Objective To investigate the clinical effect of sitagliptin combined with metformin in the treatment of sulfonylurea-deficient elderly patients with diabetes mellitus.Methods Sixty patients with diabetes mellitus were enrolled in our hospital from January 2013 to December 2016.The patients were divided into observation group(30 cases) and control group(30 cases) according to the random number method.The patients in the observation group were treated with sitagliptin and metformin.The patients in the control group were treated with gemcitabine, and the clinical treatment effect, fasting blood glucose, postprandial blood glucose, glycosylated hemoglobin, fasting C peptide and postprandial 2hC peptide Level of statistical comparison.Results The clinical effect of the observation group was significantly higher than that of the control group.Before and after treatment, the fasting blood glucose, 2h postprandial blood glucose, glycosylated hemoglobin, fasting C peptide and postprandial 2hC peptide level were not significantly different After fasting blood glucose, 2h postprandial blood glucose and glycosylated hemoglobin levels were significantly lower than before treatment, after treatment of fasting C peptide and postprandial 2hC peptide levels were significantly higher than before treatment.Conclusion The clinical efficacy of serotretine combined with metformin in the treatment of elderly patients with diabetes mellitus is similar to that of Yuxing, and the combination is more convenient and more suitable for clinical treatment.It is worthy to be popularized and applied in clinical practice.

Objective:To evaluate the efficacy and safety of acupuncture in the treatment of central post-stroke pain(CPSP). Methods:Randomized controlled trials of acupuncture treatment for CPSP in PubMed,Excerpta Medica Database(EMBASE),Cochrane Library,China National Knowledge Infrastructure(CNKI),Wanfang Data Knowledge Service Platform(Wanfang),Chongqing VIP Database(VIP),and China Biology Medicine Disc(CBM)were retrieved by computer.The retrieval time was from each database's inception to July 2023.Meta-analysis was performed using RevMan 5.3 software;GRADEprofiler 3.6.1 software was used to evaluate the quality of evidence.Dichotomous variables were analyzed by the risk ratio(RR).Continuous data were analyzed by mean difference(MD)with a confidence interval(CI)of 95%. Results:A total of 14 studies were included,comprising a total of 1 045 patients.The findings of the meta-analysis showed that compared with Western medication in treating CPSP,the acupuncture treatment had a higher clinical effective rate[RR=1.09,95%CI(1.01,1.19),Z=2.08,P<0.05],a lower visual analog scale(VAS)score[MD=-0.75,95%CI(-1.18,-0.32),Z=3.41,P<0.001],a lower pain rating index(PRI)score[MD=-1.72,95%CI(-2.76,-0.68),Z=3.24,P<0.05],a higher plasma β-endorphin(β-EP)level[MD=5.81,95%CI(3.00,8.62),Z=4.05,P<0.001],and a lower adverse reaction rate[RR=0.05,95%CI(0.01,0.18),Z=4.35,P<0.001].There was no statistical difference in the present pain intensity(PPI)score between the two treatments[MD=-0.26,95%CI(-0.54,0.02),Z=1.79,P>0.05].Compared with Western medication in treating CPSP,acupuncture plus Western medication had a higher clinical effective rate[RR=1.18,95%CI(1.05,1.34),Z=2.75,P<0.05],a lower VAS score[MD=-1.04,95%CI(-1.26,-0.82),Z=9.25,P<0.001],and a lower Pittsburgh sleep quality index(PSQI)score[MD=-2.67,95%CI(-4.80,-0.54),Z=2.46,P<0.05].The results of the evidence quality grade evaluation showed that there was no moderate-or high-quality evidence for acupuncture or acupuncture plus Western medication compared with Western medication in the treatment of CPSP. Conclusion:Acupuncture has certain therapeutic advantages over Western medication in the treatment of CPSP.It can effectively relieve pain and improve sleep,with fewer adverse reactions and better safety.However,high-quality randomized controlled trials are still needed for further study and verification.

OBJECTIVETo explore the clinical effects of negative pressure wound therapy (NPWT) combined with artificial dermis grafting and autologous skin grafting on repair of open joint wounds and/or wounds with exposed bone fracture.

