Effects of multiple interference on borderline hypertension with metabolic syndrome

Intensive insulin therapy on infection rate, days in NICU, in-hospital mortality and neurological outcome in severe traumatic brain injury patients: A randomized controlled trial

Objective To evaluate the effect of ganoderma lucidium spore (GLS) to the immunological function of patients with hepatocellular carcinoma (HCC) after operation. Methods A total of 70 HCC patients who underwent hepatectomy in the Hepatobiliary and Pancreatic Surgery of the First People's Hospital of Foshan from November 2008 and December 2010, were studied prospectively. The informed consents of all patients were obtained and the ethical committee approval was received. The patients were randomly divided into the conventional liver protection therapy group (conventional therapy group) and GLS therapy group using computer random number table method. There were 35 cases in the conventional therapy group, of which 30 were males and 5 were females with the mean age of (51±10) years old. There were 35 cases in the GLS therapy group, of which 28 were males, 7 were females with the mean age of (50±9) years old. Another 35 healthy person who received physical examination were enrolled as the control group. Patients in the conventional therapy group began to take compound glycyrrhizin and GIK injection one day after hepatectomy. Patients in the GLS therapy group were given ganoderma lucidum spores orally upon the basic of conventional therapy one day after hepatectomy. Detections of cluster differentiation (CD)4+, CD8+ and natural killer (NK) cells in peripheral blood were undertook preoperatively (or when enrolled in the study), and 1, 7 and 28 days after the operation. Comparisons of percentage of CD4+, CD8+ and NK cells between 2 groups were performed using t test. Results Percentage of CD4+ cells in HCC patients[ (34±7) %] reduced significantly, compared with the control group[ (43±7) %] (t=5.63, P 0.05). The percentages of CD4+、CD8+ and NK cells of patients in 2 groups decreased evidently one day after operation compared with the preoperative data (t= 4.01, 2.69, 2.75; P<0.01) . Compared with the conventional therapy group, the percentage of CD4+ in the GLS therapy group elevated significantly 7 and 28 days after operation (t=3.70, 2.39; P<0.05) , while the percentage of CD8+ decreased significantly (t=4.06, 2.79; P<0.05) , and the NK cells elevated significantly (t=2.79, 2.09; P<0.05) . Conclusions The cellular immunological function in patients with HCC is inhibited before and after the operation. Application of ganoderma lucidum spores early after the operation can improve the cellular immunological function and help to maintain the body immunological balance. Key words: Carcinoma, hepatocellular; Reishi; Autoimmunity; CD4-positive T-lymphocytes; CD8-positive T-lymphocytes; Killer cells, natural

It is unclear if avoiding hyperglycemia during intensive care after acute brain injury improves morbidity, mortality, and neurologic outcome. This prospective randomized trial tested whether intensive insulin therapy affected infection rates, vasospasm, mortality, or long-term neurologic outcome in subarachnoid hemorrhage patients during their intensive care unit (ICU) stay. Comparison was made against conventional insulin therapy using a randomized trial design. The primary outcome measure was infection rate until the fourteenth postoperative day in the ICU or until patient discharge. Secondary end points were the incidence of vasospasm until the fourteenth postoperative day in the ICU or until patient discharge, and neurologic outcome and mortality at 6 months follow-up. A total of 78 patients were prospectively enrolled and randomly assigned either to conventional insulin therapy or to intensive insulin therapy (38 and 40 patients, respectively). The infection rate during the study was significantly higher in patients who received conventional insulin therapy than in patients who received intensive insulin therapy (42% vs. 27%; P<0.001). The incidence of vasospasm during the study was also similar in conventional and intensive therapy groups (31.5% vs. 27.6% in the conventional and intensive insulin therapy groups; P=0.9). Overall mortality rates at 6 months were similar in the 2 groups (18% vs.15%; P=0.9), as was the neurologic outcome at 6 months [modified Rankin score >3 in 22/38 patients (57.8%) in the conventional therapy group vs. 21/40 patients (52.5%) in the intensive insulin therapy group; P=0.7]. Intensive insulin therapy in patients with acute subarachnoid hemorrhage admitted to a postoperative neurosurgical ICU after surgical clipping of intracranial aneurysms decreases infection rates. The benefit of strict glycemic control on postoperative vasospasm, neurologic outcome, and mortality rates does not seem to be affected by intensive insulin therapy.

