Effect of Prone Position Ventilation in Patients with Severe Craniocerebral Injury Complicated with Pulmonary Infection

Objective:To investigate the effects of prone ventilation in patients with severe traumatic brain injury combined with pulmonary infection.Methods:A total of 100 patients with severe traumatic brain injury combined with pulmonary infection in the hospital were randomly divided into a prone ventilation group and a conventional ventilation group,with 50 patients in each group.The Glasgow Coma Scale(GCS)score,APACHE II score,sputum culture results,oxygenation indicators,and prognosis were compared between the two groups.Data were processed using SPSS 25.0 statistical software,and t-tests and chi-square tests were used to compare continuous and categorical variables,respectively.Results:The experimental group showed better oxygenation indicators,a lower positive rate of sputum cultures,and reduced intracranial pressure compared to the control group(all P<0.05).Multivariate Cox regression analysis indicated that GCS score,APACHE II score,and prone ventilation were independent risk factors affecting patient prognosis(all P<0.05).Conclusion:Prone ventilation can improve oxygenation,reduce the risk of pulmonary infection,and decrease intracranial pressure in patients with severe traumatic brain injury combined with pulmonary infection,thereby improving patient prognosis.GCS score and APACHE II score can serve as important indicators for prognostic evaluation.

Application effect for a care bundle in optimizing nursing of patients with severe craniocerebral injury

BACKGROUND Severe craniocerebral injury(STBI)is a critical physical trauma caused by a sudden external force acting on the head.The condition is complex and changeable,and disability and mortality rates are high.Although the life of STBI patients can be saved through treatment,the sequelae of consciousness,speech,cognitive impairment,stiffness,spasm,pain and abnormal behavior in the early rehabilitation stage can be a heavy burden to a family.In the past,routine nursing was often used to treat/manage STBI;however,problems,such as improper cooperation and untimely communication,reduced therapeutic effectiveness.AIM To investigate the effect of a proposed care bundle to optimize the first aid process and assess its effectiveness on the early rehabilitation nursing of patients with STBI.METHODS From January 2019 to December 2020,126 STBI patients were admitted to the emergency department of Chongqing Emergency Medical Center.These patients were retrospectively selected as the research participants in the current study.The study participants were then divided into a control group(61 cases)and a study group(65 cases).The control group was treated with routine nursing.The study group adopted the proposed care bundle.The National Institutes of Health Stroke Scale/Score and Glasgow Coma Scale(GCS)were used to evaluate neurological function before and after emergency treatment.After 3 mo of rehabilitation,experimental outcomes were assessed.These included the GCS,Barthel Index,complication rate,muscle strength grade and satisfaction.RESULTS There was no significant difference in gender,age,cause of injury and GCS between the two groups.After emergency,the National Institutes of Health Stroke Scale/Score of the study group(10.23±3.26)was lower than that of the control group(14.79±3.14).The GCS score of the study group(12.48±2.38)was higher than that of the control group(9.32±2.01).The arrival time of consultation in the study group was 20.56±19.12,and the retention time in the emergency room was 45.12±10.21,which were significantly shorter than those in the control group.After 3 mo of rehabilitation management,the GCS and Barthel Index of the study group were 14.56±3.75 and 58.14±12.14,respectively,which were significantly higher than those of the control group.The incidence of complications in the study group(15.38%)was significantly lower than that in the control group(32.79%).The proportion of muscle strength≥grade III in the study group(89.23%)was significantly higher than that in the control group(50.82%).The satisfaction of patients in the study group was significantly higher than that in the control group.CONCLUSION Care bundles are used to optimize the nursing process.During first-aid,care bundles can effectively improve the rescue effect and improve neurological function of STBI patients as well as shorten the treatment time.In early rehabilitation,they can effectively improve the consciousness of STBI patients,improve the activities of daily living,reduce the risk of complications,accelerate the recovery of muscle strength and improve their satisfaction.

