20%Mannitol应用在重度梗阻性黄疸手术病人的临床探讨

目的探讨如何更好地防止重度梗阻性黄疸病人术后出现的肝肾综合征。方法选择1990年6月至2004年6月间重度梗阻性黄疸173例,分成A,B二组,A组为1990年6月至1999年8月间病例128例,术中均未应用20%甘露醇(20%Mannitol),本组死亡14例,其中死于HRS者10例。B组为1998年9月以后病例,共45例,术中均在解除胆道梗阻后应用20%Mannitol进行静脉滴注,死亡2例,其中死于HRS者1例。结果经对A、B二组术前肝肾功能的比较,B组较A组差,有显著差异(P<0.05),而B组术后HRS发生率及死亡率均较A组明显降低。结论HRS对重度梗阻性黄疸手术病人存在很大危害,在适当时机应用20%Mannitol对保护肾脏有不容忽视的重要作用,是有效阻止HRS的发生、发展并提高对重度梗阻性黄疸手术病人治愈率关键。

Blood-letting punctures at twelve Jing-Well points of the hand can treat cerebral ischemia in a similar manner to mannitol

A rat model of middle cerebral artery permanent occlusion was established using the modified Longa method. Successfully established model animals were treated by blood-letting puncture at twelve Jing-Well points of the hand, and/or by injecting mannitol into the caudal vein twice daily. Brain tissue was collected at 24, 48 and 72 hours after modeling, and blood was collected through the retinal vein before Evans blue was injected, approximately 1 hour prior to harvesting of brain tissue. Results showed that Evans blue leakage into brain tissue and serum nitric oxide synthase activity were significantly increased in model rats. Treatment with blood-letting punctures at twelve Jing-Well points of the hand and/or injection of mannitol into the caudal vein reduced the amount of Evans blue leakage into the brain tissue and serum nitric oxide synthase activity to varying degrees. There was no significant difference between single treatment and combined treatment. Experimental findings indicate that blood-letting punctures at twelve Jing-Well points of the hand can decrease blood-brain barrier permeability and serum nitric oxide synthase activity in rats following middle cerebral artery occlusion, and its effect is similar to that of mannitol injection alone and Jing-Well points plus mannitol injection.

Inhibitive effects of anti-oxidative vitamins on mannitol-induced apoptosis of vascular endothelial cells

Objective: Study blood vessel injury and gene expression indicating vascular endothelial cell apoptosis induced by mannitol with and without administration of anti-oxidative vitamins. Methods: Healthy rabbits were randomly divided into four groups. Mannitol was injected into the vein of the rabbit ear in each animal. Pre-treatment prior to mannitol injection was per- formed with normal saline (group B), vitamin C (group C) and vitamin E (group D). Blood vessel injury was assessed under electron and light microscopy. In a second experiment, cell culture specimen of human umbilical vein endothelial cells were treated with mannitol. Pre-treatment was done with normal saline (sample B), vitamin C (sample C) and vitamin E (sample D). Total RNA was extracted with the original single step procedure, followed by hybridisation and analysis of gene expression. Results: In the animal experiment, serious blood vessel injury was seen in group A and group B. Group D showed light injury only, and normal tissue without pathological changes was seen in group C. Of all 330 apoptosis-related genes analysed in human cell culture specimen, no significant difference was seen after pre-treatment with normal saline, compared with the gene chip without pre-treatment. On the gene chip pre-treated with vitamin C, 45 apoptosis genes were down-regulated and 34 anti-apoptosis genes were up-regulated. Pre-treatment with vitamin E resulted in the down-regulation of 3 apoptosis genes. Conclusion: Vitamin C can protect vascular endothelial cells from mannitol-induced injury.

Polymorphism of D-mannitol:Crystal structure and the crystal growth mechanism

The polymorphism of D-Mannitol(mannitol) is reviewed in this paper. It was found that the structure of the stable form is consistent in most literatures, but different authors have given different information about the two metastable forms. Therefore the commonly used nomenclature of mannitol was summarized based on the crystal unit cell parameters with the help of X-ray powder diffraction. Moreover, the crystal growth mechanism of mannitol polymorphs was summarized. Considering the lack of kinetic data for the metastable form especially, a reported method was attempted to apply to δ mannitol in an aqueous cooling crystallization process based on the induction time previously measured, and it was identified that the growth of the δ form follows the two-dimensional(2D) nucleationmediated mechanism. The results also indicate that the method based on induction time and supersaturation should have the potential to be expanded to the metastable polymorphs for the growth property study in a bulk system.

