Objective One hundred and sixteen cases of pediatric patients with severe heart fail-ure,pneumonia combined application of phentolamine dopamine synthesis with conventional medical treat-ment were compared the clinical efficacy,analyze and judge the feasibility of both combination therapy clini-cal significance and its value.Methods Collected from July 2013 to April 2015 period to the author hospi-tal and diagnosed with pneumonia in children with heart failure in 116 patients.Which were randomly divid-ed into two groups,group A +phentolamine medical treatment with dopamine and B group routine clinical medicine comprehensive treatment.Clinical observation by a number of factors to analyze comparative A,B two groups after the treatment efficacy.Results A significant effect of the treatment group and the number of effective treatments were more than group B and A group of overall response rate (91.38%)than in group B (60.34%);A group invalid proportion treated patients (8.62%)was significantly less in group B (39.66%);A group of children mortality (5.17;Change a group on heart rate and blood pressure had a better than group B;and the difference was greater (P <0.05).A,B two members appeared after treat-ment of mild nasal congestion and mild bloating and other adverse reactions,for Group A after two cases of children with nasal 1% solution of furosemide Ma nasal symptoms disappear;for two cases of group B chil-dren with mild bloating conventional medical treatment after symptoms have been effectively controlled.A, B two groups in terms of adverse events was not significantly (P >0.05)Conclusions A group of overall efficiency significantly higher in group B and body recover faster in children,low mortality,children with severe pneumonia prompted phentolamine and dopamine treatment with heart failure better.

Objective To understand the characteristics of population distribution,risk factors and risk links of occupational exposure among health care workers(HCWs)in a hospital.Methods Occupational exposure among HCWs between January 2011 and June 2014 were monitored,data about occupational categories of HCWs,expo-sure locations,exposure links and exposure modes were analyzed statistically.Results Among 286 occupational ex-posure cases,the female and male HCWs accounted for 22.03% (n=63)and 77.97% (n=223)respectively;the incidence of occupational exposure in 2011 ,2012,2013 and January-June of 2014 was 38.81 %(n=111),26.22% (n=75),23.43% (n=67)and 11 .54% (n=33)respectively;occupational exposure of junior nurses,doctors,nurs-ing attendants,technicians,senior nurses and cleaners was 31 .97%,19.90%,15.79%,7.64%,4.17%,and 2.84% respectively;exposure mainly occurred at the time of sorting waste,withdrawing or changing needles,dis-carding sharps into sharps containers,surgical suturing or instruments passing,and puncturing (including drawing blood),the constituent ratio was 22.38%,19.58%,14.34%,12.94% and 11 .19%,respectively;the main loca-tions where exposure occurred were wards,operating rooms and injection (treatment)rooms,the constituent ratio was 51 .40%,19.58% and 11 .54% respectively.Conclusion Hospital should establish comprehensive occupational exposure monitoring and risk management system,strengthen standard prevention,enhance the training about occu-pational exposure among high-risk population,and monitor and intervene on risk factors and links,so as to reduce the incidence of HCWs’occupational exposure.

Phytantriol (PT), ethanol (ET) and water were used to prepare in situ cubic liquid crystal (ISV2). The pseudo-ternary phase diagram of PT-ET-water was constructed and isotropic solution formulations were chosen for further optimization. The physicochemical properties of isotropic solution formulations were evaluated to optimize the composition of ISV2. In situ hexagonal liquid crystals (ISH2) were prepared based on the composition of ISV2 with the addition of vitamin E acetate (VitEA) and the amount of VitEA was optimized by in vitro release behavior. The phase structures of liquid crystalline gels formed by ISV2 and ISH2 in excess water were confirmed by crossed polarized light microscopy and small angle X-ray scattering, respectively. Rheological properties of ISV2 and ISH2 were studied by a DHR-2 rheometer. In vitro drug release studies were conducted by using a dialysis membrane diffusion method. Pharmacokinetics was investigated by determination of sinomenine hydrochloride (SMH) concentration in synovial membrane after intra-articular injection of SMH-loaded ISH2 in adjuvant-induced arthritis rats. The optimal ISV2 (PT/ET/water, 64 : 16 : 20, w/w/w) loaded with 6 mg x g(-1) of SMH showed a suitable pH, injectable and formed a cubic liquid crystalline gel in situ with minimum water absorption in the shortest time. The optimal ISV2 was able to sustain the drug release for 144 h. The optimal ISH2 system was prepared by addition of 5% VitEA into PT in the optimal ISV2 system. This ISH2 (PT/VitEA/ET/water, 60.8 : 3.2 : 16 : 20, w/w/w/w) was an injectable isotropic solution with suitable pH. The new ISH2 was able to sustain the drug release for more than 240 h. Local pharmacokinetics study indicated that the retention time and AUC(0-∞) of ISH2 group were increased significantly compared with that of SMH solution group and the AUC(0-∞) of ISH2 group was 6.01 times higher than that of SMH solution group. The developed ISH2 was suitable for intra-articular injection that may apply to patients in the treatment of rheumatoid arthritis.

