Objective To investigate the clinical efficacy of DPP-4 inhibitors in the treatment of newly diagnosed type 2 diabetes mellitus and its effect on blood pressure and body weight.Methods A total of 100 newly diagnosed elderly patients with type 2 diabetes mellitus were enrolled in this study from July 2013 to June 2015 in this hospital.They were divided into observation group and control group(n=50).The control group was treated with placebo on the basis of diet control and exercise.The observation group was treated with sitagliptin on the basis of diet control and exercise.Fasting plasma glucose(FPG),2 h postprandial blood glucose(2 h PG) and glycated albumin (GA) were measured before and after treatment,and the incidence rate of hypoglycemia,blood pressure,body weight and other adverse reactions were monitored.Results After treatment,two groups of patients,condition were significantly improved,FPG,2 h PG,GA changes in observation group were significantly better than that of control group,the difference were statistically significant(P＜0.05).There was no significant difference in blood pressure,body weight and body mass index before and after treatment,and also between the two groups(P＞0.05).The incidence of adverse reactions in the observation group and the control group were 10.0％ and 8.0％,The incidence of adverse reactions in the two groups was not statistically significant(P＞0.05).Conclusion The clinical efficacy of DPP-4 inhibitor siglitazide in the treatment of newly diagnosed elderly patients with type 2 diabetes mellitus is good,and it is very useful in the treatment of these patients.

Objective To assess the diagnostic value of coronary CTA (CCTA) combined myocardial CT perfusion imaging (CTP) in coronary artery disease (CAD) with Meta-analysis.Methods Chinese and English literatures evaluating CCTA combined CTP in diagnosis of CAD in PubMed,Wed of Science,Cochrane Library,China National Knowledge Infrastructure (CNKI) and Wanfang Periodical Database from inception to December 2016 were searched.The extraction was conducted according to the criteria for diagnostic recommended by Cochrane Method Group.The quality of included studies was assessed with quality assessment of diagnostic accuracy studies-2 instrument.The statistical analysis was performed by Meta-disc 1.4 software,the diagnosis efficacy was calculated and the symmetric receiver operating characteristic curves (SROC) was drawn to obtain the area under curve (AUC).Results Five studies involving a total of 611 vessels were included.The pooled sensitivity (SEN),specificity (SPE),diagnostic odds ratio (DOR),positive likelihood ratio (PLR),negative likelihood ratio (NLR) were 0.96 (95％CI [0.92,0.98]),0.91 (95％CI [0.88,0.94],206.14 (95％CI [100,424.94]),9.33 (95％CI [5.57,15.61]),0.06 (95％CI [0.03,0.13]),respectively.The AUC of SROC was 0.977.Conclusion CCTA combined CTP has significant value in diagnosis of CAD.

OBJECTIVETo compare the clinical effects between hip anterior S-P approach combined with iliac bone flap transplantation with deep circumflex iliac artery and posterior K-L approach combined with quadratus femoris bone flap transplantation for the treatment of femoral neck fracture of Garden III-IV in young and middle-aged patients.

METHODSFrom January 2004 to January 2011,46 patients with femoral neck fractures were treated by two kinds of operation. Among them, 20 cases were treated with anterior S-P approach combined with iliac bone flap transplantation with deep circumflex iliac artery, included 12 males and 8 females with an average age of (32.1 ± 7.3) years old, involved 12 cases of Garden III and 8 cases of Garden IV. The other 26 cases were treated with posterior K-L approach combined with quadratus femoris bone flap transplantation, included 20 males and 6 females with an average age of (37.8 ± 6.9) years old, involved 16 cases of Garden III and 10 cases of Garden IV. The index of hospitalization (hospitalization time, total cost, operative time, intraoperative blood loss, postoperative complications), the quality index of operation (fracture reduction, position of internal fixation, fracture healing time, nonunion and femoral head necrosis) of two groups were observed and compared. Hip joint function were evaluated by Harris score.

