Study on cumulative effects of biological craniocerebral trauma under repeated blast

Repeated blast impacts on personnel in explosive environments can exacerbate craniocerebral trauma.Most existing studies focus on the injury effects of a single blast,lacking in-depth analysis on the injury effects and cumulative effects of repeated blasts.Therefore,rats were used as the experimental samples to suffer from explosion blasts with different peak air overpressures(167 kPa~482 kPa)and varying number of repeated blasts.The cumulative effect of craniocerebral trauma was most pronounced for moderate repeated blast,showing approximately 95%increase of trauma severity with penta blast,and an approximately 85%increase of trauma severity with penta minor blast.The cumulative effect of craniocerebral trauma from severe,repeated blast has a smaller rate of change compared to the other two conditions.The severity of trauma from penta blast increased by approximately 69%compared to a single blast.Comprehensive physiological,pathological and biochemical analysis show that the degree of neurological trauma caused by repeated blasts is higher than that of single blasts,and the pathological trauma to brain tissue is more extensive and severe.The trauma degree remains unchanged after double blast,increases by one grade after triple or quadruple blast,and increases by two grades after penta blast.

Changes in platelet parameters and secondary brain injury in acute craniocerebral trauma

Changes in platelet parameters are important in secondary brain injury in acute craniocerebral trauma We selected 163 patients with craniocerebral trauma who were admitted within 24 hours with nonoperative therapy. Platelet parameters of 40 healthy subjects served as controls. Platelet number was decreased, while mean platelet volume and platelet distribution width values were increased, at 1 and 3 days after injury. Platelet number was lower and mean platelet volume and platelet distribution width were larger in patients with traumatic cerebral infarction and those in Glasgow Coma Scale score 〈 8 group. Platelet number was negatively correlated to volume of cerebral edema, but positively correlated to Glasgow Outcome Scale score. These data indicate that changes in platelet parameters may be utilized to indicate the state of central nervous system injury and patient prognosis .

Effects of Continuous Nursing Intervention on Postoperative Rehabilitation of Patients with Craniocerebral Trauma

Objective:To study and analyze the clinical effect of continuous nursing in the process of postoperative rehabilitation for patients with craniocerebral trauma.Methods:From August 2018 to July 2021,40 patients who came to our hospital for craniocerebral trauma treatment were randomly selected as clinical experimental research objects,and they were divided into continuous nursing group and routine nursing group.The rehabilitation of patients in the two groups before and after postoperative nursing was observed and counted.Results:Before nursing intervention,there was no significant difference in MMSE score and Fugl-Meyer score between the two groups,p>0.05.After nursing,the scores were scored again at 3 and 6 months after nursing.It was found that the two groups were improved,but the improvement range in the continuous nursing group was significantly higher than that in the routine nursing group,the difference was statistically significant(p<0.05).From the score of quality of life,the scores of physical pain,psychological function,mental health and social function in the continuous nursing group were better than those in the routine nursing group,the difference was statistically significant(p<0.05).Conclusion:Using continuous nursing measures for rehabilitation nursing of patients with craniocerebral trauma after discharge can significantly improve the quality of life of patients,restore the mental state and limb function of patients,and has significant clinical effect.

Craniocerebral trauma

210234 Regulating effects of the ERK1/2 signaling pathway on neurons apoptosis after diffuse brain injury in rats/Zhao Yaning(赵雅宁,Basic Med Dept,North Chin Coal Med Col,Tangshan 063000)…Chin J Neurosurg.-2010,26(1).