Objective To investigate the serum levels of biochemical indexes such as calcium,phosphorus,iron,zinc,and alkaline phosphatase of children in Kaschin-Beck disease areas and control areas in Qinghai Province.Methods According to the results of Kaschin-Beck disease monitoring in Qinghai Province,Tangnaihai Township of Xinghai County and Gandu Town of Hualong County were chosen as Kaschin-Beck disease areas and Qushian Township of Xinghai Country was chosen as a control.Children aged 7 to 15 in boarding schools in these areas were chosen as the study subjects in June 2014.Serum alkaline phosphatase level was determined by enzyme colorimetry and the serum iron,zinc,calcium and phosphorus levels were determined by colorimetry.Calcium to phosphate ratio was calculated at the same time.Results Fifty-nine qualified serum samples of children were sampled in Kaschin-Beck disease areas and 45 in control area.Serum alkaline phosphatase levels in Kaschin-Beck disease areas and control area were (311.34 ± 85.31) and (264.09 ± 73.44)U/L,respectively,and the difference was statistically significant (t =-2.97,P ＜ 0.05).Children's serum phosphorus levels in Kaschin-Beck disease areas and control area were (1.62 ± 0.17) and (1.43 ± 0.13)mmol/L,respectively,and the difference was statistically significant (t =-6.29,P ＜ 0.05).Calcium to phosphorus ratio were 1.62 ± 0.17 and 1.82 ± 0.21,respectively,and the difference was statistically significant (t =5.53,P ＜ 0.05).Compared with the control area,the level of children's serum zinc was (19.96 ± 1.70) and (20.59 ± 2.45)μmol/L;the level of serum calcium was (2.59 ± 0.11) and (2.57 ± 0.11)mmol/L;and the level of serum iron was (15.06 ± 7.02) and (17.01 ± 6.70)μmol/L.The differences between these three biochemical indicators were not statistically significant between Kaschin-Beck disease areas and control area (t =1.39,-0.64,1.44,all P ＞ 0.05).Conclusion In Kaschin-Beck disease areas in Qinghai Province,the level of children's serum alkaline phosphatase and phosphorus have increased markedly and the calcium to phosphate ratio has decreased obviously.

Objective To assess the ability of quantitative ultrasound index to predict the severity of CCl4?induced liver fibrosis in a rat model us?ing logistic regression analysis. Methods In a rat model of 40%CCl4?induced liver fibrosis,ultrasound detected the portal vein diameter,blood flow velocity,and Young's modulus. The degree of hepatic fibrosis was determined using a light microscope after hematoxylin and eosin staining of tissue. Results Portal vein diameter and Young's modulus were useful predictors of the severity of liver fibrosis,with statistical significance(P<0.05). Young's modulus was most effective with an R2 value 0.788. Young's modulus combined with the distal diameter of portal vein effectively improved the predictive ability,showing an R2 value 0.821. Conclusion Young's modulus is the most predictive index to assess the severity of liver fibrosis. A combination of multiple indices can improve the ability to predict the severity of liver fibrosis.