RESULTSAll patients were followed up from 28 to 41 months with an average of 36 months. The intraoperative blood loss of group S-P (92.3 ± 10.4) ml was less than that of group K-L (132.4 ± 11.2) ml, there was significant difference between two groups (P < 0.05). The operation time of group S-P (81.4 ± 9.2) min was more than that of group K-L (67.1 ± 4.5) min, the difference was statistically significant (P < 0.05). One case in group S-P and 9 cases in group K-L appeared postoperative complications, there was significant difference between two groups (P < 0.05). The fracture healing time of S-P group (83.5 ± 7.3) d was shorter than that of group K-L (103.2 ± 12.6) d, there was significant difference between two groups (P < 0.05). At 30 months after operation, there were significant difference in Harris scoring between two groups (P < 0.05).

CONCLUSIONAnterior S-P approach combined with iliac bone flap transplantation with deep circumflex iliac artery for treatment of femoral neck fracture of Garden III-IV of young and middle-aged patients, it has characteristics in clear anatomic and easy to operate. As compared with K-L approach, S-P approach can better reserve residual blood supply of femoral neck. While combining with the iliac bone flap transplantation with deep circumflex iliac artery, it could better reconstruct the blood supply of femoral neck to promote fracture healing.

Adult ; Case-Control Studies ; Female ; Femoral Neck Fractures ; physiopathology ; surgery ; Fracture Healing ; Humans ; Iliac Artery ; Male ; Middle Aged ; Surgical Flaps ; transplantation

The biochemical mechanism of degrading keratins by S.fradiae var S-221 was primarily studied.The compounds (Na_ 2 SO_ 4 , Na_ 2 SO_ 3 and sulfdryl acohol), which respecitively enhance specific activity of keratinase, activate keratinase intensively and mainly act on the disulfide bonds reductase in the keratinase, Na_ 2 SO_ 3 activates intensively both disulfide bonds reductase and polypeptide hydrolytase at 0.01 mol/L, whereas Na_ 2 S_ 2 O_ 3 , which acts on the disulfide bonds reductase, inhibits keratinase.On the condition that substrate, keratins exists, S.fradiae var S-221 is induced to produce exo-keratinase, which is a multiproteinase, containing disulfide bonds reductase, which is a key enzyme degrading keratins, then, with polypeptidic, hydrolytase, graduately hydrolyzates denatured keratins into polypeptides, oligopeptides and free amino acids, so that keratins have been decomposed completely.Sulfur in the keratins was transferred into sulfhydryl compounds, H_ 2 S and sulfates in the course of keratinolysine.

Three bactreiophages of Pseudomonas aeruginosa were isolated from sewage and named as PaP1, PaP2 and PaP3. All belong to double-strand DNA phages, their genome is about 47kb, 34kb and 24kb respectively. The titre (pfu/mL) of three phages is respectively 109, 1011 and 1011, PaP1 is lytic phage, both PaP2 and PaP3 are lysogenic. Under electron microscope, All show icosahedral heads with diameter of 70nm, 55nm and 65nm respectively. PaPl belongs taxonomically to Myoviridae, and both of PaP2 and PaP3 belong to Pedoviridae. The phage-re-sistance and substitution phenomenon of the resistant flora for the sensitive were observed, and the mutation frequence of Pseudomonas aeruginosa resistant to the phage is about 1.4 ? 10-7 ~ 7.9 ?10-7 determined by end-point -titer method.

OBJECTIVETo summary the recent advances in molecular research of glioblastoma (GBM) and current trends in personalized therapy of this disease.

DATA SOURCESData cited in this review were obtained mainly from PubMed in English up to 2015, with keywords "molecular", "genetics", "GBM", "isocitrate dehydrogenase", "telomerase reverse transcriptase", "epidermal growth factor receptor", "PTPRZ1-MET", and "clinical treatment".

