Objective To investigate the incidence, clinical symptoms, correlative risk factors and prognosis of dysautonomia in patients with severe traumatic brain injury. Methods A total of 142patients with severe traumatic brain injury treated from January 2008 to March 2010 were retrospectively surveyed to compare the clinical features of dysautonomia group and control group. Logistic regression was used to analyze the risk factors for dysautonomia. At 6 months post-trauma, the Glasgow Outcome Score (GOS) was used to measure the outcome. Results Of all the patients, 94 patients survived and were followed up. There were 16 patients ( 17% ) diagnosed as dysautonomia depended on clinical symptoms,with statistical difference in aspects of GCS, coma duration, ICU time and average length of stay (ALOS)(P < 0.05). The patients with dysautonomia tended to have poorer outcome ( P < 0.05 ) and showed a positive association with diffuse axonal injury (DAI) ( OR = 11. 25, CI 7.65-16.54 ). Conclusion Dysautonomia has high incidence and is usually severe in patients with severe traumatic brain injury,when DAI may contribute to its occurrence and result in poor prognosis.

This study examined the effects of ω-3 polyunsaturated fatty acid (ω-3PUFA) on the expression of toll-like receptor 2 (TLR2), toll-like receptor 4 (TLR4) and some related inflammatory factors in peripheral blood mononuclear cells (PBMCs) of patients with early-stage severe multiple trauma. Thirty-two patients who were admitted to the Department of Traumatic Surgery, Tongji Hospital (Wuhan, China) between May 2010 and November 2010, and diagnosed as having severe multiple trauma with a injury severity score (ISS) no less than 16, were enrolled in the study and divided into two groups at random (n=16 in each): ω-3PUFA group and control group in which routine parenteral nutrition supplemented with ω-3PUFA or not was administered to the patients in two groups for consecutive 7 days. Peripheral blood from these patients was collected within 2 h of admission (day 0), and 1, 3, 5 and 7 days after the nutritional support. PBMCs were isolated and used for detection of the mRNA and protein expression of TLR2 and TLR4 by using real-time PCR and flow cytometry respectively, the levels of NF-κB by quantum dots-based immunofluorescence assay, the levels of TNF-α, IL-2, IL-6 and COX-2 by ELISA, respectively. The results showed that the mRNA and protein expression of TLR2 and TLR4 in PBMCs was significantly lower in ω-3PUFA group than in control group 5 and 7 days after nutrition support (both P<0.05). The levels of TNF-α, IL-2, IL-6 and COX-2 were found to be substantially decreased in PBMCs in ω-3PUFA group as compared with control group at 5th and 7th day (P<0.05 for all). It was concluded that ω-3PUFA can remarkably decrease the expression of TLR2, TLR4 and some related inflammatory factors in NF-κB signaling pathway in PBMCs of patients with severe multiple trauma, which suggests that ω-3PUFA may suppress the excessive inflammatory response meditated by the TLRs/NF-κB signaling pathway.

This study examined the effects of ω-3 polyunsaturated fatty acid (ω-3PUFA) on the expression of toll-like receptor 2 (TLR2),toll-like receptor 4 (TLR4) and some related inflammatory factors in peripheral blood mononuclear cells (PBMCs) of patients with early-stage severe multiple trauma.Thirty-two patients who were admitted to the Department of Traumatic Surgery,Tongji Hospital (Wuhan,China) between May 2010 and November 2010,and diagnosed as having severe multiple trauma with a injury severity score (ISS) no less than 16,were enrolled in the study and divided into two groups at random (n=16 in each):ω-3PUFA group and control group in which routine parenteral nutrition supplemented with ω-3PUFA or not was administered to the patients in two groups for consecutive 7 days.Peripheral blood from these patients was collected within 2 h of admission (day 0),and 1,3,5 and 7days after the nutritional support.PBMCs were isolated and used for detection of the mRNA and protein expression of TLR2 and TLR4 by using real-time PCR and flow cytometry respectively,the levels of NF-κB by quantum dots-based immunofluorescence assay,the levels of TNF-α,IL-2,IL-6 and COX-2 by ELISA,respectively.The results showed that the mRNA and protein expression of TLR2 and TLR4 in PBMCs was significantly lower in ω-3PUFA group than in control group 5 and 7 days after nutrition support (both P＜0.05).The levels of TNF-α,IL-2,IL-6 and COX-2 were found to be substantially decreased in PBMCs in ω-3PUFA group as compared with control group at 5th and 7th day (P＜0.05 for all).It was concluded that ω-3PUFA can remarkably decrease the expression of TLR2,TLR4 and some related inflammatory factors in NF-κB signaling pathway in PBMCs of patients with severe multiple trauma,which suggests that ω-3PUFA may suppress the excessive inflammatory response meditated by the TLRs/NF-κB signaling pathway.

