Improving anti-cancer drug response prediction using multi-task learning on graph convolutional networks.

Predicting the therapeutic effect of anti-cancer drugs on tumors based on the characteristics of tumors and patients is one of the important contents of precision oncology. Existing computational methods regard the drug response prediction problem as a classification or regression task. However, few of them consider leveraging the relationship between the two tasks. In this work, we propose a Multi-task Interaction Graph Convolutional Network (MTIGCN) for anti-cancer drug response prediction. MTIGCN first utilizes an graph convolutional network-based model to produce embeddings for both cell lines and drugs. After that, the model employs multi-task learning to predict anti-cancer drug response, which involves training the model on three different tasks simultaneously: the main task of the drug sensitive or resistant classification task and the two auxiliary tasks of regression prediction and similarity network reconstruction. By sharing parameters and optimizing the losses of different tasks simultaneously, MTIGCN enhances the feature representation and reduces overfitting. The results of the experiments on two in vitro datasets demonstrated that MTIGCN outperformed seven state-of-the-art baseline methods. Moreover, the well-trained model on the in vitro dataset GDSC exhibited good performance when applied to predict drug responses in in vivo datasets PDX and TCGA. The case study confirmed the model's ability to discover unknown drug responses in cell lines.

Effects of harvest stages and lactic acid bacteria additives on the nutritional quality of silage derived from triticale, rye, and oat on the Qinghai-Tibet Plateau.

Background: Triticale (×Triticosecale Wittmack L.), rye (Secale cereale L.), and oat (Avena sativa L.) are the main forage crops on the Qinghai-Tibet Plateau, but there has been relatively little research on the silage produced from these three species. Methods: Plants were harvested at the heading, flowering, grouting, milky, and dough stages and then used to produce silage with and without additives (Sila-Max and Sila-Mix). The nutritional quality of the resulting silages was analyzed. Results: Triticale was revealed to be more suitable than oat or rye for producing silage on the Qinghai-Tibet Plateau. On the basis of the dry matter yield (DMY), triticale and rye should be harvested at the milky stage to optimize silage quality, whereas oat should be harvested at the dough stage. The lactic acid bacteria additives Sila-Max and Sila-Mix had no significant effect on the nutritional quality of the three silages regardless of when the samples were harvested. Overall, triticale produced higher quality silage than oat or rye. More specifically, triticale variety 'Gannong No.2' harvested at the milky stage is ideal for silage production.

Improving drug response prediction based on two-space graph convolution.

Patients with the same cancer types may present different genomic features and therefore have different drug sensitivities. Accordingly, correctly predicting patients' responses to the drugs can guide treatment decisions and improve the outcome of cancer patients. Existing computational methods leverage the graph convolution network model to aggregate features of different types of nodes in the heterogeneous network. They most fail to consider the similarity between homogeneous nodes. To this end, we propose an algorithm based on two-space graph convolutional neural networks, TSGCNN, to predict the response of anticancer drugs. TSGCNN first constructs the cell line feature space and the drug feature space and separately performs the graph convolution operation on the feature spaces to diffuse similarity information among homogeneous nodes. After that, we generate a heterogeneous network based on the known cell line and drug relationship and perform graph convolution operations on the heterogeneous network to collect the features of different types of nodes. Subsequently, the algorithm produces the final feature representations for cell lines and drugs by adding their self features, the feature space representations, and the heterogeneous space representations. Finally, we leverage the linear correlation coefficient decoder to reconstruct the cell line-drug correlation matrix for drug response prediction based on the final representations. We tested our model on the Cancer Drug Sensitivity Data (GDSC) and Cancer Cell Line Encyclopedia (CCLE) databases. The results indicate that TSGCNN shows excellent performance drug response prediction compared with other eight state-of-the-art methods.

Analyzing past and future trends in Pakistan's groundwater irrigation development: implications for environmental sustainability and food security.

