Objective To study the clinical efficacy of low dose thyroxine combined with irbesartan hydrochlorothiazide in the treatment of elderly patients with severe heart failure.Methods 100 cases of elderly patients with severe heart failure treated in our hospital from January 2013 to December 2016 were selected as the research object in this study.They were randomly divided into control group and experimental group, with 50 cases in each group.Patients in the control group were treated with conventional therapy, while the experimental group was treated with low dose thyroxine combined with irbesartan and hydrochlorothiazide.The clinical efficacy of the two group were compared and analyzed.Results After the corresponding treatment, the total effective rate of the experimental group was 88.0%,significantly higher than that of the control group(70.0%), the difference was statistically significant(P<0.05).After treatment, the experimental group of patients with left ventricular ejection fraction index, four triiodothyronine and three triiodothyronine levels were significantly higher than those before treatment, the control group of patients with left ventricular ejection fraction were significantly higher than before treatment, the difference was statistically significant(P<0.05).Conclusion Low dose thyroxine combined with irbesartan hydrochlorothiazide in the treatment of elderly patients with severe heart failure has better clinical effect, can improve the therapeutic effect in a certain extent, with further clinical promotion and application significance.

To reveal the mechanism of Cu enrichment of alfalfa, in-situ micro-X-ray fluorescence spectrometry (μ-XRF) and fractional extraction were used to explore in-situ Cu distribution information in alfalfa seedlings and different combination forms of Cu in organs.The results showed that alfalfa roots were enriched with Cu up to 12.06 mg/g, which was 8 times of stem and 4.9 times of leaves.The in-situ μ-XRF result showed that the root of alfalfa was the main site of enrichment of Cu, and there was a barrier of Cu at the rhizome junction to alleviate the toxic effect of excess Cu on the shoots.Excess Cu (more than 50 μmol/L) also inhibited the uptake of Zn and Ca in alfalfa, enhanced the uptake of Fe in alfalfa, but had no obvious effect on the uptake of K and Mn.Plant fractional extraction showed that the Cu in root cells was mainly fixed in the form of insoluble residues (41%) and cell wall chelate (20%), while in the stem, Cu existed as four forms including hydrophobic protein binding, cell wall binding state, residual state and water-soluble state, which further reduce the excess transport of Cu to the leaves.In the leaves, excess Cu in the leaf cells was mainly in the vacuole and insoluble residue to achieve tolerance and detoxification to Cu.

Objective To research the impact of various PEEP parameters of mechanical ventilation on liver mor-phology and function and on hemodynamics. Methods Fifty patients of respiratory failure due to COPD using mechanical ventilation was observed by prospective, exoterical and self-control methods after their condition were stabilized. The varia-tion of abdominal pressure was measured with different PEEP of 0 cmH2O, 5 cmH2O and 10 cmH2O with mechanical ventila-tion, and measured when patients breathe autonomously with tracheostomy tube. The changes of liver morphology, hepatic por-tal vein diameter, hemodynamics and liver function were also measured on above circumstances. Results With PEEP value increases:the abdominal pressure (IAP) rise (P＜0.01) while liver morphology, function and hepatic portal did not change markedly evidently (P>0.05). By contrast, blood flow of hepatic portal vein reduced with PEEP increase (P＜0.05). Conclu-sion Higher PEEP values on mechanical ventilation will causes abdominal pressure increases and low blood flow of hepatic portal , but not obvious impact on portal vein diameter and liver function.

In order to improve the staff′s ability to combine professional level and moral quality in pharmacy in-travenous admixture services and implement it in nursing practice, this paper discussed the common ethical issues and its importance in pharmacy intravenous admixture services. It analyzed the problems, found the causes out, put forward the countermeasures, and thus to promote the further development of pharmacy intravenous admixture serv-ices and offer high quality clinical services, avoid medical disputes, and provide safer pharmacy service to patients.

Subcritical butane technology was employed for the separation of abamectin on the fresh tea leaves surface.Under the conditions of solid-liquid ratio of 1∶10 (m/V), the experiment was designed via the response surface methodology and conducted at different temperature, various separation time and discrepant cycle number.Besides, the activity of the polyphenol oxidase (PPO) relating to the quality of the tea was determined and compared.At the same time, scanning electron microscopy (SEM) was used to observe the surface structure of fresh tea leaves before and after treatment, and the effect on physiological characteristics of the leaves by subcritical butane treatment was analyzed.The experimental results showed that the subcritical butane extraction could effectively isolate the abamectin, making the physical structure basically remained and the polyphenol oxidase activity preserved as well.Through the analysis by Design Expert software, the optimal processing parameters of separating abamectin were as follows: 45℃, 30 min, 1 cycle, and solid-liquid ratio of 1∶10 (m/V).Under the optimal conditions, the separation efficiency was over 91% and the relative PPO activity was 25.73%.The structure of fresh tea leaves changed insignificantly before and after the butane processing.This study suggested that the subcritical butane extraction technology could effectively remove pesticide residues in tea, thus provided a certain scientific basis for application of subcritical fluid removal of pesticide residue in natural plants.

Objective To investigate the genetic characteristics of E 1 gene of rubella virus strains isolated in Henan province for further investigation on rubella prevention and control .Methods RNA was extracted from rubella virus strains isolated from suspected measles cases in Henan during 2008 to 2012 .E1 gene of the isolates were amplified by RT-PCR and sequenced .The nucleotide ( nt ) and amino acid ( aa ) sequences of E1 gene of Henan isolates were aligned with the sequences of other reference strains downloaded from GenBank.Phylogenetic tree was constructed by using MEGA 6.0 software package.Results The pre-dominant genotype of rubella virus isolated in Henan was 1E genotype.No 1F genotype was detected.The 2B genotype emerged in 2013.The E1 gene of Henan isolates shared 87.8%-100% homologies in nucleo-tide sequences and 67.0%-100%in amino acids sequences .No variation was detected at hemagglutination inhibition and neutralization sites .A Leu to Phe mutation occurred at amino acid site 338 of 1E genotype in all isolates.Conclusion The results of this study demonstrated that genotype 1E was the predominant geno-type of rubella virus epidemic in Henan province .