Curative effect of ganglioside sodium for adjuvant therapy on acute severe craniocerebral injury

Objective: To study the effect of adjuvant therapy of ganglioside sodium on intracranial pressure (ICP), partial pressure of brain tissue oxygen (PbtO2), nerve injury molecules, nerve protection molecules and indexes of oxidative stress in patients with acute severe craniocerebral injury. <br> Methods: Forty-seven patients with severe craniocerebral injury treated in the emergency department of our hospital during the period time from December 2012 to October 2015 were selected for retrospective analyses. They were divided into the ganglioside group and the normal treatment group according to the usage of ganglioside sodium in the process of the emergency treatment. At days 1, 3, 5 and 7 before and after treatment, theICP and PbtO2 in patients of the two groups were measured. After 7 days of treatment, the nerve injury molecules, nerve protection molecules and the indexes of oxidative stress in serum of the patients of the two groups were determined. <br> Results: At days 1, 3, 5 and 7 before and after treatment, theICP in patients of the ganglioside group were all significantly lower than those of the normal treatment group, while the PbtO2 were all significantly higher than those of normal treatment group. After 7 days of treatment, the contents of serum methane dicarboxylic aldehyde, advanced oxidation protein products, 8-hydroxy-2'-deoxyguanosine urine, S100β, glial fibrillary acidic portein, neuron specific enolase, myelin basic protein, neuroglobin and ubiquitin carboxyl-terminal hydrolase L1 in patients of the ganglioside group were notably lower than those of the normal treatment group, while the contents of superoxidase dismutase, glutathione peroxidase, catalase, nerve growth factor and brain derived neurotrophic factor were significantly higher than those of the normal treatment group. <br> Conclusions: The adjuvant therapy of ganglioside sodium in patients with severe craniocerebral injury can effectively reduceICP, improve PbtO2 and alleviate the injuries of neurons and glial cells caused by oxidative stress.

Successful management of severe hypoglycemia induced by total parenteral nutrition in patients with hepatocellular injury: Three cases reports

BACKGROUND Glucose imbalance is common in total parenteral nutrition(TPN).Hypoglycemia seems to be less frequent than hyperglycemia,but it influences the clinical outcome to a greater extent.Therefore,it should be effectively prevented and treated.However,there is no relevant report on how to treat hypoglycemia caused by TPN in patients with liver cell injury.CASE SUMMARY We present three patients with liver cell injury who developed severe hypo-glycemia during or after TPN infusion.The causes of severe hypoglycemia and glucose-raising strategies were discussed.According to the physiological charac-teristics of the hepatocellular injury,the ratio of nutrition components prescribed in TPN was appropriately adjusted for the three cases.We simultaneously reduced the dose of insulin and fat emulsion,and increased the dose of glucose in TPN.The blood glucose level was restored to normal range and clinical symptoms were eliminated.CONCLUSION When hypoglycemia occurs during or after TPN in patients with hepatocellular injury,physicians need to simultaneously reduce insulin and fat emulsion,and increase glucose,and correct severe hypoglycemia in time to reduce its adverse consequences.

Effects of mild hypothermia on cerebral oxygen metabolism and brain injury in patients with severe craniocerebral injury

Objective: To investigate the effects of mild hypothermia on cerebral oxygen metabolism and brain injury in patients with severe craniocerebral injury. Methods: A total of 78 patients with severe craniocerebral injury who underwent emergency treatment in Huanggang Central Hospital between September 2015 and May 2017 were selected as the research subjects and divided into control group (n=39) and mild hypothermia group (n=39) by random number table. Control group received clinical standard large trauma craniotomy for severe craniocerebral injury, and mild hypothermia group received routine surgery and postoperative mild hypothermia therapy. The cerebral oxygen metabolism and brain injury in two groups of patients were detected immediately after admission (T0), 1 week after treatment (T1) and 4 weeks after treatment (T2). Results: At T0, there was no statistically significant difference in the levels of cerebral oxygen metabolism indexes, cerebral blood flow parameters and brain injury markers between the two groups. At T1 and T2, PO2 levels in mild hypothermia group were higher than those in control group while Da-jvO2 levels were lower than those in control group;cerebral blood flow parameters Vs and Wv levels were higher than those in control group while PI levels were lower than those in control group;brain injury markers MBP, AQP-4 and S-100B contents were lower than those in control group while BDNF contents were higher than those in control group. Conclusion: Adjuvant mild hypothermia therapy after routine surgery may further reduce the cerebral oxygen metabolism and relieve the brain injury in patients with severe craniocerebral injury.

