Objective To investigate the effect of oral intake of 10%glucose solution before surgery on the perioperative safety and postoperative insulin resistance in patients undergoing resection for gastric cancer. Methods Between March 2012 and December 2012,36 patients undergoing elective resection for gastric cancer were enrolled and randomized into three groups. Patients in group A were given 500ml of 10%glucose solution for oral intake two hours before surgery. Patients in the group B were given distilled water instead of glucose. Patients in the group C were asked to fast for 8 hours before operation. Patient′s wellbeing scores on a visual analogue scales (VAS) were recorded. Blood samples were collected to measure. Homeostasis model assessment (HOMA) was applied to assess the status of insulin resistance (HOMA-IR) and insulin sensitivity index (ISI) according to the level of blood glucose and the serum concentration of insulin. The gastric residues before anesthesia and the time of exhaustion and defecation were also recorded. Results The gastric residues were not increased significantly after the intake of 10%glucose solution (P > 0.05). Intake of 10% glucose solution before surgery relieved thirst and hunger (P < 0.01). The time of exhaustion and defecation in three groups was not significantly different (P > 0.05). The HOMA-IR levels postoperative immediately, on the first day and the third day after surgery were lower in group A than that of group B and group C (P < 0.05), but the ISI levels were higher significantly (P < 0.01). Conclusion Intake of 10%glucose solution 2 hours before surgery for gastric cancer is be safe , which can relieve preoperative thirst and hunger, and improve postoperative insulin resistance.

Objective:To evaluate the effect of Candida albicans ( C. albicans) hyphae on autophagic flux in murine bone marrow-derived macrophages (BMDM) . Methods:BMDM were in vitro stimulated with C. albicans hyphae for 0.5, 4 and 12 hours, and the 0-hour group treated without hyphae served as a control. Western blot analysis was performed to detect the conversion of microtubule-associated protein 1 light chain 3 (LC3) -Ⅰto LC3-Ⅱ, and determine the expression of phosphorylated mechanistic target of rapamycin (p-mTOR) at each time point. Some BMDM were divided into several groups: control group receiving no treatment, hyphae group treated with C. albicans hyphae, lysosomal inhibitor groups treated with different lysosomal inhibitors, including E-64d (a cysteine proteinase inhibitor) + pepstatin (a pepsin inhibitor) , bafilomycin-A1 (BAF-A1) , ammonium chloride and chloroquine, and hyphae combined with lysosomal inhibitor groups treated with lysosomal inhibitors immediately followed by C. albicans hyphae. After 4- or 12-hour treatment, the effect of C. albicans hyphae on basal autophagic flux in murine BMDM was evaluated. Statistical analysis was carried out by using unpaired t test, factorial design analysis of variance and least significant difference- t test. Results:After 0.5-, 4- and 12-hour in vitro treatment with C. albicans hyphae, the conversion of LC3-Ⅰ to LC3-Ⅱ significantly increased in murine BMDM (1.254±0.118, 1.629±0.391, 1.598±0.379, respectively) compared with the 0-hour group (0.983±0.030; t=3.875, 2.856, 2.804, respectively, all P< 0.05) , while there was no significant difference in the protein expression of p-mTOR among the 0-, 0.5-, 4- and 12-hour groups. After 4- and 12-hour in vitro treatment with C. albicans hyphae combined with lysosomal inhibitors E-64d and pepstatin, the accumulation level of LC3-Ⅱ significantly increased in BMDM compared with those treated with E-64d and pepstatin alone ( t=3.691, 6.648, respectively, both P< 0.05) . Compared with the corresponding lysosomal inhibitor groups, the accumulation level of LC3-Ⅱsignificantly increased in BMDM treated with C. albicans hyphae combined with BAF-A1, ammonium chloride or chloroquine for 4 and 12 hours (all P< 0.05) . Conclusion:In vitro treatment with C. albicans hyphae can increase the conversion of LC3-Ⅰto LC3-Ⅱ in the basal autophagic flux in murine BMDM.

OBJECTIVETo investigate the impact of preoperative oral liquid carbohydrate on postoperative insulin resistance (IR) in gastric cancer patients undergoing elective resection, and to examine the association of IR index (homeostasis model assessment, HOMA-IR) with tumor necrosis factor-α (TNF-α).

