Objective To explore the efficacy and safety of Linagliptin in combination with Metformin in newly diagnosed T2DM patients. Methods A total of 140 newly diagnosed T2DM patients were enrolled in this study. All the patients were admitted in the Endocrinology and Metabolism department of our hospital from January 2013 to October 2013. Random number table method was used in patients’ selection. All the patients were divided into two groups :Linagliptin plus Metformin group (Linagliptin group ,n=70) and Glipizide plus Metformin group (Glipizide group ,n=70) ,and followed up for 12 weeks. Efficacy and safety of treatment were compared between the two groups. Results The difference of FPG ,2 hPG and HbA1 c did not reach the statistical significance between the two groups at baseline treatment (P>0.05). FPG ,2 hPG and HbA1 c were significantly lower after treatment compared with baseline in both groups (P<0.05). FC-P ,2 hC-P ,HOMA-β,HOMA-IR ,IAI and adiponectin level at baseline were similar between the two groups ( P> 0.05 ). All these indicators were improved after treatment in both groups (P< 0.05) ,and were significant better in Linagliptin group than in Glipizide group. Adverse events rate were significantly higher in Glipizide group than in Linagliptin group (18.57%vs 5.71% ,χ2 = 5.423 ,P= 0.020 ). Conclusion The efficacy of Linagliptin in combination with Metformin in newly diagnosed T2DM patients was similar with Glipizide plus Metformin. The β cell function improvement was better and APN level was higher after Linagliptin treatment.

There is a complicated association between the liver and diabetes mellitus.Diabetes mellitus may cause various forms of liver damage,such as nonalcoholic fatty liver disease (NAFLD),hepatic cirrhosis,hepatocellular carcinoma,liver abscess,and liver transplant complications.With the growing epidemic of diabetes mellitus,this review investigates diabetes mellitus induced liver damage.

Objective:To investigate the sleep quality of the people aged over 18-years-old in Hebei province and the impact of relative factors on it.Methods:Sum total of 20 716 random samples at ages over 18 were selected among the general population.The tools were Pittsburgh Sleep Quality Index(PSQI),Simplified Coping style Questionnaire(SCSQ).Results:The total prevalence of low sleep quality was 11.6 %(2411/20716).Female had higher standardized prevalence rate than male(6.8% vs.4.8%).Logistic analysis showed that risk factors to low sleep quality were ages over 70-years-old,remarriage,divorce,bereft,negative coping style(OR=1.776,1.515,2.046,1.254,1.097).On the other hand,factors to good sleep were the Han nationality,male,farmer,the family average annual income ranged 5001-10000 RMB,10001-20000 RMB,20001-40000 RMB,positive coping style(OR=0.839,0.703,0.732,0.750,0.660,0.573,0.936).Conclusion:Low sleep quality had high prevalence in Hebei.It should be recognized by medical workers.

Objective To investigate the relationship between hepatitis B virus pre-core region 1896 site mutation in cases of chronic hepatitis B and IFN-alpha treatment.Methods 200 patients with chronic hepatitis B were randomly divided into experimental group(n=100) and control group(n=100).The patients in experimental group were treated with regular liver-protective drugs and IFN-alpha,while Control group patients received only regular liver-protective drugs for 6 months.PCR-RFLP were used to detect hepatitis B virus(HBV)DNA with pre-C region 1896 site mutation in two grops pre and post treatment.Results The mutation rates before interferon treatment were 20%(20/100) and 18%(18/100) in experimental group and control group,respectly.After treatment,the effective rates in experimental group were 60%(12/20) and 50%(40/80) in Patients with Chronic Hepatitis B variant and wild strain virus Infection,respectly.The effective rate in experimental group was significantly higher than that in control group.Conclusion IFN-alpha therapy was not correlated with genomic variability of the core region.