Prognostic Factors for Mortality in Severe Traumatic Brain Injury at HGZ 46, Villahermosa, Tabasco, Period from March 1, 2021 to December 31, 2022

Introduction: A traumatic brain injury (TBI) is caused by a forceful bump, blow, or jolt to the head or body, or by an object that pierces the skull and interrupts the normal function of the brain. Severe TBI is estimated at 73 cases per 100,000 people. The mortality of severe TBI can be reduced if a timely diagnosis and treatment of the injuries are made through prognostic factors. Objective: To determine the prognostic factors related to mortality in severe traumatic brain injury at the Hospital General de Zona No. 46. Material and Methods: Retrospective, cross-sectional and descriptive study in beneficiaries admitted to the Hospital General de Zona (HGZ) No. 46 of the Mexican Institute of Social Security (IMSS by its acronym in Spanish), with a diagnosis of severe TBI;the possible prognostic factors related to mortality of severe TBI were obtained from their records. Measures of central tendency and chi square were used for data analysis. Results: The study sample consisted of 60 subjects diagnosed with severe traumatic brain injury, of which 5 (8%) were women and 55 (92%) were men, and all 60 (100%) patients died. The average age of the sample was 26 with a standard deviation of 9 years. The variables that had a p value less than or equal to 0.05 were: Mydriasis, seizures, Hyperglycemia, Normoglycemia, Hypothermia and Hypotension. This means that these variables were associated with mortality. Conclusion: Statistical significance is demonstrated in prognostic factors of mortality in severe traumatic brain injury with p < 0.05 in the case of mydriasis, seizures, hyperglycemia, normoglycemia, hypothermia and hypotension.

Analysis of Enteral Nutritional Value in Severe Craniocerebral Injury

Objective.This study will analyze the clinical value of enteral nutrition treatment in patients with severe craniocerebral injury and discuss the safety of this treatment.Methods.This study selected patients who were treated in the hospital from January 2017 to December 2018.After the screening,all patients were diagnosed as severe craniocerebral injury.Fortyfour patients who have met the experimental criteria were undergone enteral nutrition treatment to improve the condition.The success rate of catheterization and the changes in patient’s vital signs were analyzed.Especially the effect on the disease after the insertion of nasogastric tubing for nutritional treatment.Results.From the treatment results,the success rate of catheterization was 95.45%(42/44).In term of the timeline,the average was(36.5±2.7)min,the shortest time was 30 minutes and the longest time was no more than 5 minutes.The vital signs were stable before and after treatment and no complications such as arrhythmia.For those 42 successful patients,the average time for jejunal nutrition therapy was(36.2±4.1)days,the shortest was 27 days while the longest was 53 days and no adverse cases occurred.Conclusion.Enteral nutrition has a clinical application on patients with severe craniocerebral injury and can meet the nutritional needs of patients.Moreover,it has a high degree of feasibility and safety which is conducive to the early recovery of patients and has been well received.

Clinical Evaluation of Enteral Nutrition+Probiotics in the Treatment of Gastrointestinal Dysfunction After Severe Traumatic Brain Injury

Objective:To evaluate the therapeutic effect of enteral nutrition+probiotics in patients with gastrointestinal dysfunction after severe craniocerebral injury.Methods:From September 2018 to February 2023,80 patients(20-82 years old)with gastrointestinal dysfunction who were admitted to the Intensive Care Unit at the Third People’s Hospital of Xining were included in the study.Their primary condition was severe craniocerebral injury,and all of them received conventional symptomatic treatment.Group A received enteral nutrition+probiotic therapy,whereas group B received enteral nutrition only.The differences in the following indicators were compared before and after treatment:nutritional and biochemical indicators,gastrointestinal function indicators,Glasgow Coma Scale(GCS),Sequential Organ Failure Assessment(SOFA),APACHE II score,serum procalcitonin(PCT),neutrophil(N)ratio,and C reactive protein(CRP).Result:The nutritional and biochemical indicators in group A were higher than those in group B,P<0.05;the time to first passage of flatus,time to first passage of stool,and bowel sound recovery time in group A were shorter than those in group B,P<0.05;the GCS of group A was higher than that of group B,P<0.05;the SOFA and APACHEⅡscores of group A were not different from those of group B,P>0.05;and the PCT,N ratio,and CRP levels of group A were lower than those of group B,P<0.05.Conclusion:In patients with gastrointestinal dysfunction after severe craniocerebral injury,enteral nutrition+probiotic therapy is highly effective and feasible,as it can optimize various nutritional indicators,shorten the gastrointestinal function recovery time,and reduce the body’s stress response.

