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Background. Enteral nutrition (EN) is often used in patients with traumatic brain injury (TBI), but some studies have shown that EN has its disadvantages. However, it is not clear which nutritional support is appropriate to reduce mortality, improve prognosis, and improve nutritional status in patients with TBI. We performed this Bayesian network meta-analysis to evaluate the improvement of nutritional indicators and the clinical outcomes of patients with TBI. Methods. We systematically searched PubMed, Embase, Cochrane Library, and Web of Science from inception until December 2021. All randomized controlled trials (RCTs) which compared the effects of different nutritional supports on clinical outcomes and nutritional indicators in patients with TBI were included. The co-primary outcomes included mortality and the value of serum albumin. The secondary outcomes were nitrogen balance, the length of study (LOS) in the ICU, and feeding-related complications. The network meta-analysis was performed to adjust for indirect comparison and mixed treatment analysis. Results. 7 studies enroll a total of 456 patients who received different nutritional supports including parenteral nutrition (PN), enteral nutrition (EN), and PN + EN. No effects on in-hospital mortality (Median RR = 1.06, 95% Crl = 0.12 to 1.77) and the value of 0-1 days of serum albumin were found between the included regimens. However, the value of 11–13 days of serum albumin of EN was better than that of PN (WMD = −4.95, 95% CI = −7.18 to −2.72, P < 0.0001 , I2 = 0%), and 16–20 days of serum albumin of EN + PN was better than that of EN (WMD = −7.42, 95% CI = −14.51 to −0.34, P = 0.04 , I2 = 90%). No effects on the 5–7 day nitrogen balance were found between the included regimens. In addition, the complications including pneumonia and sepsis have no statistical difference between EN and PN. EN was superior to PN in terms of LOS in the ICU and the incidence rate of stress ulcers. Although the difference in indirect comparisons between the included regimens was not statistically significant, the results showed that PN seemed to rank behind other regimens, and the difference between them was extremely small. Conclusion. Available evidence suggests that EN + PN appears to be the most effective strategy for patients with TBI in improving clinical outcomes and nutritional support compared with other nutritional supports. Further trials are required.

Background Myocardial injury is a serious complication of sepsis. It is necessary to explore the risk factors that affect the prognosis of sepsis-induced myocardial injury. Many studies have investigated the role of the neutrophil-to-lymphocyte ratio (NLR) in the early diagnosis and prognostic prediction of sepsis, but few foucus on sepsis induced myocardial injury. We assessed NLR in patients with sepsis-induced myocardial injury to find the relationship between NLR and 30-day mortality. Methods Patients with sepsis induced myocardial injury who had neutrophil counts and lymphocyte counts detected within 48 hours of admission were screened from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Patients were divided into three groups according to NLR in tertiles: the lower tertile group (NLR < 6.29), the second tertile group (NLR 6.29–13.86) and the upper tertile group (NLR > 13.86). Kaplan-Meier curve and multivariate Cox regression model were constructed. The differential effect of age on the relationship between NLR in tertiles and 30-day mortality was examined using an interaction term (difference in differences analysis). Results This study eventually included 1690 adult sepsis-induced myocardial injury patients. Compared with the surviving group, NLR of the death group was higher [9.11(5.27–16.91) vs11.5(6.43–19.75), p < 0.001]. Kaplan-Meier survival analysis showed significantly higher mortality among participants in the upper NLR tertile than among those in the reference of lower NLR tertile [191(32.43%) vs.108(21.14%), P < 0.001]. After adjustment for all clinical variables, multivariate Cox regression analysis showed the same trend (HR = 1.17; 95% CI 1.04–1.32; P = 0.01). When examining the differential effect of age, 30-day mortality was significantly higher in the upper tertile than in the lower tertile as age increased. Conclusions NLR was associated with higher 30-day mortality in patients with sepsis-induced myocardial injury.

Purpose Autophagy is a double-edged sword. The purpose of this study was to investigate the signal transduction pathway of esmolol (ES) interfered with lipopolysaccharide (LPS)-induced cardiomyocyte autophagy. Methods Sepsis was induced by intraperitoneal injection of LPS (10mg/kg) in male Sprague- Dawley rats (250–300) g, which were treated with ES (15mg/kg·h), 3-methyladenine (3-MA, 15mg/kg) and rapamycin (RAP, 4mg/kg) respectively for twelve hours. The severity of myocardial necrosis was analyzed by hematoxylin- eosin (HE) staining. The expression quantity of autophagy protein in myocardial tissue was detected by Western blotting. Results LPS-induced increase in the expression of p- mTOR as well as decrease in the expression of LC3-II, Beclin-1, p-AMPK and p-ULK1 was also inhibited by pretreatment with ES or rapamycin (agonists of autophagy). On the contrary, 3-MA didn’t play a role in enhancing LPS-induced autophagy inhibition. Conclusion This study suggests that ES may provide a new strategy for treatment of sepsis cardiomyopathy through activating the AMPK/mTOR/ULK1 signal pathway-regulated autophagy.