Effect of Ulinastatin Combined with Xingnaojing Injection on Severe Traumatic Craniocerebral Injury and Its Influence on Oxidative Stress Response and Inflammatory Response.

OBJECTIVE: This study is aimed at exploring the effect of ulinastatin combined with Xingnaojing injection on severe traumatic craniocerebral injury and its influence on oxidative stress response and inflammatory response in patients. METHODS: A total of 100 patients with severe traumatic craniocerebral injury admitted to our hospital from January 2018 to January 2020 were selected and equally assigned into a study group (50 cases) and a control group (50 cases) according to a random sampling method. Patients in study group received treatment of ulinastatin combined with Xingnaojing injection, while those in control group were treated with ulinastatin only. The study compared the two groups on the oxidative stress response, inflammatory response, the therapeutic effect, and the incidence rate of adverse reactions. RESULTS: It is observed that patients in study group obtained lower levels of free cortisol (FC) and norepinephrine (NE) in the serum and higher level of total thyroxine (TT4) after treatment compared with those in control group with significant difference (P < 0.05); in the meantime, they were examined to have significantly fewer oxidative stress response products, lower serum inflammatory factor level, and serum indicator levels of craniocerebral injury as opposed to those in control group, suggesting significant differences (P < 0.05); study group demonstrated higher treatment response rate and lower incidence rate of adverse reactions compared with control group with a significant difference (P < 0.05). CONCLUSION: The study found that ulinastatin combined with Xingnaojing infection has a significant effect in the treatment of severe traumatic craniocerebral injury, which can reduce the degree of craniocerebral injury and the level of inflammatory factors in the serum of patients. It is worthy of being promoted and applied clinically.

The effect of omega-3 fatty acids on a biomarker of head trauma in NCAA football athletes: a multi-site, non-randomized study.

BACKGROUND: American-style football (ASF) athletes are at risk for cardiovascular disease (CVD) and exhibit elevated levels of serum neurofilament light (Nf-L), a biomarker of axonal injury that is associated with repetitive head impact exposure over the course of a season of competition. Supplementation with the w-3 fatty acid (FA) docosahexaenoic acid (DHA) attenuates serum Nf-L elevations and improves aspects of CVD, such as the omega-3 index (O3I). However, the effect of combining the w-3 FA eicosapentaenoic acid (EPA) and docosapentaenoic acid (DPA) with DHA on, specifically, serum Nf-L in ASF athletes is unknown. Therefore, this study assessed the effect of supplemental w-3 FA (EPA+DPA+DHA) on serum Nf-L, plasma w-3 FAs, the O3I, and surrogate markers of inflammation over the course of a season. METHODS: A multi-site, non-randomized design, utilizing two American football teams was employed. One team (n = 3 1) received supplementation with a highly bioavailablew-3 FA formulation (2000mg DHA, 560mg EPA, 320mg DPA, Mindset®, Struct Nutrition, Missoula, MT) during pre-season and throughout the regular season, while the second team served as the control (n = 35) and did not undergo supplementation. Blood was sampled at specific times throughout pre- and regular season coincident w ith changes in intensity, physical contact, and changes in the incidence and severity of head impacts. Group differences were determined via a mixed-model between-within subjects ANOVA. Effect sizes were calculated using Cohen's dfor all between-group differences. Significance was set a priori at p< .05. RESULTS: Compared to the control group, ASF athletes in the treatment group experienced large increases in plasma EPA (p < .001, d = 1.71) and DHA (p < .001, d = 2.10) which contributed to increases in the O3I (p < .001, d = 2.16) and the EPA:AA ratio (p = .001, d = 0.83) and a reduction in the w-6: w-3 ratio (p < .001, d = 1.80). w-3 FA supplementation attenuated elevations in Nf-L (p = .024). The control group experienced a significant increase in Nf-L compared to baseline at several measurement time points (T2, T3, and T4 [p range < .001 - .005, drange = 0.59-0.85]). CONCLUSIONS: These findings suggest a cardio- and neuroprotective effect of combined EPA+DPA+DHA w-3 FA supplementation in American-style football athletes. TRIAL REGISTRATION: This trial was registered with the ISRCTN registry ( ISRCTN90306741 ).

