Th17 cells promote inflammatory reactions, whereas regulatory T (Treg) cells inhibit them. Thus, the Th17/Treg cell balance is critically important in inflammatory diseases. However, the molecular mechanisms underlying this balance are unclear. Here, we demonstrate that casein kinase 2 (CK2) is a critical determinant of the Th17/Treg cell balance. Both the inhibition of CK2 with a specific pharmacological inhibitor, CX-4945, and its small hairpin RNA (shRNA)-mediated knockdown suppressed Th17 cell differentiation but reciprocally induced Treg cell differentiation in vitro. Moreover, CX-4945 ameliorated the symptoms of experimental autoimmune encephalomyelitis and reduced Th17 cell infiltration into the central nervous system. Mechanistically, CX-4945 inhibited the IL-6/STAT3 and Akt/mTOR signaling pathways. Thus, CK2 has a crucial role in regulating the Th17/Treg balance.
Casein Kinase II* ; Casein Kinases* ; Caseins* ; Central Nervous System ; Encephalomyelitis, Autoimmune, Experimental ; In Vitro Techniques ; RNA, Small Interfering ; T-Lymphocytes, Regulatory* ; Th17 Cells

Although dietary protein restriction may protect against progression of renal failure, it is important to consider whether protein restriction can be attained without inducing malnutrition. We assessed the calculated dietary protein intake(cDPI) by 24 hour urinary collection and food intake, biochemical nutritional indices and the results of anthropometric measurement in 83 predialysis patients with different stages of chronic renal failure(CRF) and 84 controls. Dietary interventions were minimal. We categorized patients into three groups according to whether their creatinine clearance(Ccr) was greater than 25(group A), 10 to 25(group B), or less than 10ml/min(group C). 1) The mean(+/-SD) cDPI was significantly lower in group C(0.77+/-0.17g/kg/day) and group B(0.84+/- 0.16g/kg/day) than in group A(1.04+/-0.21g/kg/day) and controls(1.14+/-0.22g/kg/day)(P<0.05). The mean (+/-SD) high biologic value protein intake was significantly lower in group C(0.29+/-0.25g/kg/day) and group B(0.39+/-0.27g/kg/day) than in group A (0.48+/-0.35g/kg/day)(P<0.05). The cDPI(r=0.50, P< 0.05), high biologic value protein intake(r=0.39, P< 0.05) were positively correlated with the Ccr. 2) The mean (SD) total lymphocyte count (TLC) was significantly lower in group C(1,554+/-368/mm3) and group B(1,972+/-470/mm3) than in group A(2,111+/-540/mm3) and controls(2,177+/-589/mm3)(P<0.05). The TLC was positively correlated with the Ccr(r= 0.28, P<0.05). The levels of albumin and transferrin were lower in patients with CRF than in controls (P<0.05). There was no difference in the levels of albumin, transferrin, prealbumin, insulin-like growth factor-1, cholesterol and anthropometric measurements among the different stages of CRF. CONCLUSION: In predialysis patients with CRF, the dietary protein and high biologic value protein intake spontaneously decreases as renal function declines. Several nutritional indices, such as TLC, albumin and transferrin were lower in predialysis patient with CRF than controls. Therefore objective measurement of DPI should be considered to educate a low protein diet in predialysis patients with CRF.
Cholesterol ; Creatinine ; Diet, Protein-Restricted ; Dietary Proteins* ; Eating ; Humans ; Kidney Failure, Chronic ; Lymphocyte Count ; Malnutrition ; Nutrition Assessment* ; Prealbumin ; Renal Insufficiency ; Renal Insufficiency, Chronic* ; Transferrin

Transcervical resection of endometrium is under-utilized in the treatment of dysfunctional uterine bleeding, uterine myoma and menorrhagia. The procedure is similar to transurethral resection of prostate in men with a possibility of substantial absorption of irrigation fluid. Absorption of a large volume of fluid can cause excessive intravascular volume, hyponatremia, cerebral edema and death. Severe hyponatremia leading to extrapontine myelinolysis is an extremely rare complication of this procedure. So, We report a case of developed extrapontine myelinolysis after hysteroscopic myomectomy which, however, showed complete recovery.
Absorption ; Brain Edema ; Endometrium ; Female ; Humans ; Hyponatremia ; Leiomyoma ; Male ; Menorrhagia ; Metrorrhagia ; Myelinolysis, Central Pontine ; Transurethral Resection of Prostate

