OBJECTIVE:To observe the clinical efficacy of sitagliptin combined with benazepril in the treatment of diabetic nephropathy(DN). METHODS:Sixty DN patients admitted to our hospital during Sept. 2014-Jun. 2015 were divided into sitagliptin group,benazepril group,drug combination group according to random number table,with 20 cases in each group. Based on routine treatment,sitagliptin group was given sitagliptin 100 mg orally,qd;benazepril group was given Benazepril 10 mg orally,qd;drug combination group was given sitagliptin 100 mg+benazepril 10 mg orally,qd. The drug dosage would be doubled if the blood pressure of patients in 3 groups had not yet reached the standard. Treatment course of 3 groups lasted for 12 weeks. The levels of 24 h urine protein,IL-6 and Cys-C were measured in 3 groups before and after treatment. Clinical efficacies and the occurrence of ADR were observed. RESULTS:Total response rate of drug combination group(90.00%)was significantly higher than those of sitagliptin group (65.00%)and benazepril group(70.00%);there was statistically significance(P<0.05). After treatment,the levels of 24 h urine protein,IL-6 and Cys-C in 3 groups were significantly lowered,compared to before treatment;those of drug combination group was significantly lower than those of other 2 groups;there was statistically significance(P<0.05). There was no statistical significance in above indexes between sitagliptin group and benazepril group(P>0.05). No obvious ADR was found in 3 groups during treatment. CONCLUSIONS:Both sitagliptin and benazepril can decrease the levels of 24 h urine protein,IL-6 and Cys-C,while drug combination shows better effect and clinical response rate,and does not influence the safety of drug use.

Objective : To investigate the mechanism of micellar curcumol (MC) regulating the immune microenvironment of ovarian cancer by promoting the polarization of M2⁃type macrophages to M1 ⁃type in ovarian cancer ascites. Methods : After the mice were divided into groups , a mouse ovarian cancer ascites model was constructed by using the mouse ovarian cancer cell line ID8. Then weight changes were observed , tumor tissue and ascites were collected. The expression of CD86 and CD206 on macrophages of the tumor tissue and ascites was detected by flow cytometry. The expression of protein kinase B (PKB/Akt)/mammalian target of rapamycin ( mTOR) was detected by Western blot. A human monocytic leukemia cell line (THP⁃1) was induced to transform into M2 macrophage ( THP⁃1 M2 macrophage) in vitro , and then treated with 10 μg/ml MC. The apoptosis was detected by flow cytometry. The mRNA levels of macrophage mannose receptor (CD206) , transforming growth factor⁃β (TGF⁃ β) , interleukin (IL) Ⅳ1β and tumor necrosis factor⁃α ( TNF⁃α ) were detected by qRT⁃PCR. The expression of CD86 and CD206 was detected by flow cytometry , and Akt/mTOR expression and phosphorylation was detected by Western blot. Results : In vitro study showed that the average body weight of the MC group was lower than that of the control group. Compared with the control group , CD206 expression of macrophages decreased in tumor tissue and ascites in the MC group , while the expression of CD86 increased. The Akt and mTOR phosphorylation level of macrophages in the MC group ′s ascites was lower than that in control group. ② In vivo study showed that there was no difference in apoptosis rate among the groups detected by flow cytometry. The mRNA expression level of CD206 ,TGF⁃ β and the protein expression level of CD206 in MC group were significantly lower than those in the control group , while the mRNA expression of IL⁃1β , TNF⁃α and the protein expression level of CD86 were significantly higher than those in the control group. Compared with the control group , the phosphorylation level of Akt and mTOR in the MC group decreased. Conclusion MC promotes M1 polarization of macrophages in ascites to regulate the immune microenvironment of ovarian cancer, which may be related to the Akt/mTOR pathway.

Objective: To evaluate the clinical efficacy of hematoporphyrin monomethyl ether-based photodynamic (HMME-PDT) therapy for the treatment of port-wine stain (PWS) and its sonographic changes. Methods: A total of 45 patients with confirmed PWS were enrolled from the Department of Dermatology, Third Affiliated Hospital of Soochow University from March 2017 to June 2018, including 5 with pink PWS, 39 with purplish red PWS and 1 with thickened PWS. All the patients received 3 sessions of HMME-PDT therapy. The skin thickness and density were compared before and after the treatment by using high-frequency ultrasound. Ranked data were analyzed by using nonparametric test. Measurement data were expressed as mean ± standard deviation, and analyzed using ony-way analysis of variance. Multiple comparisons were performed using Student-Newman-Keuls-q (SNK-q) test. The results were considered to be statistically significant if P < 0.05. Results: Among the 45 patients with PWS who completed the treatment and follow-up, 10 were cured, 21 received marked improvement, 12 received improvement, and 1 showed no response. The total response rate was 97.78%, and the response rate in the patients with pink PWS was higher than that in the patients with purplish red PWS (U = 12.50, P < 0.001) . The difference value of the skin thickness or skin density before and after the treatment significantly differed among the cured patients, patients receiving marked improvement and those receiving improvement (skin thickness:0.65 ± 0.21, 0.56 ± 0.88, 0.37 ± 0.12 mm respectively; skin density: -8.65 ± 2.19, -6.86 ± 2.79, -4.92 ± 2.91 g/cm³ respectively; F = 14.528, 5.428 respectively, both P < 0.001) , and the difference values of the skin thickness and density were significantly higher in the cured patients than in those receiving improvement (q = 5.82, 4.63, both P < 0.05) . Erythematous swelling to different extents occurred at the laser-exposed sites in the zygomatic and cheek region in 23 patients with PWS and in the frontal-zygomatic region in 6 with PWS after the HMME-PDT therapy, but gradually regressed about 1 week later. Pale brown crusts were observed at the laser-exposed sites in 35 patients, and shed spontaneously about 3 weeks later. Post-inflammatory hyperpigmentation at the laser-exposed sites was observed in 4 patients, and gradually regressed after 2-month follow-up. Conclusions HMME-PDT therapy is effective for the treatment of PWS, with high safety and few adverse reactions. High-frequency ultrasound can be used for objectively evaluating the clinical efficacy of HMME-PDT therapy.