Effect of dexmedetomidine on the prevention of PSH in patients with severe craniocerebral injury by regulating TLR4/My D88/NF-kappa B signaling pathway

Objective:To investigate the clinical efficacy of dexmedetomidine in the regulation of TLR4/My D88/NF-κB in the prevention of paroxysmal sympathetic over-excitation (PSH) in patients with severe head injury. Methods:One hundred patients with severe head injury who were admitted to our hospital from September 2016 to May 2019 were enrolled. The randomized digital table method was divided into 50 cases in the study group and the control group. Patients in the study group were given dexmedetomidine at a dose of 1.0 μg/kg before anesthesia induction, followed by infusion at 0.4 μg / (kg·h), and the control group was injected with the same amount of normal saline. The incidence of PSH, clinical symptoms, imaging findings, mechanical ventilation time, tracheal intubation/incision duration, ICU hospitalization time, total length of hospital stay, and GCS scores three months after discharge were compared between the two groups. At the same time, the fluorescence intensity, TLR4, NF-κB expression level and tumor necrosis factor-α (TNF-α) expression levels in peripheral blood CD14+ monocytes of the two groups were detected. Results:The incidence of PSH was significantly lower in the study group than in the control group at 7 and 3 months (P<0.05). The total length of hospital stay, duration of ICU hospitalization, intraoperative tracheotomy, and mechanical ventilation time were significantly lower in the study group than in the control group. And the GCS score was higher than the control group, and the difference was statistically significant (P<0.05). In addition, the imaging results showed that there were some differences in the location of imaging lesions between the two groups. The proportion of lesions in the ventricular system and surrounding areas was higher in the control group than in the study group (P<0.05). And the T14-T3 CD14+ PBMC MyD88 fluorescence intensity, TLR4 and NK-κB positive expression rate were significantly higher than those of T0 (P<0.05), but the MyD88 fluorescence intensity, TLR4 and NK-κB positive expression rate in the study group were significantly lower than those in the control group at T1~T3 (P<0.05). The levels of serum TNF-α in T1~T3 groups were significantly higher than those in T0 (P<0.05), but the levels of serum TNF-α in T1~T3 in the study group were significantly lower than those in the control group (P< 0.05). Conclusions:Dexmedetomidine can reduce the oxidative stress response in patients with severe head injury by inhibiting TLR4/My D88/NF-κB signaling pathway, thus effectively reducing the risk of PSH and improving the prognosis of patients.

Clinical Observation on Effect of Xuesaitong Injection (血塞通注射液) as Auxiliary Treatment of Severe Craniocerebral Injury

Objective To evaluate the effect of Xuesai-tong injection (XSTI, 血塞通注射液 , a preparation of Panax Notoginseng) as auxilliary treatment of severe craniocerebral injury. Methods Eighty-seven patients with severe craniocerebral injury were selected and randomly divided into the treated group (n=44) and the control group (n = 43), they were treated with conventional treatment, and XSTI was given additionally to the treated group. Intracranial pressure (ICP) and Glasgow coma score (GCS) of all patients were measuredafter 1 or 2-week treatment, and Glasgow outcome scale (GOS) of them was determined 3 months later. Then the therapeutic effect in the two groups were compared. Results After treatment, the ICP was lower, GCS higher and GOS better in the treated group than those in the control group significantly, all showing statistical significance (P<0.05). Conclusion XSTI has marked clinical therapeutic effect in treating patients with severe craniocerebral injury.Original article on CJITWM (Chin) 2004 ;23 (3): 213

Effect of edaravone combined with cattle encephalon glycoside and ignotin injection adjuvant therapy on nerve function impairment in patients with severe craniocerebral injury

Objective:To study the effect of edaravone combined with cattle encephalon glycoside and ignotin injection adjuvant therapy on nerve function impairment in patients with severe craniocerebral injury.Methods: A total of 68 patients with severe craniocerebral injury who were treated in our hospital between January 2013 and May 2016 were collected and divided into control group and observation group according to the random number table, 34 cases in each group. Control group of patients received conventional + cattle encephalon glycoside and ignotin injection therapy, and observation group of patients received conventional +cattle encephalon glycoside and ignotin injection + edaravone therapy. The differences in serum levels of nerve injury indexes, oxidative stress indexes and inflammatory mediators were compared between the two groups of patients before and after treatment.Results: Before treatment, the differences in serum levels of nerve injury indexes, oxidative stress indexes and inflammatory mediators were not statistically significant between two groups of patients. After treatment, serum nerve injury index BNP level in observation group was higher than that in control group while S-100B, GFAP and NSE levels were lower than those in control group;serum oxidative stress indicators MDA and MPO levels were lower than those in control group while SOD and GSH-Px levels were higher than those in control group;serum inflammatory mediators IL-6, IL-8 and TNF-α levels were lower than those in control group.Conclusion:Edaravone combined with cattle encephalon glycoside and ignotin injection adjuvant therapy can effectively reduce the nerve function impairment in patients with severe craniocerebral injury, and the specific mechanisms are related to its effect on reducing the oxidative stress and inflammation.