Objective To analyze the expression of extracellular matrix metalloproteinase inducer (CD147)and phosphatase and tensin homolog deleted on chromosome ten(PTEN)in non small cell lung cancer (NSCLC) ,and to explore the correlations be‐tween expressions of CD147 and PTEN and those with clinicopathological factors .Methods The expressions of CD147 and PTEN proteins in tissues of 64 cases of patients with NSCLC and 10 cases of normal paracancerous tissues were determined by using im‐munohistochemical SP method .The correlations between expressions of CD147 and PTEN with clinicopathological factors were ana‐lysed ,as well .Results The expression of CD147 in NSCLC tissues(75 .00% )was significantly higher than that in paracancerous tissues(0 .00% ,P<0 .05) .The expression of CD147 was strongly associated with degrees of differentiation ,lymph node metastasis and TNM stage(P<0 .05) .The expression of PTEN in NSCLC tissues (32 .81% )was significantly lower than that in paracancerous tissues(80 .00% ,P<0 .05) .Expression of PTEN was strongly associated with TNM stage (P<0 .05) .Spearman correlation analy‐sis shown that CD147 expression was negatively correlated with PTEN expression (r= -0 .442 ,P<0 .05) .Conclusion The abnor‐mal expression of CD147 and PTEN might play an important role in the malignant progression of NSCLC .

Objective To investigate the clinical efficacy of behavioral change stage model management applied in sur-gical patients. Methods All 122 patients who were treated in our hospital from February 2013 to April 2014 were se-lected and divided into the observation group and the control group using the random number table method, with 61 patients in each group. The control group was given conventional nursing, and the observation group was given behav-ioral change stage model nursing. The postoperative pain degree and recovery situation of the two groups were com-pared. Results The observation group was significantly lower than the control group in the first getting out-of-bed time, anal exhaust time and length of hospital stay, the 24-hour sleep time and 48-hour sleep time of observation group was higher than the control group,with statistically significant differences (P<0.05). The postoperative 12-hour,1-day,3-day and 5-day VAS scores of the observation group was significantly lower than the control group, with sta-tistically significant differences(P<0.05). Conclusion Behavioral change stage model can significantly improve surgical patients' life quality,relieve postoperative pain and promote rehabilitation,thereby worthy of further promotion and ap-plication.

Objective To observe and explore the effects of different tidal volume (VT) ventilation on right ventricular (RV) function in patients with critical respiratory failure.Methods Consecutive respiratory failure patients who were treated with invasive ventilator over 24 h in the Department of Critical Care Medicine at the Fourth Hospital of Hebei Medical University from June to December in 2015 were enrolled in this study.Clinical data including patients′ vital signs, ventilator parameters and RV echocardiography were collected within 6 h (D0), day1(D1), day2 (D2) and day3 (D3) after ventilation started.According to the VT, patients with acute respiratory distress syndrome (ARDS) were assigned to low VT group [S6, ≤6 ml/kg predicted body weight (PBW)] and high VT group (L6, >6 ml/kg PBW), while non-ARDS patients were also assigned to low VT group (S8, ≤8 ml/kg PBW) and high VT group (L8, >8 ml/kg PBW).Results A total of 84 patients were enrolled in this study.44.2% ARDS patients and 58.5% non-ARDS patients were in low VT groups.After ventilation, tricuspid annulus plane systolic excursion(TAPSE)decreased progressively in S6 [from 18.30(16.70,20.70) mm to 17.55(15.70,19.50) mm, P=0.001], L6 [from 19.50(17.00,21.00) mm to 16.30(15.00,18.00) mm P=0.001], S8[from 18.00(16.00,21.00) mm to 16.50(15.50,18.00) mm, P=0.001] and L8 [from 19.00(17.50,21.50) mm to 16.35(15.15,17.00) mm, P=0.001] groups.However, TAPSE decreased less in small VT groups (S6 and S8) than those of in large VT groups (S8 and L8) without significant differences.There were not statistical differences between different VT groups in terms of ventilation days, including right ventricle area/left ventricle area (RVarea/LVarea),TAPSE,peak mitral flow velocity of the early rapid filling wave (E),peak mitral flow velocity of the late rapid filling wave (A),early diastolic velocity of the tricuspid annulus (e′),pulmonary artery systolic pressure,inferior vena cava diameter (all P>0.05).Compared to L6 group, low VT (S6 group) resulted in decreased mortality at 28 days [1/19 vs 37.5%(9/24), P=0.014].There were not statistical differences between different VT groups in terms of ventilation days, length of intensive care unit stay, length of hospital stay (all P>0.05).Logistic regression analysis showed that VT could be the independent factor of TAPSE (OR=1.104,95%CI 0.100-1.003,P=0.049).Conclusions Positive pressure mechanical ventilation resulted in RV systolic dysfunction.Lower VT may have the protective effect on RV function.Trial registration Chinese Clinical Trial Registry,ChiCTR-POC-15007563.

