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Objective To observe the therapeutic effect of combined acupuncture combined with omeprazole on patients with craniocerebral trauma complicated with stress gastric mucosal injury. Methods Patients with stress gastric mucosal injury after cerebral trauma admitted to neurology of Brain Hospital, Affiliated Hospital of Logistics University from June 2016 to July 2017 were enrolled, with the inclusion criteria within 24 hours after injury at admission, and Glasgow coma scale (GCS) less than 12. Patients were divided into omeprazole group, acupuncture group and acupuncture plus omeprazole combined treatment group according to random number table method. All patients in the three groups were given symptomatic treatment in time after admission. After diagnosis, omeprazole group was injected intravenously omeprazole, 40 mg each time, one dose in 12 hours for 7 days; acupuncture group was acupunctured at bilateral Zusanli point and Zhongwan point, 20 minutes for needle retention, once a day for 7 days;combined treatment group was given acupuncture and omeprazole at the same time. The GCS score and the occult stool test were performed at admission and treatment of 7 days; the pH of gastric juice, the levels of serum neurotensin (NT) and endothelin-1 (ET-1) were measured at admission and treatment 1, 3, 5, 7 days. At the same time, 10 healthy persons were selected as the control. Results Finally, 90 patients were selected, 30 in each group. GCS score at 7 days after treatment in omeprazole group, acupuncture group and combined treatment group were significantly higher than those at admission, but there was no statistical difference among the groups (9.46±2.81, 10.26±2.24, 10.52±2.50, F = 2.010, P = 0.141). For treatment of 7 days, the incidence of occult stool in the combined treatment group was significantly lower than that in the omeprazole group and acupuncture group (13.3% vs. 36.7%, 40.0%, both P < 0.05). The pH value of gastric excretion was increased gradually after treatment in the three groups. The pH value of gastric excretion in the combined treatment group was significantly higher than that in the omeprazole group and acupuncture group at 5 days of treatment (4.58±0.53 vs. 4.20±0.52, 4.28±0.43, both P < 0.05). The levels of serum NT in the three groups were both bi-directional: the level of NT at admission was significantly higher than that in the healthy control group, then decreased significantly, and the treatment of 3 days was significantly lower than that in the healthy control group and then rise gradually. The level of NT at treatment 5 days in the combined treatment group was significantly higher than that of the omeprazole group and the acupuncture group (ng/L: 45.88±8.03 vs. 36.15±11.54, 37.32±7.79, both P < 0.05), and had returned to normal level on the 7th day after treatment (ng/L: 56.88 ±12.54). The level of serum ET-1 in the three groups showed a bimodal change: the level of ET-1 at admission was significantly higher than that of the healthy control group. The treatment of 1 day to the normal range was gradually increased, and the peak of 5 days appeared again and then decreased slowly. The level of ET-1 at treatment of 7 days in the combined treatment group was significantly lower than that of the omeprazole group and acupuncture group (ng/L: 53.25±7.60 vs. 63.74±9.05, 65.50±12.73, both P <0.05), and had been restored to normal. Conclusion Combined acupuncture at points of Zusanli and Zhongwan for the treatment of stress gastric mucosal injury after traumatic brain injury, can reduce gastric acid secretion, promote the level of NT in serum, reduce the secretion of ET-1 level, help to repair the gastric mucosa, and the effect of combined with omeprazole is more significant.
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Objective To determine the effect of moderate hypothermia on coagulation in patients with severe traumatic brain injury (sTBI) and investigate the clinical significance of thrombelastogram (TEG) monitoring.Methods Seventy-five patients with sTBI were randomly assigned to hypothermia group (conventional treatment + moderate hypothermia within 24 hours posttrauma,n =38) and control group (conventional treatment alone,n =38).TEG aided in monitoring coagulation function by measuring clot reaction time (R),clot formation time (K),clotting rate (α),maximal amplitude (MA),and percent fibrinolysis at 30 minutes after MA (LY30).Meantime,the intracranial pressure,vital signs,blood gas values,and blood electrolytes were also measured.Outcome was evaluated by using Glasgow outcome scale (GOS).Results The two groups were similar on admission with respect to R,K,α,MA,and LY30 (P ＞ 0.05),but the coagulation index in hypothermia group was significantly different from that in control group at days 1,2,3 and 7 posttreatment (P ＜ 0.05).Moreover,moderate hypothermia therapy demonstrated decrease of intraeranial pressure (P ＜ 0.01),with no severe complications,low mortality and improved outcome in comparison with control group.Conclusion Moderate hypothermia improves the hypercoagulability in patients with sTBI without increasing the risk of hyperfibrinolysis and protects brain tissue by decreasing intracranial pressure.