Since the last four decades, groundwater irrigation has played a critical role in improving crop production and rural livelihoods. However, the flawed policies have allowed farmers to install private tube wells relentlessly, resulting in a slew of water quality and environmental issues. This study aims to investigate the key trends in temporal development of groundwater irrigation and its consequences in Pakistan. The dataset, which spanned 38 years (1981 to 2018), included variables such as the number of tube wells, wheat area and production, farm size, total cultivated area, and total irrigated area in Punjab province. Our results show that, while the number of government-installed tube wells has decreased over time, the number of private tube wells has increased by 579% since 1981. About 85% of these privately owned tube wells are diesel tube wells, while the remaining 15% are electric tube wells. The ARDL regression results show that groundwater development, as a result of growth in private tube wells, has significantly aided wheat production in both the short and long run. However, the results of ARIMA model show that, in the absence of any regulatory mechanism to limit private tube well growth, the number of private tube wells in Punjab will increase by 43% over the next two decades, potentially jeopardizing the country's groundwater sustainability and food security. To ensure the sustainability of groundwater use, farmers' incomes, and the food security of the population, there is an urgent need to devise policy options to limit the growth of probate tube wells in the province. In addition, the new regulations should consider the equity implications and the economic shock to poor farms and households.

Efficacy and safety of neoadjuvant pyrotinib plus docetaxel/liposomal doxorubicin/cyclophosphamide for HER2-positive breast cancer.

OBJECTIVE: Pyrotinib is a novel EGFR/HER2 dual tyrosine kinase inhibitor developed in China, while its role in neoadjuvant therapy of HER2-positive (HER2+) breast cancer lacks evidence. The current study aimed to explore the efficacy and safety of neoadjuvant pyrotinib plus docetaxel/liposomal doxorubicin/cyclophosphamide (TAC) for HER2+ breast cancer. METHODS: A total of 27 HER2+ breast cancer patients received neoadjuvant pyrotinib plus TAC for 6 cycles, then surgery was performed. The clinical and pathological responses, and adverse events were evaluated. RESULTS: Complete response rate, objective response rate, and disease control rate were 0.0%, 44.4% and 100.0% after 2 treatment cycles; 0.0%, 37.0%, and 100.0% after 4 treatment cycles; 37.0%, 37.0%, and 96.3% after 6 treatment cycles; as well as 37.0%, 44.4%, and 100.0% based on the best clinical response. Regarding pathological response, there were 1 (2.7%), 3 (11.1%), 8 (29.6%), 5 (18.5%), and 10 (37.0%) patients realizing Miller-Payne grade (G) 1, G2, G3, G4, and G5, respectively; besides, 10 (37.0%) patients achieved total pathological complete response (pCR), 10 (37.0%) patients realized pCR in breast, and 23 (85.2%) patients achieved pCR in lymph node. Additionally, adverse events included diarrhea (81.5%), dental ulcer (7.4%), and hand-foot syndrome (3.7%); meanwhile, grade 3-4 adverse event consisted of only diarrhea (11.1%). CONCLUSION: Neoadjuvant pyrotinib plus TAC treatment is efficient and safe in HER2+ breast cancer patients, while further validation is needed.

Correlation of TBK1, AR, and other serum cancer-related biomarkers in breast cancer patients: An observational study.

Breast cancer (BC) ranks first for incidence and mortality in gynecological malignant tumors. This study aims to investigate the diagnostic value of Tank-binding kinase 1 (TBK1) and its correlation with androgen receptor (AR) and other serum cancer-related biomarkers in BC patient. The present observational study included 451 female BC patients and 451 healthy controls. Serum levels of TBK1, AR and other cancer-related biomarkers were detected in all the patients and healthy controls. Patients' demographic data and clinical data including age, body mass index (BMI), tumor node Metastasis (TNM), pathological type, tumor size and lymph node metastasis were collected. The follow-up lasted for 5 years. The deceased group had higher rate of patients with TNM III~IV, lymph node metastasis or tumor diameter >2. Deceased group had much higher rate of patients with negative ER and positive Ki67. Besides, increased TBK1 was found in BC patients with positive correlation with AR, CA15-3, CA125, CEA, and CA19-9. Serum TBK1 was associated with the clinic outcomes of BC patients and those with high TBK1 had lower 5-year survival rate. Moreover, cutoff value of 13.95 ng/mL TBK1 showed AUC of 0.981 (93.6% for sensitivity and 86.3% for specificity) for diagnosing BC, and cutoff value of 22.65 ng/mL TBK1 had AUC of 0.996 (97.7% for sensitivity and 96.3% for specificity) for diagnosing the death of BC patients. Serum TBK1 was positively correlated with AR and other serum cancer-related biomarkers. In addition, high TBK1 predicted the poor prognosis and might be used for the diagnosis of BC.