Evaluation of mannitol effect in patients with acute hepatic failure and acute-on-chronic liver failure using conventional MRI,diffusion tensor imaging and in-vivo proton MR spectroscopy

AIM： To evaluate the effect of an intravenous bolus of mannitol in altering brain metabolites, brain water content, brain parenchyma volume, cerebrospinal fluid （CSF） volume and clinical signs in controls and in patients with acute liver failure （ALF） and acute- on-chronic liver failure （ACLF）, by comparing changes in conventional magnetic resonance imaging （MRI）, in vivo proton magnetic resonance spectroscopy （PMRS） and diffusion tensor imaging （DTI） before and after its infusion.METHODS： Five patients each with ALF and ACLF in grade 3 or 4 hepatic encephalopathy and with clinical signs of raised intracranial pressure were studied along with five healthy volunteers. After baseline MRI, an intravenous bolus of 20% mannitol solution was given over 10 min in controls as well as in patients with ALF and ACLE Repeat MRI for the same position was acquired 30 rnin after completing the rnannitol injection. RESULTS： No statistically significant difference was observed between controls and patients with ALF and ACLF in metabolite ratios, DTI metrics and brain volume or CSF volume following 45 rain of mannitol infusion. There was no change in clinical status at the end of post-mannitol imaging. CONCLUSION： The osmotic effect of mannitol did not result in significant reduction of brain water content, alteration in metabolite ratios or any change in the clinical status of these patients during or within 45 min of mannitol infusion.

Paradoxical herniation after decompressive craniectomy provoked by mannitol:A case report

BACKGROUND Paradoxical transtentorial herniation is a rare but life-threatening complication of cerebrospinal fluid drainage in patients with large decompressive craniectomy.However,paradoxical transtentorial herniation after rapid intravenous infusion of mannitol has not been reported yet.CASE SUMMARY A 48-year-old male suffered from a right temporal vascular malformation with hemorrhage.In a coma,the patient was given emergency vascular malformation resection,hematoma removal,and the right decompressive craniectomy.The patient woke up on the 1st d after the operation and was given 50 g of 20% mannitol intravenously every 8 h without cerebrospinal fluid drainage.On the morning of the 7th postoperative day,after 50 g of 20% mannitol infusion in the Fowler’s position,the neurological function of the patient continued to deteriorate,and the right pupils dilated to 4 mm and the left to 2 mm.Additionally,computed tomography revealed an increasing midline shift and transtentorial herniation.The patient was placed in a supine position and given 0.9% saline intravenously.A few hours later,the patient was fully awake with purposeful movements on his right side and normal communication.CONCLUSION Paradoxical herniation may occur,although rarely,after infusing high-dose mannitol intravenously in the Fowler’s position in the case of a large craniectomy defect.An attempt should be made to place the patient in the supine position because this simple maneuver may be life-saving.Do not use high-dose mannitol when the flap is severely sunken.

Effect of Glycerol Fructose Combined with Mannitol on Patients with Cerebral Hemorrhage and Cerebral Edema

Objective:To observe the effect of glycerol fructose combined with mannitol in the treatment of patients with clinical intracerebral hemorrhage complicated by cerebral edema and increased intracranial pressure,and to evaluate the clinical application value of this treatment.Methods:Seventy patients with cerebral hemorrhage complicated by brain edema were randomly divided into observation and control groups.Both groups had exactly the same number of study participants.There were some differences in specific treatment methods.The specific process is as follows:The control group was treated with mannitol,while the observation group was treated with dual-purpose glycerol fructose.Several important indicators after treatment in the two groups were scored,the effects between different groups were compared,and the effect of clinical treatment was evaluated.Results:The final effect was compared and analyzed.After data analysis,we found that the intracranial pressure of the observation group was lower,the volume of brain edema was significantly reduced(P<0.05),and the NIH Stroke Scale/Score(NIHSS)was lower(P<0.05).Conclusion:Using mannitol combined with glycerol fructose can achieve better treatment effect by significantly improving the problem of brain edema.

