Case report: Nutritionally supported perioperative chemo-immunotherapy for advanced gastric cancer with incomplete pyloric obstruction.

This case describes the benefits of perioperative chemo-immunotherapy for advanced gastric cancer and incomplete pyloric obstruction, supplemented with nutritional support. Early parenteral nutrition to stabilize nutritional status and mitigate nutrition impact symptoms, and in addition, throughout the chemo-immunotherapy perioperative period also maintained oral nutrition support and a tailored dietary plan. Above nutritional support maintained the patient's physical condition during immunotherapy. Eventually, this combination therapy plan leads to a partial response. On the other hand, a combination of therapies that focus more on immune checkpoint inhibitor may be able to mitigate the side effects of chemotherapy. Such findings may yield novel prospects for patients with advanced gastric cancer and incomplete pyloric obstruction, enabling them to achieve better outcomes.

α-Synuclein induces prodromal symptoms of Parkinson's disease via activating TLR2/MyD88/NF-κB pathway in Schwann cells of vagus nerve in a rat model.

BACKGROUND: Increasing evidence suggests that patients with Parkinson's disease (PD) present with peripheral autonomic dysfunction (AutD) that even precedes motor deficits, through which α-synuclein can spread to the central nervous system. However, the pathological mechanisms underlying AutD in prodromal PD remain unclear. Here, we investigated the role of α-synuclein and its interplay with the activation of Schwann cells (SCs) of the vagus nerve in AutD. METHODS: Rats were subjected to injection with adeno-associated viruses containing the human mutated A53T gene (AAV-A53T) or an empty vector into the left cervical vagus nerve and evaluated for gastrointestinal symptoms, locomotor functions, intestinal blood flow, and nerve electrophysiology. Further, we examined the impact of α-synucleinopathy on vagus nerves, SCs, and central nervous system neurons using electron microscopy, immunofluorescence, immunohistochemistry, and western blot. Finally, the role of Toll-like receptor 2 (TLR2) in regulating the neuroinflammation in the vagus nerve via MyD88 and NF-κB pathway was determined using genetic knockdown. RESULTS: We found that rats injected with AAV-A53T in the vagus nerve exhibited prominent signs of AutD, preceding the onset of motor deficits and central dopaminergic abnormalities by at least 3 months, which could serve as a model for prodromal PD. In addition, reduced intestinal blood flow and decreased nerve conduction velocity were identified in AAV-A53T-injected rats, accompanied by disrupted myelin sheaths and swollen SCs in the vagus nerve. Furthermore, our data demonstrated that p-α-synuclein was deposited in SCs but not in axons, activating the TLR2/MyD88/NF-κB signaling pathway and leading to neuroinflammatory responses. In contrast, silencing the TLR2 gene not only reduced inflammatory cytokine expression but also ameliorated vagal demyelination and secondary axonal loss, consequently improving autonomic function in rats. CONCLUSIONS: These observations suggest that overexpression of α-synuclein in the vagus nerve can induce symptoms of AutD in prodromal PD, and provide support for a deeper understanding of the pathological mechanisms underlying AutD and the emergence of effective therapeutic strategies for PD.

Effect of enteral nutrition on the intestinal microbiome and risk of death in ischemic stroke patients.

BACKGROUND: Studies have shown that the intestinal microbiome of stroke patients is significantly altered and that the degree of microbiota disturbance correlates with prognosis. Enteral nutrition (EN) can reshape the intestinal microbiome and is important for stroke patients with dysphagia. We aimed to describe the intestinal microbiome in patients with ischemic cerebral infarction receiving standard EN. METHODS: First, 17 healthy controls (HCs), 54 stroke patients with oral feeding (ON), and 50 stroke patients with EN were matched to investigate the changes in the intestinal microbiota with EN in the first week after admission and dynamic changes in the EN group in the second week. Second, we investigated the relationship between the intestinal microbiome and clinical characteristics in a larger sample of participants receiving EN (n = 147). Survival analysis was performed using Cox proportional hazards regression. The composition and structure of the intestinal microbiota were analyzed by 16S rRNA sequencing. RESULTS: Compared with the HC and ON groups, patients with EN exhibited significantly different compositions of the intestinal microbiota in the first week, including enrichment of the opportunistic pathogen Enterococcus and depletion of bacteria such as Lachnospiraceae, and Ruminococcus, which were further depleted in the second week. An increase in Parvimonas and Comamonas abundances was associated with an increased risk of 180-day mortality. CONCLUSIONS: The intestinal microbiota in ischemic stroke patients receiving EN is significantly altered, and specific strains of bacteria may be associated with prognosis and clinical indicators.