Craniocerebral trauma

209379 Calpain expression changes in response to hypothermia after traumatic brain injury/Wan Jieqing(万杰清,Dept Neurosurg,Renji Hosp,School Med,Shanghai Jiaotong Univ,Shanghai 200127)…∥Chin J Traum.-2009,25(6).-507～509Objective To determaine the effect of hypothermia on gene transcription and protein expression of calpain after traumatic brain injury(TBI).Methods Twenty-seven rats were randomly divided into three groups,ie,normal control group,normothermia TBI group and hypothermia TBI group.All rats with TBI suffered from a lateral fluid percussion injury(FPI)at the right parietal lobe.Hypothermia intervention[rectal temperature for(32±0.5)℃]was performed for four hours immediately after TBI in hypothermia TBI group.Fluorescence PCR and Western blot were utilized to semi-quantify gene transcription and protein expression of calpain and immunofluorescence used to observe protein distribution of Calpain.Results Compared with normothermia TBI group and normal control group,hypothermia TBI group showed increased calpain gene transcription at 12 and 24 hours respectively after FPI (P【0.05).However,the increase of calpain protein expression in hypothermia TBI group was inhibited more significantly by hypothermia at 6,12,24 and 72 hours after TBI,compared with normothermia TBI group(P【0.05).Conclusion Neuroprotection of hypothermia after TBI may somewhat be related to the decrease of calpain protein expression after its gene transcription.10 refs,1 fig,2 tabs.

Correlation of serum CNP and IGF-Ⅱ contents with brain injury and inflammatory response in patients with craniocerebral trauma

Objective:To study the correlation of serum C-type natriuretic peptide (CNP) and insulin-like growth factor-Ⅱ (IGF-Ⅱ) contents with brain injury and inflammatory response in patients with craniocerebral trauma.Methods: Patients with craniocerebral trauma who were treated in the First Affiliated Hospital of Xi'an Jiaotong University between March 2015 and July 2017 were included in the case group of the study, and the healthy volunteers who received physical examination during the same period were included in the control group. The contents of CNP, IGF-Ⅱ, nerve markers and pro-inflammatory cytokines in serum as well as the expression of inflammatory signaling molecules in peripheral blood were measured.Results: CNP and IGF-Ⅱ contents in serum of case group were significantly lower than those of control group whereas UCH-L1, GFAP, S100B, Tau, MIP-1α, IL-1β, IL-6, IL-8 and TNF-α contents in serum as well as JAK2, STAT3, MEK and ERK1/2 mRNA expression in peripheral blood were significantly higher than those of control group;CNP and IGF-Ⅱ contents in serum of case group were negatively correlated with UCH-L1, GFAP, S100B, Tau, MIP-1α, IL-1β, IL-6, IL-8 and TNF-α contents in serum as well as JAK2, STAT3, MEK and ERK1/2 mRNA expression in peripheral blood.Conclusion: The decrease of serum CNP and IGF-Ⅱ in patients with craniocerebral trauma is closely related to the aggravation of brain injury and the over-activation of inflammatory response.

Effects of propofol anesthesia on oxidative stress, neurological function and inflammatory cytokines in patients with craniocerebral trauma

Objective: To investigate the effect of propofol anesthesia on oxidative stress, neurological function and inflammatory cytokines in patients with craniocerebral trauma. Methods: A total of 102 patients with craniocerebral trauma who underwent surgery in our hospital from December 2014 to January 2017 were randomly divided into control group and observation group, each contained 51 cases. The control group was given 1%-2% of sevoflurane and 0.1-0.2 μg/kg/min of remifentanil and 20-30 μg/kg/h of vecuronium for anesthesia maintenance. The observation group was given propofol 4-6 mg/kg/h, remifentanil 0.1-0.2 μg/kg/min and vecuronium 20-30 μg/kg/h for anesthesia maintenance. The levels of oxidative stress, neurological function, and inflammatory factors were assessed in both groups. Results:Compared with before treatment, the levels of SOD and HO-1 in the two groups were significantly increased and the levels of MDA were significantly decreased, the difference was significant, and the levels of SOD and HO-1 in the observation group were significantly higher than control group, the level of MDA was significantly lower than that of the control group, the difference was significant. Compared with before treatment, the levels of NSE, GFAP and Tau level were significantly decreased in the two groups after treatment, and level in observation group was lower than control group, the difference was statistically significant. Compared with before treatment, the levels of IL-6, TNF-α and CRP in the two groups after treatment were significantly lower than those in the control group, the difference was statistically significant. Conclusion: Propofol anesthesia can significantly reduce the oxidative stress injury, inhibit the inflammatory reaction and protect the neurological function of patients. The effect is better than isoflurane anesthesia, and it is worthy of clinical application.

