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Objective:To investigate the risk factors of systolic dysfunction early complicated in patients with isolated traumatic brain injury (iTBI) and to evaluate the influence of complicated systolic dysfunction on the prognosis of iTBI patients.Methods:From January 2017 to October 2018, 123 patients with moderate or severe iTBI admitted to Trauma Centre in our hospital were included in the study, and patients with previous cardiovascular diseases were excluded. Left ventricular systolic function was assessed by transthoracic echocardiography within 24 h after admission. The patients were divided into normal systolic function group ( n=100) and systolic dysfunction group ( n=23) according to the results of echocardiography. Data were collected from all patients on admission, including GCS score, systolic blood pressure, heart rate, high-sensitivity cardiac troponin T (hs-cTnT), clinical treatment variables (use of sedative drugs, vasoactive drugs, etc.), craniotomy or not and clinical outcomes (survival or death) during hospitalization. Logistic regression analysis was used to analyze the related factors for iTBI patients complicated with systolic dysfunction, and receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of each index for iTBI patients complicated with cardiac insufficiency. Results:The systolic blood pressure (147.3±23.3) mmHg, the heart rate (96.1±26.3) beats/min and the hs-cTnT level (16.48±8.17) pg/mL in the systolic dysfunction group were higher than those in the normal systolic function group on admission (all P<0.05); and the GCS score in the systolic dysfunction group was lower than that in the normal systolic function group ( P<0.05). Logistic regression analysis showed that the heart rate ( OR=1.129, 95% CI: 1.001-1.516; P=0.038), the GCS score ( OR=0.640, 95% CI: 0.445-0.920; P=0.016) and the hs-cTnT level ( OR=1.054, 95% CI: 1.009-1.101; P=0.002) on admission were independent risk factors for iTBI patients complicated with systolic dysfunction. The area under the ROC curve (AUC) of the hs-cTnT levelon admission was the largest (AUC=0.863, P<0.01). The in-hospital mortality of patients in the systolic dysfunction group was higher than that of patients in the normal systolic function group (52.5% vs 22%, P=0.004). Conclusions:The heart rate, the GCS score and the serum hs-cTnT level on admission were independent risk factors for iTBI patients complicated with systolic dysfunction. The hs-cTnT level could better predict the occurrence of cardiac systolic dysfuncion, and higher in-hospital mortality was found in iTBI patients complicated with systolic dysfunction. Therefore, early detection and timely intervention may improve the prognosis of these patients.
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Traumatic brain injury (TBI)has been classified as mild,moderate,or severe,on the basis of the Glasgow coma scale (GCS)score.Mild TBI is estimated to account for 90% of all cases of TBI, and it has become a serious public health problem,with morbidity increasing year by year.At present,there is a lack of accepted uniform definition of mild TBI.Clinically,mild TBI and concussion are interchangeable terms.In recent years,advances in brain imaging,biomarkers determination,and neuropathology have encouraged people to revise and update their knowledge about mild TBI.In view of the high prevalence of mild TBI in the emergency and community,and the absence of the data concerning the long-term effects of mild TBI, further research is needed about how to reduce morbidity and costs, alleviate delayed consequences,and develop evidence-based interventions to improve outcomes.
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Objective To investigate the potential predictors and treatment for secondary sexual dysfunction following pelvic fracture. Methods 184 patients were included in this study from multiple centers in Guangzhou city, to find the potential predictors for secondary sexual dysfunction following pelvic fracture. 76 patients were identified to be secondary sexual dysfunction, which were randomized into three treatment groups, who were given continuous low dose of tadalafil (5 mg/time)combined with oral sildenafil (50 mg/time), tadalafil (5 mg/time) only and sildenafil (50 mg/time) only respectively, and followed by evaluation of therapeutic effect according to IIEF-5 questionnaire and Sexual Encounter Profile (SEP) diaries to evaluate the effect. Results Risk factors including age and the type of pelvic fractures but not urethral injury was associated with the complication of secondary sexual dysfunction . After treatment for twelve weeks, the IIEF-5 score in A groups (18.1 ± 4.2) was significantly higher than that in B (16.4 ± 3.4) or C (16.6 ± 4.0) group (P<0.05). The positive rate of response to SEP2 and SEP3 in A group were 73.0% and 79.4% respectively, both of which were remarkably higher than those in B or C group (P < 0.05). Conclusion Secondary sexual dysfunction following pelvic fracture is associated with age and type of pelvic fractures. Continuous low dose of tadalafil (5 mg/time) combined with sildenafil (50 mg/time) provides superior effective treatment for secondary sexual dysfunction following pelvic fracture.
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Hepatocyte transplantation is effective in the treatment of liver failure caused by a variety of factors.In pace with the progress of the study of induced pluripotent stem cells and its differentiation technology,a new method has arisen to obtain a great number of safe hepatocytes with biological function,which are suitable for seed cells of hepatocyte transplantation.In this article,we review the latest research progress about induced pluripotent stem cell-derived hepatocytes being transplanted to treat liver failure.