Objective:To compare the survival rate and adverse reactions of patients with advanced hypopharyngeal squamous cell carcinoma undergoing surgery combined with chemoradiotherapy, and to analyze the prognostic factors of patients.Methods:The clinicopathologic data of 78 patients with advanced hypopharyngeal squamous cell carcinoma admitted to the Department of Radiation Oncology of the First Affiliated Hospital of Bengbu Medical University from August 2013 to December 2018 were retrospectively analyzed. The patients were divided into surgery combined with chemoradiotherapy group ( n=27) and chemoradiotherapy group ( n=51) according to different treatment methods. The median follow-up time was 46 months (20-84 months). The main observation indicators were overall survival (OS), progression-free survival (PFS) and local control rate (LCR). Cox regression model was used to analyze the prognostic factors. Results:Until July 31, 2020, 51 of the 78 patients with advanced hypopharyngeal squamous cell carcinoma died, including 6 cases of local recurrence, 11 cases of distant metastasis, and 34 cases of other causes (15 cases of hemorrhage, 15 cases of cachexia, and 4 cases of other diseases). In the surgery combined with chemoradiotherapy group, 12 patients died, accounting for 44.44%. In the chemoradiotherapy group, 39 patients died, accounting for 76.47%. The 1-, 3- and 5-year OS rates of 78 patients were 57.7%, 36.3% and 27.2% respectively, the 1-, 2- and 3-year PFS rates were 49.5%, 38.7% and 32.6% respectively, and the 1-, 2- and 3-year LCR were 53.4%, 40.0% and 34.2% respectively. The 1-, 3- and 5-year OS rates in the surgery combined with chemoradiotherapy group were 74.1%, 50.1% and 44.6%, and those in the chemoradiotherapy group were 49.0%, 29.3% and 12.8%, with a statistically significant difference ( χ2=5.142, P=0.023). The 1-, 2- and 3-year PFS rates in the surgery combined with chemoradiotherapy group were 62.1%, 54.3% and 44.4%, and those in the chemoradiotherapy group were 43.1%, 30.6% and 26.7%, with no statistically significant difference ( χ2=3.222, P=0.073). The 1-, 2- and 3-year LCR of the surgery combined with chemoradiotherapy group were 69.8%, 54.3% and 44.4%, and those in the chemoradiotherapy group were 45.1%, 32.9% and 29.6%, with no statistically significant difference ( χ2=3.576, P=0.059). The results of univariate analysis showed that tumor T stage ( χ2=7.140, P=0.008), N stage ( χ2=4.493, P=0.034) and treatment method ( χ2=5.142, P=0.023) were all independent influencing factors of the OS of patient with advanced hypopharyngeal squamous cell carcinoma; T stage ( χ2=5.807, P=0.016) and N stage ( χ2=6.587, P=0.010) were both independent influencing factors of PFS. The results of multivariate analysis showed that tumor T stage ( HR=2.121, 95% CI: 1.142-3.938, P=0.017), N stage ( HR=2.088, 95% CI: 1.144-3.811, P=0.016) and treatment method ( HR=0.430, 95% CI: 0.226-0.815, P=0.010) were all independent prognostic factors of the OS of patients with advanced hypopharyngeal squamous cell carcinoma; T stage ( HR=1.884, 95% CI: 1.011-3.510, P=0.046) and N stage ( HR=1.904, 95% CI: 1.058-3.429, P=0.032) were both independent prognostic factors of PFS. During the treatment period, there were statistically significant differences in the incidences of radioactive pharyngitis [7.41% (2/27) vs. 39.22% (20/51), χ2=8.821, P=0.003] and radioactive dermatitis [3.70% (1/27) vs. 29.41% (15/51), χ2=7.156, P=0.007] between the surgery combined with chemoradiotherapy group and the chemoradiotherapy group. However, there were no statistically significant differences in the incidences of radioactive oral mucositis [11.11% (3/27) vs. 17.65% (9/51), χ2=0.186, P=0.666], bone marrow suppression [37.04% (10/27) vs. 50.98% (26/51), χ2=1.381, P=0.240], pharynx infection [11.11% (3/27) vs. 5.88% (3/51), χ2=0.143, P=0.706] and tracheal fistula [7.41% (2/27) vs. 0 (0/51), P=0.117] between the two groups. Conclusion:The 1-, 3- and 5-year OS rates in the surgery combined with chemoradiotherapy group are higher than those in the chemoradiotherapy group, and the incidences of adverse reactions are low. T stage, N stage and treatment method are independent prognostic factors for OS of advanced hypopharyngeal squamous cell carcinoma patients, while T stage and N stage are independent prognostic factors for PFS.

