Vildagliptin,a dipeptidyl peptidase-4 (DPP-4) inhibitor,is always used in combination with metformin.Data from multiple clinical trials showed that vildagliptin and metformin combination therapy can improve HbA1c,fasting blood glucose,and postprandial blood glucose without weight gain,good gastrointestinal (GI)tolerance,and no increase in the incidence of hypoglycemia.Vildagliptin increases plasma levels of glucagon-like peptide-1 ( GLP-1 ).When glucose levels are above normal fasting levels,enhanced GLP-1 levels stimulate insulin secretion.Mefformin has been shown to increase insulin sensitivity and inhibit hepatic glucose production.The effect of vildagliptin to increase plasma levels of intact GLP-1 was enhanced in patients receiving concomitant metformin.

Objective To detect the level of granulation tissue and expression of matrix metalloproteinase-1,3(MMP-1,3) in the tissues originated from both herniated and non-herniated intervertebral discs. Methods Forty specimens of herniated lumbar disc and twelve specimens of non-herniated one were stained with hematoxylin-eosin to determine the amount of granulation tissue, and immunohistochemically stained to detect MMP-1,3 expression. Results In specimens of sequestration and transligamentous extrusion, the amount of granulation tissue including macrophages,fibroblasts and capillary was more than that in the specimens of subligamentous extrusion and protrusion as well as non-herniated disc. Most of cells in granulation tissue and chondrocytes had MMP-1,3 expression. The expression level of MMP1,3 in sequestration and transligamentous extrusion specimens was significantly higher than that in subligamentous extrusion and protrusion, and in herniated specimens was also significantly higher than that in non-herniated specimens.There was no significant difference in the MMP1,3 expression level between the sequestration and transligamentous extrusion, between subligamentous extrusion and protrusion. Conclusion The expression of MMP1,3 was associated with the degradation and herniation of intervertebral disc. MMP1,3 may be involved in the pathogenesis of intervertebral disc degeneration and herniation.

BACKGROUND: There are a lot of controversies regarding the choice of short versus long segment pedicle screw fixation for the treatment of isthmic spondylolisthesis and degenerative spondylolisthesis treatment. OBJECTIVE: To investigate clinical efficacy of short versus long segment pedicle screw fixation in treatment of lumbar spondylolisthesis.METHODS: A total of 146 spondylolisthesis patients were included in this study, 36 males and 110 females, aged 22-73 years at a mean of 53 years; disease duration was from 1 to 18 years at a mean of 5 years. These patients were treated with lumbar spinal window-opened decompression or laminectomy decompression, a short or long segment pedicle screw internal fixation, transverse interbody fusion.RESULTS AND CONCLUSION: Among 146 involved patients, 72 cases were treated with four pedicle screw fixation (short segments), while 74 cases with six pedicle screw fixation (long segments). Interbody graft was performed in 101 cases, while intertransverse fusion given in 45 cases. Totally 134 cases were followed up for postoperative 1.5-14 years. According to clinical grading standards of Steffee system, the clinical efficacy was assayed excellent in 74 cases, good in 41 cases, mild in 13 cases and poor in 6 cases, with good rate of 85.8%. 77 cases achieved a complete reduction, including 32 cases using a short segment fixation and 45 cases using a long segment fixation. 69 cases achieved partial reduction, including 40 cases using a short segment fixation and 29 cases using a long segment fixation. Pedicle screws ruptures were found in 13 screws of eight patients undergoing short segment fixation, while no pedicle screw fracture was found in long segment fixation. Choice of short or long segment for the fixation is based on the analysis of spondylolisthesis type, severity, duration of disease, emergence of adjacent segment disc degeneration and instability.

Objective:To investigate the new method of nasal septal perforation repair.Methods:Through labiogingival groove,6 patient's nasal septal perforations were repaired with mucoperichondrial flap or mucoperiosteal flap rotated from the septum nasia and basis cavum nasi under nasal endoscopy.Results:Five patients had completed clusure,Another reduced in size to pinpoint hole.Conclusions:The method is a simple and effective technique for treatment of nasal septal perforation.