This study examined the effect of intensive insulin therapy on immune function and inflammatory factors at the early phase after severe trauma. At day 1, 3, 5, 7 after admission, subsets of CD4(+) helper T lymphocytes (Th1/Th2) and human leukocyte antigen (HLA)-DR expression on CD14(+) monocytes were flow cytometrically measured. Levels of cytokines, including tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), interleukin-10 (IL-10) and other immunity markers, such as IgA, IgG, IgM, C3, C4 and C reaction protein (CRP) were examined in two groups. The results showed that TNF-α, IL-6 and CRP levels in the intensive insulin therapy group were significantly lower than those in the conventional therapy group, whereas IL-10 levels were substantially increased after intensive insulin therapy. C3 level at day 3, 5, 7 and C4 levels at day 5, 7 were lower in the intensive therapy group than in the conventional therapy group. Th1/Th2 ratios decreased gradually over time in both groups, and were much lower at day 3, 5, 7 in intensive therapy group. There were significant differences among day 3 to day 7 after admission in HLA-DR expression in CD14(+) monocytes. It was concluded that the intensive insulin therapy could decrease pro-inflammatory cytokines and increase anti-inflammatory cytokines in the elderly suffering from severe trauma, at the same time, with complement recovery being delayed. Moreover, intensive insulin therapy promoted immune suppression and, therefore, measures need be taken to address the issue.

Effect of an intensified multifactorial intervention on cardiovascular outcomes and mortality in type 2 diabetes (J-DOIT3): an open-label, randomised controlled trial

Objective To observe the effects of intensive insulin therapy on C-reactive protein (CRP) ,interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α ) in the patients of critical illness complicated with hyperglycemia and its incidence of side effect. Methods Two hundred and nine patients of critical illness complicated with hyperglycemia were randomly divided into intensive insulin therapy group (106 patients,blood glucose maintained at a level of 4.4-6.1 mmol/L) and conventional insulin therapy group ( 103 patients, blood glucose maintained at a level of 9.0-11.1 mmol/L). Serum levels of CRP,TNF- α and IL-6 were determined on 0,24,48,72 h respectively after ICU admission. Results The levels of blood glucose of both groups reached the target level. The incidence rates of the hypoglycemia had no significant difference between two groups [6.60 % (7/106) vs. 4.76% ( 3/63 ),P > 0.05]. After 72 h treatment, serum level of CRP in intensive insulin therapy group was significantly lower than that in conventional insulin therapy group (P < 0.05 ). After 24,48 and 72 h treatment, serum level of IL-6 in intensive insulin therapy group was significantly lower than that in conventional insulin therapy group (P < 0.05 ). After 48 and 72 h treatment, serum level of TNF-αin intensive insulin therapy group was significantly lower than that in conventional insulin therapy group (P < 0.05). Conclusion Intensive insulin therapy can significantly decrease the levels of non-specific inflammatory factors in patients of critical illness complicated with hyperglycemia, which brings beneficial effect to the patients. Key words: Insulin; Critical illness; C-reactive protein; Interleukin-6; Tumor necrosis factor-alpha

Objective The aim of this study was to compare the efficacy and safety of metformin/thiazolidinediones (TZDs) / glucagon-like peptide 1 (GLP-1) analogs (triple therapy) with conventional glucose-lowering therapy(conventional therapy) for patients with type 2 diabetes and metabolic syndrome. Methods A prospective randomized-controlled 26-week study was carried out. A total of 82 patients with type 2 diabetes and metabolic syndrome were randomized to receive either triple therapy protocal or just conventional therapy, altogether with 41 cases in each group. Results HbA1C value was significantly reduced in triple therapy group versus the conventional therapy group [(2.23±1.75)% vs (1.48±1.59)%, P<0.05]. Values of body mass index, waist circumference, and visceral fat area were significantly reduced in triple therapy group as compared to those of conventional therapy group [(2.50±1.81 vs 0.92±1.82)kg/m2, (6.75±4.92 vs 1.66±3.25)cm, (24.10±19.10 vs 10.02±20.10)cm2, all P<0.01, respectively]. Control rates of HbA1C and fasting plasma glucose for triple therapy were higher than those for conventional therapy (both P<0.05). No hypoglycemia occurred in triple therapy group. Subjects receiving triple therapy experienced more frequent gastrointestinal side effects than those in conventional therapy group (18.87% vs 3.92%, P<0.05). The most common side event was mild nausea (90%). Conclusion Combination therapy with metformin/TZDs/GLP-1 analogs had statistically significant advantages in the control of body weight, waist circumference, and visceral fat area in addition to the control of blood glucose over conventional glucose-lowering therapy in our patient cohort, it seems to be an optimized therapeutic regimen for patients with type 2 diabete and metabolic syndrome. Key words: Diabetes mellitus, type 2; Metabolic syndrome; Triple glucose-lowering therapy