STUDY SELECTIONArticles regarding the morphological pathology of GBM, the epidemiology of GBM, genetic alteration of GBM, and the development of treatment for GBM patients were identified, retrieved, and reviewed.

RESULTSThere is a large amount of data supporting the view that these recurrent genetic aberrations occur in a specific context of cellular origin, co-oncogenic hits and are present in distinct patient populations. Primary and secondary GBMs are distinct disease entities that affect different age groups of patients and develop through distinct genetic aberrations. These differences are important, especially because they may affect sensitivity to radio- and chemo-therapy and should thus be considered in the identification of targets for novel therapeutic approaches.

CONCLUSIONThis review highlights the molecular and genetic alterations of GBM, indicating that they are of potential value in the diagnosis and treatment for patients with GBM.

Brain Neoplasms ; genetics ; pathology ; Glioblastoma ; genetics ; pathology ; Humans ; Isocitrate Dehydrogenase ; genetics ; Mutation ; PTEN Phosphohydrolase ; genetics ; Receptor, Epidermal Growth Factor ; genetics ; Telomerase ; genetics

Adolescent ; Adult ; Female ; Humans ; Liver Cirrhosis ; pathology ; Male ; Middle Aged

OBJECTIVETo evaluate the feasibility of whole body diffusion weighted imaging (DWI) in bone metastasis detection using bone scintigraphy as comparison.

METHODSForty-five patients with malignancy history were enrolled in our study. All the patients received the whole body DWI and bone scintigraphy scan within 1 week. The magnetic resonance (MR) examination was performed on 3.0T MR scanner using embedded body coil. The images were reviewed separately by two radiologists and two nuclear medicine physicians, who were blinded to the results of the other imaging modality. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the two techniques for detecting bone metastasis were analyzed.

RESULTSA total of 181 metastatic lesions in 77 regions of 34 patients were detected by whole body DWI, and 167 metastatic lesions in 76 regions of 31 patients were identified by bone scintigraphy. The patient-based sensitivity and PPV of whole body DWI and bone scintigraphy were similar (89.5% vs. 81.6%, 97.1% vs. 91.2%), whereas, the patient-based specificity and NPV of whole body DWI were obviously higher than those of bone scintigraphy (85.7% vs. 57.1%, 60.0% vs. 36.4%). Ten regions negative in scintigraphy but positive in whole body DWI, mainly located in spine, pelvis, and femur; nine regions only detected by scintigraphy, mainly located in skull, sternum, clavicle, and scapula. The region-based sensitivity and specificity of whole body DWI were slightly higher than those of bone scintigraphy (89.5% vs. 88.4%, 95.6% vs. 87.6%).

CONCLUSIONWhole body DWI reveals excellent concordance with bone scintigraphy regarding detection of bone metastasis, and the two techniques are complementary for each other.

Aged ; Bone Neoplasms ; diagnosis ; pathology ; secondary ; Diffusion Magnetic Resonance Imaging ; instrumentation ; methods ; Female ; Humans ; Male ; Middle Aged ; Predictive Value of Tests ; Radionuclide Imaging ; Sensitivity and Specificity ; Whole Body Imaging ; instrumentation ; methods

BACKGROUNDChronic liver disease causes aberrant formation of fibrous tissue that impedes normal liver function, ultimately resulting in liver cirrhosis. Iron uptake can occur within the hepatic parenchyma or within the various nodules that form in a cirrhotic liver, termed siderotic nodules (SN). We aimed to investigate the diagnostic performance of susceptibility weighted imaging (SWI) for detection of SN in patients with liver cirrhosis, and to evaluate the potential of SN numbers for assessing the degree of hepatic iron deposition, liver function, and liver fibrosis stage.