PURPOSE: The purposes of this study were to determine short- and long-term fractal correlation behavior of heart rates during daily activity in patients with neurocardiogenic syncope. METHODS: Twenty five patients with histories of neurocardiogenic syncope episodes were included. Their analogue 24h ambulatory Holter electrocardiograms were analyzed. The tape was digitized and the digitized electrocardiograms were partioned into sections of one hour. Then their RR intervals were measured and 20,000 points of RRI were used. To quantify the fractal correlation behavior, we employed the detrended fluctuation analysis, and short-term(n16, alpha2) fractal scaling exponents were calculated. RESULTS: When compared to control, 24-hour average values of alpha1 and all alpha1 values at quarters of each day were significantly higher in patients with syncope. On the contrary, their 24-hour average value of alpha2 and all alpha2 values at quarters of each day were lower in patients with syncope. However, statistical significances were found in 24-hour average value of alpha2 and in alpha2 value at MN-6AM. CONCLUSION: In the syncope patients with neurocardiogenic syncope, short-term fractal scaling exponents of RR interval was significantly high throughout the day. Therefore, their RR intervals were smoother in the short term scale and had a tendency to continue in the same direction of increase or decrease, which may contribute to persistent decrease in heart rate during a syncopal attack.
Child* ; Electrocardiography ; Fractals* ; Heart Rate* ; Heart* ; Humans ; Syncope ; Syncope, Vasovagal*

Central venous cannulation via an internal jugular vein has become a common procedure in the management and monitoring of severely ill patients. Although complications such as carotid artery puncture or pneumothorax have been reported, hemothorax is relatively uncommon. We describe a case of hydrohemothorax and subclavian artery laceration which occurred during right internal jugular vein cannulation. A 44-year-old female patient was admitted for laparoscopic adrenalectomy under general anesthesia. For central venous pressure monitoring, central venous cannulation performed. However, dilator overinsertion injured the right subclavian artery. This led to a massive ipsilateral hydrohemothorax requiring thoracotomy for subclavian artery repair. This case suggests that central venous cannulation should be done carefully and improves awareness of the potential for dilator induced injury.
Adrenalectomy ; Adult ; Anesthesia, General ; Carotid Arteries ; Catheterization* ; Central Venous Pressure ; Female ; Hemothorax ; Humans ; Jugular Veins* ; Lacerations* ; Pneumothorax ; Punctures ; Subclavian Artery* ; Thoracotomy

BACKGROUND: The aim of the present study was to detect and quantify auto-positive end-expiratory pressure (auto-PEEP) in anesthetized patients using a Laser-Flex endotracheal tube (Mallincrodt, ID, 6.0 mm), by comparing the effects of changes in tidal volume and respiratory rate. METHODS: All patients (n = 30) undergoing elective surgery were anesthetized, paralyzed and intubated with a ID 8.0 mm endotracheal tube (n = 10, control), ID 6.0 mm endotracheal tube (n = 10, group S), or ID 6.0 mm Laser-Flex endotracheal tube (n = 10, group L), respectively. After anesthetic induction, ventilator settings using a Siemens Servo 900C were changed for a tidal volume of 8, 10 ml/kg, respiratory rates of 10, 12 or 14 breaths/min. Peak airway pressure was measured and auto-PEEP was quantified using an end-expiratory occlusion method. Data recorded on the Bicore CP-100 pulmonary monitor was transfered to a PC and analyzed by processing software (ANADAT). RESULTS: In group S and L, peak airway pressure and auto-PEEP were higher than control group and increased during an increase in tidal volume (P < 0.05). But they were increased significantly during an increase of respiratory rate, only when the tidal volume was 10 ml/kg (P < 0.05). CONCLUSIONS: There was an increase of auto-PEEP in anesthetized patients using a Laser-Flex endotracheal tube during incremental changes of tidal volume and respiratory rates.
Humans ; Positive-Pressure Respiration, Intrinsic* ; Respiratory Rate* ; Tidal Volume* ; Ventilators, Mechanical