Objective To explore the regulatory mechanisms underlying the increased proportion of CD4+Foxp3+regulatory T(Treg)cells in late-stage diabetes mellitus(DM)with poorly-controlled blood glucose,and to identify new approaches and therapeutic targets for the prevention and treatment of secondary infections in the late stage of DM.Methods Wild-type C57BL/6 mice aged 6 to 8 weeks were randomly assigned to two groups,the experimental and the control groups(n=5 per group).Mice in the experimental group were injected with streptozotocin(STZ)to induce the mouse model of type 1 diabetes mellitus(T1D),while those in the control group received injection of an an equal volume of 0.1 mol/L citrate buffer.In addition,wild-type C57BL/6 mice aged 6 to 8 weeks were fed with high-fat diet for 2 months and subsequently randomly assigned to two groups,the experimental and the control groups(n=3 per group).Mice in the experimental group were injected with low-dose STZ for multiple times to induce the mouse model of type 2 diabetes mellitus(T2D),while those in the control group received an equal volume of 0.1 mol/L citrate buffer.The spleen and peripheral lymph nodes of the mice were collected 2 weeks after the stable onset of diabetes,and T cell immune responses were examined by flow cytometry.Naive T cells isolated by immunomagnetic beads were cultured to investigate the mechanisms by which high glucose regulates T cell differentiation and function.The frequency of Treg cells and effector T(Teff)cells,the expression levels of Ki67,a cell proliferation marker,cell apoptosis rate,and intracellular reactive oxygen species(ROS)levels in the mouse tissue single cell suspension and T cell culture samples were assessed by multicolor flow cytometry.Results Late-stage T1D and T2D mice with poorly-managed blood glucose exhibited increased peripheral CD4+Foxp3+Treg frequencies(P<0.05).In these diabetic mice with poorly-managed blood glucose,the expression of Ki67 in Treg cells was significantly upregulated(P<0.05),while the apoptosis of non-Treg cells(Foxp3-non-Treg cells)increased markedly(P<0.05).Under high-glucose treatment conditions,the ROS levels in Teff cells increased significantly,and the cell apoptosis also increased significantly.High-glucose treatment induced the activation of transforming growth factor-β(TGF-β)and promoted the differentiation of Treg cells,whereas blocking the TGF-β signaling pathway or neutralizing ROS completely inhibited high glucose-induced Treg differentiation(P<0.01).Conclusion Sustained hyperglycemic internal environment in poorly-controlled diabetic mice causes high level of ROS production in Teff cells by inducing oxidative stress,which leads to increased apoptosis of Teff cells,promotes the differentiation of Treg cells by activating TGF-β,and ultimately leads to exacerbated immunosuppressive environment in the late stages of DM.Inhibiting the high level of ROS in late-stage diabetic patients may be conducive to mitigating Teff apoptosis and increasing the frequencies of Treg cells,and may offer new perspectives for improving hyperglycemia-induced immunosuppression and secondary infections in the late stage of DM.

Objective To investigate the comparative effect of different spinal traction therapy on the treat-ment of degenerative lumbar spondylolisthesis based on the change of lumbosacral and pelvic sagittal position parameters.Methods The clinical data of 108 patients with degenerative lumbar spondylolisthesis admitted to Guangdong Provincial Hospital of Traditional Chinese Medicine from March 2022 to January 2024 were selected for retrospective analysis,and they were divided into the three-dimensional group(n=55)and the four-dimensional group(n=53)according to the difference in treatment methods.The four dimensional group received four dimen-sional traction combined with basic treatment,and the three dimensional group received three dimensional traction combined with basic treatment.Lumbosacral pelvis sagittal position parameters,vertebral glide reduction degree,lumbar curvature value,coronal Cobb Angle of lumbar spine,lumbar function,pain degree and clinical efficacy were compared between the two groups.Results At the end of treatment and 3 months after treatment,the levels of sacral inclination Angle(SS)and lumbar lordosis Angle(LL)in 3D and 4D groups were lower than before treat-ment,and at 3 months after treatment were lower than at the end of treatment(P＜0.05).At the end of treatment,SS and LL levels in 3D group were lower than those in 4D group(P＜0.05),while there was no difference in SS and LL levels between the two groups at 3 months after treatment(P＞0.05).The lumbar lordotic index and coro-nal Cobb Angle of both groups were lower than before treatment(P＜0.05),and at 3 months after treatment,the lumbar lordotic index and coronal Cobb Angle of both groups were lower than at the end of treatment(P＜0.05).At the end of treatment,the lumbar protrusion index and coronal Cobb Angle in the three-dimensional group were lower than those in the four-dimensional group(P＜0.05).At the end of treatment and 3 months after treatment,the distance of lumbar arch top in both groups was higher than before treatment(P＜0.05),and at 3 months after treatment,the distance of lumbar arch top in both groups was higher than at the end of treatment(P＜0.05).At the end of treatment,the distance of