Analysis of blood trace elements and biochemical indexes levels in severe craniocerebral trauma adults with Glasgow Coma Scale and injury severity score.

We aimed to investigate the correlation between the Glasgow Coma Scale (GCS), the injury severity score (ISS) and serum levels of trace elements (TE) in severe trauma patients to analyze alteration of the levels of trace elements and serum biochemical indexes in the period of admission from 126 adult cases of severe brain trauma with traffic accidents. Multi-trace elements for patients in the trauma-TE groups were used. The results indicated that all patients presented an acute trace elements deficiency syndrome (ATEDs) after severe trauma, and the correlation between ISS and serum levels of Fe, Zn, and Mg was significant. Compared to the normal control group, levels of the trace elements in serum were significantly decreased after trauma, suggesting that enhancement of immunity to infection and multiple organ failure (MOF) via the monitoring and supplement of trace elements will be a good strategy to severe traumatic patients in clinics.

The effects of Rhizoma drynariae on interleukin-2 and T-lymphocyte levels in rats after severe head injury.

OBJECTIVE: To investigate the effects of Rhizoma drynariae on the levels of interleukin-2(IL-2) and T-lymphocyte subset in rats with severe head injury (SHI). METHODS: 72 Sprague Dawley (SD) rats were randomly divided into 3 groups: control group, model group, and R. drynariae group. The experimental group received intragastrical infusions of with aqueous R. drynariae extract four hours after SHI while the other groups were administered with equivalent volumes of physiological saline. Infusions were administered to the 3 groups once a day for 7 d. IL-2 and T-lymphocyte (CD3, CD4, CD8) levels were measured at 24, 72, and 168 h after initial infusion. RESULTS: The levels of IL-2 and CD4 T cells reduced obviously after 24 h in the model group (P<0.05), but recovered to the levels of the control group after 72 h, and remained elevated after 168 h. In the R. drynariae group, IL-2 and CD4 levels were did not decrease while the level of CD8 T cells was reduced significantly (P<0.05). CONCLUSIONS: R. drynariae can protect against immune dysfunction or improve immunity in rats with severe head injury (SHI).

[Dynamics of changes in the concentrations of selenium in plasma, urine, and erythrocytes in children with severe brain injury].

The role of selenium in man is diverse. In particular, selenium is a cofactor of the major antioxidative enzyme glutathione peroxidase, which inhibits free radical oxidation reactions and restores the normal vital functions of cells and organs. This study deals with selenium metabolism in severe brain injury and its correction modes.

Plasma vitamin E and selenium levels in rats with head trauma.

BACKGROUND: Free radicals play an important role in brain damage induced by a head trauma. In this study, we examined the prevention of brain damage that occurs after oxidative stress in rats that had undergone an experimental head trauma and the determination of plasma levels of vitamin E and selenium, which are recognized as antioxidant agents. METHODS: In this study, adult male Sprague-Dawley rats were used. Rats were divided into 2 groups. In the first group (control group, n = 10), pretraumatic plasma selenium and vitamin E levels were investigated and rats were not traumatized. In the second group (trauma group, n = 10), posttraumatic plasma selenium and vitamin E levels were investigated at the 6th and 24th hours in traumatized rats. RESULTS: In the control group, the plasma selenium level was 107 +/- 8.113 microg/L, whereas vitamin E level was 1.310 +/- 0.048 mg/dL. In the trauma group, the plasma selenium level was 79.93 +/- 3.130 microg/L at the 6th hour and 74.74 +/- 2.947 microg/L at the 24th hour, whereas the vitamin E level was 1.211 +/- 0.056 mg/dL at the 6th hour and 1.136 +/- 0.044 mg/dL at the 24th hour. Normal plasma selenium and vitamin E levels were significantly reduced in the early period after trauma. CONCLUSION: Because of oxidative stress that occurs directly after a head trauma, vitamin E and selenium depletion occurs in the early period. This condition supports the idea that brain damage can be reduced if decreased antioxidants are replaced when a head trauma occurs. We believe that these findings will guide and assist in future studies to develop clinical management strategies to prevent brain damage induced by head trauma.

Safety of magnesium-lidocaine combination for severe head injury: the Turin lidomag pilot study.