Objective To observe the expression of connective tissue growth factor (CTGF) in pancreas, and discuss its significance. Methods The pancreatic fibrosis model was induced by high fat diets. The rats were sacrificed 16 weeks later, and the pancreatic tissue was harvested for routine pathologic examinations. Pancreatic collagen fibrosis I was determined by HE and Sirius red staining;α-SMA and CTGF expression were detected by immunohistochemistry. Results After pancreatic fibrosis, pancreatic lobules and acinar atrophy was observed, lobules gap was widened, interstitial fibrous tissue was significantly proliferated, the synthesis of pancreatic collagen fibrosis I was significantly increased when compared with normal pancreas ( 1500.2 + 255.8 vs. 57.4 ± 23.2, P ＜ 0. 01 ), the expression of α-SMA was significantly increased when compared with normal pancreas( 1500.2 + 255.8 vs. 57.4 + 23.2, P ＜ 0. 01 ), and the expression of CTGF was significantly increased when compared with normal pancreas (2950.5 ± 431.9 vs. 382.2 + 190.8, P ＜0.01 ), and there were abundant activated PSCs. Conclusions CTGF participated in the regulation of pancreatic fibrosis development; the function of CTGF was closely related to PSCs activation.

Objective To summarize the result of several kinds of flaps treated to first web space contraction. Methods Thirty-two cases of sever contracture of the first web space were treated between September 2000 and March 2009. Ultrathin groin flap, blood vessel pedicle reverse-flow island flap, neurocutaneous flap of the forearm, and free skin flap were used. The area of flaps were 3.0 cm × 5.0 cm-4.5 cm× 8.0 cm.The therapeutic result was observed by 3-12 months follow-up. Results There were partial necrosis at the distal part of flap in 1 case of nerve nutritional vascular pedicle skin flap and 1 case of ultrathin groin flap.The raw surface was healed by free skin grafting. The other flaps were all survived. There was some contraction observed in some patients after the K-wire released. The width of the first web space was augmented to an average of 50 mm (35-60 mm) and account to 80% to the uninjured side. The angle of the first web space was increased to an average of 70°(45°-80°). The contracture was improved significantly. The abduction and opposition function of thumb were restored. There was some degree decrease of grasp strength. The patients can fulfil daily life and partial work. But sensation was not good in some patients. The contour of the flaps:the contour of ultrathin groin flap was good. The contour of flaps in 3 cases of island skin flaps, 1 case of nerve nutritional vascular pedicle skin flap and 2 cases of free flaps were trimmed again in order to be improved. Conclusion The sever contracture of the first web space could be treated by different kinds of flaps, the suitable management should be chosen according to the specific situation.

Objective To investigate the relationship of icaA,aap ,atlE,sarA gene with biofilm phenotype in Staphyloccus epi-dermidis .Methods Tissue culture plates assays were used to assess biofilm-forming ability of 78 Staphyloccus epidermidis strains.The presence of icaA,atlE,aap ,sarA gene was amplified with PCR method,the relationship between these genes and bio-film phenotype was evaluated by χ2 test and the difference of the biofilm OD′s value in TSB and TSB+3% NaCl by icaA + strains and icaA - strains was evaluated by Wilcoxon sign test,respectively.Results The positive rates of icaA,atlE,aap ,sarA gene were 24.4%(19/78),79.5%(62/78),73.8%(57/78),82.1%(64/78),respectively.40 biofilm-positive strains were detected(51.3%), among which 16 strains carried icaA gene,24 strains showed weak biofilm-forming ability.Those genes above with biofilm forma-tion were statistically correlated.Moreover,there was a relation between the icaA gene and the high biofilm-producing phenotype. There was a significant difference between the biofilm OD values in TSB and TSB+3% NaCl by icaA + strains and icaA - strains, respectively.Conclusion Multiple genes are involved in Staphylococcus epidermidis biofilm-positive phenotype,but the icaA gene contributes to the high biofilm-forming phenotype.Biofilm phenotype is also influenced by environmental factors.