Comparison of the Efficacy of Standard Decompressive Craniectomy Combined with Cerebrospinal Fluid Circulation Reconstruction in the Treatment of Severe Craniocerebral Injury

Objective:To observe and discuss the clinical effect of standard decompressive craniectomy combined with cerebrospinal fluid circulation reconstruction in the treatment of severe craniocerebral injury.Methods:Seventy patients who underwent surgery in our hospital were selected as subjects for this study.The time was from August 2016 to August 2018,and patients were divided into experimental group(35 cases)and control group(35 cases)according to the random number table method.The control group was treated with a single standard decompressive craniectomy according to clinical symptoms.The experimental group was treated with standard decompressive craniectomy combined with cerebrospinal fluid circulation reconstruction.The surgical treatment effect,GCS(Glasgow Coma Scale)score and operation time were compared between the two groups.Results:After comparison,the surgical treatment effect of the experimental group was higher than that of the control group and there was a significant difference between the two groups(P<0.05).The GCS score and operation time of the experimental group were also better than of the control group and there was a significant difference the two groups(P<0.05).Conclusion:The use of standard decompressive craniectomy combined with cerebrospinal fluid circulation reconstruction in the treatment of severe craniocerebral injury is more effective and worthy of widespread promotion and application.

Effect of adjuvant ganglioside sodium therapy on nerve injury degree as well as cytokines and humoral immunity in patients with acute severe craniocerebral injury

Objective:To study the effect of adjuvant ganglioside sodium therapy on nerve injury degree as well as cytokines and humoral immunity in patients with acute severe craniocerebral injury. Methods:94 patients with severe craniocerebral injury treated in our hospital between March 2013 and March 2016 were selected and randomly divided into the ganglioside sodium group (GM1 group) and control group. Before treatment as well as after 4 weeks and 8 weeks of treatment, serum levels of nerve injury molecules, nerve injury cytokines, inflammatory cytokines and humoral immune molecules were determined respectively.Results: After 4 weeks and 8 weeks of treatment, serum neuron-specific enolase (NSE), S100β protein (S100β), ubiquitin carboxy-terminal hydrolase L1 (UCH L1), glial fibrillary acid protein (GFAP), hypersensitive C-reactive protein (hs-CRP), tumor necrosis factor α(TNF-α), and interleukin-6 (IL-6) content of both groups were significantly lower than those before treatment (P<0.05) while brain-derived neurotrophic factor (BDNF), nerve growth factor (NGF), IgG, IgM and IgA content were significantly higher than those before treatment (P<0.05), and serum NSE, S100β, UCH-L1, GFAP, hs-CRP, TNF-α and IL-6 content of GM1 group were significantly lower than those of control group (P<0.05) while BDNF, NGF, IgG, IgM and IgA content were significantly higher than those of control group (P<0.05).Conclusions: Adjuvant ganglioside sodium therapy can relieve the nerve injury, inhibit the inflammatory reaction and improve the humoral immune response in patients with acute severe craniocerebral injury.

Effect of recombinant human erythropoietin therapy on convalescent serological indicators in patients with severe craniocerebral injury

Objective:To study the effect of recombinant human erythropoietin (rHu-EPO) therapy on convalescent serological indicators in patients with severe craniocerebral injury.Methods:Patients with severe craniocerebral injury who were treated in Fifth Hospital in Wuhan between July 2014 and February 2017 were selected and randomly divided into the rHu-EPO group who accepted rHu-EPO combined with conventional therapy and the control group who accepted conventional therapy. Before and after treatment, serum levels of nerve injury indexes, inflammation indexes, oxidative stress indexes and apoptosis indexes were measured. Results:Serum Tau, S100B, GFAP, NSE, IL-1β, TNF-α, VCAM-1, ICAM-1, LPO, AOPP, 8-iso-PGF2 , sTRAIL, sFas and sFasL levels of both groups of patients 14 d after treatment were significantly lower than those before treatment, and serum Tau, S100B, GFAP, NSE, IL-1β, TNF-α, VCAM-1, ICAM-1, LPO, AOPP, 8-iso-PGF2 , sTRAIL, sFas and sFasL levels of rHu-EPO group were significantly lower than those of control group.Conclusion: rHu-EPO therapy can significantly improve the convalescent nerve injury, inflammation, oxidative stress and apoptosis in patients with severe craniocerebral injury.