Densities and Viscosities of the Quaternary System Mannitol-Sorbitol- D-Glucose-H2O and Its Ternary Subsystems at 298.15K

To check the applicabilities of the simple density equation and viscosity equation in the semi-ideal solution theory to nonelectrolyte solutions, the densities and viscosities were measured for the quaternary system mannitol-sorbitol-D-glucose-HzO and its ternary subsystems mannitol-D-glucose-H2O and sorbitol-D-glucose-H2O at 298.15K. The results were used to test the applicability of the simple equations for the density and viscosity of the multicomponent nonelectrolyte solution. The agreements between the predicted and measured results are good.

Protective effect of controlled reperfusion with warm blood cardioplegia containing mannitol on mitochondrial function after myocardial ischemia

It is known that reperfusion injury occurs after reperfusion with normal blood in ischemic myocardium. Using the cat cardiopulmonary bypass model, this study documented that myocardial mitochondrial function was sigmficantly depressed 60min after reperfusion, but was only slightly depressed in the controlled reperfusion group. Significantly increased MDA content and decreased activity of SOD was observed 60 min after reperfusion, whereas in the controlled reperfusion group, the MDA content was low and the activity of SOD was protected. These results indicate that controlled reperfusion with warm blood cardioplegia containing mannitol after ischemia provides benefit in avoiding myocardial mitochondrial reperfusion injury by preventing or reducing a potentially harmful component of reperfusion.

The research progress in external application of physic liquor exosmosis in mannitol intravenous infusion

Mannitol is the first choice of clinical dehydrating agent, which can alleviate brain edema and reduce intracranial pressure. As a hypertonic solution, it has strong vascular irritation. Moreover, fast infusion speed is required, which can be related to pain, physic liquor exomosis and some other side effects. Regarding of the physic liquor exosmosis in mannitol intravenous infusion, this paper reviewed the research progress of different external application treatment, and provided references for clinical treatment of physic liquor exosmosis in mannitol intravenous infusion.

Is mannitol combined with furosemide a new treatment for refractory lymphedema?A case report

BACKGROUND Mannitol is a hyperosmolar agent and the combination of mannitol and furosemide is a widely used treatment for intracranial pressure control.Considering the hypertonic properties of mannitol to move water out of intracellular spaces,we hypothesized that mannitol combined with furosemide could relieve focal tissue swelling in refractory lymphedema.CASE SUMMARY A 90-year-old female had been diagnosed with intracranial hemorrhage and received a combination of mannitol and furosemide for intracranial pressure control.Independent of the intracranial hemorrhage,she had refractory lymphedema of the left lower extremity since 1998.Remarkably,after receiving the mannitol and furosemide,the patient’s lower extremity lymphedema improved dramatically.After the mannitol and furosemide were discontinued,the lymphedema worsened in spite of complete decongestive therapy(CDT)and intermittent pneumatic compression treatment(IPC).To identify the presumed effect of mannitol and furosemide on the lymphedema,these agents were resumed,and the lymphedema improved again.CONCLUSION The present case raises the possibility that a combination of mannitol and furosemide might be considered another effective therapeutic option for refractory lymphedema when CDT and IPC are ineffective.

Comparison of treatment guidance based on bronchial responsiveness to mannitol, spirometry or exhaled nitric oxide in stable asthmatic children

Aim: The goal of this study was to compare asthma treatment guidance based on bronchial hyper-responsiveness to mannitol, spirometry or exhaled nitric oxide (FeNO) in stable asthmatic children. Methods: 60 stable allergic asthmatic children aged 7 to 16 years on a low to medium dose treatment with inhaled corticosteroids (ICS) were recruited to a double blind randomised controlled trial. At study entry (visit 1), the following was assessed: FeNO, spirometry, bronchial hyper-responsiveness to mannitol (MDP-?test), quality of life (paediatric asthma quality-of-life questionnaire;PAQLQ) and asthma control (asthma control test;ACT). Subjects were randomly assigned to one of three groups and treatment was modified by a blinded respiratory physician according to the test results of visit 1: ICS dose was doubled when FeNO was >22 ppb (group 1), in case of a positive MDP-test (group 2) or when FEV1 was <80% of a predicted one (group 3), respectively, or remained unchanged for the remaining subjects. After 3 months (visit 2), the subjects were reassessed and all tests were repeated. Results: 48 children successfully completed the study. At the first visit, 8 out of 16 (50%) children in group 1 showed a FeNO > 22 ppb, 8 children out of 16 (50%) in group 2 showed a positive MDP-test and 3 children out of 16 (18.7%) in group 3 had a FEV1 < 80% of that predicted and had their ICS-dose doubled. In group 1, FeNO decreased significantly after the intervention (p = 0.005), whereas the self-administered and the interviewer-administered PAQLQ (p = 0.02 resp. p = 0.033) as well as the ACT (p = 0.031) increased. Neither the number of children with a positive mannitol challenge nor spirometric results changed significantly. In group 2 and group 3, there were no significant changes in none of the assessed parameters. Conclusion: In this small pragmatic double blind randomised controlled study, we showed that ICS dose modification based on FeNO led to increased quality of life and enhanced asthma control, and to a reduction in airway inflammation and was superior to treatment modifications based on bronchial hyper-responsiveness to mannitol or on FEV1.

