Objective To compare and explore the optimal pathway of enteral nutrition between nasointestinal tube and nasogastric tube in patients with severe traumatic brain injury (sTBI). Methods One hunderd patients with sTBI, admitted to our hospital from January 2016 to December 2016, were divided into nasointestinal tube group and nasogastric tube group (n=50) according to different enteral nutrition pathways. The serum levels of tumor necrosis factor-α (TNF-α) and interleukin (IL)-6 were tested with enzyme linked immunosorbent assay (ELISA). Meanwhile, intestinal mucosal barrier function indexes D-lactate acid and intestinal fat acid binding protein (I-FABP) were evaluated by enzymology spectrophotometer method. On the admission, and one, 3, 7 and 14 d after treatment, gastrointestina complications, pneumonias and prognoses of the two groups were compared. Results As compared with those in the nasogastric tube group, the serum levels of inflammatory related factors (TNF-α and IL-6) in the nasointestinal tube group were significantly decreased 3 d after treatment (TNF-α: [112.77± 14.52] μg/L vs. [163.16±18.85] μg/L P=0.01; IL-6: [80.11±8.02] μg/L vs. [100.97±9.82], P=0.02). As compared with those in the nasogastric tube group, the intestinal mucosal barrier function indexes (D-lactate acid and I-FABP) in the nasointestinal tube group were significantly decreased 7 d after treatment (D-lactate: [47.51±4.87] μg/L vs. [62.20±6.01] μg/L, P=0.04; I-FABP: [29.12±3.74] μg/L vs. [40.08±5.51] μg/L, P=0.01). The nasointestinal tube group had significantly lower gastric retention incidence (18% vs. 28%, P=0.00) and aspiration incidence (14% vs. 26%, P=0.06). Meanwhile, the nasointestinal tube group had significantly lower incidence of pneumonia (24% vs. 34%, P=0.01), reduced pneumonia severity (clinical pulmonary infection scores [CPIS]: 14.27±1.22 vs. 17.30±1.50, P=0.03), better prognosis (GCS scores: (9.41±0.66 vs. 8.23±0.57, P=0.03; APACHE II scores: 14.27± 1.22 vs. 17.30±1.50, P=0.03) 14 d after treatment as compared with the nasogastric tube group. Enteral nutrition by nasointestinal tube could shorten the hospitalization days of patients (18.52±2.00 vs. 24.82± 2.31, P=0.02). Conclusion Enteral nutrition by nasointestinal tube can effectively reduce the incidences of gastrointestinal and pulmonary complications, and alleviate inflammatory response and intestinal mucosal barrier function damage in patients with sTBI, possibly improving prognosis.

We report a complete genomic sequence of rare isolates (minor genotype) of the SARS-CoV from SARS patients in Guangdong, China, where the first few cases emerged. The most striking discovery from the isolate is an extra 29-nucleotide sequence located at the nucleotide positions between 27,863 and 27,864 (referred to the complete sequence of BJ01) within an overlapped region composed of BGI-PUP5 (BGI-postulated uncharacterized protein 5) and BGI-PUP6 upstream of the N (nucleocapsid) protein. The discovery of this minor genotype, GD-Ins29, suggests a significant genetic event and differentiates it from the previously reported genotype, the dominant form among all sequenced SARS-CoV isolates. A 17-nt segment of this extra sequence is identical to a segment of the same size in two human mRNA sequences that may interfere with viral replication and transcription in the cytosol of the infected cells. It provides a new avenue for the exploration of the virus-host interaction in viral evolution, host pathogenesis, and vaccine development.
Base Sequence ; China ; Cluster Analysis ; Gene Components ; Genetic Variation ; Genome, Viral ; Genotype ; Molecular Sequence Data ; Phylogeny ; Reverse Transcriptase Polymerase Chain Reaction ; SARS Virus ; genetics ; Sequence Analysis, DNA ; Severe Acute Respiratory Syndrome ; genetics

Beijing has been one of the epicenters attacked most severely by the SARS-CoV (severe acute respiratory syndrome-associated coronavirus) since the first patient was diagnosed in one of the city's hospitals. We now report complete genome sequences of the BJ Group, including four isolates (Isolates BJ01, BJ02, BJ03, and BJ04) of the SARS-CoV. It is remarkable that all members of the BJ Group share a common haplotype, consisting of seven loci that differentiate the group from other isolates published to date. Among 42 substitutions uniquely identified from the BJ group, 32 are non-synonymous changes at the amino acid level. Rooted phylogenetic trees, proposed on the basis of haplotypes and other sequence variations of SARS-CoV isolates from Canada, USA, Singapore, and China, gave rise to different paradigms but positioned the BJ Group, together with the newly discovered GD01 (GD-Ins29) in the same clade, followed by the H-U Group (from Hong Kong to USA) and the H-T Group (from Hong Kong to Toronto), leaving the SP Group (Singapore) more distant. This result appears to suggest a possible transmission path from Guangdong to Beijing/Hong Kong, then to other countries and regions.
Genome, Viral ; Haplotypes ; Humans ; Mutation ; Open Reading Frames ; Phylogeny ; SARS Virus ; genetics