Dehydroepiandrosterone attenuates microglial activation and exerts neuroprotective effect after subarachnoid hemorrhage / 国际脑血管病杂志

Objective:To investigate the regulatory effect of dehydroepiandrosterone (DHEA) on the microglial activation after subarachnoid hemorrhage (SAH) in vivo and in vitro.Methods:C57BL/6 mice were used for in vivo experiments. A SAH model was induced by intravascular puncture. They were randomly divided into solvent group, model group, and DHEA pretreatment group. TUNEL staining was used to detect neuronal apoptosis level at 24 h after modeling. Iba-1/CD86 fluorescence double staining was used to detect the activation of microglia. Quantitative fluorescent polymerase chain reaction and Western blot analysis were used to detect the expression of inflammatory factors, including interleukin (IL) -1β, IL-6, tumor necrosis factor (TNF) -α, and inducible nitric oxide synthase (iNOS). The primary cultured microglia was used for in vitro experiments and it was simulated SAH by hemoglobin stimulation. They were randomly divided into control group, model group, and DHEA pretreatment group. Iba-1/CD86 fluorescence double staining was used to detect the microglial activation, and fluorescence quantitative polymerase chain reaction and Western blot analysis were used to detect the expression of inflammatory factors.Results:In vivo model experiments showed that DHEA significantly reduced neuronal apoptosis ( P<0.01) and microglial activation ( P<0.01) after SAH modeling, and IL-6 expression level significantly decreased ( P<0.01), while IL-1β, TNF-α and iNOS showed a downward trend, but there were no statistical differences. In vitro model experiments showed that DHEA could significantly inhibit microglial activation ( P<0.001) and the expression levels of various inflammatory factors ( P<0.001). Conclusions:DHEA pretreatment can reduce neuronal apoptosis and microglia activation after SAH, and it has neuroprotective effect.

Clinical analysis and treatment of nasal complications after transsphenoidal pituitary adenomasectomy / 中国耳鼻咽喉头颈外科

OBJECTIVE To exlpore the prevention and therapy methods of nasal complications after transsphenoidal pituitary adenomasectomy.METHODS 129 cases of pituitary adenomas underwent transsphenoidal surgery.The postoperative nasal complications were observed and disposed.RESULTS A total of 26 cases(20.1％) of nasal complications appeared in all 129 cases of pituitary adenomas underwent transsphenoidal surgery,including nasal hemorrhage 6 cases(4.8％),eerebrospinal fluid rhinorrhea 9 cases(6.9％),sphenoid sinusitis 3 cases(2.3％),atrophy rhinitis 2 cases(1.6％),olfactory dysfunction 2 cases(1.6％),nasal septum perforation 1 case(0.8％),and nasal adhesion 3 cases(2.3％).They were all cured after nasal endoscopic regular cavity clean,nasal hormone,nasal irrigation.CONCLUSION The nasal complications after transsphenoidal pituitary adenomas ectomy surgery should be timely disposed,which can effectively improve the patients' clinical symptoms.

Risk factor analysis of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage / 中国脑血管病杂志

Objective To investigate the clinical risk factors of delayed cerebral ischemia (DCI) in patients with aneurysmal subarachnoid hemorrhage (aSAH).Methods From January 2015 to April 2016,106 consecutive patients with aSAH treated with endovascular embolization at the Department of Neurosurgery,Nanjing General Hospital of Nanjing Military Command were enrolled retrospectively.The patients were divided into either a DCI group (n =34) or a non-DCI group (n =72) according to whether the occurrence of DCI.The general information of patients were collected,including sex,age,Hunt-Hess grade,modified Fisher grade,world federation of neurosurgical societies (WFNS) grade,acute cerebral edema,early (bleeding 1-3 d) hypoalbuminemia,and hypohemoglobinemia.Univariate and multivariate Logistic regression analyses were used to analyze the risk factors for occurrence of DCI.Results The incidence of DCI was 32.1％ (34/106).The Hunt-Hess grade ≥ Ⅲ,modified Fisher grade ≥ Ⅲ,WFNS grade ≥ Ⅳ,acute cerebral edema,the incidences of hypoalbuminemia and hypohemoglobinemia in the DCI group were higher than those in the non-DCI group.There were significant differences between the 2 groups (all P ＜ 0.05).There were no significant differences in the ratios of sex,age ≥ 55 years,hypertension,diabetes and hyponatremia between the 2 groups (all P ＞ 0.05).In univariate analysis,the Hunt-Hess grade ≥ Ⅲ grade,modified Fisher grade ≥ Ⅲ,WFNS grade ≥ Ⅳ on admission,and hypoalbuminemia were used as the independent variables for multivariate analysis,the results showed that WFNS grade ≥ Ⅳ (OR,8.02;95 ％ CI 2.41-26.70),modified Fisher grades ≥ Ⅲ (OR,4.44;95％ CI 1.38-14.32),and hypoalbuminemia at day 1-3 (OR,5.42;95％ CI 1.40-20.76) were the independent risk factors for occurring DCI in patients with aSAH (all P ＜ 0.05),and the Hunt-Hess grade ≥ Ⅲ was not the risk factor for occurring DCI in patients with aSAH (OR,1.86;95％ CI 0.39-8.88,P ＞ 0.05).Conclusion The patients with hypoalbuminemia,WFNS grade≥Ⅳ on adrnission,and modified Fisher grade ≥ Ⅲ may were the independent risk factors DCI after aSAH,and the clinical diagnosis and treatment should attach great importance to.