Predicting cancer drug response using parallel heterogeneous graph convolutional networks with neighborhood interactions.

MOTIVATION: Due to cancer heterogeneity, the therapeutic effect may not be the same when a cohort of patients of the same cancer type receive the same treatment. The anticancer drug response prediction may help develop personalized therapy regimens to increase survival and reduce patients' expenses. Recently, graph neural network-based methods have aroused widespread interest and achieved impressive results on the drug response prediction task. However, most of them apply graph convolution to process cell line-drug bipartite graphs while ignoring the intrinsic differences between cell lines and drug nodes. Moreover, most of these methods aggregate node-wise neighbor features but fail to consider the element-wise interaction between cell lines and drugs. RESULTS: This work proposes a neighborhood interaction (NI)-based heterogeneous graph convolution network method, namely NIHGCN, for anticancer drug response prediction in an end-to-end way. Firstly, it constructs a heterogeneous network consisting of drugs, cell lines and the known drug response information. Cell line gene expression and drug molecular fingerprints are linearly transformed and input as node attributes into an interaction model. The interaction module consists of a parallel graph convolution network layer and a NI layer, which aggregates node-level features from their neighbors through graph convolution operation and considers the element-level of interactions with their neighbors in the NI layer. Finally, the drug response predictions are made by calculating the linear correlation coefficients of feature representations of cell lines and drugs. We have conducted extensive experiments to assess the effectiveness of our model on Cancer Drug Sensitivity Data (GDSC) and Cancer Cell Line Encyclopedia (CCLE) datasets. It has achieved the best performance compared with the state-of-the-art algorithms, especially in predicting drug responses for new cell lines, new drugs and targeted drugs. Furthermore, our model that was well trained on the GDSC dataset can be successfully applied to predict samples of PDX and TCGA, which verified the transferability of our model from cell line in vitro to the datasets in vivo. AVAILABILITY AND IMPLEMENTATION: The source code can be obtained from https://github.com/weiba/NIHGCN. SUPPLEMENTARY INFORMATION: Supplementary data are available at Bioinformatics online.

Surface Modification of Polyurethane Membrane with Various Hydrophilic Monomers and N-Halamine: Surface Characterization and Antimicrobial Properties Evaluation.

Reducing microbial infections associated with biomedical devices or articles/furniture noted in a hospital or outpatient clinic remains a great challenge to researchers. Due to its stability and low toxicity, the N-halamine compound has been proposed as a potential antimicrobial agent. It can be incorporated into or blended with the FDA-approved biomaterials. Surface grafting or coating of N-halamine was also reported. Nevertheless, the hydrophobic nature associated with its chemical configuration may affect the microbial interactions with the chlorinated N-halamine-containing substrate. In this study, a polymerizable N-halamine compound was synthesized and grafted onto a polyurethane surface via a surface-initiated atom transfer radical polymerization (SI-ATRP) scheme. Further, using the sequential SI-ATRP reaction method, different hydrophilic monomers, namely poly (ethylene glycol) methacrylate (PEGMA), hydroxyethyl methacrylate (HEMA), and [2-(methacryloyloxy) ethyl] dimethyl-(3-sulfopropyl) ammonium hydroxide (SBMA), were also grafted onto the polyurethane (PU) substrate before the N-halamine grafting reaction to change the surface properties of the N-halamine-modified substrate. It was noted that the chains containing the hydrophilic monomer and the polymerizable N-halamine compound were successfully grafted onto the PU substrate. The degree of chlorination was improved with the introduction of a hydrophilic monomer, except the HEMA. All of these hydrophilic monomer-containing N-halamine-modified PU substrates demonstrated a more than 2 log CFU reduction after microbial incubation. In contrast, the surface modified with N-halamine only exhibited significantly less antimicrobial efficacy instead. This is likely due to the synergistic effects caused by the reduced chlorine content, as well as the reduced surface interactions with the microbes.