Effect of adjuvant recombinant EPO therapy on neural functional recovery, inflammation and erythrocyte glucose metabolism in patients with severe craniocerebral injury

Objective:To study the effect of adjuvant recombinant EPO therapy on neural functional recovery, inflammation and erythrocyte glucose metabolism in patients with severe craniocerebral injury.Methods:A total of 78 patients with severe craniocerebral injury treated in our hospital between May 2013 and March 2016 were selected and randomly divided into the EPO group and control group who received recombinant human erythropoietin (rhEPO) combined with conventional therapy and conventional therapy respectively. Before treatment as well as 7 d and 14 d after treatment, the degree of brain tissue hypoxia, nerve injury and inflammation as well as erythrocyte glucose metabolism were evaluated respectively.Results:PbtO2 levels, serum NGB and HGB content as well as PFK activity of both groups 7 d and 14 d after treatment were significantly higher than those before treatment while serum NF-H, NF-L, NF-M, NSE, S100β, IL-2, P-selectin and sICAM-1 content as well as G-6PD and AR activity were significantly lower than those before treatment;PbtO2 levels, serum NGB and HGB content as well as PFK activity of EPO group 7 d and 14 d after treatment were significantly higher than those of control group while serum NF-H, NF-L, NF-M, NSE, S100β, IL-2, P-selectin and sICAM-1 content as well as G-6PD and AR activity were significantly lower than those of control group.Conclusion:Adjuvant recombinant EPO therapy can inhibit inflammation and improve erythrocyte glucose metabolism to reduce the nerve injury degree in patients with severe craniocerebral injury.

Early Enteral Combined with Parenteral Nutrition Treatment for Severe Traumatic Brain Injury:Effects on Immune Function,Nutritional Status and Outcomes

Objective To compare the conjoint effect of enteral nutrition (EN) and parenteral nutrition (PN)with single EN or PN on immune function, nutritional status, complications and clinical outcomes of patientswith severe traumatic brain injury (STBI).Methods A prospective randomized control trial was carried out from January 2009 to May 2012 inNeurological Intensive Care Unit (NICU). Patients of STBI who met the enrolment criteria (Glasgow ComaScale score 6~8; Nutritional Risk Screening ≥3) were randomly divided into 3 groups and were administratedEN, PN or EN＋PN treatments respectively. The indexes of nutritional status, immune function,complications and clinical outcomes were examined and compared statistically.

Pathological changes at early stage of multiple organ injury in a rat model of severe acute pancreatitis

BACKGROUND: Severe acute pancreatitis (SAP) is a commonly seen acute abdominal syndrome characterized by sudden onset, rapid progression and high mortality rate. The damage in peripheral organs may be more severe than that in the pancreas, and can even lead to multiple organ dysfunction. It is critical to recognize early pathological changes in multiple organs. This study aimed to assess the early pathological features of damaged organs in a rat model of SAP. METHODS: Thirty clean grade healthy male Sprague-Dawley rats weighing 250-300 g were randomly divided into a model control group (n=15) and a sham-operated group (n=15). The SAP rat model was induced by sodium taurocholate. Samples of blood and from multiple organs were collected 3 hours after operation. We assessed the levels of IL-6, TNF-alpha, PLA2, NO, ET-1, MDA, amylases and endotoxin in blood and observed the early pathological changes in multiple damaged organs. RESULTS: Levels of IL-6, TNF-alpha, PLA2, NO, ET-1 and MDA in serum and of amylase and endotoxin in plasma of the model control group rats were significantly higher than those of the sham-operated group (P<0.01). Different degrees of pathological change were observed in multiple damaged organs. CONCLUSION: Multiple organ injury may occur at the early stage of SAP in rats.

