Objective To evaluate the stability of human immunoglobulin(pH 4)for intravenous injection(IGIV)after process optimization.Methods A filter plate and B filter membrane were used to filter the protein components in different separation stages to reduce the residue of immunoglobulin A(IgA)in the product in multi-batch large-scale production. The finished product was examined for the physical properties(appearance,visible foreign body,insoluble particle examination and thermal stability test)and the chemical properties[protein content,purity,molecular size distribution,titers of antiHBs,diphtheria antibody,prokallikrein activator(PKA),anti-complement activity(ACA),anti-A and anti-B hemagglutinin,and IgA residue]. The accelerated and long-term stability tests were performed.Results There was no significant difference in the key quality indicators between IGIV batches produced by the optimized process and the normal process,while the IgA residue decreased significantly(t = 3. 992 and 11. 215 respectively,each P < 0. 05). In the accelerated stability and long-term stability tests,all the test results of IGIV after process optimization were qualified,which met the relevant regulations in the third part of Chinese Pharmacopoeia(2020 edition).Conclusion IGIV after process optimization can effectively reduce IgA residue with good stability,which is of great significance for blood product manufacturers to improve the quality of IGIV products.

Intracranial arterial stenosis is the most common vascular lesions in patients with acute stroke in Chinese population,and most of them are middle cerebral artery (MCA) stenosis.The treatment of asymptomatic MCA stenosis is mainly to control the risk factors and treat with drugs,and the prognosis is better.Statins can reduce new stroke events.The treatment programs of symptomatic MCA stenosis are mainly to control the risk factors,treat with drugs and stenting.Now it is considered that anticoagulants are not superior to antiplatelet drugs in the treatment of MCA stenosis,but whether dual antiplatelet drugs are superior to monotherapy and stenting remains to be determined.The prognosis of symptomatic MCA stenosis is poor.The prognosis of acute phase mainly depends upon imaging features,and the risk of recurrent stroke is primarily associated with the MCA stenosis.Future research should focus on whether dual antiplatelet therapy is superior to monotherapy,and whether stenting is superior to drug treatment,as well as the relationship between the degree of MCA stenosis and prognosis of acute phase or the risk of recurrent stroke.

At present,there are many problems in the cultivation for the young clinicians including lack of subjective initiative,insufficient innovation education.This paper analyzed the current status of the academic and charactersfic training of the young clinicians then put forward new training methods which can be used for reference.Developing prominent features and novelty is the most important way to implement the aforementioned training methods.

The syndrome of insulin-dependent diabetes mellitus(IDDM)includes not only abnor-mal glucose metabolism but also specific microvascular complications that include nephropathy,retinopathy and neuropathy.In the short term,improvement in the quality of life and possible prevention of further morbidity associated with diabetes makes pancreas trans-plantation an important therapeutic option,particularly when combined with a kidney trans-plant,in appropriately selected diabetic patients.The focus of the early management of the pancreas transplant recipient is the prevention of acute rejection.In this article we review the methods for clinical diagnosis of the early acute rejection due to pancreas transplanta-tion.

Objective To explore rehabilitation effect of graphic interactive education in humanistic care in lung cancer patients underwent thoracic surgery. Methods Two groups were randomly formed based on a total of 95 lung cancer patients underwent open thoracic surgery from January 2016 to December 2016: normal group (47 people) and experimental group (48 people). The patients in normal group were treated with routine health method. The experimental group was cared with graphic interactive education, i.e. cares were applied based on humanistic thoughts. Results The average rehabilitation accuracy score of the patients in the experimental group (18.833 ± 2.999) was significantly higher than the one in the normal group (12.255 ± 3.247). The difference is statistical significant (t=10.261, P < 0.01). In the experimental group the patients were more satisfied and the compliance of upper limb during rehabilitation exercise was significantly higher. The difference comparing to the normal group was statistically significant (Z=-3.419,-6.232, P<0.01). Conclusions The rehabilitation effect of using interactive graphics in humanistic care is apparent. This method is recommended to be used as a highlight of special high qualified nursing service to improve patients′satisfaction.

Objective To observe the symptoms,short and long term effects of body gama-knife in treatment of obstructive jaundice caused by cholangiocarcinoma.Methods 76 patients with obstructive jaundice caused by cholangiocarcinoma were treated with OUR-QGD body gamma-knife.The single therapeutic dose was 3.0-4.0 Gy,isodose curves was 50.0 ％-65.0 ％,the total treatment time was 10-12 times.The liver function,blood routine and adverse effects were monitored.Results Among 76 patients,the jaundice symptoms of 69 cases were significantly reduced,the TBIL and ALT levels were significantly lower than that before treatment (P ＜ 0.05),the ORR was 88.16 ％ (67/76),DCR was 90.79 ％ (69/76).The median TTP was 8.8 months and the median OS was 13.4 months.Conclusions Body gamma-knife treatment for obstructive jaundice caused by cholangiocarcinoma can significantly improve symptoms of patients,and improve their life quality.This treatment has less adverse effects and satisfaction short-time and long-term effects.