Corrections to: Molluscicidal effectiveness of Luo-Wei, a novel plant-derived molluscicide, against Oncomelania hupensis, Biomphalaria alexandrina and Bulinus truncatus.

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Molluscicidal effectiveness of Luo-Wei, a novel plant-derived molluscicide, against Oncomelania hupensis, Biomphalaria alexandrina and Bulinus truncatus.

BACKGROUND: Control of snail intermediate hosts has been proved to be a fast and efficient approach for interrupting the transmission of schistosomiasis. Some plant extracts have shown obvious molluscicidal activity, and a new compound Luo-Wei, also named tea-seed distilled saponin (TDS), was developed based on the saponins extracted from Camellia oleifera seeds. We aimed to test the molluscicidal activity of 4% TDS against the intermediate host snails in China and Egypt, and evaluate its environmental safety to non-target organisms. METHODS: In the laboratory, Oncomelania hupensis, Biomphalaria alexandrina and Bulinus truncatus were exposed to 4% TDS, and the median lethal concentration (LC50) was estimated at 24, 48 and 72 h. In the field, snail mortalities were assessed 1, 2, 3 and 7 d post-immersion with 2.5 g/m3 4% TDS and 1, 3, 7 and 15 d post-spraying with 5 g/m2 4% TDS. In addition, the acute toxicity of 4% TDS to Japanese quail (Coturnix japonica), zebrafish (Brachydanio rerio) and freshwater shrimp (Macrobrachium nipponense) was assessed by estimations of LC50 or median lethal dose (LD50). RESULTS: In the laboratory, the LC50 values of 4% TDS for O. hupensis were 0.701, 0.371 and 0.33 mg/L at 24, 48 and 72 h, respectively, and 4% TDS showed a 1.975 mg/L [corrected] 24 h LC50 against B. alexandrina, and a 1.396 mg/L 24 h LC50 against B. truncatus. Across all study regions, the pooled mortalities of O. hupensis were 72, 86, 94 and 98% at 1, 2, 3 and 7 d, following field immersion of 4% TDS at a dose of 2.5 g/m3, and were 69, 77, 85 and 88% at 1, 3, 7 and 15 d, following field spraying at 5 g/m2, respectively. 4% TDS had moderate toxicity to Japanese quail (7 d LD50 > 60 mg/kg) and to shrimp (96 h LC50 = 6.28 mg/L; 95% CI: 3.53-11.2 mg/L), whereas its toxicity to zebrafish was high (96 h LC50 = 0.15 mg/L; 95% CI: 0.14-0.17 mg/L). CONCLUSIONS: 4% TDS is active against O. hupensis, B. alexandrina and B. truncatus under laboratory and field conditions, and it may be a candidate molluscicide of plant origin.

[Research on competency building standards of institutions of schistosomiasis prevention and control in Hubei Province I Investigation of institution management].

OBJECTIVE: To investigate the current situation of management of institutions of schistosomiasis prevention and control in Hubei Province, so as to explore the probable competency building standards for these institutions at the county and township levels. METHODS: By using a combination of quantitative and qualitative methods, the institutions of schistosomiasis prevention and control at county and township levels were investigated for the institutional setup, staffing and fulfillment functions since the reform of 2004. RESULTS: Among 63 schistosomiasis endemic counties (cities, districts) of Hubei Province, there were 26 independent schistosomiasis control institutions (41.27%), there were 24 institutions which were incorporated into CDC (38.10%), and there were no institutions in 13 counties (20.63%). Among 518 endemic towns, there were 299 institutions (57.72%). The total staffing size were 1 932, but there were 1 586 (82.09%) people actually working in the post, and therefore there were 346 (17.91%) empty positions. The average rates of carrying out the six functions were 91.48%-71.19%, but only 19.23% of the institutions participated in the comprehensive schistosomiasis control management project and its effect assessment. CONCLUSION: According to the management model for schistosomiasis control institutions under the current institutional mechanisms, we need a rigorous industry standard to constrain, guide and standardize the management and capacity-building of the institutions in different historical periods.