Apolipoprotein C-III (apoC-III) is a marker of triglyceride (TG)-rich lipoproteins, which are often increased in metabolic syndrome (MS). The T-455C polymorphism in the insulin-responsive element of the APOC3 gene influences TG and apoC-III levels. To evaluate the contribution of apoC-III levels and T-455C polymorphisms in the coronary artery disease (CAD) risk of MS patients, we studied 873 patients, 549 with CAD and 251 with normal coronary arteries. Patients were classified also as having or not having MS (MS, n = 270; MS-free, n = 603). Lipids, insulin, apolipoprotein levels, and APOC3 T-455C genotypes were evaluated. ApoC-III levels were significantly increased in MS patients, and the probability of having MS was correlated with increasing quartiles of apoC-III levels. MS patients with CAD had significantly higher apoC-III levels than did CAD-free MS patients. The carriership for the -455C variant multiplied the probability of CAD in MS in an allele-specific way and was associated with increased apoC-III and TG levels. Obesity was less frequent in MS carriers of the -455C allele than in MS noncarriers (21.6% vs. 34.8%, P < 0.05). In conclusion, apoC-III-rich lipoprotein metabolism and the APOC3 polymorphism have relevant impacts on the CAD risk of MS patents.

Objective To study the therapeutic effect of hyperbaric oxygen (HBO) combined with repetitive transcranial magnetic stimulation (rTMS) in the treatment of coma following craniocerebral trauma. Methods One hundred and twenty coma patients caused by craniocerebral trauma were randomly selected for the study. Those patients without treatment or without rTMS were assigned as the control groups, and the group with Glasgow coma scale (GCS) scores of 6-8 was further assigned as the CA group, and the group with GCS scores of 3-5 was assigned as the CB group. In those patients who received HBO therapy, the ones with GCS scores of 6-8 were assigned as the HA group, and the ones with GCS scores of 3-5 were assigned as the HB group (conventional therapy group B). In those patients who received both HBO and rTMS therapy, the ones with GCS scores of 6-8 were assigned as the rTA group, while the ones with GCS scores of 3-5 were assigned as the rTB group. The patients of the 6 groups were given conventional therapy for the treatment of brain trauma, such as neural nutrition, anti-infection and maintenance of electrodes. The patients in the HA group and HB group were additionally treated with HBO, while the patients in the rTA and rTB groups were further treated with HBO and rTMS. The patients received HBO therapy at a pressure of 0.25 MPa, once a day, 10 days a treatment course, for a succession of 3 courses. The stimulation intensity of the rTMS treatment protocol was set at 0.72 T, with the frequency of the magnetic field being 0.5 HZ. The patients had 30 stimulations for every sequence, one sequence a day, 12 days a treatment course for a succession of 3 courses. Scores of Glasgow Coma Scale (GCS) and Glasgow Outcome Scale (GOS) before and after treatment were assessed and statistically analyzed. Results After 3 successive treatment courses, the patients with GCS scores of 6-8 were further treated with HBO combined with rTMS in addition to conventional therapy. The GCS scores of the HBO+rTMS+conventional therapy group were as high as(11.15±4.17), which were higher than the scores of the HBO+conventional therapy group(9.05±3.12), which were also higher than the scores of the conventional therapy group(7.50±1.99). Statistical significance could be noted, when comparisons were made between the 3 groups(P<0.05). GOS scores of the HBO+rTMS+conventional therapy group(4.45±0.83)were higher than those of the conventional therapy group (3.90±0.55), with statistical significance (P<0.05). Conclusions The patients with GCS scores of 6-8 treated with HBO+rTMS+conventional therapy had better rehabilitation effect and prognosis, and therapeutic results were obviously superior to those of the patients treated with simple conventional therapy and HBO+conventional therapy. Key words: Craniocerebral trauma; Coma; Hyperbaric oxygen; Repetitive transcranial magnetic stimulation

FABP4 plasma levels are increased in familial combined hyperlipidemia

The use of the Internet-of-Things has improved glycemic control in individuals with diabetes in several small-scale studies with a short follow-up period. This large-scale randomized controlled trial investigates whether a smartphone-based self-management support system prevents the worsening of glycemic control in individuals with type 2 diabetes. Individuals with type 2 diabetes (age range 20-74 years; n = 2,000) will be recruited, enrolled, and randomly assigned to two groups: the intensive therapy group and the conventional therapy group. Participants in the intensive therapy group will be supervised to use an automated Internet-of-Things system that demonstrates a summary of lifelogging data (e.g., weight, blood pressure, and daily activities) obtained from each measurement device and will receive feedback messages via smartphone applications to encourage them to increase their physical activity and to monitor weight and blood pressure. Participants in the conventional therapy group are allowed to use the same measurement devices as part of the routine diabetes care but without the Internet-of-Things system. The primary endpoint is the between-group difference in HbA1c levels from baseline to 52 weeks. This randomized controlled study will test the hypothesis that an Internet-of-Things-based self-monitoring system could effectively prevent the worsening of diabetes in individuals with type 2 diabetes. The expected results of the study should facilitate the development of novel strategies for both diabetes treatment and social health.

