Acute Severe Traumatic Injury Research Articles

Effects of enteral nutrition added with glutamine on gastrointestinal functions and prognosis of acute severe traumatic brain injury

Objective To investigate the effects of enteral nutrition added with glutamine on the incidences of gastrointestinal complications, intestinal mucosal barrier function and inflammatory responses in patients with acute severe traumatic brain injury (sTBI). Methods A prospective case control study was made on 107 patients with sTBI hospitalized from January 2016 to June 2017. The patients were divided into experimental group added with glutamine (n=54) and control group without glutamine (n=53) according to the random number table. The general data of the patients were recorded. After treatment, the incidences of gastrointestinal complications in both groups were compared. The serum levels of intestinal mucosal barrier function indices, namely, diamine oxidase (DAO), D-lactate acid, and intestinal fat acid binding protein (I-FABP) were evaluated by enzymology spectrophotometer method. Meanwhile, the serum levels of C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6) were also tested with enzyme-linked immunosorbent assay (ELISA). Glasgow coma scale (GCS), acute physiology and chronic health evaluation II (APACHE II), and hospital stay in both groups were compared. Results The two group were comparable with respect to gender, age, injury reasons, body mass index, preoperative GCS, preoperative APACHE II, injury type and injury time (P>0.05). The experimental group had lower incidences of stress ulcer, gastric retention and diarrhea compared with the control group 14 days after treatment (P<0.05). Within 14 days after treatment, the serum levels of DAO, D-lactate acid and I-FABP were significantly decreased in the experimental group at days 7 and 14 after treatment (P<0.05). The serum levels of CRP, TNF-α and IL-6 in the experimental group were significantly decreased after treatment (P<0.05). The experimental group had better prognosis compared with the control group (P<0.05), with higher GCS scores [(9.3±0.7) points vs. (8.2±0.7) points], lower APACHE II scores [(15.3±1.1)points vs. (17.7±1.2) points] at day 14, and shorter hospital stay [(19.1±2.2)days vs. (25.3±2.4)days] (P<0.01). Conclusions Enteral nutrition added with glutamine can effectively reduce the incidence of gastrointestinal complications, as well as alleviate the intestinal mucosal barrier function damage and the inflammatory responses at early stage after sTBI, which possibly improves prognosis. Key words: Craniocerebral trauma; Enteral nutrition; Glutamine; Gastrointestinal tract; Prognosis

Clinical significance of dynamic morphological changes of circle cistern observed by computed tomography scanning in patients with severe traumatic brain injury

Objective To investigate the clinical significance of observing the dynamic morphological changes of circle cistern on CT scanning in the patients with acute severe traumatic brain injury (TBI). Methods The CT imaging data of circle cistern of 135 patients with acute severe TBI were analyzed retrospectively. According to the morphological changes of circle cisterns on the initial CT images, 135 cases were divided into 5 groups, and 135 cases carried on prognostic evaluation with Glasgow outcome score (GOS) 6 months later. The relationship between the dynamic morphological changes of circle cistern and the prognosis of patients were analyzed statistically. Results There was a significant relationship between the state of circle cistern and the prognosis of patients. The more obvious the dynamic morphological changes of circle cistern were, the worse prognosis and the higher the fatality was, especially higher mortality in patients with exacerbation of the dynamic morphological changes of circle cistern (79.5%), and the difference was statistically significant among 5 groups (P<0.01). Conclusions There was a significant relationship between the state of circle cistern and the prognosis of the patients with acute severe TBI. The dynamic morphological changes of circle cistern on CT scanning might be used as a promising marker to evaluate the severity of severe TBI, especially in the patients at earlier posttraumatic interval. It is necessary to observe the dynamic change of circle cistern. Key words: Craniocerebral trauma/RA/PA; Tomography, X-ray computed

