BACKGROUND: Although regulatory T cells (Tregs) are key to the maintenance of immunologic homeostasis and tolerance, little is known about Treg-mediated immunosuppression in the stage of sepsis. This article aimed to review the current literature on the role of Tregs in the pathophysiology of septic response, attempting to investigate the role of Tregs in immune dysfunction during sepsis. DATA SOURCES: A literature search was conducted in January 2014 using the China National Knowledge Infrastructure and PubMed. Articles on the role of Tregs in immune dysfunction during sepsis were identified. RESULTS: The identified articles indicated that Treg levels can be used for the assessment of the course of sepsis. The inhibition of Treg activity can promote the recovery of immune function. CONCLUSION: Since the mechanism of Tregs is complex during the sepsis, more studies are needed.

OBJECTIVETo investigate the effects of intensive insulin therapy on insulin resistance(IR) and serum proteins after radical gastrectomy.

METHODSTwenty-two gastric cancer patients were randomly divided into the control (n=11) and intensive insulin therapy group (n=11), and underwent distal radical subtotal gastrectomy under epidural anesthesia. Fasting blood glucose (FBG), fasting insulin (FINS) and serum proteins were assayed preoperatively and at day 1, 3, 7 postoperatively. Insulin resistance index was calculated using homeostasis model assessment (HOMA). The length of hospital stay and postoperative complications were recorded respectively.

RESULTS(1)The levels of FBG, FINS, lnHOMA-IR (P<0.01,P<0.05) and the incidence of insulin resistance were remarkably decreased by intensive insulin therapy after the surgical procedure.(2)The levels of serum transferrin (TRF), prealbumin (PRE) and retinal binding protein (RBP) in the intensive insulin therapy group were significantly improved as compared to control group after operation(P<0.05). (3) The duration of fever, antibiotic use, passage of gas by anus, length of hospital stay and the occurrence of postoperative complications were also significantly lower than those in control group(P<0.01,P<0.05).

CONCLUSIONCompared to routine therapy, the intensive insulin therapy has more beneficial effects on the patients undergone distal radical subtotal gastrectomy in decreasing the insulin resistance, improving the status of nutrition and preventing postoperative complications.

Adult ; Aged ; Blood Glucose ; metabolism ; Blood Proteins ; metabolism ; Female ; Gastrectomy ; Humans ; Insulin ; metabolism ; therapeutic use ; Insulin Resistance ; Male ; Middle Aged ; Postoperative Complications ; Stomach Neoplasms ; drug therapy ; metabolism

OBJECTIVETo explore the mechanism of cake-separated moxibustion in treatment of hyperlipemia.

METHODSSixty rabbits were randomly divided into 4 groups, a blank group,a model group, a direct moxibustion group and a cake-separated moxibustion group. Hyperlipemia model was developed by high fat diet of cholesterol. Changes of ultrastructures of endothelial cells of the aorta of the rabbit were observed with electron microscope.

RESULTSThe endothelial cells in the cake-separated moxibustion group were more intact, most of them were normal in forms, internal elastic membrane was continuous, their thickness was even, the cells of smooth muscles in the medial membrane were relatively normal, which are similar to those in the blank control group. But the structure of endothelial cells of the aorta in the model group disappeared, in cytoplasm the sedimentation of a great number of lipids can be seen, internal elastic membrane was interrupted, the thickness was uneven, with focal dissolution, the cells of smooth muscle in the medial membrane had sedimentation of lipids, with frothy change.

CONCLUSIONCake-separated moxibustion has a certain protective action on endothelial cells of the aorta in the rabbit of hyperlipemia.

Animals ; Aorta ; Endothelial Cells ; Hyperlipidemias ; Lipids ; Moxibustion ; Rabbits

0.05);2)After 12,24,36 months' treatment,BP was decreased significantly in each group (P0.05).Conclusion Both combined spirono- lactone/HCTZ and captopril/HCTZ significantly reduced BP and LVMI or LVMI and the maguitude of reduction was further enhanced after prolonged treatment.

OBJECTIVETo study the clinicopathologic features and prognostic factors of gastrointestinal stromal tumor (GIST).

METHODSClinicopathologic data of 247 patients with GIST from January 2003 to November 2012 in the Affiliated Hospital of Qingdao University Medical College, and the prognostic factors were evaluated retrospectively by univariate and multivariate analysis with Log-rank test and Cox proportional hazard model.

RESULTSPatients were followed up with a median time of 26 months (1 to 113 months). Twenty-six patients developed recurrence or metastasis, and 18 died of GIST. The 1-, 3-, 5-year survival rates were 94%, 91% and 83% respectively. Univariate analysis showed that age, tumor location, tumor size, mitotic count and tumor rupture were predictive factors of survival after resection of primary GIST (all P<0.01). For patients at intermediate and high risk to relapse, imatinib group had a higher 5-year overall survival rate than non-imatinib group (85.7% vs. 81.0%, P<0.05). Multivariate analysis revealed that tumor size (RR=2.248, 95%CI:1.081-4.677, P=0.030), mitotic count (RR=2.220, 95%CI:1.032-4.776, P=0.041) and tumor rupture (RR=5.183, 95%CI:1.677-16.017, P=0.004) were independent prognostic factors.