Improvement of stress adaptation and insulin resistance in women with GDM by WeChat group management during novel coronavirus pneumonia.

Aim: To evaluate the improvement of glycemic control and stress adaptation in patients with GDM by mobile phone WeChat management during novel coronavirus pneumonia. Methods: In this study, 75 women with GDM were included, of whom 35 were included in mobile WeChat group management as the GDM-M group and 40 as the GDM group. Results: After mobile WeChat group management for 4 weeks, E and NE were lower. MDA was lower, and SOD was higher. HOMA-IR was lower. E, NE, and cortisol were related to HOMA-IR positively, MDA was positively related to HOMA-IR, and SOD was negatively related to HOMA-IR. E and cortisol were positively related to MDA but negatively related to SOD. Conclusion: The stress adaptation disorder and insulin resistance in patients with GDM who have completed mobile WeChat group management can be improved during novel coronavirus pneumonia. Mobile WeChat management played a positive role in improving the insulin resistance of women with GDM under special circumstances, which may reduce the risk of maternal and fetal complications.

Whey protein preloading can alleviate stress adaptation disorder and improve hyperglycemia in women with gestational diabetes mellitus.

AIMS: To investigate the change of stress hormones, oxidative stress and insulin resistance (IR) in women with gestational diabetes mellitus (GDM) after supplement whey protein, in an attempt to gain insights into the prevention and treatment of GDM. MATERIALS AND METHODS: 60 GDM women were recruited in this study, and 30 women received a preload drink containing 20 g whey protein as group GDM-W, and the other 30 women received control flavoring drink as group GDM, and the trial lasted for 14 days. Plasma epinephrine (E), noradrenaline (NE), and cortisol were detected; we also determined levels of malondialdehyde (MDA), superoxide dismutase (SOD), and glutathione (GSH). Homeostasis model assessment of insulin resistance (HOMA-IR) was used to assess IR. RESULTS: In the GDM-W group, postprandial blood glucose was decreased significantly on 3, 5, 7, and 14 days (all p < .05), plasma 2 h insulin was increased by 7.2, 8.6, and 20.5% on days 5, 7, and 14 (p < .05, .05, .01). HOMA-IR was decreased significantly on day 14 (p < .05). MDA was decreased by 20.7% on day 14 (p < .01), and anti-oxidative enzymes' SOD was decreased by 13.4% on day 14 (p < .05) and GSH was decreased by 16.7 and 29.1% on days 7 and 14 (both p < .05). Stress hormones E and cortisol were decreased by 10.8 and 19.8%, respectively, on day 14 (p < .05). There was no significant difference in NE between the two groups within 14 days. CONCLUSIONS: Whey protein supplementation may improve hyperglycemia by alleviating stress disorder and oxidative stress injury in GDM women. This trial was registered at chictr.org.cn/as ChiCTR1800020413.

The relationship between iron metabolism, stress hormones, and insulin resistance in gestational diabetes mellitus.

