Early enteral and parenteral nutrition on immune functions of neurocritically ill patients.

This study was designed to investigate the influence of early enteral and parenteral nutrition on immune functions of neurocritically ill patients. Patients who were admitted to the neurological intensive care unit (ICU) of The Second Affiliated Hospital of Zhengzhou University between May 2014 and January 2016 were selected. They had been hospitalized for more than one week and received enteral nutrition (EN) via nasogastric tube, with a gross energy of 25 kcal/(Kg • d). Patients were divided into EN group, EN + early PN (EPN) group and EN + supplemental PN (SPN) group according to the time of PN support. Differences in patients’ general information and changes in serum protein and immune indexes were compared between the three groups. On admission, patients’ Glasgow coma scale (GCS), age, immune functions and protein indexes had no obvious differences between the three groups. After nutritional support, serum protein level reduced in the EN group while prealbumin (PALB) and retinol binding protein (RBP) increased in the EN + EPN group and EN + SPN group after one week of admission to hospital, and the differences were statistically significant (p less than 0.05). Total protein (TP), albumin (ALB), PALB and transferrin (TRF) increased significantly in the EN + EPN group and EN + SPN group compared with the EN group (p < 0.05); before and after treatment, an increase was found in ALB in the EN + EPN group in comparison with EN + SPN group, with a notable difference (p < 0.05); C3, C4, immunoglobulin M (IgM) and immunoglobulin A (IgA) increased in the EN + SPN group after nutritional support compared with before treatment, and the difference was statistically significant (p < 0.05). Moreover, immunoglobulin G (IgG) and IgA in the EN + EPN group increased after nutritional support comparing to prior to nutritional support, and the difference was statistically significant (p < 0.05). After nutritional treatment, IgA and IgG increased markedly in the EN + EPN group, and there was a statistical significance between the groups (p < 0.05); the EN + EPN group and EN + SPN group exceeded the EN group in total lymphocyte count (TLC), and the difference had a statistical significance (p less than 0.05). These results demonstrate that neurocritically ill patients achieving the target energy can avoid malnutrition and immunodeficiency; serum protein decrease can cause malnutrition after one week of EN support; and enteral and parenteral nutrition can improve nutritional and immune indicators of neurocritically ill patients in the acute phase. In addition, EPN is more likely to improve malnutrition and immune functions of critical patients than SPN.

Ten-year outcome of early childhood traumatic brain injury: Diffusion tensor imaging of the ventral striatum in relation to executive functioning.

PRIMARY OBJECTIVE: The long-term effects of TBI on verbal fluency and related structures, as well as the relation between cognition and structural integrity, were evaluated. It was hypothesized that the group with TBI would evidence poorer performance on cognitive measures and a decrease in structural integrity. RESEARCH DESIGN: Between a paediatric group with TBI and a group of typically-developing children, the long-term effects of traumatic brain injury were investigated in relation to both structural integrity and cognition. Common metrics for diffusion tensor imaging (DTI) were used as indicators of white matter integrity. METHODS AND PROCEDURES: Using DTI, this study examined ventral striatum (VS) integrity in 21 patients aged 10-18 years sustaining moderate-to-severe traumatic brain injury (TBI) 5-15 years earlier and 16 demographically comparable subjects. All participants completed Delis-Kaplan Executive Functioning System (D-KEFS) sub-tests. MAIN OUTCOMES AND RESULTS: The group with TBI exhibited lower fractional anisotropy (FA) and executive functioning performance and higher apparent diffusion coefficient (ADC). DTI metrics correlated with D-KEFS performance (right VS FA with Inhibition errors, right VS ADC with Letter Fluency, left VS FA and ADC with Category Switching). CONCLUSIONS: TBI affects VS integrity, even in a chronic phase, and may contribute to executive functioning deficits.

[The clinical analysis of extracorporeal membrane oxygenation for adult severe acute respiratory distress syndrome].