Endovascular embolization and prognosis of middle cerebral artery aneurysms / 中国脑血管病杂志

Objective To investigate the effectiveness and safety of endovascular embolization for the treatment of middle cerebral artery aneurysms. Methods From March 2007 to May 2015,the clinical data of 170 patients with 173 middle cerebral artery aneurysms treated with endovascular embolization at the Department of Neurosurgery,Nanjing Jinling Hospital were analyzed retrospectively,including 120 (69.4%)ruptured aneurysms and 53 (30. 6%)unruptured aneurysms. The incidence of complications and prognosis were compared between the 2 groups. Results (1)A total of 170 patients who could perform endovascular embolization after preoperative evaluation successfully completed the interventional procedure. None of the patients died. (2)18 patients (10. 6%)had intraoperative and postoperative complications,including 4 (7. 5%,4/53)in the unruptured aneurysm group and 14 (11. 7%,14/120)in the ruptured aneurysm group. There was no significant difference in the incidence of complications between the two groups. (3)101 patients were followed up for 3-48 months. No new nervous system symptoms and reruptured aneurysm were observed. One patient had recurrence in the unruptured aneurysm group and 4 had recurrence in the ruptured aneurysm group. Conclusion Endovascular treatment of middle cerebral artery aneurysms is a safe,effective,and feasible technique.

Expression and prognostic value of ubiquitin carboxyl hydrolase L1 in the cerebrospinal fluid of patients with subarachnoid hemorrhage / 医学研究生学报

[Abstract ] Objective Ubiquitin carboxyl hydrolase L1(UCH-L1) is a neuron cytoplasm protein and increased UCH-L1 lev-el in cerebrospinal fluid( CSF) indicates brain injury.The study aimed to indentify UCH-L1 level in CSF of patients with subarachnoid hemorrhage(SAH) and assess the prognosis value of UCH-L1. Methods Retrospective analysis was made on 40 aneurismal SAH patients hospitalized in our department from August 2014 to February 2015.In the experiment group, CSF was taken by lumbar punc-ture in day1-day3, day5-day7, and day8-day10 after subarachnoid hemorrhage.In the control group, a single CSF sample was collect-ed during spinal anesthesia before surgery in 10 patients without neurologic disease.ELISA was applied to determine the concentration of UCH-L1 in CSF followed by comparison.Analysis was also made on relationship of the changes of UCH-L1 and modified rankins scale( MRS) 6 months later. Results CSF UCH-L1 concentrations in all SAH patients were significantly increased in day1-day3 ( P<0.05) after SAH, peaked in day5-day7 (P<0.01) and elevated un-til days 8-10 ( P<0.01 ) .MRS at 6 months showed a significant correlation with CSF levels of UCH-L1 in day5-day7 ( correlation co-efficient CC=0.691, P=0.001) and day8-day10 (CC=0.583,P=0.03), but not in days1-day3 (CC=0.364,P=0.08).SAH pa-tients with a good outcome at 6 months ( MRS<4) had much lower UCH-L1 levels in day5-day7 ( P=0.001) and day8-day10 ( P=0.041) than those with a poor outcome (MRS≥4).Higher UCH-L1 level at day5-day7 was a predictive marker of poor outcome in bi-nary logistic regression analysis (P=0.003); Conclusion The study suggests that increased CSF UCH-L1 level in day5-day7 after SAH is correlated with higher MRS and predicts an adverse clinical outcome 6 months after SAH.