Objective To investigate the correlations between plasma indoxyl sulfate and p-cresyl sulfate in the pathogenesis of cardiovascular complications in maintenance hemodialysispatients.Methods A total of 145 maintenance hemodialysis patients were selected.The researchers measured the physiological parameters of the subjects,including pre albumin,albumin,hemoglobin,blood urea nitrogen,creatinine,uric acid,calcium,phosphorus,alkaline phosphatase,total cholesterol,triglyceride,low-density lipoprotein cholesterol,high-density fat cholesterol,intact parathyroid hormone,C-reactive protein,apolipoprotein,lipoprotein,homocysteine,beta 2-microglobulin,sulfuric acid indoxyl,sulfuric acid cresol,serum iron,transferrin,ferritin,and N-terminal pro brain natriuretic peptide carrier.Subjects underwent cardiac ultrasound examination.Results The researchers used heart structure and function as the dependent variable.The single factor Cox regression analysis showed that the risk of heart structure and function changes increased with the increase of systolic blood pressure,N-terminal B-type natriuretic peptide,and left ventricular mass index.This study also showed that the risk of heart structure and function changes in patients with previous history of coronary heart disease also increased.The researchers took the systolic blood pressure,coronary heart disease history,N-terminal brain natriuretic peptide,and the left ventricular mass index as the dependent variables.Multifactor Cox regression analysis showed that the history of coronary heart disease,the high left ventricular mass index and the change of the heart structure and function of the patients with acute coronary heart disease were the independent predictors of the change of heart structure and function.The researchers used cardiovascular complications as the dependent variable.Cox regression analysis showed that,with the increase in patient's age,dialysis duration,elevated high C-reactive protein and sulfuric acid p-cresol,patients suffering from the risk of fatal cardiovascular complications rise.The researchers used the complications of cardiovascular deaths as dependent variable,age,duration of dialysis,C-reactive protein,and sulfuric acid p-cresol as covariates,multivariate Cox regression analysis of the results showed that with increasing age,dialysis duration increased,high sulfate of cresol and C-reactive protein,patients suffering from the risk of death from cardiovascular complications rise.Conclusions The history of coronary heart disease,left ventricular mass index,systolic blood pressure,indoxyl sulfate,Nterminal brain natriuretic peptide,age,dialysis age,high C-reaction protein,and p-cresol sulfate are the independent risk factors for cardiovascular complications.The relationship between indoxyl sulfate and sulfuric acid serum concentration of p-cresol and adverse cardiovascular events is most closely.

Objective To analyze the effect of cyclooxygenase-2（COX-2）on the invasion and metastasis of gastric cancer with Helicobacter pylori（H.pylori）infection.Methods A total of 60 gastric cancer specimens were included in this study.H.pylori infection was deter-mined by improved Giemsa method and the expression of COX-2 was examined by immunohistochemistry.The correlation between H.pylori infection and the clinical pathological features of gastric cancer was analyzed.Results H.pylori infection was detectable in 36 of 60 cases（60.0%）,and correlated with the staging（χ2=28.040,P =0.000）and lymph node metastasis（χ2=25.482,P =0.000）,but not with the age,sex of patients or histological types.H.pylori infection also significantly linked to the expression of COX-2（χ2=24.326,P 〈 0.001）.Con-clusion H.pylori infection may promote the invasion and metastasis of gastric cancer by increasing the expression of COX-2.

OBJECTIVE:To observe the effects of sitagliptin phosphate combine with acarbose on blood glucose,blood lipid and the serum glucose transporter 4(GLUT4)in elderly patients with type 2 diabetes. METHODS:86 elderly patients with type 2 diabetes were randomly divided into control group and observation group,43 cases in each group. All patients received guidance about diet,exercise and living habits,etc.,as well as the care about psychology and medication. Based on it,control group was given Acarbose tablet 50 mg/times,tid,chewing when a meal;observation group was given Acarbose tablet(the same dosage and usage)+ Sitagliptin phosphate tablet 100 mg/times,qd,orally. They were treated for 3 months. Fasting blood glucose(FBG),2 h postprandial blood glucose(2 hPG),glycosylated hemoglobin(HbAlc),body mass index(BMI),fasting insulin(FINs),insulin resistance index(HOMA-IR),islet B-cell function index(HOMA-B),total cholesterol(TC),triglyceride(TG),low-density lipo-protein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C)before and after treatment in 2 groups were compared, the incidence of adverse reactions was recorded. Other 43 healthy people were selected as healthy control group,the differences of serum GLUT4 levels before and after treatment between the 2 groups and healthy control group were respectively compared. RE-SULTS:After treatment,the BMI,FBG,2 hPG,HbAlc,HOMA-IR,FINs,TC,TG and LDL-C level were significantly lower than before,observation group was lower than control group;HOMA-B and HDL-C level were significantly higher than before,ob-servation group was higher than control group,with statistical significance(P<0.05). Before treatment,the serum GLUT4 level in 2 groups were significant lower than healthy control group with satistical significance(P<0.05);after treatment,the serum GLUT4 level in control group there was no significant different than before(P>0.05),while the serum GLUT4 level in observation group was significant higher than before and control group;and the serum GLUT4 level in 2 groups were still significant lower than healthy control group(P<0.05). And there was no significant difference in the incidence of adverse reactions(P>0.05). CON-CLUSIONS:Sitagliptin phosphate combine with acarbose can effectively control patients'blood glucose and lipid levels in the treatment of elderly patients with type 2 diabetes,improve HOMA-B and serum GLUT4 level,and does not increase the incidence of adverse reactions,with good safety.

The rehabilitation exercise has been found to be an important part of the treatment of the senior coronary heart disease in the recent researches. The senior patients with coronary heart disease are always complicated, so the exercises should start with low intensity and increase gradually. It is important to pay attention to the warm up and relaxation before and after the exercises. There are few patients accepted rehabilitation, which need pay more attention on it to help the senior patients improve their quality of life.