Objective:To study the efficacy and safety of saxagliptin or pioglitazone combined with metformin in the newly diag-nosed patients with type 2 diabetes mellitus(T2DM) with inadequate glycemic control by metformin alone. Methods:Totally 82 newly diagnosed T2DM patients with inadequately control by metfomin monotherapy for 12 weeks were randomly divided into two groups, sax-agliptin group ( saxagliptin combined with metforminc) and pioglitazone group ( pioglitazone combined with metformin) . The blood glu-cose control, homeostatic model assessment of insulin resistance index ( HOMA-IR) , body weight change and adverse reactions were assessed before and after the treatment for 12 weeks. Results:After the 12-week treatment,the level of fasting plasma glucose ( FPG) , two-hour postprandial plasma glucose (2hPG) and glyeosylated hemoglobin(HbA1c) in both groups were significantly decreased. Compared with the pioglitazone group,the level of 2hPG and HbAlc was lower while the level of FPG was higher in the saxagliptin group (P<0. 05). Compared with the saxagliptin group,the level of fasting plasma insulin(FINS) was significantly decreased and HOMA-IR was significantly improved in the pioglitazone group. The body mass index ( BMI) of the patients was increased in the pioglitazone group(P<0. 05) and showed no change in the saxagliptin group(P>0. 05). There was no statistical difference in the adverse reac-tions between the two groups(P>0. 05). Conclusion:The combination of saxagliptin or pioglitazone with metformin in the treatment of newly diagnosed patients with type 2 diabetes can improve glycemic control with low incidence of hypoglycemia and adverse reactions. Saxagliptin is more suitable for the patients with heart diseases or old patients.

Parkinson disease(PD) is a degenerative disorder characterized by the loss of midbrain dopamine (DA) neurons. Recently it has been demonstrated that ES cells can differentiate into dopaminergic neurons in vitro and is a potentiol item for transplantation. In this paper we reviewed clinical study in treating Parkinson disease、methods and mechanisms of ES cells differentiation into dopaminergic neurons in vitro and progress of its application.

Objective To study the influence factors affecting the blood sodium level of patients with respiratory system diseases for the first time. Methods A retrospective analysis of 557 cases in our hospital from January 1,2013 to April 31, 2013 were analyzed.According to the serum sodium levels, patients were divided into normal blood sodium group and hyponatremia group.The basic data, clinical indexes, prognosis were collected and the relationships between the epidemiology study of hyponatremia and the diseases of respiratory system were analysed.Results 557 cases of respiratory patients, 121 cases were complicated with hyponatremia, the incidence rate was about 21.72%; hyponatremia incidence of the top three diseases of respiratory system:57 cases of pneumonia ( 47.1%) , 26 cases of chronic bronchitis ( 21.5%) , 11 cases of lung cancer ( 9.1%); temperature, diastolic blood pressure, heart rate, WBC, Hb, Alb, BUN, Cl, might had an impact on the level of serum sodium (P<0.05); hyponatremia group prognosis was significantly worse than normal blood sodium group (P<0.05).Conclusion Patients in the department of respiratory internal medicine are easy suffered with hyponatremia, the factors are more, prognosis is poor, requiring clinical attention.

Objective:To explore the role of PDCA cycle in the standardized residency training in the department of hematology.Methods:Thirty residents trained in the department of hematology of Peking University Third Hospital from January 2019 to September 2019 were enrolled into experimental group, and 36 residents trained from January 2018 to December 2018 were enrolled into control group. Experimental group received the PDCA cycle teaching method and control group did the traditional one. At the end of the training, the results of theory examination and practical operation skills examination of the two groups were compared. The statistical significance was analyzed on the assessment scores and teaching satisfaction between the two groups. SPSS 20.0 was used for t test. Results:Compared with the control group, the examination scores and teaching satisfaction of the residents in the experimental group were higher than those in the control group ( P < 0.05). Conclusion:The teaching mode of PDCA cycle is conducive to improving the effect of standardized residency training in the department of hematology.