Relationship of Nogo-A gene expression in serum and cerebrospinal fluid with nerve injury and inflammatory factor levels in patients with craniocerebral trauma

Objective:To study the relationship of Nogo-A gene expression in serum and cerebrospinal fluid with nerve injury and inflammatory factor levels in patients with craniocerebral trauma. Methods:82 patients with craniocerebral trauma who were treated in our hospital between January 2015 and February 2017 were collected as observation group, and 58 normal subjects who received internal hemorrhoids surgery under lumbar anesthesia in our hospital during the same period were collected as control group. Fluorescence quantitative PCR method was used to detect Nogo-A gene expression in serum and cerebrospinal fluid of both groups, and enzyme-linked immunosorbent assay (ELISA) was used to determine serum levels of nerve injury indexes and inflammatory factors in two groups. Pearson test was used to assess the relationship of Nogo-A gene expression in serum and cerebrospinal fluid with disease severity in patients with craniocerebral trauma.Results: Nogo-A mRNA expression in the serum and cerebrospinal fluid of observation group were higher than those of the control group;serum IGF-Ⅱ level was lower than that of control group while NSE, MBP and S100B levels were higher than those of control group;serum HSP-70, PCT, IL-1β, IL-6 and CRP levels were higher than those of control group. Pearson test showed that Nogo-A gene expression in serum and cerebrospinal fluid of patients with craniocerebral trauma were directly correlated with the nerve injury degree and inflammatory factor levels.Conclusions: Nogo-A gene is highly expressed in patients with craniocerebral trauma, and its expression is directly correlated with the nerve injury and systemic inflammatory response.

Effect of propofol and isoflurane general anesthesia on nerve injury in patients with craniocerebral trauma after emergency surgery

Objective: To study the effect of propofol and isoflurane general anesthesia on nerve injury in patients with craniocerebral trauma after emergency surgery. Methods: Patients with craniocerebral trauma who accepted emergency surgery in Dangyang People's Hospital between May 2015 and February 2017 were selected and randomly divided into propofol group and isoflurane group who received propofol + fentanyl + vecuronium bromide as well as isoflurane + fentanyl + vecuronium bromide anesthesia respectively. Serum levels of nerve injury markers, excitatory amino acids, inhibitory amino acids and oxidative stress indicators were detected before operation, immediately after operation and 12 h after operation. Results:Immediately after operation and 12 h after operation, serum NSE, GFAP, NGB, Tau, GLU, ASP, 8-iso-PGF2 and MDA levels of both groups of patients were significantly lower than those before operation while GABA, ALA, HO-1, NQO-1 and SOD levels were significantly higher than those before operation, and serum NSE, GFAP, NGB, Tau, GLU, ASP, 8-iso-PGF2 and MDA levels of propofol group immediately after operation and 12 h after operation were significantly lower than those of isoflurane group while GABA, ALA, HO-1, NQO-1 and SOD levels were significantly higher than those of isoflurane group. Conclusion: Propofol for emergency surgery of patients with craniocerebral trauma is more effective than isoflurane in alleviating nerve injury degree, correcting the excitatory and inhibitory amino acid disorder, and inhibiting oxidative stress reaction.

RELATIONSHIP BETWEEN THE COURSE OF THE DISEASE AND P_300 OF PATIENTS WITH CLOSED CRANIOCEREBRAL TRAUMA

目的:研究闭合性颅脑外伤患者病程与P300之间的关系,并探讨作P300测定的最佳时间。方法:应用Medicid-03E脑诱发电位仪测定518例闭合性颅脑外伤患者的视觉刺激诱发的P300波之潜伏期和波幅。结果:病人组P300波潜伏期较正常对照组明显延长,波幅也明显降低。结论:P300波的变化可作为判断闭合性颅脑外伤患者脑认知功能变化的一项客观指标。

Characteristics of postintensive care syndrome in survivors of pediatric critical illness: A systematic review