[Molluscicidal effect comparison between TDS and MNSC in field].

OBJECTIVE: To compare the molluscicidal effects between "Luo-wei" (TDS), a plant molluscicide in 4 percent, and metaldehyde and niclosamide (MNSC) in the field. METHODS: A natural ecological environment with Oncomelania hupensis was selected as the test area, the test concentrations of TDS and MNSC were 2.5 g/m3 and 2 ml/m3 respectively by the immersion method; the test doses of TDS and MNSC were 3 g/m2 and 2 ml/m2 respectively by the spray method; the doses of WPN in a control group were 2 g/m3 and 2 g/m2 respectively by the two methods above-mentioned. The molluscicidal effects between TDS and MNSC were compared by using the synchronous design method and parallel comparative method. RESULTS: In the TDS group, the death rate of snails was 90.70% by immersion for 24 hours, reached to 81.40% after spraying for 7 days, and there were no significant differences among the observation time points in molluscicidal effects (P > 0.05). One day after the spraying, the death rate of snails was less in the TDS group compared with that in the MSCN group (P < 0.01), but the death rates of snails were similar in both groups 3 days after the spraying (P > 0.05). In the MSCN group, the death rate of snails was 99.17% by immersion for 24 hours, reached to 66.07% by spraying for 1 day. In the WPS group, the death rate of snails was 97.15% by immersion for 24 hours, reached to 71.43% after spraying for 1 day, and there were no significant differences (both P > 0.05). CONCLUSION: TDS has a good molluscicidal activity and stable efficacy, and the molluscicidal effect of TDS is similar to that of MSCN in the filed, but the molluscicidal sensitivity of TDS is lower than that of MSCN.

[Research on competency building standards of institutions of schistosomiasis prevention and control in Hubei Province. II. Investigation of human resources].

OBJECTIVE: To understand the human resources of the grassroots institutions of schistosomiasis control and prevention, so as to provide the evidence for formulating the standards of institutional capacity-building. METHODS: By using the combination of quantitative and qualitative methods, the hierarchy of schistosomiasis control institution workers, structural features of workers, and benefits of workers were investigated and the results were analyzed statistically after the 2004 reform. RESULTS: The constituent ratios of personnel ≤ 30 years old, 30 to 45 years old, and ≥ 45 years old were 6.8%, 64.0% and 29.2% respectively, with an average age of 43.1 years. For education levels, 61.35% of the personnel had secondary or high school levels. At the city level, the structural proportion of the senior professional; medium professional and primary professional titles was 1.4 : 5.6 : 3.0, and at the county level, the proportion was 0.5 : 6.1 : 3.4. There was 14 200 yuan per capita at the township schistosomiasis control institutions. CONCLUSION: The technology of the personnel in schistosomiasis institutions of Hubei Province is weak, the average age of personnel is old, and the salary is low.

[Molluscicidal effect of plastic film mulch covering method].

OBJECTIVE: To evaluate the molluscicidal effect of the plastic film mulch covering method. METHODS: In the barren land with a lot of Oncomelania hupensis snails, 3 experimental groups were set up, in which respectively using 3 different methods: a simple plastic film mulch covering method, film assisted with ammonium bicarbonate, and film assisted with amine molluscicide. In the canals, two experimental groups were set up, in which respectively using 2 different methods: simple plastic film mulch covering method and film assisted with ammonium bicarbonate. In above-mentioned areas, obstacles were cleared artificially. In each experiment group, 4 observation spots were set up, and 100 living snails were pot in each spot, and then, the plastic film mulch was evenly covered. The status of the snails was observed 3, 7, 15 and 30 days after the intervention. RESULTS: In the barren land, the snail death rates of the simple plastic film group were 20.77% and 96.92% 15 days and 30 days after the intervention, respectively. The snail death rate of the film assisted with amine molluscicide group was 80.46% 3 days after the intervention. In all the experiment groups, the snail death rates were from 96.92 to 100% 30 days after the intervention. CONCLUSION: The plastic film mulch covering method has a great molluscicide effect in the hill subtype and water network type of schistosomiasis epidemic areas.

