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Objective:To investigate the risk factors of in-hospital mortality in elderly patients with traumatic brain injury (TBI).Methods:A case control study was conducted on 709 elderly patients with TBI admitted to Luhe Hospital, Capital Medical University from January 2012 to October 2018, including 468 males and 241 females; aged 60-97 years [(70.4±8.5)years]. Patients were divided into death group ( n=82) and survival group ( n=627) based on death or not during hospitalization. Data of the two groups were documented, including gender, age, causes of injury (traffic accident injury, fall injury, assault injury or others), history of comorbidities (hypertension, coronary heart disease, diabetes or coronary heart disease), Glasgow coma score (GCS) on admission, operation modalities (trepanation and drainage, hematoma evacuation, decompressive craniectomy or intracranial pressure monitoring), complications (pneumonia, stress ulcer, electrolyte imbalance, hypoproteinemia or secondary epilepsy) and length of hospitalization. Univariate analysis was used to analyze the correlation between the above factors and in-hospital mortality in elderly patients with TBI. Multivariate Logistic regression analysis was used to determine the independent risk factors for their in-hospital mortality. Results:Univariate analysis showed that sex, causes of injury, hypertension, cerebral infarction, diabetes, GCS on admission, hematoma evacuation, decompressive craniectomy, intracranial pressure monitoring, pneumonia, stress ulcer and length of hospital stay were correlated with in-hospital mortality in elderly patients with TBI ( P<0.05 or 0.01), while there was no correlation with age, history of coronary heart disease, trepanation and drainage, electrolyte imbalance, hypoproteinemia and secondary epilepsy (all P>0.05). Multivariate Logistic regression analysis showed that fall injury ( OR=0.28, 95% CI 0.08-0.96, P<0.05), hypertension ( OR=0.29, 95% CI 0.10-0.84, P<0.05),GCS of 9-12 points on admission ( OR=12.98, 95% CI 4.70-35.84, P<0.01), GCS of 3-8 points on admission ( OR=33.67, 95% CI 14.01-80.93, P<0.01) and length of hospital stay<11 days ( OR=0.06, 95% CI 0.02-0.13, P<0.01) were significantly associated with their in-hospital mortality. Conclusions:Fall injury, hypertension, GCS≤12 points on admission and length of hospital stay <11 days are independent risk factors for in-hospital mortality in elderly patients with TBI, especially that patients with GCS of 3-8 points on admission have higher in-hospital modality than patients with GCS≥ 9 points, indicating the importance of above independent risk factors in evaluating outcome.
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Objective To analyze the clinical characteristics and treatment Methods of severe com?plications after percutaneous tracheotomy( PDT) in neurosurgery patients,and to provide reference for the treat?ment and rescue of these patients. Methods A retrospective analysis of 578 cases after PDT was performed in Neurosurgery Intensive Care Unit ( NSICU ) of Xuanwu Hospital of Capital Medical University from 2005 to 2015. The types of complications,treatment method and prognosis were analyzed. Follow?up was 3 months to 1 year. Results Eighteen cases with severe complications,including bleeding,wound infection,asphyxia caused by tracheal mucosa suffocation,airway stenosis caused by granulation tissue,subcutaneous emphysema and neu?momediastinum,etc. After treatment and active rescue,most patients recovered,no patients die directly associated with surgery. Conclusion PDT plays an important role in the treatment of patients in NSICU,but it is still pos?sible to have serious complications,so physicians must understand and be prepared for complications,and pay more attention to prevent poor prognosis.
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Objective To evaluate the effect of angiotensin Ⅱ ( Ang Ⅱ ),angiotensin- (1-7) [ Ang- ( 1-7 ) ],and co-action of Ang Ⅱ and Ang-( 1-7 ) on β cell insulin signaling pathway.Methods Mouse pancreatic β cell line NIT-1 was incubated with( 1 )0,10-7,10-6,10-s,10-4 mol/L concentrations of Ang Ⅱ for 24 h ; ( 2 )0,10-7,10-6,10 -5,10-4 mol/L concentrations of Ang- ( 1-7 ) for 24 h; ( 3 ) co-administration of Ang Ⅱ and Ang- ( 1-7 ) was divided into control,10-5mol/L Ang Ⅱ,10-6mol/L Ang-( 1-7 ),10-5mol/L Ang Ⅱ + 10-6mol/L Ang-( 1-7 ) group.Tyrosine phosphorylation of insulin receptor β subunit(IR-β-Tyr) and serine phophorylation of protein kinase B(Akt-Ser) were detected by Western blot.ResultsInsulin-stimulated IR-β-Tyr and Akt-Ser phosphorylation was significantly decreased in Ang Ⅱ 10-5 and 10-4 mol/L group; no significant changes in insulin-stimulated IR-β-Tyr and Akt-Ser phosphorylation were detected between Ang-( 1-7 ) treatment groups and control; Ang-( 1-7 ) blocked the inhibitory effect of Ang Ⅱ on Akt-Ser phosphorylation,yet exerted no effect on Ang Ⅱ-induced IR-β-Tyr phosphorylation inhibition.Conclusion Ang Ⅱ significantly inhibits insulin signaling pathway in β cell; Ang-( 1-7 ) reverts the inhibitory effect of Ang Ⅱ on insulin-stimulated Akt-Ser phosphorylation in β cell.