METHODSEleven patients with open joint wounds and/or wounds with exposed bone fracture, hospitalized from November 2008 to November 2014, were enrolled in the study. According to the differences of the first stage treatment, all patients were divided into experimental group ( n = 6, including 4 patients of open joint wounds, 1 patient of wound with exposed bone fracture, and 1 patient of open joint wound with exposed bone fracture), and control group ( n 5, including 2 patients of open joint wounds, 2 patients of wounds with exposed bone fracture, and 1 patient of open joint wound with exposed bone fracture). After debridement, the wounds in both groups were grafted with punctured artificial dermis, while NPWT was only used over the artificial dermis of experiment group for 1 week. In the operation at sacsod stage, autologous split-thickness skin was grafted on the vascularized artificial dermis in both groups. Results In 5 patients of open joint wounds in experimental group, the artificial dermis was vascularized well, autologous skin grafts survived, and wounds were healed. In 3 patients of open joint wounds in control group, the artificial dermis grafting all failed due to local infection, and then these wounds were repaired with local tissue flap grafting. Artificial dermis in 3 patients of wounds with exposed bone fracture in both groups was vascularized well after grafting, and the wounds were healed after autologous skin grafting, whether or not NPWT was used.

CONCLUSIONSNPWT combined with artificial dermis grafting and autolognus skin grafting can be used for repairing open joint wounds and/or wounds with exposed bone fracture.

Debridement ; Dermis ; transplantation ; Humans ; Negative-Pressure Wound Therapy ; methods ; Skin Transplantation ; methods ; Skin, Artificial ; Surgical Flaps ; Wound Healing

Asphyxia Neonatorum ; blood ; drug therapy ; Creatine Kinase, MB Form ; blood ; Female ; Humans ; Infant, Newborn ; Male ; Naltrexone ; analogs & derivatives ; therapeutic use ; Natriuretic Peptide, Brain ; blood ; Peptide Fragments ; blood

Objective To compare the inspiratory cycling-off synchronization with expiratory trigger sensitivity (ETS) setting during noninvasive pressure support ventilation (PSV) under the different conditions of respiratory mechanics. Methods Bi-level pressure ventilator was connected to a lung model (Hans Rudolph Series1101 simulator). And its mechanics was set to normal, obstructive and restrictive ventilation dysfunction. Tests were performed with pressure support levels of 10 (in normal condition, 1 cmH2O = 0.098 kPa) and 15 cmH2O, 5 cmH2O positive end-expiratory pressure (PEEP). The data including cycling delay time (Td), tidal volume (TV) and airflow were collected in the presence of air leaks (24-28 L/min). Results Significant performance on airflow was observed in various respiratory mechanics conditions. The peak inspiratory flow (PIF) and peak expiratory flow (PEF) were different, and the tidal volume, PEF and inspiratory time were increased after decreasing the ETS level. Premature cycling occurred frequently in normal and restrictive model. Delay cycling was found only when the ETS setting was at the lowest level (about 5% of PIF), at which Td were (15.20 ± 0.43) ms and (105.00 ± 15.82) ms. In obstructive model, PIF and PEF were significantly decreased, and delay cycling was always present. Td were increased after the ETS setting was changed from the most sensitive level to moderate level:(51.30 ± 12.63) ms vs. (162.40 ± 15.59) ms, as cycling-off criteria were reduced from (34.52 ± 3.36)% to (16.04 ± 2.58)% of PIF, and there were statistical differences (P<0.05). Severe delay cycling was found when the ETS level was at the lowest level. Conclusions There are significant differences in performances and cycling-off synchrony in various respiratory mechanics models during PSV. For Curative Flexo ST30 bi-level pressure ventilator, its flow cycling-off criteria range is about 5%-35%of PIF. The higher ETS level might be beneficial to improve patient-ventilator synchrony in patients with obstructive airway diseases, which could result in premature cycling in patients with restrictive disease.

Purpose To investigate the expression of insulin-like growth factorIImRNA binding protein 3 ( IMP3 ) and microvessel density (MVD) in squamous carcinoma of the cervix (SCC) and analysis their relationship in SCC. Methods The expression of IMP3 and MVD was examined by immunohistochemistry SP method in normal cervical epithelium ( NCE) , low-grade cervical intraepi-thelial neoplasia (CIN-L), high-grade cervical intraepithelial neoplasia (CIN-H) and SCC. Results (1)The positive expression rates of IMP3 in NCE, CIN-L, CIN-H, SCC tissues were 0(0/15), 0(0/11), 37.5%(9/24) and 86.0%(43/50), the difference was statistically significant (x 2 =53.345, P=0.000). IMP3 expression was significant difference among NCE and CIN-H, SCC (P<0.008 3), and that was also among SCC and CIN-L, CIN-H (P<0.008 3). (2)The MVD count was increased with the development of cervical squamous lesion, there was significant difference among those groups (F=145.968, P<0.01), and the difference was al-so statistically significant between every two groups (P<0.05). The positive expression of IMP3 and MVD count in 50 cases of SCC tissues showed statistical difference in different pathologic grade, lymph node metastasis, and depth of tumor invasion groups ( P<0.05), but didn't in different patients’age groups (P>0.05). And the positive expression of IMP3 was closely related with MVD count in SCC tissues (rs =0.323, P<0.05). Conclusion IMP3 plays an important role in the occurrence, infiltration and metasta-sis of SCC, and the abnormal expression of IMP3 may relate with the angiogenesis of tumors.