[Effects of preoperative oral carbohydrate on postoperative insulin resistance in radical gastrectomy patients].

OBJECTIVE: To investigate the effects and mechanism of postoperative insulin resistance in gastrectomy patients with preoperative oral carbohydrate. METHODS: From 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. RESULTS: There 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. CONCLUSIONS: Preoperative 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.

[Perioperative blood glucose control].

Hyperglycemia can result in severe adverse effects on the body. The mortality and morbidity of surgery are increased significantly in diabetic patients. The surgical stress-related hyperglycemia and insulin resistance can also produce the same adverse consequences. The metabolic state of the surgical patients, anesthesia method, glucose infusion, stress-induced neuroendocrine responses and insulin resistance can affect the perioperative blood glucose levels, resulting in poor clinical outcomes. The relationship between tight glycemic control and reducing post-operative mortality and morbidity is not clear. It's necessary to control blood sugar level during the perioperative period but the ideal state of glycemic control still needs a mult-center clinical trial evidence. It is generally believed that perioperative blood glucose level should be controlled below 10 mmol/L. The efficacy and safety of tight glycemic control needs further study.

[Effect of different perioperative treatments on gut flora in SD rats].

OBJECTIVE: To study the effects of different perioperative treatments on the number and proportion of gut flora in SD rats. METHODS: Forty-eight SD rats were randomized into 8 groups including the control group, antibiotics group, bowel preparation group, fasting group, antibiotic-bowel preparation group, antibiotics-bowel preparation-fasting group, bowel preparation-surgery-antibiotics-early postoperative feeding group (early feeding group), and bowel preparation-surgery-antibiotics-postoperative fasting group. The rats were sacrificed and stool specimens were collected from the cecum. Stools were diluted and transferred to selective medium. Bacteria counts were calculated after 48 hours of culture under constant temperature. The changes in gut flora between the different groups were compared in terms of E.coli, Bacteroides, Bifidobacterium, and Enterococcus. RESULTS: Compared with the control group, the total bacteria, Bacteroid, Enterococcus, Bifidobacterium were all significantly decreased(P<0.05), while the E.coli count and the bacillus/coccus ratio were significantly elevated(P<0.05). In the bowel preparation group, the total bacteria count, Bacteroid, Enterococcus, Bifidobacterium were all significantly decreased(P<0.05), while the E.coli count remained stable(P>0.05) and the bacillus/coccus ratio was significantly elevated(P<0.05). In the fasting group, the total bacteria count, Bacteroid, Enterococcus, Bifidobacterium were all significantly decreased(P<0.05), while the E.coli count remained stable(P>0.05) and the bacillus/coccus ratio was significantly elevated(P<0.05). Early postoperative feeding increased E.coli, Enterococcus, and total bacteria count(P<0.05), and lowered bacillus/coccus ratio(P<0.05) as compared to the fasting group. CONCLUSIONS: Antibiotics, bowel preparation, and fasting have influence on the gut flora of SD rats in count and bacillus/coccus ratio, leading to dysbiosis. Early postoperative feeding may improve dysbiosis.

Effect of intensive vs conventional insulin therapy on perioperative nutritional substrates metabolism in patients undergoing gastrectomy.

