Objective:To investigate the efficacy and safety of metformin in the treatment of elderly patients with diabetes. Meth-ods:Totally 72 cases of elderly patients with diabetes in our hospital from January 2012 to December 2012 were randomly divided into the observation group and the control group. The observation group was received metformin, and the control group was given repaglin-ide. The efficacy and safety of the two groups were compared. Results:After the treatment, blood sugar of fasting, 2h after meals and 10:00 p. m. in the observation group and the control group was significantly decreased (P<0. 05), and blood sugar of fasting in the observation group was significantly lower than that in the control (P<0. 05), while that of the other time points was without significant difference (P>0. 05). The HbA1c levels before and after the treatment in the observation group was with statistically significant differ-ence (P<0. 05), and those in the control group was without significant difference (P>0. 05). The incidence of adverse reactions in the observation group was lower than that in the control group(P<0. 05). Conclusion:Effect of metformin in the treatment of elderly patients with diabetes is remarkable and safe, which is worthy of further promotion and application.

Objective:To discuss the effect of amlodipine combined with atorvastatin in the treatment of elderly patients with acute cerebral infarction hypertension. Methods:Totally 86 cases with acute cerebral infarction hypertension were randomly divided into the treatment group (43 cases) and the control group (43 cases). The control group received amlodipine 5mg, po, qd, and the treatment group was given atorvastatin 20mg additionally, po, qd. After the one-month treatment, the efficacy of the two groups was studied and compared, and the changes in neural function defect scale, blood pressure, blood lipids and CRP were also investigated. Results:Af-ter the treatment, the total effective rate and the total effective rate of antihypertensive effect in the treatment group were both signifi-cantly higher than those in the control group (P<0. 05). The neurological deficit scores of the two groups were significantly higher than those before the treatment (P<0. 05), and those of the observation group was significantly higher than those of the control group (P<0. 05). The blood pressure of the two groups was both decreased after the treatment(P<0. 05), and the decrease in the treat-ment group was more significant (P<0. 05). TC, TG, LDL-C and CRP levels of the two groups had significant decrease after the treatment (P>0. 05), and those in the treatment group was significant lower than those in the control group (P<0. 05). Conclu-sion:Amlodipine combined atorvastatin in the treatment of elderly patients with acute cerebral infarction hypertension shows significant effect with low incidence of adverse drug reaction, which is worthy of wider application.

Objective:To analyze the genetic mutations and clinical features of the subtypes of classical BCR-ABL-negative myeloproliferative neoplasm (MPN) .Methods:Mutations of 108 newly diagnosed BCR-ABL-negative MPN patients [including 55 patients with essential thrombocytopenia (ET) , 24 with polycythemia vera (PV) , and 29 with primary myelofibrosis (PMF) ] were identified using next-generation sequencing with 127-gene panel, and the relationship between gene mutations and clinical features were analyzed.Results:Total 211 mutations in 32 genes were detected in 100 MPN patients (92.59% ) , per capita carried (1.96±1.32) mutations. 85.19% (92/108) patients carried the driver gene (JAK2, CALR, MPL) mutations, 69.56% (64/92) of these patients carried at least 1 additional gene mutation. In descending order of mutation frequency, the highest frequency was for activation signaling pathway genes (42.2% , 89/211) , methylation genes (17.6% , 36/211) , and chromatin-modified genes (16.1% , 34/211) . There was a significant difference in the number of mutations in the activation signaling pathway genes, epigenetic regulatory genes, spliceosomes, and RNA metabolism genes among the three MPN subgroups. The average number of additional mutations in PMF patients was higher than that in ET and PV patients (1.69±1.39, 0.67±0.70, 0.87±1.22, χ2=13.445, P=0.001) . MPN-SAF-TSS (MPN 10 score) ( P=0.006) and myelofibrosis level ( P=0.015) in patients with ≥ 3 mutant genes were higher and the HGB level ( P=0.002) was lower than in those with<3 mutations. Twenty-six patients (24.1% ) carried high-risk mutation (HMR) , and patients with HMR had lower PLT ( P=0.017) , HGB levels ( P<0.001) , and higher myelofibrosis level ( P=0.010) and MPN10 score ( P<0.001) . The frequency of ASXL1 mutations was higher in PMF than in PV patients (34.5% vs. 4.2% , P=0.005) . PMF patients with ASXL1 had lower levels of PLT and HGB ( P=0.029 and 0.019) . Conclusion:69.56% of MPN patients carry at least one additional mutation, and 24.1% patients had HMR. Each subgroup had different mutation patterns. PMF patients had a higher average number of additional gene mutations, especially a higher frequency of ASXL1 mutation; PLT and HGB levels were lower in ASXL1 mutation PMF patients.

OBJECTIVE: To analyze the clinical features of chronic myeloid leukemia (CML) with T315 I mutation (CML-T315I) and compare the effectiveness of different treatments. METHODS: We retrospectively analyzed the clinical data and outcomes of 19 patients with CML-T315I receiving different treatments. The T315 I mutations in these patients were detected by examination of BCR-ABL kinase domain (KD) mutation by RTQ-PCR and Sanger sequencing. The relapse following the treatments, defined as hematological, cytogenetic and molecular biological recurrences, were analyzed in these patients. RESULTS: Of the 19 patients with CML-T315I, 14 (73.7%) were in CML-CP stage at the initial diagnosis, and 13 (81.2%) were high-risk patients based on the Sokal scores. All the 19 patients were treated with TKI after the initial diagnosis, and during the treatment, 15 (78.9%) patients were found to have additional chromosomal aberrations, and 10 (52.6%) had multiple mutations; 13 (68.4%) of the patients experienced disease progression (accelerated phase/blast crisis) before the detection of T315I mutation, with a median time of 40 months (5-120 months) from the initial diagnosis to the mutation detection. After detection of the mutation, 12 patients were treated with ponatinib and 7 were managed with the conventional chemotherapy regimen, and their overall survival rates at 3 years were 83.3% and 14.2%, respectively ( < 0.001). CONCLUSIONS CML patients resistant to TKI are more likely to have T315I mutations, whose detection rate is significantly higher in the progressive phase than in the chronic phase. These patients often have additional chromosomal aberrations and multiple gene mutations with poor prognoses and a high recurrence rate even after hematopoietic stem cell transplantation. Long-term maintenance therapy with ponatinib may improve the prognosis and prolong the survival time of the patients.
Drug Resistance, Neoplasm ; Fusion Proteins, bcr-abl ; Humans ; Imidazoles ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; Mutation ; Pyridazines ; Retrospective Studies