CONCLUSIONSTumor size, mitotic count and tumor rupture affect the prognosis after resection of primary GIST independently. Imatinib adjuvant therapy can improve overall survival of patients at intermediate and high risk to relapse after surgery.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Female ; Follow-Up Studies ; Gastrointestinal Neoplasms ; diagnosis ; pathology ; surgery ; Gastrointestinal Stromal Tumors ; diagnosis ; pathology ; surgery ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Prognosis ; Proportional Hazards Models ; Retrospective Studies ; Young Adult

OBJECTIVETo investigate the effects and mechanism of postoperative insulin resistance in gastrectomy patients with preoperative oral carbohydrate.

METHODSFrom April to October 2011, 60 consecutive gastric cancer patients met inclusion criteria were divided into oral carbohydrate group and placebo group by randomized double-blind principles. Resting energy expenditure (REE), fasting blood glucose, insulin and triglyceride level were detected in 4 hours preoperatively. The 500 ml carbohydrate or placebo were administrated orally 2-3 hours before anaesthesia. Two group patients underwent radical distal subtotal gastrectomy under epidural compounded intravenous anesthesia. After laparotomy and before the abdomen was closed, a piece of rectus abdominis was taken and fixed in 3% glutaraldehyde. REE, fasting blood glucose, insulin and triglyceride level were detected immediately after surgery. The changes of insulin resistance index, blood triglycerides level, REE and respiratory quotient were compared pre- and post-operatively. The changes of rectus abdominis mitochondrial ultrastructure were observed by transmission electron microscopy respectively.

RESULTSThere were 48 patients (34 males and 14 females) completed the trial. The 24 and 24 patients in oral placebo and carbohydrate groups respectively. In oral placebo group, post-operative insulin resistance index, REE, respiratory quotient, serum triglyceride level and the rectus abdominis mitochondrial damage index were 12.68 ± 3.13, (1458 ± 169) kcal/d, 0.73 ± 0.42, (0.53 ± 0.24) g/L and 1.14 ± 0.33, respectively. And the above items were 5.67 ± 1.40, (1341 ± 110) kcal/d, 0.79 ± 0.22, (1.04 ± 0.97) g/L and 0.92 ± 0.19 in oral carbohydrate groups respectively. All difference was statistically significant (t = 6.646, 2.851, 6.546, 2.542 and 2.730, all P < 0.05). Oral placebo group showed a markedly swollen mitochondria, steep membrane was not clear, mitochondria appeared vacuolated changes.

CONCLUSIONSPreoperative oral carbohydrate could reduce the insulin resistance and REE, improve the material metabolism status in radical gastrectomy patients. The possible mechanisms should be related to promotion of insulin release and protection of mitochondrial function.

Administration, Oral ; Aged ; Basal Metabolism ; Carbohydrates ; administration & dosage ; therapeutic use ; Double-Blind Method ; Female ; Gastrectomy ; Humans ; Insulin Resistance ; Male ; Middle Aged ; Mitochondria ; ultrastructure ; Postoperative Complications ; prevention & control ; Stomach Neoplasms ; surgery

Background:Over the years,the mechanical ventilation (MV) strategy has changed worldwide.The aim of the present study was to describe the ventilation practices,particularly lung-protective ventilation (LPV),among brain-injured patients in China.Methods:This study was a multicenter,1-day,cross-sectional study in 47 Intensive Care Units (ICUs) across China.Mechanically ventilated patients (18 years and older) with brain injury in a participating ICU during the time of the study,including traumatic brain injury,stroke,postoperation with intracranial tumor,hypoxic-ischemic encephalopathy,intracranial infection,and idiopathic epilepsy,were enrolled.Demographic data,primary diagnoses,indications for MV,MV modes and settings,and prognoses on the 60th day were collected.Multivariable logistic analysis was used to assess factors that might affect the use of LPV.Results:A total of 104 patients were enrolled in the present study,87 (83.7％) of whom were identified with severe brain injury based on a Glasgow Coma Scale ＜8 points.Synchronized intermittent mandatory ventilation (SIMV) was the most frequent ventilator mode,accounting for 46.2％ of the entire cohort.The median tidal volume was set to 8.0 ml/kg (interquartile range [IQR],7.0-8.9 ml/kg) of the predicted body weight;50 (48.1％) patients received LPV.The median positive end-expiratory pressure (PEEP) was set to 5 cmH2O (IQR,5-6 cmH2O).No PEEP values were higher than 10 cmH2O.Compared with partially mandatory ventilation,supportive and spontaneous ventilation practices were associated with LPV.There were no significant differences in mortality and MV duration between patients subjected to LPV and those were not.Conclusions:Among brain-injured patients in China,SIMV was the most frequent ventilation mode.Nearly one-half of the brain-injured patients received LPV.Patients under supportive and spontaneous ventilation were more likely to receive LPV.

