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.

In this article we report the results on the synthesis and accumulation of PHAs by Rhodocista pekingensis (strain 3-p), a phototroph that was isolated from wastewater treatment plant. Our results showed that the optimal conditions for PHAs accumulation with strain 3-p were as following: 0.01% Yeast Extract, 0.01% NH 4Cl, Acetate 5 g/L, and medium pH of 7.0～7.2.Under optimized conditions, strain 3-p accumulated PHAs up to 60% of its cellular dry weight. Enzymatic activities of ?-ketothiolase, acetoacetyl-CoA reductase, and PHA polymerase were detected and their activities increased as PHA synthesis initialized. Based on these study, we proposed the metabolic pathway of this strain should be:Acetate (or other fatty acids) - Acetyl-CoA --- thiolase Acetoacetyl-CoA --- reductase D (-)-?-Hydroxybutyryl-CoA ----- PHA polymerase PHAs.

Objective To study the microsurgical and anatomic structures of brachial plexus roots and vertebral canal to find the best approaches for reimplantation of avulsed brachial plexus ventral roots into the spinal cord.Methods On nineteen cervicothoracic spine specimens,the brachial plexus nerves were exposed along to intervertebral foramen,and the spinal cord and brachial plexus roots were exposed by excising the vertebral arch and sectioning the spinal dura mater.The anatomy of brachial plexus roots and vertebrae,and the relative positions of spinal cord segments to vertebral discs were measured and observed.Results The relative positions of spinal cord segments to vertebral discs are:C5-7 spinal cord segments face C3,4,C4,5 and C5,6 vertebral discs;and C8 and T1 spinal cord segments face C6 and C7 vertebrae.Based on the anatomic finding,four approaches were found out: the lateroventral approach,the lateral approach by enlarging intervertebral foramen,the laterodorsal approach and the lateral and dorsal combined approach.Conclusions The brachial plexus ventral roots can be best reimplanted into the spinal cord by the lateroventral approach and the lateral approach.Although the laterodorsal approach and the lateral and dorsal combined approach are not the best,they are less difficuh and dangerous.

Objective To investigate the protective effects of ambroxol on lung during perioperation in elderly patients with myasthenia gravis.Methods 58 elderly patients diagnosed as myasthenia gravis combined with thymic disease were divided into treatment group and control group randomly.During the perioperation,the treatment group was treated with ambroxol,while the control group was not.Comparative analysis of pulmonary complications,pulmonary ventilation indexes,blood gas indexes,and serum concentration of C-reactive protein (CRP),tumor necrosis factor-α (TNF-α),interleukin 1β (IL-1β) and IL-10 was performed.Results The incidence rate of postoperative pulmonary complications (pulmonary atelectasis,pneumonia and bronchitis) was significantly lower in the treatment group in the control group (9.4％ vs 15.6％,P＜0.05).Peak inspiratory pressure (PIP) and resistance of air way (RAW) were lower in treatment group than in control group [(22.32±3.43) cmH2O vs (26.54±4.81) cmH2O,(29.17±5.74) cmH2O· L-1s-1vs (34.47±7.94) cmH2O · L-1 · s-1 both P＜0.05],while compliance of lung (CL) washigher in treatment group than in control group [(106.04±-14.73)ml/cmH2O vs (95.11±9.50) ml/cmH2O,P＜0.05].Two days after operation,PaO2,SaO2 and PaO2/FiO2 were significantly higher in treatment group than in control group [(89.66 ±13.23) mmHg vs (70.94±12.75) mmHg,(96.95±2.65)％ vs (89.44±2.78)％,(219.47±54.05)mmHg vs (187.38±37.72) mmHg,respectively,all P＜0.05].Serum concentration of CRP,TNF-α,IL-1β were lower and serum level of IL-10 was higher in treatment group than in control group [(29.37 ± 14.87)mg/L vs (43.94 ±21.42) mg/L,(35.55±4.74)μg/L vs.(52.80±6.63) μg/L,(17.06±6.85)μg/L vs.(28.62±7.72) μg/L],[(132.84± 12.91)μg/L vs.(87.18± 16.37)μg/L,respectively,all P＜0.05].Conclusions Ambroxol hydrochloride can effectively reduce the incidence rate of postoperative pulmonary complications after thymectomy,improve the pulmonary ventilation function,and inhibit the inflammatory reaction in elderly patients with myasthenia gravis,which is worthy of wide application in the perioperation.

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 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.

Objective To explore the value of follow-up of serum TSH stimulating thyroglobulin (Tg) test and 131I whole body scan(WBS) in patients with differentiated thyroid cancer(DTC) who were treated by 131I.Methods By SPSS software,Kappa test was performed between results of serum Tg,TgAb test and WBS for diagnosis of persistent/recurrent DTC.Results Consistency test of TSH stimulating Tg,TgAb and 131I WBS for diagnostic persistent/recurrent or metastasis of DTC:kappa value =0.587,SE =0.076,P ＜ 0.01.Although the results showed that two measurements appeared definite consistency,it is dissatisfactory.Conclusion Serum TSH stimulating Tg test and 131I whole body scan(WBS) are important follow-up tools for patients with DTC.Because of Tg interfering it is necessary to performed TgAb test simultaneously,when Tg test was performed.Especially 131I WBS do is not absent because false negative would be able to appeared in single serum TSH stimulating Tg and TgAb test.

The normative research on safeguarding intangible cultural heritage of traditional Chinese medicine is the important measure after building list and filing work of Convention of the protection of intangible cultural heritage of UNESCO, and also a strategy in accordance with the principle of the protection of traditional knowledge of traditional Chinese medicine.This article discussed the arrangement and standardization in the academic level of folk medicine technology teaching orally from generation to generation, to provide protection for the living inheritance of intangible cultural heritage of traditional Chinese medicine, and a pilot measure for the construction of intangible cultural heritage protection system.

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.