lumbar arch in the three-dimensional group was higher than that in the four-dimensional group(P＜0.05).At 3 months after treatment,there were no significant differences in lumbar lordo-sis index,coronal Cobb Angle of lumbar spine and distance between the two groups(P＞0.05).At the end of treatment and 3 months after treatment,visual analogue pain scale(VAS)scores in both groups were lower than before treatment(P＜0.05),and at 3 months after treatment,VAS scores in both groups were lower than at the end of treatment(P＜0.05).At the end of treatment and 3 months after treatment,the Japanese Orthopaedic Asso-ciation evaluated treatment score(JOA)in both groups was higher than that before treatment(P＜0.05),and at 3 months after treatment,the JOA score in both groups was higher than that at the end of treatment(P＜0.05).At the end of treatment and 3 months after treatment,there was no significant difference in JOA score and VAS score between the two groups(P＞0.05).At the end of treatment and 3 months after treatment,there was no difference in the reduction rate of vertebral slippage between the two groups(P＞0.05).There was no difference in total effec-tive rate between the two groups(P＞0.05).Conclusion Four dimensional traction and three dimensional traction combined with basic treatment of degenerative lumbar spondylolisthesis have the same efficacy,both can effectively reduce pain and improve lumbar function,but three dimensional traction is better in improving lumbar function and lumbosacral pelvic sagittal position parameters,and correcting lumbar curvature abnormalities.

Objective To investigate the comparative effect of different spinal traction therapy on the treat-ment of degenerative lumbar spondylolisthesis based on the change of lumbosacral and pelvic sagittal position parameters.Methods The clinical data of 108 patients with degenerative lumbar spondylolisthesis admitted to Guangdong Provincial Hospital of Traditional Chinese Medicine from March 2022 to January 2024 were selected for retrospective analysis,and they were divided into the three-dimensional group(n=55)and the four-dimensional group(n=53)according to the difference in treatment methods.The four dimensional group received four dimen-sional traction combined with basic treatment,and the three dimensional group received three dimensional traction combined with basic treatment.Lumbosacral pelvis sagittal position parameters,vertebral glide reduction degree,lumbar curvature value,coronal Cobb Angle of lumbar spine,lumbar function,pain degree and clinical efficacy were compared between the two groups.Results At the end of treatment and 3 months after treatment,the levels of sacral inclination Angle(SS)and lumbar lordosis Angle(LL)in 3D and 4D groups were lower than before treat-ment,and at 3 months after treatment were lower than at the end of treatment(P＜0.05).At the end of treatment,SS and LL levels in 3D group were lower than those in 4D group(P＜0.05),while there was no difference in SS and LL levels between the two groups at 3 months after treatment(P＞0.05).The lumbar lordotic index and coro-nal Cobb Angle of both groups were lower than before treatment(P＜0.05),and at 3 months after treatment,the lumbar lordotic index and coronal Cobb Angle of both groups were lower than at the end of treatment(P＜0.05).At the end of treatment,the lumbar protrusion index and coronal Cobb Angle in the three-dimensional group were lower than those in the four-dimensional group(P＜0.05).At the end of treatment and 3 months after treatment,the distance of lumbar arch top in both groups was higher than before treatment(P＜0.05),and at 3 months after treatment,the distance of lumbar arch top in both groups was higher than at the end of treatment(P＜0.05).At the end of treatment,the distance of lumbar arch in the three-dimensional group was higher than that in the four-dimensional group(P＜0.05).At 3 months after treatment,there were no significant differences in lumbar lordo-sis index,coronal Cobb Angle of lumbar spine and distance between the two groups(P＞0.05).At the end of treatment and 3 months after treatment,visual analogue pain scale(VAS)scores in both groups were lower than before treatment(P＜0.05),and at 3 months after treatment,VAS scores in both groups were lower than at the end of treatment(P＜0.05).At the end of treatment and 3 months after treatment,the Japanese Orthopaedic Asso-ciation evaluated treatment score(JOA)in both groups was higher than that before treatment(P＜0.05),and at 3 months after treatment,the JOA score in both groups was higher than that at the end of treatment(P＜0.05).At the end of treatment and 3 months after treatment,there was no significant difference in JOA score and VAS score between the two groups(P＞0.05).At the end of treatment and 3 months after treatment,there was no difference in the reduction rate of vertebral slippage between the two groups(P＞0.05).There was no difference in total effec-tive rate between the two groups(P＞0.05).Conclusion Four dimensional traction and three dimensional traction combined with basic treatment of degenerative lumbar spondylolisthesis have the same efficacy,both can effectively reduce pain and improve lumbar function,but three dimensional traction is better in improving lumbar function and lumbosacral pelvic sagittal position parameters,and correcting lumbar curvature abnormalities.

