Objective To investigate the effect of carvedilol combined with spironolactone in the treatment of elderly patients with chronic heart failure clinical efficacy and to provide reference for clinical treatment of formulation. Methods 104 elderly patients with chronic heart failure were randomly divided into observation group and control group,52 cases were randomly divided into observation group and control group.Control group intervention in accord-ance with the conventional treatment of chronic heart failure program,the observation group in the conventional scheme based on,combined with oral carvedilol and spironolactone therapy.6 months after treatment,clinical efficacy was compared between the two groups.The results of echocardiography before and after treatment in two groups were compared.The adverse reactions in the treatment process were compared.Results The effective rate in the observation group was 59.62%,the total effective rate was 96.15%,which were significantly higher than those of the control group (χ2 =4.10,9.82,all P <0.05);After treatment,LVEDD and LVESD of the two groups were significantly lower than those before treatment[(51.89 ±7.06)mm,(41.39 ±6.85)mm,(60.71 ±7.43)mm,(51.02 ±7.95)mm], LVEF[(52.31 ±9.02)% and (41.64 ±7.73)]were significantly higher than that before treatment,there were statistifically significant differences between the two groups(t =4.92,5.10,5.45,2.87,2.98,3.03,all P <0.05);After treatment,LVEDD[(51.89 ±7.06 )mm],LVESD [(41.39 ±6.85 )mm]of the observation group were significantly lower than those of the control group,and LVEF(52.31 ±9.02)% were significantly higher than that of the control group,there were statistifically significant differences between the two groups (t =3.02,2.98,2.97,all P <0.05);There was no significant difference in the incidence of adverse reactions between the two groups(P >0.05).Conclusion Carvedilol combined with spironolactone can significantly improve the clinical effect of the treatment of elderly patients with chronic heart failure,effectively improve the left ventricular remodeling in patients with,improve myocardial contractility in patients and has good security.

Objective To explore the relationship between fibroblast growth factor 21(FGF21) and islet β cell function in pregnant women with different glucose tolerance status.Methods A total of 441 pregnant women were selected in this study from our hospital.Their 50 g GCT at 24~28 gestational weeks were all positive.One week later,all the subjects were treated with 75 g OGTT,and divided into three groups according to their test results:GDM group (n=228),GIGT group (n=112) and GNGT group (n=91).Serum FGF21 level was tested by ELISA.Islet β cell function was evaluated by HOMA-IR,ISI-Matsuda,HOMA-IS,Stumvoll first,second phase secretion and ISSI.The correlation between FGF21 and islet β cell function was evaluated by Pearson correlation analysis.Results (1) BMI,0 h,1 h,2 h,3 hPG and 1 h,2 h,3 hIns were higher in GDM group and GIGT group than in GNGT group,and highest in GDM group (P<0.05 or P<0.01).SBP,DBP,0 hIns and HbA1c were higher in GDM group than in GNGT group and GIGT group(P<0.05 or P<0.01);(2)From GNGT group,GIGT group to DGM group,the levels of FGF21[(101.74±20.40) vs (137.93±25.52) vs (185.69±31.61) ng/L]and HOMA-IR[1.74(0.91,2.85) vs 2.39(1.31,4.87) vs 3.38(2.19,6.75)]were increased,while ISI-Matsuda[(58.74±15.68) vs (41.62±15.65) vs (39.73±18.98)],HOMA-IS[(157.69±88.41) vs (144.35±78.98) vs (107.30±87.23)]and ISSI[(72253.55±15167.53) vs (42313.91±7112.47) vs (30032.50±11500.24)]were decreased (P<0.05 or P<0.01).The stumvoll first,second phase secretion were lower in GDM group than in GNGT group and GIGT group(P<0.01),but there was no statistical significance between GNGT and GIGT group(P>0.05).(3)Pearson correlation analysis showed that FGF21 was positively correlated with HOMA-IR(r=0.255,P=0.030) and was negatively correlated with ISI-Matsuda,HOMA-β,Stumvoll first,second phase secretion and ISSI(r=-0.289,-0.256,-0.224,-0.230,-0.277,P=0.019,0.037,0.045,0.040,0.023).Conclusion Along with the worsening of glucose metabolic damage,the FGF21 level is increased gradually.FGF21 is related to islet β cell function,and may enroll in the occurrence and development of GDM.

Objective To study the expression of CD44V6 in human epidermal tumours and malignant melanoma. Methods The expression of CD44V6 was detected by an immunohistochemical technique in squamous cell carcinoma(SCC), basal cell carcinoma(BCC) and malignant melanoma(MM). Results CD44V6 was expressed on the membrane of tumour cells of 10 patients with SCC, and there was downregulation of CD44V6 expression which along with the decrease of differentiation of SCC tumour cells. Tumour cells of 8 patients with MM and 10 patients with BCC did not express CD44V6. Conclusion Our findings suggest that CD44V6 expression is correlated with the types of skin tumours.

Objective To evaluate the clinical value bronchofiberscope and perfusion in the treatment of multi- drug resistant pulmonary tuberculosis (MDR-TB).Methods Forty-two cases were treated by injecting amikacin (0.4 g), ofloxacin (0.4 g), after cleaning up exudation through bronchofiberscope and catheter intervention combined with chemotherapy therapy, while 37 controls were treated by chemotherapy only.Results By the end of 9 months, the sputum tubercle bacillus conversion rate, radiographical improvement rate were 92.9% and 90.5% respectively in the treated groups,while all these indications were higher than those of control group 62.2% and 59.5% (P

Objective To construct an eukaryotic vector expressing short hairpin RNA(shRNA) of HIF-1α,and to observe its effects on location and metastasis of HeLa cells under hypoxic condition.Methods shRNA templates was developed based on HIF-1α gene sequence and then cloned into pSilencer2.1-U6-neo vector.The resultant plasmid was transfected into HeLa cells with Lipofectamine 2000.The cells were incubated in hypoxic condition.The HIF-1α protein and mRNA were detected by Western blot and RT-PCR.The colony formation assay and Transwell cabin assay were performed to measure the colony formation and metastasis.Results The plasmid pSilencer2.1-U6-neo-HIF-1α was successfully constructed and transfected into HeLa cells.The expression of HIF-1α in HeLa cells decreased,and the number of colony formation in soft agar and cells penetrating matrigel also decreased under hypoxic condition.Conclusion The shRNA expressing plasmid targeting at HIF-1α may suppress the location and metastasis of cervical carcinoma cells under hypoxic condition.

