the functional outcome, but in shock with mortality. Alternative sepsis criteria were associated with mortality for sepsis and in shock with mortality and the functional outcome. While Sepsis-1 criteria were irrelevant for the outcome in SAH patients, septic shock, according to the Sepsis-3 criteria, adversely impacted survival. This impact was higher for the modified Sepsis-3 criteria, accounting for SAH-specific treatment. Modified Sepsis-3 and alternative sepsis criteria diagnosed septic conditions of a higher relevance for outcomes in patients with an SAH.

Response of glucosinolate and flavonoid contents and composition of Brassica rapa ssp. chinensis (L.) Hanelt to silica formulations used as insecticides.

Silica-based substances have increased in popularity in recent years as alternative insecticides in horticultural crop protection. However, no research has been conducted into the influence of silica on plant biochemistry. Formulations (Fossil Shield 90.0s, AE R974, AL-06-109, Surround) were applied electrostatically on pak choi. Plants were harvested on two dates to measure immediate (first) and decelerated (second) influence, as well as recovery following the removal of silica formulations. The predominant individual glucosinolate (GS) in pak choi Black Behi was 1-methoxy-3-indolylmethyl GS. A significant increase in total glucosinolate contents in all treatments was measured from the first to second harvest. During the first harvest, no changes in glucosinolate levels in plants were found in any of the treatments. After a 48 h recovery period, two substances showed decreased amounts for indole GS compared to the control. Flavonoids (kaempferol and isorhamnetin) decreased from the first to second harvest. Kaempferol in particular decreased in treated plants from the first to second harvest date. The shading of leaves by silica mainly caused the decrease in secondary metabolites in treated plants. Treatments with silica formulations as an alternative insecticide cause shifts in the composition and contents of bioactive secondary metabolites in Brassica rapa spp. chinensis plants and should, therefore, be used with care to control insects.

Comparison of different silicas of natural origin as possible insecticides.

Many insect-pests have developed resistances to pesticides. Therefore, there is always a need for new plant protection substances. For example the physically active insecticide diatomaceous earth (DE) gained much attention as an alternative insecticide in stored products. DE is a naturally occurring silica, which acts by destroying the insect's cuticle by absorbing the protective wax layer. This results in body water loss and ultimately the insect's death by desiccation. The silica-based materials tested were the commercial DE product Fossil Shield 90.0s, Advasan, and a formulation newly developed by the Urban Horticultural Department at Humboldt University, called Al-06. The trials were performed in small covered plastic boxes. Test substances were either dusted onto the surface of the boxes (E. vigintioctopunctata, S. litura) or mixed into rice medium (S. oryzae). The mortality was observed after 1, 2, 4, 7, 14, and 28 days. Untreated insects served as control. The first test series showed that some AL-06-formulations and FS90.0s were very effective against adults of S. oryzae and S. litura and larvae of E. vigintioctopunctata. For adult Epilachna beetles, we could not detect any differences between the treatments. The highest mortality rate in S. oryzae trials occurred with FS90.0s (100%) after 21 days. The same efficiency was achieved after 2 days with some AL-06 formulations against S. litura and E. vigintioctopunctata. The results of this study indicate that silica dusts can effectively control insect pests from different orders. At higher dosages, all materials resulted in higher insect mortality rates. It was also found that some substances did not perform well under higher rel. humidity; therefore, the conclusion was drawn that hydrophilic substances saturate with water from the surrounding air and lose their insecticidal efficacy. Earlier studies have proven that particles with a larger surface area are more effective than particles with smaller surfaces. As a result, the most effective substances in the field trials were the ones containing the small particles, since there is a larger surface area available to interact with the insects' cuticles. Further studies will be conducted to analyse the relevance of water saturation of substances in order to examine their effectiveness under greenhouse conditions. Greenhouse experiments are generally considered to study practicability of silica dusts in horticulture. Perhaps the silica dusts will show phytotoxic side effects.