Objective:To evaluate the effect of inhalation of sevoflurane during cardiopulmonary bypass (CPB) on early postoperative brain injury in the patients undergoing cardiac valve replacement.Methods:Forty-two American Society of Anesthesiaologists physical status Ⅱ or Ⅲ patients of either sex, aged 40-70 yr, weighing 47-86 kg, scheduled for elective single valve replacement under CPB, were divided into 3 groups ( n=14 each) using a random number table method: control group (group C), combined intravenous-inhalational anesthesia group (group CA) and sevoflurane group (group S). During CPB, propofol 4-6 mg·kg -1·h -1 was intravenously infused in group C, propofol 2-3 mg·kg -1·h -1 was intravenously infused, and 0.5 MAC sevoflurane was inhaled via the membrane oxygenator in group CA, and 1.0-1.5 MAC sevoflurane was inhaled via the membrane oxygenator in group S. The anesthesia and sedation index values were maintained at 40-60 during operation in the three groups.Blood samples were taken from arteries before anesthesia induction (T 1), at 30 min and 6 and 24 h after termination of CPB (T 2-4) for determination of plasma concentrations of neuron-specific enolase (NSE) and Tau protein. Results:Compared with group C, the plasma concentration of NSE was significantly decreased at T 2, 3, and plasma concentration of Tau protein was decreased at T 2-4 in group S, and the plasma concentration of Tau protein was decreased at T 2 in group CA ( P<0.05). Compared with group CA, the plasma concentration of NSE was significantly decreased at T 2, 3, and the plasma concentration of Tau protein was decreased at T 2-4 in group S ( P<0.05). Conclusions:Inhalation of sevoflurane during CPB can reduce early postoperative brain injury to a certain extent in the patients undergoing cardiac valve replacement.

Objective To explore the effect of using cluster nursing measures on expectoration in mechanical ventilation patients after craniocerebral operation. Methods Convenient sampling and controlled trials at not the same period were used. Sixty-seven mechanical ventilation patients after craniocerebral operation were selected as the research objects in Department of Neurosurgery Intensive Care Unit (ICU) of the First Hospital Affiliated to Wenzhou Medical College. Thirty-two patients treated from June 2015 to June 2016 were assigned in the control group, and they were given routine respiratory nursing care; 35 patients admitted and treated from July 2006 to July 2017 were included in the intervention group, and they were given evidence-based cluster nursing intervention measures on the basis of routine care. The differences in expectoration effect, arterial blood gas analysis index, incidence of pulmonary infection and prognosis of patients in two groups were compared. Results Compared with control group, the amount of expectoration in the intervention group was significantly increased (mL/d: 49.69±9.45 vs. 33.72±10.63, P < 0.05), while the daily number of sputum suction (times: 21.57±2.31 vs. 28.76±22.66), the time needed for each sputum suction(s: 6.81±1.74 vs. 9.28±2.52), respiratory frequency (bpm: 26.26±1.83 vs. 28.58±1.36), incidence of pulmonary infection [0 vs. 12.5% (4/32)], time of mechanical ventilation (days: 6.37±2.51 vs. 8.92±3.32), time of ICU stay (days: 7.49±3.87 vs. 10.33±2.12), time of hospital stay (days: 10.31±1.99 vs. 14.56±3.57), fatality rate [8.6% (3/35) vs. 21.9% (7/32)] in the intervention group were significantly decreased (all P < 0.05); after treatment the arterial partial pressure of oxygen (PaO2) and pulse oxygen saturation degree (SpO2) were significantly increased than those before treatment, and the arterial partial pressure of carbon dioxide (PaCO2) was significantly decreased than that before treatment, and the degrees of improvement in the intervention group on 5 days were significantly better than those in the control group [PaO2(mmHg, 1 mmHg = 0.133 kPa): 60.89±3.44 vs. 57.34±2.49, PaCO2(mmHg): 41.06±4.32 vs. 45.22±4.78, SpO2: 0.986±0.030 vs. 0.963±0.023, all P < 0.05]. Conclusion The cluster nursing measures can effectively improve the expectoration effect for mechanical ventilation patients after craniocerebral surgery, reduce the mortality and incidence of pulmonary infection, shorten the stay in ICU and improve the prognosis, suggesting that the measures be worthy to be applied widely in clinics.