Anesthesia modality does not affect clinical outcomes of intra-arterial vasodilator treatment in patients with symptomatic cerebral vasospasms.

Background: Delayed cerebral ischemia and cerebral vasospasm remain the leading causes of poor outcome in survivors of aneurysmal subarachnoid hemorrhage. Refractory cerebral vasospasms can be treated with endovascular vasodilator therapy, which can either be performed in conscious sedation or general anesthesia. The aim of this study is to compare the effect of the anesthesia modality on long-term clinical outcomes in patients undergoing endovascular vasodilator therapy due to cerebral vasospasm and hypoperfusion. Methods: Modified Rankin Scale (mRS) scores were retrospectively analyzed at time of discharge from the hospital and six months after aneurysmal subarachnoid hemorrhage. Additionally, National Institutes of Health Stroke Scale (NIHSS) was assessed 24 hours before, immediately before, immediately after, and 24 hours after endovascular vasodilator therapy, and at discharge and six months. Interventional parameters such as duration of intervention, choice and dosage of vasodilator and number of arteries treated were also recorded. Results: A total of 98 patients were included in this analysis and separated into patients who had interventions in conscious sedation, general anesthesia and a mix of both. Neither mRS at discharge nor at six months showed a significant difference for functionally independent outcomes (mRS 0-2) between groups. NIHSS before endovascular vasodilator therapy was significantly higher in patients receiving interventions in general anesthesia but did not differ anymore between groups six months after the initial bleed. Conclusion: This study did not observe a difference in outcome whether patients underwent endovascular vasodilator therapy in general anesthesia or conscious sedation for refractory cerebral vasospasms. Hence, the choice should be made for each patient individually

High strength steel in seismic resistant building frames (HSS-SERF)

The aim of “HSS-SERF” project was to investigate and evaluate the seismic performance of dual-steel building frames, realized from two different steel grades: Mild Carbon Steel (MCS) and High Strength Steel (HSS). A comprehensive set of dual-steel frames (moment resisting, concentrically and eccentrically braced) were designed, which allowed the identification of realistic member sizes for both MCS and HSS components. Several practical solutions for bolted and welded beam-to-column joints were identified and designed. Further, an extensive numerical program was carried out for the seismic performance evaluation of frames. The ductility and over-strength demands, and q-factors associated with different performance levels were evaluated. Furthermore, experimental and numerical investigations were carried out on joint assemblies and components. Guidelines were elaborated for the conceptual design and PBD of dual-steel frames under seismic actions, and the technical and economic efficiency of dualsteel structures vs. conventional ones were finally evaluated. The main outcomes of the project consist in: (i) development and characterisation in terms of global ductility and over-strength demands of dual-steel frames with composite columns (innovative solutions in European context); (ii) development of design recommendations; (iii) proposal of innovative solutions for beam-to-column joints with composite columns; (iv) recommendation for weld details and appropriate component method design approaches; (v) evaluation of technical and economic efficiency of the dual-steel approach