Objective To study the effects of ethanol extract of rhizoma phragmitis on liver glycogen content and glycogen synthetase (GS) in streptozotocin (STZ) induced diabetic mice. Methods The diabetic model mice were divided in-to model control group, high-dose group and low-dose group, 10 mice for each group. Another 10 normal mice were used as control group. The liver glycogen content was detected by histochemical staining of glycogen (PAS) method. The expression of GS mRNA was detected by reverse transcription polymerase chain reaction (RT-PCR) and Western blot assays. Results After PAS staining the hepatic glycogen content decreased significantly in model control group, and which was significantly increased in low-dose group and high-dose group compared with that of model control group (P＜0.01). The hepatic glyco-gen content was the highest in high-dose group compared with that of other three groups. The levels of GS mRNA and GS protein were significantly lower in model control group than those of other three groups, which were significantly lower in low-dose group than those of high-dose group (P＜0.05). Conclusion There is a dose-dependent effect of ethanol extract of rhizoma phragmitis on liver glycogen in STZ induced diabetic mice, which may be related with the increased expression of liver glycogen synthetase.

Objective To evaluate the role of transient receptor potential ion channel 1 (TRPA1) in the spinal dorsal horn neurons in maintenance of neuropathic pain in rats.Methods Fifty-six adult male SpragueDawley rats,weighing 200-250 g,were randomly divided into 4 groups (n =14 each):sham operation group (group S); chronic compression of dorsal root ganglia (CCD) group; CCD + dimethyl sulfoxide group (group D); and CCD + TRPA1 blocker HC-030031 group (group H).CCD was produced by infiltrating the L5 intervertebral foramen with 50 μl of a hemostatic matrix (SURGIFLO) in anesthetized rats in CCD,D and H groups.In D and H groups,10％ dimethyl sulfoxide 20 μl and HC-030031 50 μg were injected intrathecally at 7 days after CCD operation,respectively.Paw withdrawal threshold to mechanical stimulation (PWMT) was measured at 1 day before operation (T0),at 1 h before intrathecal administration (T1),and at 1,2,4,6,8,and 24 h after intrathecal administration (T2-7).Six rats in each group were sacrificed at T4 and T7,the L3-5 segments of the spinal cord were obtained for determination of TRPA1 expression in the spinal cord by Western blot.Results Compared with group S,PWMT was significantly decreased at T1-7,the expression of TRPA1 in the spinal cord was up-regulated at T4 and T7 in CCD and D groups,and the PWMT was decreased at T1 and T5-7 and the expression of TRPA1 was up-regulated at T7 in H group (P ＜ 0.05).Compared with CCD group,the PWMT was significantly increased at T2-5 and the expression of TRPA1 was down-regulated at T4 in H group (P ＜ 0.05).Conclusion TRPA1 in the spinal dorsal horn neurons is involved in the maintenance of neuropathic pain in rats.

Hepatic tumor-specific magnetic resonance (MR) enhancement with Gd-EOB-DTPA can detect and distinguish small hepatocellular carcinoma (HCC) with greater sensitivity than conventional magnetic resonance imaging and computed tomography.Hepatic tumor-specific MR enhancement with Gd-EOB-DTPA is more sensitive in detecting focal HCC,and more reliable in detecting lesions with a diameter smaller than 2cm.Gd-EOB-DTPA is excreted through the kidneys and biliary tract,and thus may provide more information about anatomic structures,demonstrate non-obstruction of the intra- and extrahepatic bile duct system,and provide information about hepatic function.

Objective To evaluate effectiveness of ex vivo adenoviral gene transfer creating human bone morphogenetic protein 7-producing mesenchymal stem cells (Ad-hBMP-7 cells) compounded with nano-hydroxyapatite/collagen(NHAC) composite to induce spinal fusion in a rat posterolateral spine fusion model. Methods Mesenchymal stem cells were cultured and transduced by Ad-hBMP-7. Then Ad-hBMP-7 cells were cocultured with NHAC. Totally 56 Wistar rats were divided into four groups. Intertransverse spinal arthrodesis was attempted in four groups of Wistar rats with autogenous bone (group A); NHAC(group B); NHAC and BMSCs (group C); Ad-hBMP-7 cells and NHAC (group D). Each specimen underwent plain radiography, manual palpation and histological analysis. Results All spines in group D had fusion. In contrast, none of the spines in group A and group B had fusion. Three of ten rats in group C achieved fusion at the 12th week post-operatively.Conclusion BMP-7-producing mesenchymal stem cells compounded with NHAC composite may induce intertransverse fusion in the rat spine model.