Objective To evaluate the nursing effect of warming feeding formulation of the enteral nutrition associated diarrhea in the critically ill tube-fed patients. Methods A total of 60 patients with enteral feeding were enrolled and divided randomly into the warming group and the room temperature group with 30 cases in each group by random digits table method. The room temperature group received room temperature oral feeding by nutrition pump. The warming group used nutrition pump and heating rod was placed on the nutritional tube 50 cm far from patient's nose. A semi-quantitative scale based on stool volume and consistency was used for daily assessment of diarrhea. Results Patients were tube-fed for a mean duration of (11.20±2.98) and (10.93±2.69) days, respectively in the room temperature group and the warming group. There was no significant difference in these two groups (U=425.000, P > 0.05). The diarrhea score was 4.88 ±3.41 in the room temperature group and 5.51±4.44 in the warming group. There was no significant difference in these two groups (U=436.500, P > 0.05). The diarrhea per total feeding days was 10.42%(35/336) in the room temperature group and 16.24%(51/314)in the warming group. There was no significant difference in these two groups (χ2=4.862, P < 0.05). Conclusions The airtight enteral nutrition does not need warming when it is infused with the enteral nutrition pump at room temperature.

Objective To study the relationship between the mutation of the inverted repeat (IR) gene in the multiple transferable resistant (mtr) system and multiple antibiotic resistance of Neisseria gonorrhoeae. Methods The antimicrobial susceptibilities of isolated strains were tested. An agar plate dilution method was used to determine the minimum inhibitory concentrations. The target genes were amplified by PCR and subjected to sequencing. Results No mutation was found in the IR gene of either of 2 sensitive or 5 penicillin-resistant Neisseria gonorrhoeas strains. Among the 17 multiple-antibiotic-resistant strains, a strain with both azithromycin- and penicillin-resistance had T/A and T/A insertions, and another had A/T deletion. Conclusion Mutations in the IR gene of the mtr system of Neisseria gonorrhoeae might result in multiple antibiotic resistance.

Objective To explore the bone marrow stromal cells,anti-late antigen-4 (VLA-4) antibody (aVLA-4),cytarabine (Ara-C) on the proliferation and apoptosis of leukemia HL-60 cells.Methods The experiment was divided into five groups:HL-60 cells were cultured alone (control group),HL-60 cells and stromal cells group (stromal cells group),HL-60 cells + stromal cells + aVLA-4 (antibody group),HL-60 cells + stromal cells + Ara-C group (drug group),HL-60 cells + stromal cells + aVLA-4 + Ara-C group (antibody +drug group).Cell proliferation or inhibition rate was detected by CCK-8 method,the HL-60 cells apoptosis was detected by flow cytometry.The expression of anti-apoptotic gene bcl-2 in HL-60 cells was determined by Western blot.Results After 24 h and 48 h,treatment,the number of the stromal cells group HL-60 cells were higher than that of the control group with significant difference cultured [(7.2±0.3)×1O5/ml vs (5.3±0.4)×105/ml,(8.4±0.2)×105/ml vs (6.8±0.3)×105/m1,P ＜ 0.001],while the HL-60 cell proliferation inhibition rate [(24.3±2.1) ％,(37.0±2.6) ％,(65.6±3.8) ％] and apoptosis rate [(5.7±0.6) ％,(8.0±0.5) ％,(10.4±0.9) ％,(16.5±0.7) ％] of antibody group,drug group,antibody + drug group were higher than the control group with a difference of statistically significant (P ＜ 0.05),and the increase of antibody + drug group was most obvious.With the decreasing of the bcl-2 protein expression,which was most the decrease of antibody + drug group was most obvious.Conclusion Bone marrow stromal cells can stimulate the proliferation of leukemia cells,aVLA-4 interference the interaction between stromal cells and leukemia cells can enhance the chemosensitivity of leukemia cells to Ara-C.

Objective To observe the clinical efficacy and adverse reaction of the combination of fiudarabine,cytarabine and granulocytecolony-stimulating factor (G-CSF) (FLAG regime) therapy for refractory and relapsed acute leukemia in children. Methods From 2004 to date, a total of 9 patients with relapsed and refractory acute leukemia patients in our hospital accepted the treatment, in 9 cases 8 cases were AML,1cases were ALL; in 9 cases 5 cases were refractory acute leukemia, 4 cases were recurrent acute leukemia.Results Among the 9 cases,6 cases with 1 cycles of chemotherapy achieved complete remission (CR),CR rate was 66.7 ％ (6/9); partial remission (PR) rate was 22.2 ％ (2/9),total efficiency (CR+PR) was 88.9 ％.In 6 CR patients 2 underwent hematopoietic stem cell transplantation, are disease-free survival; this regimen' s main adverse reactions were infection,bone marrow depression and gastrointestinal reaction.Conclusion The remission rate of FLAG regimen in the treatment of children with refractory and relapsed acute leukemia is relatively high, adverse reactions were tolerable; the FLAG program is a choice for the treatment of children with refractory and relapsed acute leukemia,which provides the opportunity for subsequent hematopoietic stem cell transplantation.