OBJECTIVE: To investigate the clinical experience and associated factors of extracorporeal membrane oxygenation(ECMO) for adult patients with severe acute respiratory distress syndrome (ARDS). METHODS: The clinical data of 58 adult patients with severe ARDS, which met the criteria for ECMO and treated in comprehensive intensive care unit of the Second Affiliated Hospital of Zhengzhou University from August 2012 to June 2015, were retrospectively collected and analyzed. The patients were divided into the ECMO group and the control group according to whether ECMO support was used. The ECMO group was further divided into the survival group and the non-survival group according to outcomes 3 months after the initiation of ECMO. The statistics software of SPSS 17.0 was used for data analysis. RESULTS: Of the 58 patients, 28 were treated with VV-ECMO. There were 22 males and 6 females, aged from 34 to 61 years, with a mean age of (49±8) years. Mean time of mechanical ventilation before ECMO therapy was(71±25) h. The main factors(the lowest PaO2/FiO2 and pH, the highest PEEP, PaCO2 and serum lactate level, the grade of APACHEⅡ, Murray and SOFA) between the ECMO group and the control group were not significantly different(all P>0.05). There were no significant differences in the factors before therapy(all P>0.05), except pH, heart rate (HR) and mean arterial pressure (MAP) between the ECMO survival group and the ECMO non-survival group. Compared with the factors at the same time point in the control group, those of the ECMO group were significantly improved after ECMO running 2 hours and 1 day (all P<0.05). Most factors of the ECMO group were also significantly improved after ECMO running 2 days (all P<0.05) except MAP; the MAP of the ECMO non-survival group being lower than the control group (t=2.433, P=0.019). After ECMO running 3 days, most factors of the ECMO survival group were better than those of the control group (all P<0.05) except MAP, but most factors between the ECMO non-survival group and the control group were not significantly different (all P>0.05), while the serum lactate level was higher (t=-3.156, P=0.003) and the MAP lower (t=3.578, P=0.001). Eighteen patients were successfully weaned from ECMO, and 15 patients survived to 3 months without severe disability. The survival rate between the ECMO group and the control group was not significantly different(53.57% and 43.33%, χ(2)=0.608, P=0.436). CONCLUSIONS: Our experience suggests that VV-ECMO may be an effective life support treatment for severe ARDS and should be used as early as possible when the ECMO criteria are met. Indexes such as age, time of mechanical ventilation before ECMO therapy, time between disease onset and ECMO therapy, HR, MAP, serum lactate level and serum procalcitonin level, may be the risk factors for prognosis.

Brain Network Architecture and Global Intelligence in Children with Focal Epilepsy.

BACKGROUND AND PURPOSE: The biologic basis for intelligence rests to a large degree on the capacity for efficient integration of information across the cerebral network. We aimed to measure the relationship between network architecture and intelligence in the pediatric, epileptic brain. MATERIALS AND METHODS: Patients were retrospectively identified with the following: 1) focal epilepsy; 2) brain MR imaging at 3T, including resting-state functional MR imaging; and 3) full-scale intelligence quotient measured by a pediatric neuropsychologist. The cerebral cortex was parcellated into approximately 700 gray matter network "nodes." The strength of a connection between 2 nodes was defined by the correlation between their blood oxygen level-dependent time-series. We calculated the following topologic properties: clustering coefficient, transitivity, modularity, path length, and global efficiency. A machine learning algorithm was used to measure the independent contribution of each metric to the intelligence quotient after adjusting for all other metrics. RESULTS: Thirty patients met the criteria (4-18 years of age); 20 patients required anesthesia during MR imaging. After we accounted for age and sex, clustering coefficient and path length were independently associated with full-scale intelligence quotient. Neither motion parameters nor general anesthesia was an important variable with regard to accurate intelligence quotient prediction by the machine learning algorithm. A longer history of epilepsy was associated with shorter path lengths (P = .008), consistent with reorganization of the network on the basis of seizures. Considering only patients receiving anesthesia during machine learning did not alter the patterns of network architecture contributing to global intelligence. CONCLUSIONS: These findings support the physiologic relevance of imaging-based metrics of network architecture in the pathologic, developing brain.