Objective To observe the correlation of histologicalactivity(HAI) of chronic hepatitis B (CHB) with CCL20 expression, and to investigate the impact of CCL20 expression in CHB infection. Methods On the basis of established competitive quantitative RT-PCR with an internal standard, the expression of the CCL20 in the hepatocytes in different infected patterns of HBV infected cells and liver biopsies were quantified and at the same time its correlation to HAI were explored. Results In the cell levels, the expression quantity of CCL20 in control cells (HepG2), persistent HBV infected hepatocytes( HepG2. 2. 15) are (2. 65 ± 0. 02) pg/106 cells, ( 1.22± 0. 04) pg/106 cells, respectively. There were significantly differences between them ( t = 39. 66, P < 0. 01 ). The expression of CCL20 was enhanced in hepatocytes stimulated by PMA but their expression pauern was not changed. Moreover, CCL20 expression in liver biopsies with CHB was (3.54 ± 0. 65 ) pg/20 mg and CCL20 expression in control groups was ( 8. 74±0. 56) pg/20 mg. The expression of CCL20 between two groups was different (t =30. 09,P <0. 01 ) and correlation lied in between HAI and CCL20 expression in liver biopsies of CHB patients ( r = 0. 675, P =0. 023 ). Conclusion CCL20 expression was down-regulated and it was correlated to HAI of liver biopsies in CHB patients.

Objective The concentration of NE and TNF-α was detected for elucidating the change of them in sera and bronchoalveolar lavage fluid (BALF) of rabbits with acute lung injury interposed by XueBiJing therapy in underwater explosion.Methods Underwater explosion decive was applied to cause acute lung injury of rabbits.The 20 rabbits were randomly divided into two groups which were injury group and XueBiJing therapy group,respectively.The concentration of NE and TNF-α in sera and BALF were detected by ELISA method in 24 hours after bursting.Results The concentration of TNF-α in sera (353.30±166.86 ng/L) of rabbits in therapy group were significantly lower than those in injury group (552.30± 169.64 ng/L;t=2.645,P =0.016).The concentration of NE in sera (63.40 ± 36.09 ng/ml) were lower than that of rabbits in injury group (97.60 ± 36.20 ng/ml;t=2.116,P=0.049).At the same time the concentration of NE in BALF (102.10± 9.50 ng/ml) of rabbits in therapy group were significantly lower than those in injury group (136.70± 13.60 ng/ml;t=6.593,P=0.000).Conclusion The expression of TNF-α in sera and NE in sera and BALF in rabbits with acute lung injury interposed by XueBiJing in underwater explosion were lower than those of injury group.

Objective To investigate the level of urinary protein in type 2 diabetic patients with different glucose excursion and investigation the effect of the glucose excursion on early diabetic nephropathy.Methods Fifty-six type 2 diabetes patients were divided into two groups by the level of glycosylated hemoglobin(HbA1c),good glycemic.Patients in control group with HbA1c ＜ 7.0％ and patients in poor glycemic control group with HbA1c ＜ 7.0％.Microalbuminuria,urine transferring (UTRF),α1-microglobulin (α1-MG) and 32-microglobulin(32-MG) were measured.All the patients were monitored using the continuous glucose monitoring system (CGMS),and mean amplitude of glucose excursions (MAGE) were analyzed.Patients were divided into two groups by MAGE,one group's MAGE was lower than 3.9 mmol/L,and another group's MAGE was higher than 3.9 mmol/L.Urinary proteins were measured and analyzed in the two groups.Results In the poor glycemic control group,the levels of microalbuminuria,UTRF and albunin/ creatinine(A/C) rate were (81.28 ±44.13) mg/L,(4.54 ± 1.54) mg/L and (22.17 ± 14.52) mg/mmol significantly higher than that in the good glycemic control group((21.63 ± 10.16) mg/L,(2.48 ±0.29) mg/L and (2.05 ± 0.76) mg/mmol; t =4.758,5.360,4.805 ; P ＜ 0.05).Fasting C peptide in the poor glycemic control group was (1.01 ± 0.13) ng/ml,significant lower than that in the good glycemic control group ((1.51 ± 0.21) μg/L;t =4.826;P ＜0.05).The levels of A/C rate,α1-MG and β2-MG in the group with MAGE above 3.9 mmol/L significantly higher than those in the group with MAGE below 3.9 mmol/L(t =4.358,8.641,12.702;P ＜ 0.05).Conclusion Both persistent hyperglycemia and blood glucose variability could influent diabetic nephropathy.