BACKGROUND: Neuroprotection in the setting of severe head injury (SHI) remains an unsettled problem. We tested a combination of high-dose magnesium and low-dose lidocaine, infused over 3 days, in a pilot study to assess safety. This combination appears indicated to protect both gray and white matter from secondary injury following SHI. METHODS: We studied 32 consecutive patients admitted to the emergency department of our hospital, a large tertiary referral center. RESULTS: No toxicity was observed. Mortality was lower than published statistics. CONCLUSIONS: These results open the stage to a controlled randomized study.

[Severe hypophosphatemia and grave head trauma]. / Hypophosphorémie sévère et traumatisme crânien grave.

The authors report the case of an 18-year-old man with polytrauma, who died at the third day of its accident from brain death and who presented during his stay in the intensive care unit, a deep hypophosphatemia. Two physiopathologic mechanisms were presumed: increase of renal losses and intracellular transfer of phosphorus. Consequences, as well as the indications and the therapeutic modalities of hypophosphatemia are discussed.

Plasma vitamin C levels are decreased and correlated with brain damage in patients with intracranial hemorrhage or head trauma.

BACKGROUND AND PURPOSE: Free radical hyperproduction may play an important role in brain hemorrhage and ischemia/reperfusion injury. The aims of this study were to assess whether antioxidant depletion occurs after intracranial hemorrhage (ICH) and head trauma (HT) and to evaluate the relation between the diameter of the brain lesion, the degree of the neurological impairment, and any observed antioxidant changes. METHODS: We measured plasma levels of vitamin C (ascorbic acid, AA), uric acid (UA), vitamin E (alpha-tocopherol), and ubiquinol-10 in 13 patients with ICH and 15 patients with HT on the day of the brain injury and subsequently every other day up to 1 week. Patients were compared with 40 healthy control subjects. RESULTS: ICH and HT patients had significantly lower plasma levels of AA compared with healthy subjects, in contrast to plasma levels of UA, alpha-tocopherol, and ubiquinol-10. AA levels were significantly inversely correlated with the severity of the neurological impairment as assessed by the Glasgow Coma Scale and the National Institutes of Health Stroke Scale. AA levels were also significantly inversely correlated with the major diameter of the lesion. In addition, mean plasma AA levels were lower in jugular compared with peripheral blood samples obtained from 5 patients. CONCLUSIONS: These findings suggest that a condition of oxidative stress occurs in patients with head trauma and hemorrhagic stroke of recent onset. The consequences of early vitamin C depletion on brain injury as well as the effects of vitamin C supplementation in ICH and HT patients remain to be addressed in further studies.

Transfusión en la cirugía intracraneal / Transfusion in intracraneal surgery

Fundamentos: Analizar la transfusión en los pacientes de cirugía intracraneal a partir de los datos del Conjunto Mínimo Básico de Datos del paciente. Métodos: Informes de alta de los pacientes intervenidos durante 1996, codificados según la Clasificación Internacional de Enfermedades (CIE-9-MC), evaluando: edad, sexo, los códigos de diagnósticos, de procedimientos, incluidas las transfusiones, y los códigos de las intervenciones quirúrgicas. Resultados: Fueron operados 203 pacientes, de los que se transfundieron 19 (9.4 por ciento). El mayor riesgo de transfusión ocurre en los pacientes con fractura de cráneo (18.5 por ciento), hemorragias intracraneales (12.1 por ciento) y tumoraciones benignas (10.3 por ciento). Mediante análisis univariante, se detecta una asociación estadísticamente significativa de la transfusión con el diagnóstico (p: 0.049), número de diagnósticos codificados (p: 0.049) y de técnicas quirúrgicas codificadas (p: 0.018), posibles indicadores indirectos de la severidad clínica y quirúrgica. Sin embargo mediante el análisis multivariante de regresión logística no se detectó ninguna asociación ajustada de las variables estudiadas con el riesgo de transfusión. Conclusiones: 1º Aunque no hemos podido encontrar un modelo predictor del riesgo de transfusión, este es mayor en los pacientes con fractura de cráneo, hemorragias intracraneales y tumores benignos. 2º Es coste-efectivo el poder monitorizar las transfusiones a partir de los datos administrativos del hospital, dada su fácil disponibilidad y los beneficios del análisis de los mismos. 3º Son necesarios ulteriores estudios para intentar definir con exactitud el subgrupo de los pacientes con mayor riesgo a priori de ser transfundido en la cirugía intracraneal (AU)

Nutritional and metabolic variables correlate with amino acid forearm flux in patients with severe head injury.