Applicative value of three-dimensional DSA and MRI or CT fusion technology in the treatment of intracranial arteriovenous malformations / 中国脑血管病杂志

Objective Toinvestigatetheapplicativevalueof3D-DSAandheadMRIorCTfusion technology for guiding the individualized treatment of intracranial arteriovenous malformation (AVM ). Methods Twenty-onepatientswithAVMdiagnosedwithDSAattheDepartmentofNeurosurgery,Nanjing General Hospital of Nanjing Military Command from January 2015 to May 2015 were analyzed retrospectively. All patients performed DSA,MRI,and CT scan respectively before procedure,and they also performed 3 D-DSA and MRI or CT fusion. Of the 21 patients,15 performed MRI and 3D-DSA fusion,6 performed CT and 3D-DSA fusion. According to the image fusion results of the patients,the individualized treatment regimens were further developed,including microsurgical resection,endovascular embolization,and stereotactic radiotherapy (alone or combined treatment). The patients were followed up and observed for 2 to 6 months after procedure.Results Fromthe3D-DSAwithheadMRIorCTfusionimagesofthepatientsbeforetheprocedure not only could observe the vascular architecture of AVM,the relationship between the niduses and the surrounding nerve structures,but also could precisely locate the positions of AVM with small aneurysms or tiny AVMs. According to the results of image fusion,17 patients with AVM were treated with microsurgical resection,2 were treated with interventional embolization and stereotactic radiotherapy,and 2 were treated with stereotactic radiotherapy only. Of the 17 patients with AVM underwent microsurgical resection, none experienced intracranial rebleeding during the follow-up period. The last Glasgow outcome scale (GOS)score was 5 in 13 cases,and 4 in 4 cases. One patient with AVM underwent combined stereotactic radiotherapy had intracranial rebleeding during the follow-up period,and their last GOS score was 4. The other remaining 3 patients did not have new neurological deficits or rebleeding during the follow-up period,and theirGOSscorewas5.Conclusions 3D-DSA,headMRI,andCTfusiontechnologyarenovel, the operative method is simple,and the fusion image is accurate. They can effectively develop the individualized treatment regimens for patients with AVM.

Assessed values of color-coded digital subtraction angiography for intracranial arteriovenous malformation / 中国脑血管病杂志

Objective To investigate the preoperative and intraoperative assessed values of the color-coded digital subtraction angiography (DSA ) for intracranial arteriovenous malformation (AVM). Methods Fifteen patients with AVM performed preoperative routine whole brain DSA were analyzed retrospectively,and the iFlow software was used to perform color-coded DSA of image post-processing. A comprehensive analysis such as the range of lesions,vascular architecture and hemodynamics of AVM was conducted on the two-dimensional DSA images and color-coded DSA. Results Of the 15 patients with AVM,9 were small-sized (including 4 nidi showed diffuse type),3 were medium-sized,and 3 were large-sized;8 patients had single feeding artery,and 7 had multiple feeding arteries;11 had single draining vein,and 4 had multiple draining veins. When showing the size of AVM nidus,particularly diffuse type nidus, the color-coded DSA was clearer than the two-dimensional image. The color-coded DSA could visually display the traveling of the superficial and deep draining veins,at the same time,the primary and secondary draining veins could be identified according to the size of the area under the curve and the full width at half maximum,and intuitively reflected the complete cycle of cerebral blood flow. Conclusion The color-coded DSA can quickly and accurately depict the range of AVM,angioarchitecture features and intraoperative hemodynamic changes.

Application of whole brain angiography via radial approach in young patients for the diagnosis of ischemic cerebrovascular disease / 中国脑血管病杂志

Objective To assess the feasibility and safety of transradial puncture route for digital subtraction angiography (DSA)in young patients with ischemic cerebrovascular disease. Methods One hundred young patients with cerebrovascular disease who underwent whole brain angiography at the Department of Neurology,the 81 st Hospital of PLA were enrolled. They were divided into either a radial group (n =50)or a femoral group (n = 50)using a computer random number method. The time of puncture,success rate of puncture,success rate of selective angiography,exposure time,and incidence of complications were compared and analyzed. Results (1)The puncture time of the radial group was significantly longer than that of the femoral group,they were 3. 00 ± 0. 50 min and 1. 50 ± 0. 25 min respectively. There was significant difference (t = 18. 97,P 0. 05). (2)The incidence of complications of the radial group (4%,n = 2)was significantly 1ower than that of the femoral group (18%,n = 9 ). There was significant difference between the two groups (χ2 = 5. 01,P < 0. 05 ). Conclusion Transradial route puncture for whole brain DSA in young patients with cerebrovascular disease is safely and feasible.