Lung cancer is one of the most common malignant tumor in the world, severely threatening human life. Recently, targeted therapy such as the epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) made huge progress in treatment of lung cancer. EGFR-TKIs, with its high selectivity and low toxicity, is the ifrst choice for EGFR-mutated patients in stage IV non-small cell lung cancer (NSCLC). However, secondary drug resistance becomes a clinical problem to be urgently resolved. In recent years, a series of preclinical studies showed that EGFR-TKI can enhance the antitumor activ-ity of ionizing radiation. hTerefore, EGFR-TKI combined with radiation is extremely promising therapy pattern for advanced NSCLC. hTis review will discuss the research status in EGFR-TKI and radiotherapy for advanced NSCLC.

Prenatal care services are an important part of my country's public health services, and play an important role in enhancing the pregnancy and childbirth experience of urban migrant women and improving their pregnancy and childbirth outcomes. The accessibility of prenatal care services is an important indicator for evaluating the equalization of basic public services. This paper outlines the concept and measurement dimensions of the accessibility of prenatal care services. This paper also analyzes the factors affecting the accessibility of prenatal care services for urban migrant women in my country from the perspectives of service providers, demanders, and both parties, and proposes strategies to improve the accessibility of prenatal care services for urban migrant women.

Objective:Presacral recurrence of rectal cancer have altered the adjacent structures of original pelvic organs due to the previous radical surgery of rectal cancer, and the boundary between recurrent tumor tissues and pelvic internal structures is not clear. Conventional CT examination has poor soft tissue resolution, which makes it difficult to accurately delineate the target area of radiotherapy. This study aimed to explore the guiding role of magnetic resonance imaging (MRI) in delineating the target area of presacral recurrence after radical resection of rectal cancer.Methods:A descriptive case series research method was adopted. From May 2014 to May 2019, the clinical data of 30 patients with presacral recurrence after radical resection of rectal cancer were collected, who were admitted to Peking University People's Hospital, confirmed by pathology or discussed by multidisciplinary team (MDT), with complete MRI, CT and case information. According to the gross tumor volume (GTV) with presacral recurrence outlined in CT and MRI images, including presacral recurrent lesions (GTVT) and metastatic lymph nodes (GTVN), the GTV volume was calculated, and the tumor boundary and diameter were measured. The differences between MRI and CT were compared.Results:The volume of GTVT-CT was larger than that of GTVT-MR in all the 30 patients. The median volume of GTVT-CT was 67.86 (range 5.12-234.10) cm 3, which was significantly larger than 43.02 (range 3.42-142.50) cm 3 of GTVT-MR with statistically significant difference ( Z=-4.288, P<0.001). The mean volume of GTVN outlined by CT and MRI was (0.43±0.11) cm 3 and (0.40±0.10) cm 3 respectively without statistically significant difference ( t=1.550, P=0.132). The mean values of boundary and radial line of the presacral lesions on CT images were all longer than those on MRI images. The vertical diameter of GTVT on CT and MRI images was (6.66±2.92) cm and (5.17±2.40) cm ( t=5.466, P<0.001); the anterior boundary was (3.24±2.51) cm and (2.69±2.48) cm ( t=4.685, P<0.001); the anteroposterior diameter was (4.92±2.02) cm and (4.04±1.57) cm ( t=6.210, P<0.001); the left boundary was (3.05±1.00) cm and (2.64±0.78) cm ( t=2.561, P=0.016); the right boundary was 2.66 (0.00-4.23) cm and 1.82 (-1.10-3.59) cm ( Z=-3.950, P<0.001); the transverse diameter was (5.01±1.78) cm and (3.82±1.29) cm ( t=4.648, P<0.001), respectively, whose differences were all statistically significant. MRI was superior to CT in judging the involvement of anterior organs, such as intestine, prostate, bladder and the posterior sacrum. Fifteen patients received radiotherapy according to the target area guided by MRI and 10 patients obtained clinical symptom relief. Conclusion:Compared with CT, the GTV of postoperative presacral recurrence of rectal cancer outlined in MRI images is smaller, and MRI can determine the boundary between tumor and surrounding normal tissues more precisely, so it can show the invasion range of tumor more accurately and guide the accurate implementation of radiotherapy.