AIM: To analyze the relationship between iron metabolism index and stress hormones, insulin resistance, and oxidative stress in gestational diabetes mellitus (GDM). METHODS: From January to November 2019, 75 patients with GDM were selected as GDM group, according to age of 1:1; 75 normal pregnant women were selected as Control group. Blood glucose, insulin, stress hormones such as cortisol, norepinephrine (NE), and epinephrine (E), and iron metabolism index such as serum iron, serum ferritin (SF), and transferrin saturation (TS) were measured. Insulin resistance was evaluated by homeostasis model insulin resistance index (HOMA-IR). Multiple linear regression was used to analyze the relationship between iron metabolism index and stress hormones, insulin resistance, and oxidative stress. RESULTS: The levels of NE, E, serum iron, SF, and TS saturation in the GDM group were higher than Control group (t = 3.82, 2.75, 3.14, 6.12, and 3.90, P < 0.05, <0.05, <0.05, <0.01, <0.01); HOMA-IR was higher in the GDM group (t = 4.92, P < 0.01); malondialdehyde (MDA) was higher, while superoxide dismutase (SOD) was lower than Control group (t = 5.25, 4.98, both P < 0.01). Epinephrine, norepinephrine, cortisol, and serum ferritin were positively correlated (r = 0.21, 0.17, and 0.21); epinephrine, cortisol, and transferrin were positively correlated (r = 0.12, 0.31). There was a positive correlation between HOMA-IR and SF and TS (r = 0.34, 0.34). MDA was positively correlated with SF and TS (r = 0.24, 0.29); SOD was negatively related to SF and TS (r = -0.12, -0.17). CONCLUSIONS: Iron metabolism index is related to insulin resistance in GDM women. The change in iron metabolism may be involved in the pathogenesis of gestational diabetes caused by stress- adaptive disorder.

Stress adaptation is associated with insulin resistance in women with gestational diabetes mellitus.

AIM: Oxidative stress is known to increase the risk of insulin resistance (IR). The aim of this study was to investigate the association between stress hormones and IR in women with gestational diabetes mellitus (GDM), in an attempt to gain insights into the pathogenesis of GDM. METHODS: Recruited in this study were 70 GDM women and 70 healthy pregnant women as control. Malondialdehyde (MDA), superoxide dismutase (SOD), glutathione (GSH), plasma epinephrine (E), noradrenaline (NE), glucagon, and cortisol levels were detected. IR was assessed by homeostasis model assessment of IR (HOMA-IR) in both groups. Correlations among stress hormones, oxidative stress, and IR were analyzed by Pearson's correlation after log transformation. RESULTS: Compared with the Control group, MDA was increased and anti-oxidative enzymes SOD and GSH were decreased significantly in the GDM group. Glucagon, E, and NE in the GDM group were increased by 22.42%, 36.82%, and 35.09%, respectively, as compared with those in the Control group. MDA showed a significant positive correlation, and SOD showed a negative correlation with HOMA-IR in the GDM group. In addition, HOMA-IR was positively related to glucagon, E, NE, and cortisol. CONCLUSIONS: Elevation of stress hormones and stress adaptation disturbance may be associated with the pathogenesis of GDM in pregnant women.

Stress adaptation disorders play a role in rat gestational diabetes with oxidative stress and glucose transporter-4 expression.

Stress adaptation disorder exists in gestational diabetes mellitus (GDM) women, this study was to investigate the impact of stress adaptation disorder on glucose disposal and skeletal muscle glucose transporter4 (GLUT4) expression in GDM rat model. Rats were assigned randomly to Normal control (NC) group and GDM group. We analyzed the levels of corticosterone, epinephrine (E), norepinephrine (NE), malondialdehyde (MDA) and superoxide dismutase (SOD), interleukin-6 (IL-6) and expression of GLUT4 were also detected. Homeostasis model assessment (HOMA-IR) was used to evaluate insulin resistance. Compared with NC group, E, NE and Corticosterone were increased significantly, SOD and MDA were higher and GLUT4 expression was significantly lower in GDM rats. Corticosterone was positively related to MDA, MDA was positively and SOD was negatively related to HOMA-IR in both groups, IL-6 showed significant positive correlations with HOMA-IR. NE and Corticosterone were negative related to GLUT4 in GDM group. Stress hormones (E, NE and Corticosterone), MDA and IL-6 were the risk factors of GDM, SOD was the protective factor of GDM. Changes of stress hormones indicate that stress adaptation disorder exists in GDM rats. Stress adaptation disorder increase oxidative stress injury and inflammation, decrease GLUT4 and lead to incline of glucose uptake, result in hyperglycemia. Gaining an insight into correlations of these changes may be beneficial to maternal and child health and is important for the prevention of glycemia-related diseases.