Objective:To analyze the characteristics of hospital infection of hematological disease, so as to provide reference for clinical therapy. Methods: Bacterial strains and antimicrobial resistance of pa-tients with hospital infection in Department of Hematology, Peking University Third Hospital from Jan. 2011 to Dec. 2013 were identified and analyzed retrospectively. The specimens were from their blood, urine, sputum, throat swabs and etc. Results:Among the total of 168 isolates of bacteria,the majority of the bacteria strains were from sputum (42. 9%);114(67. 9%) bacteria strains were gram negative and 54(32. 1%) bacteria strains were gram positive;the pathogen testing showed that 20. 8% were Pseudo-monas aeruginosa,18. 5% Escherichia coli,17. 9% Staphylococcus aureus, 9. 5% Klebsiellar pneumonia, 5. 9% Staphylococcus epidermis and 27. 4% other bacteria ;The gram negative bacilli to cefepime, ami-kacin and carbapenems showed the lowest antimicrobial resistance rates, and S. aureus showed the lowest antimicrobial resistance rates to vancomycin and linezolid. Conclusion:Patients with hemopathy are the main population of hospital infections, the gram negative bacteria are the most common pathogens. It is very important to promptly know the change in distribution of the pathogens in order to rationally select antibiotics and reduce the incidence of bacterial infections.

ObjectiveTo analyse treatments and prognostic factors of T cell non-Hodgkin lymphoma (T-NHL). MethodsNinety-one patients with T-NHL were retrospectively analyzed, and clinical features,histopathology, laboratory data were included in Kaplan-Meier and prognostic analysis. Results Median age was 38 years,58 (63.7 ％) had high-intermediate and high risk by IPI,72 (79.1％) presented with advanced stage disease,extranodal disease was present in 64.8 ％ of patients.The overall response rate (ORR) for the whole group was 63.8 ％,and the estimated 3,5-year ORR were 55.5 ％,41.3 ％ respectively.Compared with CHOP-like regimen, the addition of etoposide could improve the survival of patients, meanwhile radiation therapy could improve the outcome of patients with NK/T cell lymphoma and mediastinal bulky disease, and consolidation chemotherapy with HSCT could improve the survival and reduce the recurrence of patients.Clinical stage,B symptoms,ECOG score,the level of LDH,extranodal involvment,anemia,initial treatment outcome, IPI score, the level of serum albumin and fibrinogen were predictive to overall survival. Cox multivariate analysis showed initial treatment outcome and B symptoms were independent prognostic factors.IPI and m-PIT were useful for stratified patients into different prognostic risk groups. Conclusion T-NHL is a heterogeneous group of malignancies with an inferior long term outcome. New treatment modality needs to be explored for these patients,and new drugs and HSCT may be good choices.

Objective To investigate the effect of bortezomib combined with doxorubicin on lymphoblastic lymphoma cell line Molt-4.Methods Molt-4 cells were cultured in the presence of bortezomib and doxorubicin,cell viability was monitored by CCK-8 and trypan-blue exclusion.Apoptosis was detected by flow cytometry and mitochondrial membrane potential,expression of Fas was also measured with flow cytometry.Results Molt-4 cell proliferation was substantially inhibited in concentration-dependent manners when treated with either bortezomib or doxorubicin.The combination of both drugs synergistically inhibited Molt-4 cell proliferation at 48 hours [(57.24±0.10) ％].Combination therapy further enhanced bortezomib and doxorubicin induced apoptosis [48 h (23.08±1.25) ％] (P ＜ 0.05).Detection of mitochondrial membrane potential showed that combination therapy could promote apoptosis (15.84 ％,5.38 ％,5.52 ％) but did not significantly change the level of Fas expression (P ＞ 0.05).Conclusion Combination therapy of bortezomib with doxorubicin efficiently inhibits proliferation and induces apoptosis of Molt-4 cells.Activation of mitochondrial and intrinsic apoptotic pathway may play important roles.