AIM To synthesize the available evidence focusing on morbidities in pediatric survivors of critical illness that fall within the defined construct of postintensive care syndrome(PICS) in adults, including physical, neurocognitive and psychological morbidities.METHODS A comprehensive search was conducted in MEDLINE, EMBASE, the Cochrane Library, Psyc INFO, and CINAHL using controlled vocabulary and key word terms to identify studies reporting characteristics of PICS in pediatric intensive care unit(PICU) patients. Two reviewers independently screened all titles and abstracts and performed data extraction. From the 3176 articles identified in the search, 252 abstracts were identified for full text review and nineteen were identified for inclusion in the review. All studies reporting characteristics of PICS in PICU patients were included in the final synthesis. RESULTS Nineteen studies meeting inclusion criteria published between 1995 and 2016 were identified and categorized into studies reporting morbidities in each of three categories-physical, neurocognitive and psychological. The majority of included articles reported prospective cohort studies, and there was significant variability in the outcome measures utilized. A synthesis of the studies indicate that morbidities encompassing PICS are well-described in children who have survived critical illness, often resolving over time. Risk factors for development of these morbidities include younger age, lower socioeconomic status, increased number of invasive procedures or interventions, type of illness, and increased benzodiazepine andnarcotic administration.CONCLUSION PICS-related morbidities impact a significant proportion of children discharged from PICUs. In order to further define PICS in children, more research is needed using standardized tools to better understand the scope and natural history of morbidities after hospital discharge. Improving our understanding of physical, neurocognitive, and psychological morbidities after critical illness in the pediatric population is imperative for designing interventions to improve long-term outcomes in PICU patients.

Alcoholism and critical illness: A review

Alcohol is the most commonly used and abused drug in the world, and alcohol use disorders pose a tremendousburden to healthcare systems around the world. The lifetime prevalence of alcohol abuse in the United States is estimated to be around 18%, and the economic consequences of these disorders are staggering. Studies on hospitalized patients demonstrate that about one in four patients admitted to critical care units will have alcohol-related issues, and unhealthy alcohol consumption is responsible for numerous clinical problems encountered in intensive care unit(ICU) settings. Patients with alcohol use disorders are not only predisposed to developing withdrawal syndromes and other conditions that often require intensive care, they also experience a considerably higher rate of complications, longer ICU and hospital length of stay, greater resource utilization, and significantly increased mortality compared to similar critically ill patients who do not abuse alcohol. Specific disorders seen in the critical care setting that are impacted by alcohol abuse include delirium, pneumonia, acute respiratory distress syndrome, sepsis, gastrointestinal hemorrhage, trauma, and burn injuries. Despite the substantial burden of alcoholinduced disease in these settings, critical care providers often fail to identify individuals with alcohol use disorders, which can have significant implications for this vulnerable population and delay important clinical interventions.

Intensive care organisation: Should there be a separate intensive care unit for critically injured patients?

In the last two decennia, the mixed population general intensive care unit(ICU) with a "closed format" setting has gained in favour compared to the specialized critical care units with an "open format" setting. However, there are still questions whether surgical patients benefit from a general mixed ICU. Trauma is a significant cause of morbidity and mortality throughout the world. Major or severe trauma requiring immediate surgical intervention and/or intensive care treatment. The role and type of the ICU has received very little attention in the literature when analyzing outcomes from critical injuries. Severely injured patients require the years of experience in complex trauma care that only a surgery/trauma ICU can provide. Should a trauma center have the capability of a separate specialized ICU for trauma patients("closed format") next to its standard general mixed ICU?