Circulating miRNAs as biomarkers for severe acute pancreatitis associated with acute lung injury

AIM To identify circulating micro(mi)RNAs as biological markers for prediction of severe acute pancreatitis(SAP) with acute lung injury(ALI).METHODS Twenty-four serum samples were respectively collected and classified as SAP associated with ALI and SAP without ALI, and the mi RNA expression profiles were determined by microarray analysis. These mi RNAs were validated by quantitative reverse transcriptionpolymerase chain reaction, and their putative targets were predicted by the online software Target Scan, mi Randa and Pic Tar database. Gene ontology(GO) and Kyoto encyclopedia of genes and genomes(commonly known as KEGG) were used to predict their possible functions and pathways involved.RESULTS We investigated 287 mi RNAs based on microarray data analysis. Twelve mi RNAs were differentially expressed in the patients with SAP with ALI and those with SAP without ALI. Hsa-mi R-1260 b, 762, 22-3 p, 23 b and 23 a were differently up-regulated and hsa-mi R-550 a*, 324-5 p, 484, 331-3 p, 140-3 p, 342-3 p and 150 were differently down-regulated in patients with SAP with ALI compared to those with SAP without ALI. In addition, 85 putative target genes of the significantly dysregulated mi RNAs were found by Target Scan, mi Randa and Pic Tar. Finally, GO and pathway network analysis showed that they were mainly enriched in signal transduction, metabolic processes, cytoplasm and cell membranes.CONCLUSION This is the first study to identify 12 circulating mi RNAs in patients with SAP with ALI, which may be biomarkers for prediction of ALI after SAP.

Dynamic changes in peripheral blood-targeted miRNA expression profiles in patients with severe traumatic brain injury at high altitude

Background:The aim of this work is to detect and compare the peripheral blood mi RNA expression profiles in patients with severe traumatic brain injury(s TBI)2,12,24,48,and 72 h after injury at high altitude and to predict the target genes of differential expressed mi RNAs.Methods:Twenty s TBI patients from high-altitude areas were randomly selected according to the inclusion and exclusion criteria and were divided into five groups:the 2-h group,12-h group,24-h group,48-h group,and 72-h group.Peripheral blood mi RNA expression profiles were detected using real-time quantitative PCR(q RT-PCR).Results:The expression levels of mi R-18 a,mi R-203,mi R-146 a,mi R-149,mi R-23 b,and mi R-let-7 b in peripheral blood showed significant differences between the 2-h group and the 12-h group.The expression levels of mi R-203,mi R-146 a,mi R-149,mi R-23 b,and mi R-let-7 f in peripheral blood were up-regulated in the 24-h group.In the 48-h group,the expression levels of mi R-181 d,mi R-29 a,and mi R-18 b were upregulated.In the 72-h group,the expression levels of mi R-203,mi R-146 a,mi R-149,mi R-23 b,and mi R-let-7 f changed.The main target genes of the differentiation expressed mi RNAs were genes that regulate inflammatory responses,apoptosis,and DNA damage/repair.Conclusions:mi RNAs may be involved in the pathogenesis of s TBI by dynamically regulating the target genes that regulate inflammatory responses,apoptosis,and DNA damage/repair pathways.

Pathogenesis of acute lung injury in rats with severe acute pancreatitis

BACKGROUND: Acute lung injury (ALI) is the most common and severe complication of severe acute pancreatitis (SAP). The elucidation of the mechanism of ALI contributes to the diagnosis and treatment of the illness. In this study, we studied the pathogenesis of ALI in rats with severe acute pancreatitis. METHODS: The rats were sacrificed at 1, 3, 5, 6, 9 and 12 hours after the establishment of the model of SAP. Pancreas and lung tissues were obtained for pathological study, and examination of microvascular permeability and myeloperoxidase (MPO) examination. The gene expressions of tumor necrosis factor-α (TNF-α) and intercellular adhesion molecule-1 (ICAM-1) in the pancreas and lung tissues were detected by reverse transcriptase-polymerase chain reaction (RT-PCR). RESULTS: After the establishment of the SAP model, the degree of pancreatic and lung injury increased gradually along with the gradual increase of MPO activity and micro-vascular permeability. Gene expressions of TNF-α and ICAM-1 in the pancreas rose at 1 hour and peaked at 7 hours. In contrast, their gene expression in the lungs rose slightly at 1 hour and peaked at 9-12 hours. CONCLUSION: An obvious time window existed between SAP and lung injury, which is beneficial to the early prevention of the development of ALI.