Research progress on anti-tumor effects and potential mechanisms of ethyl pyruvate / 医学研究生学报

Ethyl pyruvate ( EP) is a stable lipophilic ester derivative of pyruvate with many pharmacological actions confirmed by researches , the anti-tumor effects of EP has attracted the attention of many domestic and foreign scholars .EP exerts antitumor activi-ty through several ways , such as inhibiting proliferation , inducing apoptosis , inhibiting angiogenesis , blocking cell cycle .This paper briefly reviews the rencent findings of antitumor function of EP .

Parent artery occlusion with Onyx for the treatment of distal intracranial aneurysms:a follow-up analysis / 中国脑血管病杂志

Objective To investigate the effect of parent artery occlusion with liquid embolic agents (Onyx)for the treatment of distal intracranial aneurysms. Methods The clinical data of 27 patients with 29 ruptured distal intracranial aneurysms were analyzed retrospectively.Seventeen aneurysms located in the posterior inferior cerebellar artery,3 in the anterior inferior cerebellar artery,2 in the superior cerebellar artery,2 in the posterior cerebral artery,1 in the anterior cerebral artery,and 4 in the middle cerebral artery.Twenty-eight aneurysms were treated with Onyx to occlude proximal parent arteries and aneurysms, and 1 distal middle cerebral artery aneurysm was occluded spontaneously. Results All the aneurysms treated were occluded completely.One patient died of intraoperative hemorrhage.The remaining patients were followed up for 8 to 67 months.The final Glasgow outcome scale (GOS)scores were 5 in 23 patients and 4 in 3 patients. 17 patients were followed up with digital subtraction angiography (DSA)and 5 were followed up with computed tomography angiography (CTA)after procedure.There was no recurrence of the aneurysm. Four patients were followed up clinically.No new neurological disturbance or rebleeding was found in all the survived patients. Conclusion Medium-long term follow-up results have shown that the clinical efficacy of proximal parent artery occlusion with Onyx for the treatment of distal intracranial aneurysms is satisfactory,and the recurrence rate is low.

Selection of surgical options for temporal occipital epidural hematomas / 中华创伤杂志

Objective To investigate the choice of surgical procedures in the treatment of temporal occipital epidural hematomas.Methods From March 2006 to March 2011,176 cases with acute temporal occipital epidural hematomas were treated in our hospital.Their clinical data including preoperative Glasgow Coma Sale (GCS),pupil size,hematoma volume,cerebrospinal fluid leakage,time between injury and operation,cerebral midline shift on CT,and brain beat and brain swelling in the operation were retrospectively analyzed.Results There were significant differences in the choice of surgical treatment and prognosis of temporal occipital epidural hematoma according to the preoperative GCS score,pupillary changes,hematoma volume,length of time before surgery,shift of cerebral midline structures,and brain beat and brain swelling in the operation.Conclusion Appropriate surgical procedures selected according to their preoperative and intraoperative conditions is of significant importance for sound prognosis of the patients with acute temporal occipital epidural hematoma.

Application of simultaneous monitoring of cortical EEG and scalp EEG during anterior circulation aneurysm surgery / 国际脑血管病杂志