Objective: To investigate the clinical characteristics and prognostic factors in elderly patients with acute myeloid leukemia(AML). Methods: Clinical data of 232 patients with acute myelocytic leukemia(AML, except for acute promyelocytic leukemia) admitted in our hospital from January 2012 to December 2015 were retrospectively analyzed.Factors affecting complete remission(CR) were analyzed by using χ² test, and Kaplan-Meier survival analysis was conducted.Univariate and multivariate analysis of prognostic factors were performed by using Log-Rank test and Cox regression model respectively. Results: Of 232 patients, 195 patients received induction chemotherapy, among whom 8 patients died in early phase, efficacy could not be evaluated in 25 cases, with 162 patients for final statistical study.The CR rate was 37.0%(60/162) after the first therapy course, and overall CR rate was 54.9%(89/162). Thirty-seven patients received palliative treatment, among whom 6 patients died in early phase and none achieved CR.Therefore, the 162 patients receiving an induction chemotherapy, whose efficacy can be evaluated, could be clinically analyzed.They were in 60-69 years old(χ²=4.102, P=0.043), with ECOG score≤2(χ²=9.917, P=0.002), NPM1⁺ FLT3-ITD^-(χ²=6.423, P=0.038), favorable karyotypes(χ²=6.033, P=0.049), and related to a higher CR rate.The median overall survival(OS) was 205 days in the 232 patients.Univariate analysis results demonstrated that age(χ²=8.700, P=0.003), white blood cell(WBC) count≥100×10⁹/L(χ²=4.249, P=0.039), karyotypes(χ²=4.807, P=0.028), palliative treatment(χ²=191.221, P=0.000) were influencing factors for the prognosis.Multivariable analysis showed that age(HR=0.464, 95%CI: 0.245-0.877, P=0.018), karyotypes(HR=3.618, 95%CI: 1.491-6.728, P=0.003) and whether or not to receive induction chemotherapy(HR=0.076, 95%CI: 0.030-0.194, P=0.000) were independent influencing factors for OS in elderly patients with AML. Conclusions The prognosis of elderly patients with AML is affected by multiple factors.Age, karyotypes and whether or not to receive induction chemotherapy are independent influencing factors for OS in elderly patients with AML.

Objective To analyze the radiographic characteristics of right hand X-ray film of adult patients with Kaschin-Beck disease (KBD) in Qinghai Province, to understand the most affected locations in adult KBD. Methods According to the criteria of KBD diagnose (WS/T 207-2010), 111 cases of patients were taken X-ray films of right hands. Joint space narrow, joint deformity, subchondral sclerosis, osteophyte, coarse and irregularity of joint, marginal retraction sign and capsule changes were chosen as the descriptive indexes, and these indexes were analyzed with SPSS 17.0. Results A total of 111 cases adult patients with KBD were examined right hand by X-ray, abnormality on X-ray film were 103 cases, the abnormal rate was 92.79%. The most affected fingers were Ⅱ- Ⅳphalanx bones, Ⅱphalanx bones accounted for about 92.23% (95/103), Ⅲ phalanx bones accounted for about 99.03% (102/103), and Ⅳ phalanx bones accounted for about 99.03% (102/103). There was significant difference of the abnormality between th e proximal phalanx and the middle phalanx among the Ⅱ - Ⅳ phalanx bones(χ2=79.33, P<0.05). Abnormal numbers of joint deformity, marginal retraction sign, coarse and irregularity of joint, osteophyte, capsule changes and joint space narrow in the proximal phalanx were 212, 7, 134, 47, 15 and 115 in Ⅱ - Ⅳ proximal phalanx, respectively; while the abnormal numbers of joint deformity, marginal retraction sign, coarse and irregularity of joint, osteophyte, capsule changes and joint space narrow in the middle phalanx were 77, 37, 137, 26, 19 and 126 in Ⅱ - Ⅳmiddle phalanx, respectively. Conclusion The Ⅱ - Ⅳ phalanx bones of right hand are the most affected locations in adult KBD.