Comparison between Hypertonic Saline with Dextran and Mannitol on Vasodilatation of Encephalic Vessels Using a Magnetic Resonance Imaging in the Dogs

This study aimed to investigate whether a small volume of 7.2% hypertonic saline solution with 6% dextran 70 (HSD) is superior to mannitol in vasodilatation of encephalic vessels in the dogs using magnetic resonance imaging (MRI). Fifteen healthy 2.4 ± 0.9 year-old purpose-bred male Beagle dogs were assigned to receive 5 mL/kg of isotonic saline solution (ISS) as control, 20% mannitol or HSD infusion at a flow rate of 20 mL/kg/hours via right cephalic vein.Venous blood samples were collected immediately before fluid infusion (pre) and every 15 minutes until 120 minutes after the initiation of fluid infusion. Immediately after collection of each blood sample, T1 and T2-weighted magnetic resonance imaging recordings were undergone. Immediately after HSD infusion, the area of the cross-section of superior sagittal sinus was significantly greater than that of beagles in the other groups (p p < 0.001). Our results indicate that HSD induced a rapid and strong reduction in the area of the cross-section of CSF more than mannitol did. Therefore, it is suggested that 5 mL/kg of HSD might be superior to isovolume of mannitol in inducing vasodilatation in the dog.

Mannitol and Sorbitol Improve Uniformity of Adventitious Shoots Regeneration in Echinacea purpurea L. Moench

Mannitol or sorbitol was added into the Murashige and Skoog (MS) medium contain-ing certain concentrations of 6-Benzyladenine (BA) which was used to induce adventi-tious buds of Echinacea purpurea L. Results showed that the induced adventitious buds growing from medium added with 15 g·L-1 mannitol or sorbitol of the same con-centration were more consistent in height. The regeneration rates in MS medium containing 0.2 mg·L-1 BA and 15 g·L-1 mannitol were increased, while in MS medium containing 0.2 and 0.5 mg·L-1 BA, and 15 g·L-1 sorbitol, the regeneration rates were suppressed. On the other hand, genotype of explants and the concentration of BA in-fluenced the incidence of hyperhydricity, and the hyperhydricity of regenerated buds was more severe when the petiole explants were inoculated on medium with 15 g·L-1 mannitol or 15 g·L-1 sorbitol. The present study offers new possibility to the production of uniform plantlets for commercial cultivation in this important medicinal plant.

Comparative Heat Transfer Data for Solid-Liquid Phase Change of D-Mannitol and Adipic Acid

The goal of this work was to measure the heat transfer rates from thermofluid, Therminol 66, to two phase change materials, D-mannitol and adipic acid. It concerns the determination of heat transfer coefficients for the design of a concentrated solar energy plant requiring PCM thermal energy storage and is part of a wider set of experiments, where several PCMs were tested. An experimental installation was used with a cylindrical vessel with three tubes disposed almost horizontally (5°inclination), containing the phase change material, around which the thermal fluid flowed almost perpendicular to the tubes. The experimental installation allowed to recreate heating and cooling cycles. In order to evaluate the influence of the flow on the rate at which the heating and cooling processes took place, tests were performed at different thermofluid mass flow rates, concluding that there is no great influence, since the thermal resistance inside the tubes is much higher than on the outside. D-mannitol and adipic acid, present different phase change temperatures, 164°C for D-mannitol and 152°C for adipic acid. The average heat transfer coefficient, during the phase change process, was of 340 W/(m2K) for D-mannitol and 1320 W/(m2K) for adipic acid.