Effect of hypocaloric enteral nutrition on acute severe traumatic brain injury

Objective To evaluate the clinical efficacy of hypocaloric enteral nutrition in patients with acute severe traumatic brain injury (TBI). Methods A total of 100 patients with severe TBI [Glasgow Coma Scale (GCS) 3-8 points] were enrolled and randomly divided into hypocaloric enteral nutrition group (hypocaloric group, 41.86-62.79 kJ·kg-1·d-1) and traditional caloric enteral nutrition group (traditional caloric group, 104.65-125.58 kJ·kg-1·d-1), 50 patients per group. The enteral nutrition was given at 24-72 hours postoperatively. The changes of total serum protein (TP), serum-albumin (ALB), plasma hemoglobin (Hb), fasting blood glucose (Glu) and major gastrointestinal tract complications were observed and compared at 7 and 14 days after enteral nutrition support. Results Levels of TP, ALB and Hb were lowered in both groups at 7 and 14 days after nutritional support but showed no statistical difference (P>0.05). Glu was (6.37±1.02)mmol/L in hypocaloric calorie group, significantly lower than (7.35±1.70)mmol/L in traditional caloric group at day 7 after nutritional support (P 0.05), but abdominal distension, diarrhea and stomach retention rate in hypocaloric group were significantly lower than those in traditional caloric group (P<0.05). Conclusion Hypocaloric enteral nutrition can significantly reduce the stress hyperglycemia, abdominal distention, diarrhea, gastric retention and other gastrointestinal symptoms in patients with acute severe TBI. Key words: Craniocerebral trauma; Enteral nutrition; Complications

Correlation between the changes of neural cell apoptosis and caspase-3 gene expression after the brain traumatic injury in rats

Objective To observe the correlation between the changes of neural cell apoptosis arid caspase-3 gene expression in brain tissues following acute severe traumatic injury to brain(TIB).Method A total of 120 adult Spraque-Dawley rats were divided into a control group(n=8)，TIB group(n=56)and TIB with administration of caspase-3 inhibitor group(n=56).TIB models of rats were made with Feeney's method.The z-DEVDfmk(5 μg)，caspase-3 inhibitor，was administered by intracerebral infusion，and the rats were sacrificed 1，6，24，48 hours and 3，7，14 days postinjury(n=8 for each interval).The specimens of the injured cerebral cortex，suhcerticai white matter，hippocampus，dentate gyrus and contrahteral corresponding brain tissues were taken for detecting apoptesis of neural cells by the terminal deoxynucleotidyl transferase mediated DUTP nick end labeling (TUNEL)methods and flow cytomeay.Caspase-3 mRNA and protein expression were detected by using RT-PCR，immunohistochemistry and western blot analysis.The caspase-3 activity was detected by using caspase-3 fluorescent assay kit.Student t-test and Spearman correlation analysis were used to analyze the data with SPSS version 10.1 software package.Results Apoptesis indexes(AI)and the apoptesis percentage(AP)of neural cells in the injured brain regions increased quickly after injury，and reached its peak 24 to 48 hours later，then decreased slowly,but it remained at higher level above that of normal till 14 days later(P＜0.01).The levels of caspase-3 mRNA,eastme-3 protein and caspase-3 activity were increased significantly post injury，and reached its peak at 24 to 48 hours，then it gradually decreased.Compared with control group，the levels ofoptical density of caspase-3 proteins in the injured hippocampus and subcortical white matter at 24 and 48 hours post injury increased 1484% and 1690%，caspase-3 mRNA expressiom increased 1043%and 1180%，and the degreas of caspase-3 activity increased 148% and 183%，respectively.The expression of caspase-3 proenzyme and its P17 subarrit increased.After trealment with caspase-3 inhibitor z-DEVD-fmk，the levels of caspase-3 mRNA，protein expression and caspase-3 activity were significantly decreased.and AI and AP were significantly decreased as well.The correlation between caspase-3 mRNA and level of neural apoptesis was positive(r=0.821，P＜0.01)，and it was likewise betweencaspase-3 protein and level of neural apoptosis(r=0.638.P＜0.01).Interestingly enough，a positive correlation was found between caspase-3 mRNA and easpase-3 proteins(r=0.945，P＜0.01).Conclusions The activation of caspase-3 leads to apoptosis of neural cells after acute TIB.The expression of caspase-3 are consistent with apoptosis of neural cells following TIB.The regulation of caspase-3 induced by TIB occurs at a ceriain critical link before transduction.Caspase-3 inhibitor can efficiently inhibit apoptosis of neural cells following TIB. Key words: Brain injury; Neural cells; Apoptesis; Caspase-3; z-DEVD-fmk