METHODSNinety-one patients with chronic liver cirrhosis, who underwent megnetic resonance imagine (MRI) scanning in our department between November 2010 and April 2011, were included in the study. A 3.0T MRI scanner was used to acquire T1WI, T2WI, T2WI, and SWI images. The number of nodules, signal intensity ratio (SIR), and contrast noise ratio (CNR) were recorded and analyzed by chi-square and ANOVA statistical tests. Correlation analysis was performed to evaluate the correlations between the number of SN and Child-Pugh classification, ferritin and hyaluronic acid levels.

RESULTSThe sensitivity of SWI, T1WI, T2WI, and T2 WI for detecting SN was 62.5%, 12.1%, 24.2% and 41.8%, respectively. SWI detected significantly more nodules than routine T1WI, T2WI, and T2 WI procedures (P < 0.05). The SIR was the lowest in SWI (0.361 ± 0.209), as compared to T1WI (0.852 ± 0.163), T2WI (0.584 ± 0.172), and T2 WI (0.497 ± 0.196). The CNR was the highest in SWI (13.932 ± 5.637), as compared to T1WI (9.147 ± 5.785), T2WI (9.771 ± 5.490), and T2 WI (11.491 ± 4.573). The correlation coefficients of the number of SN with ferritin, Child-Pugh classification, and hyaluronic acid levels were 0.672, -0.055, and 0.163, respectively.

CONCLUSIONSThe sensitivity and contrast of SWI for detecting SN in patients with liver cirrhosis are higher than conventional MRI. The number of SN can help to assess the degree of iron deposition in patients with liver cirrhosis.

Adult ; Diffusion Magnetic Resonance Imaging ; methods ; Female ; Ferritins ; blood ; Humans ; Hyaluronic Acid ; blood ; Liver ; pathology ; Liver Cirrhosis ; blood ; pathology ; Male ; Middle Aged ; Sensitivity and Specificity

OBJECTIVETo summarize our experiences in the diagnosis and treatment of placenta accreta in the second trimester of pregnancy.

METHODSWe retrospectively analyzed the clinical data of 31 patients were admitted to Peking Union Medical College Hospital with placenta accreta in the second trimester of pregnancy from January 2002 to January 2010.

RESULTSAmong 31 cases, one case (3.2%) was suspected to be with placenta accreta by ultrasound examination and 30 cases (96.8%) were normal before delivery. Placenta accreta was identified during follow-up in 12 cases (38.7%) after delivery. Fourteen patients underwent curettage again after delivery,which was effective in 6 patients (42.9%) and failed in 8 patients,in whom uterine artery embolization (UAE) was further applied. Thirteen patients underwent UAE without curettage. In total,21 cases underwent UAE, which was effective in 19 patients (90.5%); one patient with abnormal β-human chorionic gonadotropin (β-HCG) 5 months after embolization underwent lesion resection and one case with slightly increased β-HCG were lost to follow-up. Hysteroscopy was effective in 3 patients,of whom two patients underwent lesion resection by hysteroscopy and one case who was suspected to be with trophoblastic disease by ultrasonography before surgery and confirmed to be placenta accreta during hysteroscopy examination underwent lesion resection. One case experienced hemorrhagic shock during vaginal delivery and underwent emergency laparotomy. Among all these 31 patients,massive hemorrhage occurred in 13 cases during delivery and hemorrhagic shock in 2 cases. Three cases had postpartum hemorrhage and stopped bleeding after UAE. None needed hysterectomy.

CONCLUSIONSPlacenta accreta in the second trimester of pregnancy is usually diagnosed after childbirth,which may be delayed in some cases. Therefore,special attention should be paid to this disease during follow-up. Conservative treatment was the main therapy of placenta accreta in the second trimester of pregnancy. UAE is effective in stopping bleeding.

Adult ; Dilatation and Curettage ; Female ; Follow-Up Studies ; Humans ; Placenta Accreta ; diagnosis ; therapy ; Pregnancy ; Pregnancy Trimester, Second ; Retrospective Studies ; Uterine Artery Embolization ; Young Adult