Optical coherence tomography findings in a case of cilioretinal artery occlusion reversal,treated with mannitol and carbogen administration

To present spectral domain optical coherence tomography(OCT)findings during treatment in a case of acute isolated cilioretinal artery occlusion(CLRAO)reversed with intravenous systemic administration of mannitol and carbogen inhalation.Close monitoring with OCT thickness topographic map and cross section scans,every 12 hours,during treatment and till complete reversal of retinal nerve fiber layer edema.Fundus photography and fluorescein angiography(FFA)were used to illustrate occlusion and recanalization.After 72 hours of therapy,visual acuity improved from counting fingers(CF)to 7/10,Snellen’s chart.Consecutively OCT scans showed that the initial macular edema was gradually restored to typical 72 hours of treatment initiation.FFA performed after treatment confirmed recanalization of the cilioretinal artery.Early intervention with the combined intravenous administration of mannitol and carbogen inhalation can reverse acute onset loss of vision due to CLRAO.The reflectivity of retinal layers differs significantly regarding stages of acute CLRAO.In our case report increased reflectivity of the innermost layers of the retina was illustrated and a corresponding reduction in the outer retina and the retinal pigment epithelium and choriocapillaris layers.Macular thickness follow-up data recorded the course of intracellular edema to normal.

Mannitol inhibits the proliferation of neural stem cell by a p38 mitogen-activated protein kinase-dependent signaling pathway

Purpose:Mannitol is one of the first-line drugs for reducing cerebral edema through increasing the extracellular osmotic pressure.However,long-term administration of mannitol in the treatment of cerebral edema triggers damage to neurons and astrocytes.Given that neural stem cell(NSC)is a subpopulation of main regenerative cells in the central nervous system after injury,the effect of mannitol on NSC is still elusive.The present study aims to elucidate the role of mannitol in NSC proliferation.Methods:C57 mice were derived from the animal house of Zunyi Medical University.A total of 15 pregnant mice were employed for the purpose of isolating NSCs in this investigation.Initially,mouse primary NSCs were isolated from the embryonic cortex of mice and subsequently identified through immunofluorescence staining.In order to investigate the impact of mannitol on NSC proliferation,both cell counting kit-8 assays and neurospheres formation assays were conducted.Thein vitro effects of mannitol were examined at various doses and time points.In order to elucidate the role of Aquaporin 4(AQP4)in the suppressive effect of mannitol on NSC proliferation,various assays including reverse transcription polymerase chain reaction,western blotting,and immunocytochemistry were conducted on control and mannitol-treated groups.Additionally,the phosphorylated p38(p-p38)was examined to explore the potential mechanism underlying the inhibitory effect of mannitol on NSC proliferation.Finally,to further confirm the involvement of the p38 mitogen-activated protein kinase-dependent(MAPK)signaling pathway in the observed inhibition of NSC proliferation by mannitol,SB203580 was employed.All data were analyzed using SPSS 20.0 software(SPSS,Inc.,Chicago,IL).The statistical analysis among multiple comparisons was performed using one-way analysis of variance(ANOVA),followed by Turkey’’s post hoc test in case of the data following a normal distribution using a Shapiro-Wilk normality test.Comparisons between 2 groups were determined using Student’s t-test,if the data exhibited a normal distribution using a Shapiro-Wilk normality test.Meanwhile,data were shown as median and interquartile range and analyzed using the Mann-WhitneyU test,if the data failed the normality test.A p<0.05 was considered as significant difference.Results:Primary NSC were isolated from the mice,and the characteristics were identified using immunostaining analysis.Thereafter,the results indicated that mannitol held the capability of inhibiting NSC proliferation in a dose-dependent and time-dependent manner using cell counting kit-8,neurospheres formation,and immunostaining of Nestin and Ki67 assays.During the process of mannitol suppressing NSC proliferation,the expression of AQP4 mRNA and protein was downregulated,while the gene expression of p-p38 was elevated by reverse transcription polymerase chain reaction,immunostaining,and western blotting assays.Subsequently,the administration of SB203580,one of the p38 MAPK signaling pathway inhibitors,partially abrogated this inhibitory effect resulting from mannitol,supporting the fact that the p38 MAPK signaling pathway participated in curbing NSC proliferation induced by mannitol.Conclusions:Mannitol inhibits NSC proliferation through downregulating AQP4,while upregulating the expression of p-p38 MAPK.