Brain arousal dysfunction induced by severe craniocerebral trauma treated with acupuncture

Objective To observe the early rehabilitation effects of acupuncture on brain arousal in patients with severe craniocerebral injury. Methods One hundred and two patients with severe craniocerebral injury were randomly divided into an acupuncture group and an electrical stimulation （ES） group with 51 cases in each group. In addition to conventional treatment and nursing in neurosurgery, acupuncture at Shuigou （水沟 GV 26）, Neiguan （内关PC 6） and Sanyingjiao （三阴交 SP 6）, as the main aeupoints, were applied for the cases in acupuncture group, and functional electrical stimulation （FES） was applied at selected muscles in the affected upper limb for the cases in ES group. The awaken rate, time for arousal and clinical therapeutic effects were compared between the two groups after 30 days of treatments. Results The awaken rate was 82.4%（42/51） in acupuncture group, which was significantly higher than 56.9%（29/51） in ES group （P〈0.01）, and the arousal time was significantly shorter and therapeutic effects were better in acupuncture group than those in ES group （both P〈0.01）. Conclusion On the basis of conventional treatment, early application of acupuncture provides better effects on restoration of arousal function of the brain in patients with severe craniocerebral injury than functional electrical stimulation.

Clinical analysis of craniocerebral trauma complicated with thoracoabdominal injuries in 2165 cases

Objective: To explore the optimal treatment for craniocerebral trauma complicated with thoraco-abdominal injuries. Methods: A total of 2 165 cases of craniocerebral trauma complicated with thoraco-abdominal injuries admitted to our hospital between July 1993 and June 2003 were retrospectively studied. Among them, 382 cases sustained severe craniocerebral trauma (in which 167 were complicated with shock), 733 thoracic injuries, 645 abdominal injuries and 787 thoraco-abdominal injuries. On admittance, 294 cases had developed shock. With the prime goal of saving life, respiratory and circulatory systems and encephalothilipsis were especially treated and monitored. Priority in management was directed to severe or open injures rather than to moderate or closed injures. For cases with cerebral hernia due to intracranial hematoma and severe shock due to blood loss, cerebral hernia and shock were treated concurrently. Results: After treatment, 2024 ( 93.49%) cases survived and the other 141 ( 6.51%) died. Among patients who had severe craniocerebral injury with shock and those without, 78 ( 46.71%) and 53 ( 24.56%) died, respectively. For patients who had underwent craniocerebral and thoraco-abdominal operations concurrently and those who had not, the death rates were 58.49%- 65.96% and 28.57% respectively, indicating a significant difference (P< 0.05). Conclusions: Treatment for hematoma hernia, shock and disturbed respiration is the key in the management of multiple trauma of craniocerebral, thoracic or abdominal injuries, especially when two or three conditions occurred simultaneously. Unless it is necessary, operations at two different parts at the same time is not recommended. It is preferred to start two concurrent operations at different time.

Cranial ultrasound in perioperative period of acute severe traumatic brain injury

Objective To observe the value of cranial ultrasound for perioperative patients with acute severe traumatic brain injury(sTBI).Methods Data of 55 sTBI patients who underwent craniotomy were retrospectively analyzed.The patients were divided into observation group(n=15)and control group(n=40)according to received perioperative cranial ultrasound or not.The general data and surgical data were compared between groups,and ultrasonic data of observation group were analyzed.Results The proportions of good prognosis 1 and 6 months after operation in observation group were both higher than those in control group,while the incidence of cerebral infarction in observation group was lower than that in control group(all P<0.05).No significant difference of general data nor other surgical data was found between groups(all P>0.05).Acute encephalocele occurred in 1 case in observation group during operation,and cranial ultrasound accurately showed the contralateral secondary epidural hematoma.Increased intracranial pressure in different degrees were found in all 15 cases(15/15,100%)in observation group after operation with transcranial color coded Doppler(TCCD)or transcranial Doppler(TCD),while cerebral vascular spasm was observed in 5 cases(5/15,33.33%),among them 4 cases(4/5,80.00%)were diagnosed cerebral infarction based on CT examination.Conclusion Cranial ultrasound could be used to evaluate changes of sTBI in perioperative period and guide adjusting treatment strategy in time,being valuable for reducing risk of postoperative cerebral infarction and improving prognosis.