A Comparison of the Nutritional Risk Screening 2002 Tool With the Subjective Global Assessment Tool to Detect Nutritional Status in Chinese Patients Undergoing Surgery With Gastrointestinal Cancer.

The objectives of this study were to describe the nutritional status of Chinese patients with gastrointestinal cancer undergoing surgery and to compare the ease of use, diversity, and concordance of the Nutritional Risk Screening 2002 with the Subjective Global Assessment in the same patients. A total of 280 gastrointestinal cancer patients admitted for elective surgery were evaluated by the Nutritional Risk Screening 2002 (NRS 2002) and Subjective Global Assessment (SGA) tools within 48 hours of admission from April to October 2012. Related opinions about ease of using the tools were obtained from 10 nurses. The prevalence of patients at nutritional risk with the SGA and NRS 2002 was 33.9% and 53.2% on admission. In the total group, ≤70 age group, and >70 age group, respectively, consistency was observed in 214 (76.4%), 175 (91.1%), and 39 (44.3%); and kappa values were 0.54 (p < .001), 0.81 (p < .001), and 0.085 (p = .096). McNemar paired chi-square test showed a significant difference between the NRS 2002 and SGA in the total group and >70 age group (p < .001); however, no difference was observed in the ≤70 age group (p = .14). Nurses reported ease of use of the NRS 2002 as a "very easy" or "easy" to complete (3-5 minutes) and the SGA as an "easy" or "fair" tool to complete (5-10 minutes). The diversity and concordance between the SGA and NRS 2002 were varied in different age groups. The NRS 2002 is more suitable in nursing practice than the SGA to identify the nutritional status of patients with gastrointestinal cancer undergoing surgery, but it appeared to detect more patients at nutritional risk in the >70 age group.

[Serum carotenoid concentrations in some Chinese adults from urban, suburban and rural communities].

OBJECTIVE: The study was carried out to analyze serum carotenoids concentration of some Chinese adults by HPLC. METHODS: One hundred and eighty four 30 - 60 year-old adults (84 males and 100 females) from three different communities were recruited in the investigation. The fast blood samples were collected and separated into serum in summer, autumn, winter and spring of the year, respectively. The serum were extracted with organic solvents and analyzed with a HP1100 HPLC for the concentration of beta-carotene, alpha-carotene, beta-cryptoxanthin, lycopene, and lutein/zeaxanthin. RESULTS: The average serum concentration of carotenoids of investigated population in summer, autumn, winter and spring were as followed (inmicromol/L), respectively: beta-carotene, 0.72 +/- 0.20, 0.71 +/- 0.18, 0.70 +/- 0.19 and 0.63 +/- 0.20; alpha-carotene, 0.037 +/- 0.018, 0.039 +/- 0.015, 0.038 +/- 0.017 and 0.030 +/- 0.019; beta-cryptoxanthin, 0.11 +/- 0.03, 0.14 +/- 0.03, 0.13 +/- 0.04 and 0.10 +/- 0.03; lutein + zeaxanthin, 0.61 +/- 0.16, 0.45 +/- 0.09, 0.46 +/- 0.12 and 0.47 +/- 0.14; lycopene, 0.43 +/- 0.26, 0.11 +/- 0.06, 0.07 +/- 0. 04 and 0.07 +/- 0.03. The average serum beta-carotene concentration of total-population was lowest in spring, but the descent did not occurred from urban sub-population. There were significant seasonal changes in average serum concentrations of alpha-carotene, beta-cryptoxanthin, lutein + zeaxanthin, and lycopene from total population. Further more, there was significant difference of serum concentration of every carotenoid between three sub-populations in every season. CONCLUSIONS: The data of serum carotenoid concentration in total 713 blood samples from some Chinese adults were reported here, which would be helpful to understanding the population distribution of carotenoid concentration in China.