甘露醇对草菇继代菌株生产性状和ROS清除能力的影响

【目的】研究甘露醇对草菇继代菌株的生产性状和活性氧(ROS)清除能力的影响,探索一种简便、有效的草菇退化菌种复壮方法。【方法】以笔者课题组前期获得的组织分离继代菌株T6、T12、T19为试验菌株,T6为连续继代6次,T12为连续继代12次,T19为连续继代19次;草菇原种V844(T0)为商业栽培种。将传统马铃薯葡萄糖琼脂培养基(PDA)中的葡萄糖替换为等质量的甘露醇,进行菌丝生理性状测定;在栽培基质中添加甘露醇,测定子实体农艺学性状;以硝基四氮唑蓝(NBT)染色、超氧阴离子(O_(2))、过氧化氢(H_(2)O_(2))含量反映活性氧(ROS)积累;采用实时荧光定量PCR(RT-qPCR)测定抗氧化酶基因表达量;利用试剂盒测定抗氧化酶活力;通过菌丝染色法测定细胞核数量和线粒体膜电位;利用高效液相色谱仪(HPLC)测定菌丝能量指标。【结果】甘露醇处理对未退化菌株T0、T6的影响不显著,但能有效恢复草菇退化菌株T12、T19的生产性状和ROS清除能力。甘露醇使T12、T19的菌丝生长速度分别提高31.46%、20.99%,菌丝生物量分别提高97.33%、76.36%;使T12的生产周期缩短12.24%,生物学效率提高17.97%,恢复至T0水平;并使退化严重、失去出菇能力的T19重新长出子实体。同时,甘露醇使T12、T19的Cu/Zn超氧化物歧化酶基因(Cu/Zn-sod)相对表达量分别上调24.64%和61.54%,Mn-sod2相对表达量分别上调19.76%和267.09%,谷胱甘肽过氧化物酶基因(gpx)相对表达量分别上调25.67%和55.82%,并使SOD活力分别提高10.79%和72.32%,GPX活力分别提高16.98%和103.85%;使T12、T19中的ROS积累量显著降低,T12、T19中的O_(2)含量分别下降35.96%和41.62%,H_(2)O_(2)含量分别下降14.44%和18.26%;并使T12、T19的细胞核数目和线粒体膜电位显著增加;使T12、T19中的ATP含量分别提高17.08%和14.55%,EC值分别提高4.52%和0.92%。【结论】甘露醇能显著提高草菇退化菌株T12、T19的抗氧化能力和线粒体功能,并有效恢复其生产性状。

The role of singlet oxygen and hydroxyl radical in the photobleaching of meso-substituted cationic pyridyl porphyrins in the presence of folic acid

Using a photosensitizer(PS),light,and oxygen,photodynamic therapy creates cytotoxic reactive oxygen species,such as singlet oxygen(1O2),that kill cancer cells.Many cancer cell lines have up to 300 times more folic acid receptors than healthy cells.Therefore,folic acid is often used to improve selectivity of PSs.Photobleaching poses a disadvantage for PSs.In this paper,we have studied the photoinduced changes of meso-substituted cationic pyridyl porphyrins in the presence of folic acid using uorescence and absorption spectroscopy.In this work,it was demonstrated that L-histidine,which is a 1O2 quencher,and D-mannitol,which is a hydroxyl radical quencher,can reduce photobleaching of cationic porphyrins and their interaction products with FA.This implies both singlet oxygen and hydroxyl radicals are involved in photobleaching.Additionally,our study revealed certain important features of the photobleaching of cationic porphyrins in the presence of folic acid.

Paradoxical herniation associated with hyperbaric oxygen therapy after decompressive craniectomy: A case report

BACKGROUND Whether hyperbaric oxygen therapy(HBOT)can cause paradoxical herniation is still unclear.CASE SUMMARY A 65-year-old patient who was comatose due to brain trauma underwent decompressive craniotomy and gradually regained consciousness after surgery.HBOT was administered 22 d after surgery due to speech impairment.Paradoxical herniation appeared on the second day after treatment,and the patient’s condition worsened after receiving mannitol treatment at the rehabilitation hospital.After timely skull repair,the paradoxical herniation was resolved,and the patient regained consciousness and had a good recovery as observed at the follow-up visit.CONCLUSION Paradoxical herniation is rare and may be caused by HBOT.However,the underlying mechanism is unknown,and the understanding of this phenomenon is insufficient.The use of mannitol may worsen this condition.Timely skull repair can treat paradoxical herniation and prevent serious complications.