Shock index and its variants as predictors of mortality in severe traumatic brain injury

BACKGROUND The increase in severe traumatic brain injury(sTBI)incidence is a worldwide phenomenon,resulting in a heavy disease burden in the public health systems,specifically in emerging countries.The shock index(SI)is a physiological parameter that indicates cardiovascular status and has been used as a tool to assess the presence and severity of shock,which is increased in sTBI.Considering the high mortality of sTBI,scrutinizing the predictive potential of SI and its variants is vital.AIM To describe the predictive potential of SI and its variants in sTBI.METHODS This study included 71 patients(61 men and 10 women)divided into two groups:Survival(S;n=49)and Non-survival(NS;n=22).The responses of blood pressure and heart rate(HR)were collected at admission and 48 h after admission.The SI,reverse SI(rSI),rSI multiplied by the Glasgow Coma Score(rSIG),and Age multiplied SI(AgeSI)were calculated.Group comparisons included Shapiro-Wilk tests,and independent samples t-tests.For predictive analysis,logistic regression,receiver operator curves(ROC)curves,and area under the curve(AUC)measurements were performed.RESULTS No significant differences between groups were identified for SI,rSI,or rSIG.The AgeSI was significantly higher in NS patients at 48 h following admission(S:26.32±14.2,and NS:37.27±17.8;P=0.016).Both the logistic regression and the AUC following ROC curve analysis showed that only AgeSI at 48 h was capable of predicting sTBI outcomes.CONCLUSION Although an altered balance between HR and blood pressure can provide insights into the adequacy of oxygen delivery to tissues and the overall cardiac function,only the AgeSI was a viable outcome-predictive tool in sTBI,warranting future research in different cohorts.

Changes of plasma C-reactive protein in patients with craniocerebral injury before and after hyperbaric oxygenation: A randomly controlled study

Changes of plasma C-reactive protein in patients with craniocerebral injury before and after hyperbaric oxygenation： A randomly controlled study BACKGROUND： Plasma inflammatory factor, such as C-reactive protein, whose content is regarded as a sensitively pathological marked protein and quantitative indexes of central nervous system injury, has been paid more and more attention in clinic. OBJECTIVE： To observe the effects and clinical significance of C-reactive protein in patients with craniocerebral injury after hyperbaric oxygenation. DESIGN： Randomized controlled study. SETTING： Departments of Neurosurgery, Laboratory and Hyperbaric Oxygen, the Second Affiliated Hospital, Medical College of Shantou University. PARTICIPANTS： A total of 60 patients with craniocerebral injury were selected from Department of Neurosurgery, the Second Affiliated Hospital, Medical College of Shantou University from October 2006 to April 2007. There were 37 males and 23 females and the mean age was 26 years. All subjects were certainly diagnosed as history of craniocerebral injury. Patients hospitalized at 24 hours after injury, Glasgow Coma Score ranged from 3 to 12 points, and all patients were certainly diagnosed with CT or MR scanning. Patients and their relatives provided confirmed consent. All the subjects were randomly divided into hyperbaric oxygenation group and control group with 30 in each group. METHODS： Patients in the control group were treated with routinely neurosurgical therapy after hospitalization; however, based the same basic treatment in the control group, patients in the hyperbaric oxygenation group received hyperbaric oxygenation by using iced-wheel four-door 2-cabin air-compression chamber （made in Yantai） from 24 hours to 10 days after operation or injury. After entering the cabin, patients who had a clear consciousness breathed the oxygen by using face mask; contrarily, patients directly breathed the oxygen. Therapeutic project： Expression was increased for about 15–20 minutes, maintained for about 70–80 minutes, and decreased for 20 minutes. Otherwise, pressure was maintained from 0.2 to 0.25 MPa. Hyperbaric oxygenation took an hour for once a day and 10 times were regarded as a course. Venous blood was collected before treatment and on the next day of the first course end. Content of C-reactive protein in plasma was measured with immune turbidimetry in hyperbaric oxygenation group; in addition, content of C-reactive protein in plasma was directly measured with the same method at the corresponding time in the control group. If the content was less or equal to 8 mg/L, it was regarded as normal value. Effects of the two groups were evaluated based on Glasgow Coma Score before and after treatment. MAIN OUTCOME MEASURES： Content of plasma C-reactive protein and Glasgow Coma Score in the two groups before and after treatment. RESULTS： All 60 patients were involved in the final analysis. ① Content of plasma C-reactive protein： The two contents were obviously higher than normal value after craniocerebral injury. There was no significant difference in the two groups before treatment （P 〉 0.05）, but both contents were decreased after treatment, and there was significant difference between HBOT group and control group after treatment （t =4.756, P 〈 0.01）. In addition, there was significant difference in hyperbaric oxygen therapy group before and after treatment （t =5.236, P 〈 0.01）. ② Glasgow Coma Score： There was no significant difference in the two groups before treatment （P 〉 0.05）, but scores were increased in both groups after treatment （t =9.92, 2.51, P 〈 0.01, 0.05）; on the other hand, therefore, there was significant difference between the two groupsafter treatment （t =9.21, P 〈 0.01）. CONCLUSION： Hyperbaric oxygenation can remarkably decrease content of plasma C-reactive protein in patients with craniocerebral injury at the phase of stress.