AIM: To investigate the effect of intensive vs conventional insulin therapy on perioperative nutritional substrates metabolism in patients undergoing radical distal gastrectomy. METHODS: Within 24 h of intensive care unit management, patients with gastric cancer were enrolled after written informed consent and randomized to the intensive insulin therapy (IIT) group to keep glucose levels from 4.4 to 6.1 mmol/L or the conventional insulin therapy (CIT) group to keep levels less than 10 mmol/L. Resting energy expenditure (REE), respiratory quotient (RQ), resting energy expenditure per kilogram (REE/kg), and the lipid oxidation rate were monitored by the indirect calorimeter of calcium citrate malate nutrition metabolism investigation system. The changes in body composition were analyzed by multi-frequency bioimpedance analysis. Blood fasting glucose and insulin concentration were measured for assessment of Homeostasis model assessment of insulin resistance. RESULTS: Sixty patients were enrolled. Compared with preoperative baseline, postoperative REE increased by over 22.15% and 11.07%; REE/kg rose up to 27.22 ± 1.33 kcal/kg and 24.72 ± 1.43 kcal/kg; RQ decreased to 0.759 ± 0.034 and 0.791 ± 0.037; the lipid oxidation ratio was up to 78.25% ± 17.74% and 67.13% ± 12.76% supported by parenteral nutrition solutions from 37.56% ± 11.64% at the baseline; the level of Ln-HOMA-IR went up dramatically (P < 0.05, respectively) on postoperative days 1 and 3 in the IIT group. Meanwhile the concentration of total protein, albumin and triglyceride declined significantly on postoperative days 1 and 3 compared with pre-operative levels (P < 0.05, respectively). Compared with the CIT group, IIT reduced the REE/kg level (27.22 ± 1.33 kcal/kg vs 29.97 ± 1.47 kcal/kg, P = 0.008; 24.72 ± 1.43 kcal/kg vs 25.66 ± 1.63 kcal/kg, P = 0.013); and decreased the Ln-HOMA-IR score (P = 0.019, 0.028) on postoperative days 1 and 3; IIT decreased the level of CRP on postoperative days 1 and 3 (P = 0.017, 0.006); the total protein and albumin concentrations in the IIT group were greater than those in the CIT group (P = 0.023, 0.009). Postoperative values of internal cell fluid (ICF), fat mass, protein mass (PM), muscle mass, free fat mass and body weight decreased obviously on postoperative 7th day compared with the preoperative baseline in the CIT group (P < 0.05, respectively). IIT reduced markedly consumption of fat mass, PM and ICF compared with CIT (P = 0.009 to 0.026). CONCLUSION: There were some benefits of IIT in decreasing the perioperative insulin resistance state, reducing energy expenditure and consumption of proteins and lipids tissue in patients undergoing gastrectomy.

[Effect of intensive insulin therapy on resting energy expenditure in postoperative patients underwent radical distal gastrectomy].

OBJECTIVE: To investigate the effect of intensive insulin therapy on resting energy expenditure in postoperative patients underwent radical distal gastrectomy. METHODS: Sixty-four patients with gastric neoplasms in the middle or lower part of stomach from January to October 2010 were enrolled and underwent radical distal gastrectomy, then were randomized to intensive insulin therapy (IIT) group to keep glucose levels from 4.4 to 6.1 mmol/L or conventional insulin therapy (CIT) group to keep levels from 4.4 to 10.0 mmol/L. Resting energy expenditure (REE), respiratory quotient (RQ), resting energy expenditure per kilogram (REE/kg) and lipid oxidation ratio (LOR) were monitored by indirect energy metabolic system on preoperative and postoperative 1(st), 3(rd) and 7(th) day. Fasting blood glucose and insulin concentration were measured for HOMA-IR assessment. RESULTS: Compared with preoperative baseline, postoperative REE, REE/kg, LOR, Ln-HOMA-IR increased dramatically (P < 0.05, respectively). RQ decreased markedly (P < 0.05). Compared with group CIT, IIT reduced the REE/kg level [(27.2 ± 1.3) kcal/kg vs. (30.0 ± 1.5) kcal/kg, P = 0.008; (24.7 ± 1.4) vs. (25.7 ± 1.6) kcal/kg, P = 0.013]; and decreased the Ln-HOMA-IR score (P = 0.019 and 0.028) on postoperative 1(st) and 3(rd) day; IIT could decrease obviously the level of C-reaction protein level on postoperative 1(st) and 3(rd) day (P = 0.017, 0.006). The total protein and albumin concentration in IIT group were more than its levels in group CIT (P = 0.023, 0.009). CONCLUSION: There are some benefits of IIT in reducing mean energy expenditure and the consumption of proteins, decreasing postoperative insulin resistance level in this small population underwent radical distal gastrectomy.