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Objective To study the feasibility of stem cell transplantation under mild hypothermia so as to provide a prerequisite for stem cell transplantation in patients with traumatic brain injuries (TBI) during mild hypothermia treatment. Methods After transfecting plasmid containing temperature-sensitive simian virus 40 large T-antigen (tsSV40LT) into temperature-sensitive umbilical cord mes-enchymal stem cells (tsUCMSCs) , the changes of cell morphology, nuclear proliferation index (PIx) and telomerase activity were detested when the tsUCMSCs were cultured at 33℃ and 37℃. After the mouse model with tTBI treated with mild hypothermia was established, tsUCMSCs were transplanted into semi-injury area to detect survival rate, proliferation and apoptosis indices and perform neurological deficit scoring. Results When cultured at 33℃, the tsUCMSCs displayed long spindle-shaped and highly refractive, with higher proliferation index and telomerase activity than those cultured at 37℃. Compared with control group (non-temperature-sensitive UCMSCs transplantation), tsUCMSCs in semi-injury area showed much higher cell survival and proliferating cell nuclear antigen expression ( P < 0.05 ) , with fewer apoptotic cells and better neurological function (P < 0.05). Conclusion The establishment of temperature-sensitive stem cell line enables stem cell transplantation during treatment of TBI with mild hypothermia, as provides us a new direction for treatment of TBI.
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@#ObjectiveTo investigate the dynamic changes in microvascular ultrastructure in the cortex after the acute cerebral ischemia-reperfusion.Methods40 male rats were randomly divided into two groups（n=20 for sham operation group and cerebral ischemia-reperfusion group）. Cerebral ischemia-reperfusion model was produced using suture middle cerebral artery occlusion. Rats were sacrificed and the brain samples were adopted 1,3,12,72 h after ischemia-reperfusion, methyl methacrylate composite brain microvascular casting. The production of brain microvascular specimens, scanning electron microscopy of normal rat cerebral cortex microvessels and cerebral cortex of acute brain injury morphological changes in microvascular.ResultsCompared with the sham-operated group, cerebral ischemia-reperfusion in the cortex after the signs of vascular damage, then, vascular casting was to "bean" shape or even had a completely broken "tears candles" stump-like vascular casting, finally, to further the formation of a vascular zone cortex. ConclusionThe structural changes of brain microvascular in the cortex after acute cerebral ischemia-reperfusion is an important cause of cerebral microcirculation in rats.
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@#ObjectiveTo analyze the distribution and antibiotic resistance of bacteria isolated from cerebrospinal fluid. Methods569 cerebrospinal fluild specimens were analyzed. ResultsPathogens were isolated from 93 specimens (16.3%), in which 52 were Gram positive bacteria and 38 were negative, 3 were fungi. All the Gram positive cocci were sensitive to vancomycin and linezolid, while the Gram negative bacteria were resistant to routine antibiotics such as cefotaxime and ceftriaxone, but sensitive to carbapenems. ConclusionThe prevailing pathogens in intracranial infection are Gram positive cocci, especially Staphylococcus epidermidis and Staphylococcus aureu.
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Objective To judge injury severity of severe traumatic brain injury (sTBI) by using surface enhanced laser desorption-ionization (SELDI) protein chip technique. Methods Serum sam-ples from sTBI patients were used to detect expression of differential proteins by protein chip CM10 and SELDI to analyze the correlation between expression peak intensity and GCS. Results We obtained 101 protein peaks, with statistical difference upon expression of 27 protein peaks, when negative correla-tion was found between two peaks ( m/z 4 972 and m/z 5 322 ) and GCS score and positive correlation be-tween six peaks (m/z 3 941, m/z 4 295, m/z 8 714, m/z 8 792, m/z 14 020 and m/z 28 148) and GCS score. Conclusion SELDI protein chip technique may become a new and objective detection method in judging injury severity of sTBI.
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Objective To study the clinical features and therapeutic method of severe cerebral injured patients with hyponatremia.Methods The electrolyte and central venous pressure were examined on 45 cases of severe cerebral injured patients with hyponatremia every day.According to plasma sodium value and central venous pressure,we regulated treatment perscription daily.Results 45 patients occured hyponatremia in total 288 of severe cerebral injured patients.Hyponatremia was detected 5～13 days after operation or after injure.The morbility is usually the highest in the seventh day.Plasma sodium recovered to normal value in 14 days after operation.Conclusion Severe cerebral injured patients with hyponatremia should be diagnosed and treated as early as possible,then it will receive better prognosis.