Umbilical cord-derived mesenchymal stem cell transplantation combined with hyperbaric oxygen treatment for repair of traumatic brain injury

Transplantation of umbilical cord-derived mesenchymal stem cells（UC-MSCs） for repair of traumatic brain injury has been used in the clinic. Hyperbaric oxygen（HBO） treatment has long been widely used as an adjunctive therapy for treating traumatic brain injury. UC-MSC transplantation combined with HBO treatment is expected to yield better therapeutic effects on traumatic brain injury. In this study, we established rat models of severe traumatic brain injury by pressurized fluid（2.5–3.0 atm impact force）. The injured rats were then administered UC-MSC transplantation via the tail vein in combination with HBO treatment. Compared with monotherapy, aquaporin 4 expression decreased in the injured rat brain, but growth-associated protein-43 expression, calaxon-like structures, and CM-Dil-positive cell number increased. Following combination therapy, however, rat cognitive and neurological function significantly improved. UC-MSC transplantation combined with HBO therapyfor repair of traumatic brain injury shows better therapeutic effects than monotherapy and significantly promotes recovery of neurological functions.

Preventive strategies for feeding intolerance among patients with severe traumatic brain injury:A cross-sectional survey

This study aimed to investigate the application status of preventive measures for feeding intolerance in patients with severe traumatic brain injury(STBI)in China and analysis the differences and their causes.Methods A cross-sectional survey was conducted.From December 2019 to January 2020,ICU nurses and physicians of 89 hospitals in China were surveyed by using a questionnaire on preventive strategies for feeding intolerance in patients with STBI.The questionnaire included two parts:the general information of participants(10 items)and application of preventive measures for feeding intolerance in STBI patients(18 items).Results Totally 996 nurses and physicians completed the questionnaire.Among various methods,gastrointestinal symptoms(85.0%)and injury severity(71.4%)were mostly used to assess gastrointestinal functions and risk of feeding intolerance among STBI patients,respectively.Initiating enteral nutrition(EN)within 24–48 h(61.5%),nasogastric tubes(91.2%),30°–45°of head-of-bed elevation(89.5%),continuous feeding by pump(72.9%),EN solution temperature of 38–40°C(65.5%),<500 ml initial volume of EN solution(50.0%),monitoring gastric residual volume with a syringe(93.7%),and assessing gastric residual volume every 4 h(51.5%)were mostly applied for EN delivery among STBI patients.Prokinetic agents(73.3%),enema(73.6%),probiotics(79.0%),antacid agents(84.1%),and non-nutritional preparations as initial EN formula(65.6%)were commonly used for preventing feeding intolerance among STBI patients.Conclusions The survey showed that nurses and clinicians in China have a positive attitude towards preventive strategies for feeding intolerance.However,some effective new technologies and methods have not been timely applied in clinical practice.We suggest that managers,researchers,clinicians,nurses,and other health professionals should collaborate to explore effective and standard preventive strategies for feeding intolerance among patients with STBI.