Objective To develop a simple and effective method for monitoring cortical ischemia after temporary occlusion of the parent arteries during anterior circulation intracranial aneurysm surgery. Methods Fifty-two patients with anterior circulation aneurysm (58 aneurysms) received craniotomy from April to November 2008, and at the same time,cortical electroencephalograpby (EEG) and scalp EEG were monitored during the surgery.According to the international 10/20 electrode placement system, scalp electrodes were placed on O1, O2, P3, P4, T5, and T6 for monitoring the changes in the depth of anesthesia. A cortical strip electrode was placed on the cortical surface supplied by the artery that was possibly blocked during the operation, which was used to monitor the possible cortical ischemia. For patients who had cortical EEG suppression after the temporary occlusion of the parent arteries Were compared with the changes of scalp EEG. Whether there were ischemic events in the corresponding supply territory after vascular occlusion were observed after surgery. Results Of the 58 aneurysms, 40 aneurysms and 41 major arteries were occluded temporarily. After being occluded temporarily in 19 arteries of 18 patients, cortical EEG changed significantly,while scalp EEG did not change significantly. Only 9 patients had ischemic events in the corresponding supply territories after the occlusion in the cortical EEG significant change group. The changes in the depth of anesthesia had the consistent impact on cortical and scalp EEG. Conelusions Simultaneous monitoring of cortical and scalp EEG is a simple and effective method for monitoring cortical ischemia during anterior circulation intracranial aneurysm surgery, and may effectively identify the effect of anesthesia on EEG.

Expression changes of intestinal proinflammatory cytokines in response to glutamine following traumatic brain injury in rats / 中华创伤杂志

Objective To study the role of the cytokine-mediated inflammation in the pathogenesis of acute intestinal mucosa damage and explore the potential mechanisms of glutamine reducing intestinal inflammatory factors on the intcstines and protecting the structure and barrier of intestinal mucosa after traumatic brain iniury(TBI).Methods A total of 54 male Wistar rats were divided equally into nine groups(6 rats in each group),ie,control group,TBI groups(sacrificed at days 1,3,5 and 7 postinjury,respectively)and Glutamine group.Levels of TNF-α and IL-1β in the intestinal tissues were determined by using ELISA and activity of NF-κB by immunohistochemical method.Results Activity of NF-κB in ileum was significantly increased at day 1 following TBI,reached peak at day 3 and remained hjgh level till at day 7 postinjury.TNF-α and IL-1β levels in the intestinal tissues were also significantly increased after TBI,peaked at day 1 and remained high level at day 3 pestinjury.NF-κB activity and the expressions of TNF-α and IL-1β were all obviously decreased posterior to glutamine administration through stomach tube after TBI,compared with normal foodintake group after TBI.Conclusions TBI can induce a rapid and persistent up-regulation of NF-κB and proinflammatory cytokines in the intestine.Inflammation response may play an important role in the pathogenesis of acute intestinal mucosa injury.Glutamine administration throush stomach tube can inhibit NF-κB activity in ileum and reduce TNF-α and IL-1β levels after TBI,indicating that the intestinal barrier function at stress state may be protected by glutamine administration.

Surgical treatment of gliomatosis cerebri / 医学研究生学报

Objective:To discuss the diagnosis, treatment and outcome of patients with gliomatosis cerebri (GC). Methods:Retrospectively reviewed the clinical manifestations and radiological appearances of 6 patients with GC, which were diagnosed in our hospital between 1993 and 2003. We employed surgical treatment in three patients, stereotactic biopsy in two, and the other one received both biopsy and surgery. Results: The lesions of GC infiltrated more than two lobes in brain. CT studies showed diffuse hypodensity changes and enhancement was absent in four patients. MRI examinations revealed isointense or hypointense regions on T1WI, and uniformly high signal on T2WI. MRI also disclosed structural enlargement. All patients received radiotherapy after surgery and three patients underwent chemotherapy additionally. Five patients died during follow up with average course of 16.4 months. Conclusion:MRI examination is valuable in the diagnosis and the prognosis of GC is poor.

Apoptosis and c-fos expression in the rat gut mucosa following traumatic brain injury / 肠外与肠内营养

Objective:The aim is to study the apoptosis and c-fos expression occurred in the rat gut following traumatic brain injury,and to explore the potential role of mucosal apoptosis in the intestinal barrier dysfunction and the relation of c-fos expression with the mucosal apoptosis.Methods:Male Wistar rats were randomly divided into six groups(6 rats each group) including controls with sham operation and TBI groups at hours 3,12,24,and 72,and on day 7.Parietal brain contusion was adopted using weight-dropping method.Rat jejunum was taken at each corresponding time point.Apoptosis was detected by in situ immunohistochemical staining(TUNEL) and c-fos expression by immunohistochemistry.Results:Mucosal epithelium appeared to be the major apoptotic cells,and the number of apoptotic cells increased since 3 h after TBI,peaking at 72 h postinjury.The apoptotic cells initially located at the tip of villus and gradually spread to the whole villus.The c-fos expression of gut mucosa gradually increased after TBI,predominantly in epithelial cells,smooth muscle cells and lymphocytes and with the maximal expression appeared at 24 h,72 h and 7 d postinjury.Conclusion:It is highly suggested that intestinal mucosa apoptosis plays an important role in the pathogenesis of gut barrier damage,and c-fos expression might be highly responsible for the apoptosis,proliferation and renovation of the small intestinal mucosa.