Objective To investigate the effect of combination with magnetic nanoparticle of Fe3O4and adriamycin (ADM) on Raji cell line.Methods Raji cells were cultured with Fe3O4-magnetic nanoparticle and ADM after using mechanical absortion polymerization,and the cell viability was detected by MTT and trypan-blue exclusion.The apoptosis was detected by flow cytometry,and the expression of p53 and NF-κB were measured by Western blot. Results Raji cell proliferation ratio was significantly inhibited in concentration-and time-dependent manners in both ADM and Fe3O4-MNP-ADM groups (r =0.412,P =0.027;r =0.523,P =0.014).The percentages of apoptotic cells induced by ADM and Fe3O4-MNP-ADM were 8.76 ％ vs 14.85 ％,35.08 ％ vs 44.50 ％,44.00 ％ vs 69.40 ％ in 12,24 and 48 hours,respectively (t =-9.137,-4.808,-6.337; P =0.012,0.041,0.024).The grey straps of NF-κB measured by Western blot were 4.22±0.32,3.31±0.28 in ADM and Fe3O4-MNP-ADM group (t =-54.416,P =0.035),whereas the grey straps of p53 were 1.042±0.114,1.270±0.091,respectively (t =33.963,P =0.047).Conclusion Combination therapy of Fe3O4-MNP and ADM could inhibit proliferation and induce apoptosis of Raji cells line,which may due to upregulation of p53 and down-regulation of NF-κB.

Objective To investigate the relationship between plasma docetaxel concentration and the efficacy as well as toxic and side effects in patients with breast cancer after chemotherapy.Methods Seventy -one patients with breast cancer who accepted AC sequential T chemotherapy regimen as first line treatment were selected from April 2015 to September 2015 in Hubei Provicial Tumor Hospital.The plasma concentration of docetaxel was detected by latex immunoturdidimetry after the docetaxel continuous infusion in each cycle.The three groups were assigned according to the concentration distribution of docetaxel:group A (plasma concentration docetaxel ≤ 2.0mg·h -1 · L -1 ),group B (2.1 -2.5mg·h -1 ·L -1 )and group C (≥2.6 mg·h -1 ·L -1 ).The relationship between the drug plasma concentration,therapeutic efficacy and adverse reactions in different docetaxel plasma concentration was analyzed retrospectively by Chi -square tests.Results The average plasma concentrations of docetaxel of the three groups were (1.55 ±0.36)mg·h -1 ·L -1 ,(2.28 ±0.13)mg·h -1 ·L -1 ,(2.87 ±0.38)mg· h -1 · L -1 respectively.The adverse reactions were enhanced with the increasing of docetaxel plasma concentration (χ2 =5.169, 4.463,3.630,P =0.023,0.035,0.047).The therapeutic efficacy of group C and group B was same(95.8%),which was higher than 87.0% of group A,but there was no statistically significant difference (χ2 =1.559,P =0.24). Conclusion Breast cancer patients whose plasma concentration of docetaxel is between 2.1 ~2.5mg·h -1 ·L -1 has a better prognosis,and its adverse reactions are controlled in a certain extent.

Background and purpose:Solitary plasmacytoma of bone(SBP) is a rare disease,reports releveant to this disease are rarely seen. The purpose of this study was to investigate the relation between the clinical features and the prognosis of solitary plasmacytoma of bone. Methods:We reviewed the data of 12 patients diagnosed with solitary plasmacytoma of bone from 1998 to 2007 in Peking University third hospital,the clinical features,treatment and prognosis of the patients were analyzed retrospectively. Results:The age ranged from 37-71 years(mean 49.6 years) ,the male/female ratio was 3 to 1. Immunophenotype analysis showed that 11(91.6%) cases were positive for CD79a,10(83.3%) positive forVS38C,and all negative for CD20. With 12 to 87 months follow-up(average 40?22 months) ,three cases(33%) developed to multiple myeloma,two of them died from infection,the median survival time was 73 months,the 3 year and 5 year survival rate were 90 percent and 75 percent respectively. Conclusion:Middle and old male are more likely to develop SP. The prognosis is good,but some of them can progress to multiple myeloma.