OBJECTIVE: To measure the arterial-venous amino acid flux across the forearm muscle in patients with severe head injury. DESIGN: Prospective, interventional study. SETTING: Level I trauma hospital in the neurosurgery intensive care unit (ICU) at a university medical center. PATIENTS: Eight nonsteroid-treated patients with severe head injury. INTERVENTIONS: Patients were prospectively randomized to receive either standard or supplemental intravenous zinc therapy. MEASUREMENTS AND MAIN RESULTS: Net forearm alanine, glutamine, tyrosine, phenylalanine, and branch-chain amino acid forearm flux were measured and compared with metabolic markers of energy expenditure and nitrogen excretion. There was a significant inverse relationship between the measured energy expenditure/predicted energy expenditure ratio and glutamine flux (r2 = .62; p < .05). The patients with the highest measured energy expenditure/predicted energy expenditure ratio had the greatest release of glutamine from forearm muscle. Nitrogen balance was significantly correlated with leucine flux (r2 = .53; p < .05) and with isoleucine flux (r2 = .67; p < .05). The patients with the most positive nitrogen balance had the least release of branch-chain amino acids from skeletal muscle. Tyrosine flux was highly correlated with net amino acid flux (r2 = .76; p < .01). Tyrosine flux was therefore indicative of overall muscle catabolism. Four patients had an overall negative flux of amino acids from skeletal muscle. Three patients had an overall negative flux of branch-chain amino acids. CONCLUSIONS: This preliminary descriptive report suggests that increased skeletal muscle efflux of amino acids correlates significantly with metabolic variables of hypermetabolism and hypercatabolism in nonsteroid-treated, head-injured patients.

Effect of recombinant human insulin-like growth factor I and early total parenteral nutrition on immune depression following severe head injury.

OBJECTIVE: To determine the effects of insulin-like growth factor I (IGF-I) and aggressive nutrition on CD4/CD8 ratios following head injury. DESIGN: Randomized controlled trial. SETTING: An urban level 1 trauma center. PARTICIPANTS: Head-injured patients with a Glasgow Coma Scale score of 4 to 10 within 6 hours of hospital admission requiring no major extracranial surgery with the exception of isolated lower-extremity fracture fixation. Fourteen patients were recruited and 11 completed the study. INTERVENTIONS: Patients were randomized to a continuous infusion of saline or 0.01 mg/kg per hour of recombinant human (rh) IGF-I. Both groups received parenteral nutrition and rapidly advanced to a total protein intake of 2 g/kg per day and a maximum nonprotein calorie intake of 40 kcal/kg per day. The nonprotein prescription was 1.25 times the metabolic energy expenditure determined by metabolic cart not to exceed a nonprotein calorie intake of 40/kcal. MAIN OUTCOME MEASURES: The CD4/CD8 ratios and serum IGF-I levels on days 1, 7, and 14. RESULTS: Administration of early aggressive nutrition eliminated the depressed CD4/CD8 ratio usually seen after head injury; administration of IGF-I increased the CD4/CD8 ratio while IGF-I levels were elevated. CONCLUSIONS: Infusion of rhIGF-I and aggressive early intravenous nutrition affects the immunologic response of patients with severe head injury.

Precocious puberty following head injury. Case report.

A 6-year-old girl developed secondary sexual characteristics 5 months after severe closed head injury. Endocrinological tests confirmed a pubertal sexual condition; there was also diminution of serum melatonin and disruption of the diurnal pattern. Magnetic resonance imaging demonstrated focal hypothalamic injury; this is believed to be the first time such a posttraumatic lesion has been demonstrated by imaging techniques. The pathophysiology of this condition is discussed.

The alterations of plasma potassium in patients with severe acute head injury.

Twenty patients with a severe head injury were studied; 70 per cent of these were admitted with hypokalaemia accompanied by tachycardia and sometimes arrhythmias. These abnormalities are easily corrected by means of a rapid infusion of supplementary potassium.