The use of the Internet-of-Things has improved glycemic control in individuals with diabetes in several small-scale studies with a short follow-up period. This large-scale randomized controlled trial investigates whether a smartphone-based self-management support system prevents the worsening of glycemic control in individuals with type 2 diabetes. Individuals with type 2 diabetes (age range 20-74 years; n = 2,000) will be recruited, enrolled, and randomly assigned to two groups: the intensive therapy group and the conventional therapy group. Participants in the intensive therapy group will be supervised to use an automated Internet-of-Things system that demonstrates a summary of lifelogging data (e.g., weight, blood pressure, and daily activities) obtained from each measurement device and will receive feedback messages via smartphone applications to encourage them to increase their physical activity and to monitor weight and blood pressure. Participants in the conventional therapy group are allowed to use the same measurement devices as part of the routine diabetes care but without the Internet-of-Things system. The primary endpoint is the between-group difference in HbA1c levels from baseline to 52 weeks. This randomized controlled study will test the hypothesis that an Internet-of-Things-based self-monitoring system could effectively prevent the worsening of diabetes in individuals with type 2 diabetes. The expected results of the study should facilitate the development of novel strategies for both diabetes treatment and social health.

Anakinra, a recombinant interleukin-1 receptor antagonist is effective in treatment of idiopathic recurrent pericarditis. However, its efficacy in non-idiopathic pericarditis (secondary to a diagnosed inflammatory condition, or other known etiology) is unclear. We evaluated the efficacy of anakinra in patients with non-idiopathic (secondary to a diagnosed inflammatory condition, or other known etiology) and idiopathic pericarditis, who were intolerant or refractory to conventional therapy (colchicine and corticosteroids). This was a single-center study in which we performed a retrospective chart review of consecutive adult patients hospitalized with pericarditis intolerant or refractory to conventional therapy who were treated with conventional therapy and anakinra between January 2016-October 2018. The control group included age-matched hospitalized pericarditis patients treated with conventional therapy only. Symptom relief at discharge, time to symptom relief and recurrence on treatment were compared. The effect of outpatient continuation of anakinra on post-treatment recurrence risk was assessed. Twelve patients received anakinra for pericarditis; 22 age-matched controls were identified. Ten patients (83.3%) in the conventional therapy and anakinra group and 13 patients (54.1%) in the conventional therapy groups had non-idiopathic pericarditis. All conventional therapy and anakinra patients and 16 of 22 patients in the conventional therapy group reported symptom relief at discharge (p=0.04). Time to symptom relief was decreased in the conventional therapy and anakinra group (3.75±1.87 vs 5.63±3.28 days, p=0.08). During treatment, all conventional therapy and anakinra-treated patients continued to be symptom free, while nine of 22 conventional therapy patients (40.9%) experienced recurrence (p=0.009). Recurrence risk after treatment discontinuation was similar in the conventional therapy and anakinra group and the conventional therapy group. In hospitalized patients with non-idiopathic or idiopathic pericarditis refractory, or intolerant to, conventional therapy, anakinra is associated with improved symptom relief and decreased recurrence risk during treatment.

Objective To investigate the surgical technique and the curative effects of neuroendoscopic surgery via superior frontal sulcus in the treatment of hypertensive intracerebral hemorrhage. Methods The clinical data of 63 patients with hypertensive intracerebral hemorrhage were analyzed retrospectively. Thirty-one of them were treated by neuroendoscopic surgery via superior frontal sulcus(neuroendoscopic surgery group), and 32 of them were treated by mini-invasive drainage (conventional therapy group). All of them were followed up for 6 months, and were assessed by the activity of daily living (ADL) scale. Results After treatment, all patients reviewed CT. The clear rate of hematoma in neuroendoscopic surgery group was 86.0%, in conventional therapy group was 23.3%, and there was significant difference (P <0.05). There were one death case in neuroendoscopic surgery group and 2 death cases in conventional therapy group. The survival patients were followed up for 6 months .The rate of better prognosis in neuroendoscopic surgery group was 83.3% (25/30), in conventional therapy group was 53.3% (16/30), and there was significant difference (P <0.05). Conclusions The surgical technique of neuroendoscopic surgery via superior frontal sulcus in the treatment of hypertensive intracerebral hemorrhage is safe and effective. Key words: Intracranial hemorrhage, Hypertensive; Punctures; Neuroendoscopy

What is the evidence base for the randomized controlled trial?