ObjectiveTo investigate the clinical features of elderly patients with hepatitis B virus-related acute-on-chronic liver failure （HBV-ACLF） and the risk factors affecting the short-term prognosis of patients. MethodsA retrospective analysis was performed for 417 patients with HBV-ACLF who were admitted to The General Hospital of Western Theater Command from January 2015 to January 2023， and related clinical data were collected， including general status， routine blood test results， biochemical parameters， and conditions of liver cirrhosis and decompensated events （ascites， hepatic encephalopathy， and their severities）. The patients were followed up to observe 90-day survival. According to the age， the patients were divided into elderly group （with 106 patients aged ≥60 years） and non-elderly group （with 311 patients aged<60 years）， and according to the 90-day survival， the elderly group were further divided into survival group with 41 patients and death/transplantation group with 65 patients. The independent-samples t test or the Mann-Whitney U test was used for comparison of quantitative data between two groups， and the chi-square test was used for comparison of qualitative data between two groups. The binary logistic regression analysis was used to determine the independent influencing factors for the risk of death within 90 days in elderly patients with HBV-ACLF， and a nomogram model was constructed for predicting the risk of death. The receiver operating characteristic （ROC） curve was used to investigate the value of the model in predicting the prognosis of HBV-ACLF patients in both the training set and the validation set. Calibration curve and decision curve were plotted for the models constructed in the training set and the validation set， and the model was assessed in terms of the degree of fitness and predicting benefits. ResultsThe elderly patients had a significantly higher 90-day mortality rate than the non-elderly patients （P<0.05）， and compared with the non-elderly group， the elderly group had significantly higher incidence rate in female individuals， basic incidence rate of liver cirrhosis， incidence rate and grade of hepatic encephalopathy， incidence rate of ascites， and liver fibrosis markers （aspartate aminotransferase-to-platelet ratio index and fibrosis-4） （all P<0.05）， as well as significantly lower total cholesterol， high-density lipoprotein， albumin， alpha-fetoprotein， and lymphocytes （all P<0.05）. As for the elderly patients with HBV-ACLF， there were significant differences between the survival group and the death/transplantation group in total cholesterol， total bilirubin， international normalized ratio （INR）， alpha-fetoprotein， platelet， creatinine， serum sodium， monocytes， and the incidence rate and grade of hepatic encephalopathy （all P<0.05）. In addition， the multivariate logistic regression analysis showed that INR （odds ratio ［OR］=11.351， 95% confidence interval ［CI］： 1.942‍ ‍—‍ ‍66.362， P<0.05）， monocyte count （OR=23.636， 95%CI： 1.388‍ ‍—‍ ‍402.529， P<0.05）， total bilirubin （OR=1.007， 95%CI： 1.001‍ ‍—‍ ‍1.013， P<0.05）， and platelet count （OR=0.968， 95%CI： 0.945‍ ‍—‍ ‍0.993， P<0.05） were independent influencing factors for the 90-day prognosis of elderly patients with HBV-ACLF， and the nomogram model constructed based on these factors had a relatively high predictive value， with an area under the ROC curve of 0.915， a sensitivity of 88.0%， and a specificity of 86.7%. The nomogram model showed relatively high efficiency and degree of fitness in the verification set， and the decision curve suggested that the model had good benefits， with a higher prediction efficiency compared with the commonly used prediction models such as MELD score and COSSH-ACLF Ⅱ score. ConclusionElderly HBV-ACLF patients may have a high short-term mortality rate due to the reductions in liver synthesis， reserve function， and regenerative ability and immune dysfunction. INR， monocyte count， total bilirubin， and platelet count have a relatively high value in predicting the risk of death in elderly HBV-ACLF patients， and the nomogram model constructed based on these factors has a relatively high prediction efficiency.