METHODSBetween January 2013 and September 2013, 35 patients undergoing elective resection for gastric cancer were prospectively enrolled and randomized into two groups. Patients in trial group (n=18) received oral 500 ml of 10% glucose solution two hours before surgery. Patients in control group (n=17) were asked to fast for 8-12 hours before operation. About 300 mg of rectus abdominis and subcutaneous fatty tissues was removed before the closure of abdominal wall. Blood samples were collected to measure the serum concentration of TNF-α with double antibody sandwich ELISA in perioperative period (3-hour before operation, end of operation, 1-day and 3-day after operation). HOMA-IR was calculated on preoperative 3-hour and postoperative 1-day. Western blotting was used to detect protein expression of TNF-α. Correlation of HOMA-IR with TNF-α was examined.

RESULTSHOMA-IR on the first day after surgery was not different from that at 3-hour before surgery in trial group (P=0.090), which was significantly lower than that in control group (P=0.000). In trial group, serum TNF-α at the end of operation was higher than that at 3-hour before surgery, which declined rapidly on the first day after surgery and had no significant difference compared with that on the third day after surgery. In control group, serum TNF-α at the end of operation was also higher than that before surgery, which rose to the peak on the first day after surgery and was still higher than that at 3-hour before surgery. The TNF-α protein expression in muscle tissues of trial group was higher than that of control group (P=0.001), while no significant difference was observed between two groups in adipose tissues (P=0.987). Correlation analysis showed that HOMA-IR was positively correlated with TNF-α on the first day after surgery (r=0.832, P=0.000).

CONCLUSIONOral intake of liquid carbohydrate 2 hours before surgery can reduce the level of TNF-α, which is likely to improve the postoperative insulin resistance.

Carbohydrates ; Fasting ; Humans ; Insulin Resistance ; Postoperative Period ; Prospective Studies ; Stomach Neoplasms ; Tumor Necrosis Factor-alpha

Objective To explore the therapeutic effect of traditional Chinese medicine (TCM) on subsolid nodule (SSN). Methods A practical randomized controlled study method, including 254 SSN patients was adopted. The patients were divided into the TCM (102 cases) and follow-up (152 cases) groups. The follow-up group received regular check-ups in accordance with the guidelines, and the TCM group received TCM syndrome differentiation treatment for 24 weeks. The two groups were compared in terms of the changes in their SSN diameter, SSN number, TCM symptom score, and overall therapeutic effect before and after treatment. Adverse reactions and safety indicators were also recorded. Results The TCM group showed a significantly higher effective rate of treatment (16.7%) than the follow-up group (2.6%) (P<0.01). Compared with their condition before treatment, the TCM group showed no significant changes in their SSN diameter and number but presented considerably reduced fatigue, yellow and red urine symptoms, and overall TCM symptom score (P<0.05). The follow-up group exhibited significantly increased diameter and number of SSN (P<0.01). The follow-up group showed the significantly higher increase in SSN diameter after treatment than the TCM group (P<0.05). Moreover, the follow-up group showed significantly higher fatigue, depression, yellow and red urine symptom scores, and overall TCM symptom score than the TCM group (P<0.05 or P<0.01). Conclusion TCM treatment for SSN has a distinct clinical efficacy, reduces the malignant risk of SSN and improves clinical symptoms of SSN patients, and is safe and feasible.

The authors introduced a pharmaceutical care mode by establishing a medication management platform(" Smart Pharmacists" platform), automatically and regularly sending personalized medication reminders for out-of-hospital patients. In virtue of the medication consultation service built on mobile internet technology, the hospital information system was seamlessly connected with the WeChat public account of the hospital, hence broadening pharmaceutical care. The " Smart Pharmacists" platform covered such six parts as medication reminder, medication record, voice broadcast, medication consultation, prescription query, and package insert inquiry. It serves as a reminder of taking medicine for patients out of the hospital and provides an accessible " pharmacist-patient interaction" service window, which will guarantee the safety and effectiveness of medication for out-of-hospital patients.