Objective To analyze the level of satisfaction and its influencing factors in emergency patients, and to improve the satisfaction level of emergency patients. Methods The patients who visited the emergency department with the triage number ended with 1 from August 1 to August 15, 2015 in Second Affiliated Hospital of Zhejiang University School of Medicine were selected by the method of convenience and equidistant sampling, to take the Press Ganey′s Patient Satisfaction Questionnaires which were collected and analyzed at the end of the patient's emergency treatment. Results A total of 200 cases were investigated. Patient experience overall satisfaction was (91.64 ± 8.74) points. There were no significant differences in satisfaction between the gender, age, place of residence, the investigator, the clinic department, the time to wait, whether the first visit and the previous stay in hospital (P>0.05). The correlation between the satisfaction score and the patient's education, prognosis was less (r=-0.251,0.262, P =0.009,0.018) , but more higher correlated with the service attitude of ancillary hospital staff, nursing staff in the provision of nursing instructions, nursing staff can protect the privacy, the waiting time of the triage and the doctor′s explanation of the treatment of the disease (r=0.79-0.84, P<0.05). Conclusions The service attitude of the ancillary hospital staff, nursing staff in the provision of care instructions and privacy protection, and the waiting time of the triage and the doctor′s explanation of the treatment are the most important factors influencing the patients′ satisfaction in emergency department which also will be the key content for us to improve the patients′experience and satisfaction inemergency patients.

Objective To check the change of content of serum beta-apoliprotien(?-AP) and insulin(INS) in the patient with Alzheimer disease, and to reflect the effect of using different drug. Methods 60 cases of this disease and 30 cases of the control group were been detected by radioimmunoassay(RIA). Results The content of ?-AP in Alzheimer disease(AD) was obviously higher than that in control groups(P

Objective:To investigate the efficacy and safety of insulin glarsine combined with sitagliptin in elderly type 2 diabetic patients whose blood glucose levels were inadequately controlled by oral anti-diabetic drugs ( OAD) . Methods: In the open-labeled, randomized and parallel study, 98patients (≥60 years) were randomly divided into two groups: insulin glargine/sitagliptin combina-tion group (n=52, the observation group ) and insulin Aspart 30 injection group (n=46, the control group). The dose was adjusted according to the blood glucose. The fasting blood glucose (FBG), 2h postprandial blood glucose (2hPBG), glycosylated hemoglobin (HbA1c), the incidence of hypoglycemia and body mass index (BMI) after the 12-week treatment were compared between the two groups. Results:The fasting glucose and the incidence of hypoglycemia in the observation group were lower than those in the control group (P<0. 05). There were no significant differences in 2h postprandial blood glucose, HbA1c and BMI between the two groups (P>0. 05). Conclusion:The treatment of insulin glargine combined with sitagliptin is safe, effective and convenient in elderly type 2 diabetes patients with poor glycemic control. By diabetic education, the lower incidence of hypoglycemia treatment will be a better choice for elderly type 2 diabetic patients.

Objective:To investigate the effects of chronic exposure to low concentration sevoflurance on hippocampus in SD fetal rats.Methods:Totally sixty female SD rats at clean grade weighing 240-260 g were randomly divided into four groups , the control group and sevoflurane groups (n=15).The three experimental groups were respectively treated with 30 mg· L-1(parts permillion1 × 10 -6), 100 mg· L-1 and 300 mg· L-1 sevoflurane with 6-hour inhalation, qd for 2 weeks, while the control group breathed fresh air with the same volume .After mating conception , the rats inhaled the same concentration sevoflurane or air till scarification on the 19 th day.Half of brain in the fetal rats was withdrawn to prepare the paraffin specimens , and immunohistochemistry was used to detect the apoptosis in hippocampal CA 1 region associated with protein Bcl-2 and Bax.The hippocampus was stripped from the other half of brain and 10%homogenate was prepared, and the activity level of superoxide dismutase (SOD) and the content of malondialdehyde (MDA) were detected.Results:Bcl-2 in hippocampus CA1 region in 300 mg· L-1 group was lower than that in the control group , while Bax was higher than that in the control group (P<0.05);SOD was lower in 300mg· L-1 group than that in the control group , and MDA was higher than that in control group (P <0.05) .The other two sevoflurane groups had no differences when compared with the con-trol group (P >0.05).Conclusion:Low concentration inhalation of sevoflurane above 300mg· L-1 can enhance the cell apoptosis in hippocampus through increasing the oxidative stress reaction in embryonic brain of SD rat resulting in excessive MDA and reduced SOD.

After discussing the reason for insufficiency of committee member in current ethical review , and considering the requirement for improving the function of Ethics Review Committee , this paper proposes that Ethics Review Committee should appoint more non -affiliated scientific members to ensure the independence of ethical re-view , thus protecting the rights and beneficence of subjects , and to secure the justice in ethical review of protocols , the paper also discussed the resolutions to address the challenge brought by appointing non -affiliated members .