Classification and surgical approach for tentorial meningiomas / 医学研究生学报

Objective:To explore the classification and the choice of surgical approach for tentorial meningiomas. Methods: 56 patients with tentorial meningiomas operated on between 1992 and 2002 were retrospectively analysed. According to Gkalp , there were 28 cases with medial tumor,17 cases with lateral tumor,11 cases with falcotentorial tumor. The tumors developing mainly supratentorial were approached from modified pteronal, subtemporal, temporooccipital or occipital craniotomy. For tumors developing mainly in the posterior cranial fossa, suboccipital craniectomy or combined occipital- suboccipital craniectomy was performed. The tumors developing both supratentorial and infratentorial the subtemporal-presigmoidal craniotomy were approached . Results: Total removal was achieved in 53 cases and partial removal in 3 cases. Two cases died of severe postoperative complications. The mortality rate was 3.6%. Five had additional neurological deficits postoperatively. Recurrences occurred in 6 cases. Conclusion: Surgical approach for tentorial meningiomas must be individualized for each case. The operators must master well about microanatomy of the tentorium and its specifically regional structures and expertly use microsurgical techniques for obtaining successful surgery and good outcome.

Expression of nuclear factor-?B and metalloproteinase-9 in the small intestine after traumatic brain injury / 医学研究生学报

Objective:The aim of the current study was to investigate the expression of nuclear factor-?B(NF-?B) and metalloproteinase-9(MMP-9) in the small intestine and to explore the potential role of NF-?B and MMP-9 in the damage of gut mucosal barrier after traumatic brain injury.Methods:The trauma was produced by a free-falling weight on the exposed dura of right parietal lobe.The rats were randomly divided into control group and traumatic brain injury groups at hours 3,12,24 and 72,and on day 7.NF-?B binding activity in the small intestine was studied by electrophoretic mobility shift assay(EMSA),and the expression of MMP-9 was studied by immunohistochemistry.Results:The results showed that NF-?B binding activity and MMP-9 expression in the small intestine was progressively increased,reached the maximum at 72 h and kept at high level up to 7 d after TBI.Concomitant upregulation of NF-?B~()and MMP-9 was observed.MMP-9 positively immunostained cells were mainly located at villous interstitium,lamina propria,crypt and submucosal layer,including endothelial cells,lymphocytes and neutrophils.Conclusion:It was concluded that cortical contusion trauma could induce a concomitant and persistent upregulation of NF-?B binding activity and MMP-9 expression in the small intestine which might play a central role in the~()damage of gut mucosal barrier.

Current state and clinical progress on therapy of sequent cerebral vasospasm in subarachnoid hemorrhage / 医学研究生学报

Cerebral vasospasm(CVS) is a common complication following aneurysmal subarachnoid hemorrhage(SAH),and is the leading cause of death and disability in SAH patients.Till now,although there is no special treatmemt for CVS,the clinical intervention of CVS has gotten a rapid progress with the development of basic research in recent years.The clinical advancement of CVS management is reviewed.

Systemic inflammatory response syndrome following acute brain injury / 医学研究生学报

Acute brain injury is usually complicated by systemic inflammatory response syndrome (SIRS) which is initiated by cytokines and inflammatory mediators and induces a series of adverse physiological changes, culminating in the development of multiple organ failure. SIRS plays a pivotal role on the function of brain and extra cerebral organs, exacerbates the brain edema, and increases the septic rate. The diagnostic criteria and pathological courses of SIRS, and its relationship with acute brain injury and sepsis are briefly reviewed.

The metabolic response to traumatic brain injury and implications for nutritional support / 肠外与肠内营养

The metabolic response to traumatic brain injury includes hypermetabolism, hypercatabolism, hyperglycemia, acute phase response and immunosuppression, which are mediated mainly by hypothalamus pituitary adrenal axis and cytokines. Sufficient nutritional support and appropriate metabolic intervention are believed clinically to play an important role on the mitigation of secondary brain damage, reduction of septic rate and improvement of patient′s outcomes.