BACKGROUND:At present, many researches have shown that tacrolimus has protecting effect on peripheral nerves,however,whether tacrolimus has a similar effect on central neural system has not been known yet.OBJECTIVE:To investigate the effect of tacrolimus on neural behaviors and memory by observing the neural behaviors and detecting the expression of synaptophysin in cortex,hippocampus and basipodite.DESIGN:Parallel and before and post contrast study.SETTING:Department of neurosurgery, affiliated hospital of the two medical universities.MATERIALS:The experiment was carried out in the Laboratory of Department Neurosurgery,Shanghai Changzheng Hospital in November 2002.Twenty-four qualified Sprague-Dawley rats supplied by Shanghai Experimental Animal Center of medical institution of Fudan University,with body mass of 180-220 g,were randomly divided into three groups:control, injury and treatment,with 8 rats in each group.INTERVENTIONS:Anesthesia was induced by administration of sodium pentobarbital(with the concentration of 20 g/L,40 mg/kg) twenty-four hours before the operation.The coup energy was 151.95-172.21 kPa that was equal to medium injury. The control rats did not receive the coup. Tacrolimus was given to the treatment group in the dosage of 1 mg/kg body weight by intraperitoneal injection at 5 minutes post trauma. The drug was given once physiological saline. Before and post trauma (on the third and seventh day)all rats Accepted Beam Walking Test,Beam Balance Test and Memory Test,respectively. One week after trauma,all rats' heads was removed and the brain was taken out within seconds.The hippocampus,cortex and basipodite of the traumatic hemisphere were kept in methanal with the concentration of 4 percent. Immunohistochemistry and image analysis system were used to study the expression of synaptophysin in cortex,hippocampus and basipodite of the traumatic hemisphere.MAIN OUTCOME MEASURES: ①The performance records of neural behaviors and memory of the three groups. ②Results of the expression of synaptophysin in cortex, hippocampus and basipodite of the three groups.③Apoptotic cellscalculation of synaptophysin in cortex,hippocampus and basipodite.RESULTS:Totally 24 rats entered the final analysis. ①On the third day and the seventh day,the scores recorded in Walking Test and Balance Test of the treatment group were less than those in the injury group[Walking Test: (7.5±2.5) s,(5.5±2.1) s,(10.5±2.5) s,(8.2±2.5) s. Balance Test:(3.4±0.5)score,(2.5±0.2) score,(5.7±0.2) score,(5.0±0.5) score,P ＜ 0.05-0.01].But the scores recorded in memory test of the treatment group were still more than those in the control group,memory test[(4.9±1.7) s,(6.2±2.3) s,(4.0±1.5) s,(4.4±2.6) s,P ＜ 0.05-0.01]. ②The expression of synaptophysin in cortex,hippocampus and basipodite in the treatment group was still more than that in the injury group(140.36±3.87, 45.52±2.16,31.67±2.35,96.25±2.85,24.35±2.47,20.49±2.08,P ＜ 0.01);The expression of synaptophysin control group was especially more than that in treatment group (162.24±3.52,50.58±2.31,42.69±2.53, P ＜ 0.01).Apoptotic cells calculation of cortex,hippoeampus and basipodite in treatment group was far less than those in injury group,(10.37±2.12)%,(18.39±2.87)%, (12.78±2.45)%,(21.14±4.85)%,(38.57±3.78)%, (21.18±4.59)%,P ＜ 0.01].And apoptotic cells calculation in injury group was more than those in control group [(3.85±2.56)%,(4.96±2.15)%, (3.52±2.17)%,P ＜ 0.01].CONCLUSION:Tacrolimus can facilitate the expression of synaptophysin,refrain from calcineurin involving in the process of transcription-dependent and nontranscription-dependent apoptosis,and can also contribute to the recovery of memory and neural behaviors post trauma.

Objective To examine the effect of valproic acid (VPA) on concentration of Intracellular Ca2+ and on cell apoptosis in spinal cord motor neurons after brachial plexus injury in rats. Methods Totally 210 adult male Wistar rats were randomly divided into Sham operation group (disposed the brachial plexus nerve root, but not cutted it off), control group (rats with brachial plexus nerve root amputating wound)and VPA group(rats with brachial plexus nerve root amputating wound and fed by VPA water),with 70 rats in each group.The specimens were taken at 12,24,48,72 h,1,2 and 4 weeks after operation.Whole-cell patch-clamp recording techniques were used to assayed the L-type calcium channel of motoneuron and monitored the changes in intracellular concentration of Ca2+ with spectrofluorometer. The motoneruron apoptosis was detected by TUNEL. Results The set of indicators did not change in the sham group.From 12h to 1 weeks after the operation, the electrical current of L-type calcium channel and the intra-cellular Ca2+ concentration of the neuron were obviously more in control group than in sham operation group (P ＜0.05). From 12 h to 4 weeks after the injury, there were more apoptosis neurons in control group than in sham operation group (P ＜ 0.05). There was no obviously difference in electrical current of L-type calcium channel between the VPA group and the control group at each time point(P ＞ 0.05).Compared to the control group,the intra-cellular Ca2+ concentration was lower in VPA group from 48 h to 1 week after nerve injury (P ＜ 0.05) ; the number of apoptosis neurons were less in VPA group from 24 h to 2 weeks after the injury (P ＜ 0.05). Conclusions Brachial plexus nerve root amputating wound in rats can increase the intra-cellular Ca2+ concentration and apoptosis of the motor neuron.VPA can reduce the intra-cellular Ca2+ concentration and apoptosis,but has no effect on the L-type calcium channel of the motor neuron.