Objective To measure the upper airway of obstructive sleep apnea hypopnea syndrome by 256 slice spiril CT, and to access the airway obstruction plane with the airway plane data in OSAHS patients.Through these measurements, we can provide assistance for clinical diagnosis and treatment.Methods This study randomly selected 178 patients diagnosed with OSAHS and 110 cases non-snoring healthy people as the control group by the Philips 256 slice CT.Under the nasopharyngeal area, velopharyngeal area, glossopharyngeal area, epiglottis area, we measured the cross-sectional area and volume of the narrowest plane in the two groups of quiet respiration and Müller status.Results The OSAHS group underwent quiet respiration and Müller status during CT scanning, and the two states about epiglottis area in cross-sectional area and volume had no significant difference, Other groups had differences between the parameters.There was a significant difference in the volume about velopharyngeal area and glossopharyngeal area. In the control group undergoing quiet respiration and Müller status during CT scanning, there was difference in velopharyngeal cross-sectional area.Other parameters had no significant difference.Conclusions The obstruction plate of OSAHS patients with 256-slice spiril CT measurement is mostly in the velopharyngeal area and glossopharyngeal area. The volume measurement of upper airway by CT can predict airway obstruction plate in patients with OSAHS.

Tamoxifen(TAM)has been widely used for the treatment of ER+breast cancer.However,the inevitable emergence of resistance to tamoxifen obstructs the successful treatment of this cancer.The tumor suppressor gene N-myc downstream-regulated gene 2(NDRG2)plays a significant role in the de-velopment of ER+breast cancer.However,it is unclear whether NDRG2 participates in mediating TAM resistance in ER+breast cancer.Here,we investigate the expression of NDRG2 mRNA and protein in TAM-sensitive and TAM-resistant ER+breast cancer cells.The results of immunoblotting experiments re-vealed a negative correlation between NDRG2 expression and TAM resistance ability in ER+breast cancer cells(P＜0.001).CCK-8 cell viability assays and soft agar colony formation assays showed that NDRG2 overexpression in TAM resistant cells significantly reduced the TAM IC50 value and the soft agar colony formation rate(P＜0.001).For the mechanism,the ERAD reporter protein assays showed that NDRG2 overexpression upregulated the expression of the ERAD reporter protein CD3ε-YFP and increased the lev-els of spliced XBP1s mRNA,leading to severe endoplasmic reticulum stress in TAM resistant cells(P＜0.001).Immunoblot analysis confirmed that overexpression of NDRG2 significantly increased the level of phosphorylation of the endoplasmic reticulum stress sensor IRE 1α and the expression levels of its down-stream protein factors,including ERdj4,P58IPK,EDEM and PDIA5(P＜0.001).The in vivo xenograft tumor experiments in mice further verified that NDRG2 overexpression significantly inhibited the growth of resistant tumors,which enhanced the therapeutic effect of TAM(P＜0.001).These findings indicate that increasing NDRG2 expression and triggering severe endoplasmic reticulum stress upon TAM treatment can reverse the resistance of ER+breast cancer cells to TAM and inhibits the growth of ER+breast canc-er tumors.Our results provide valuable new insights and potential targets for improving the clinical man-agement of TAM-resistance and prognosis in ER+breast cancer.

OBJECTIVETo investigate the influence of intensive insulin therapy on the results of postoperative patients with gastric cancer.

METHODSForty-six patients with gastric cancer underwent radical operation were randomly divided into two groups: intensive group (n=23, to control blood glucose at 4.4 to 6.1 mmol/L) and conventional group (n=23, to control blood glucose at 10.0 to 11.1 mmol/L). Fasting blood glucose( FBG), fasting insulin (FINS), tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6) and C reaction protein (CRP) in 46 patients were detected dynamically during perioperative period. Insulin resistance index (HOMA-IR) were calculated using Homeostasis Model Assessment (HOMA) to evaluate insulin sensitivity. Postoperative complications and other clinical data were recorded.

RESULTSNo hypoglycemia occurred in the two groups. Compared with conventional group, morbidity and postoperative duration of fever, antibiotic use and the length of hospital stay in intensive group were significantly reduced (P < 0.05). On the day 1 and 3 after surgery, HOMA-IR and serum levels of TNF-alpha, IL-6 and CRP in patients of intensive group were significantly lower than those in conventional group (P < 0.05).

CONCLUSIONSIntensive insulin therapy could counteract the state of high-inflammation and then improve the outcome of postoperative patients.

Blood Glucose ; metabolism ; C-Reactive Protein ; metabolism ; Female ; Humans ; Hypoglycemic Agents ; therapeutic use ; Insulin ; blood ; therapeutic use ; Interleukin-6 ; blood ; Male ; Middle Aged ; Perioperative Care ; Stomach Neoplasms ; blood ; drug therapy ; surgery ; Treatment Outcome ; Tumor Necrosis Factor-alpha ; blood