Objective To summarize the experience of the nursing care of indwelling catheter thrombolysis for acute thrombosis in the arteriovenous fistula in eight hemodialysis patients.Methods After breaking thrombus through indwelling catheter,both bolus injection and micro-pump continuous infusion of urokinase was employed in eight hemodialysis patients with acute thrombosis in the arteriovenous fistula.The necessary nursing measures were carried out to assist the whole therapeutic procedure.Results All the patients could well cooperate with the procedure of indwelling catheter thrombolysis and urokinase infusion.The reopening rate of the obstructed fistula was 100%.Conclusion Indwelling catheter thrombolysis with urokinase infusion is a simple,effective and safe treatment for acute thrombosis in the arteriovenous fistula in hemodialysis patients.In order to obtain optimal results,necessary nursing measures must be carried out.

To reconstruct the heat-labile enterotoxin subunit B (LTB) gene of Escherichia coil in order to increase the outputs of the prokaryotic expression on recombinant LTB (rLTB), and to determine its immune adjuvant activity on mucosa,the nucleotide sequence of the whole length of LTB gene was synthesized according to the preferred codons of E. coli, and the prokaryotic expression plasmid pET32a-rLTB and its expression system in E. coli BL21DE3 were reconstructed. The recombinant plasmid was extracted and the inserted sequence of rLTB gene was determined. Meanwhile, the expression quantity of the reconstructed rLTB was identified by SDS-PAGE and BioRad agarose image analyzing system, and compared with that of the un-reconstructed rLTB. The abilities of the reconstructed rLTB and the un-reconstructed rLTB to bind with bovine GM1 were determined by means of GM1-ELISA assay. By using the recombinant urease subunit B as antigen, the effects of the reconstructed and the un-reconstructed rLTB on the improvement of immune protection of BALB/c mice infected with Helicobacter pylori strain SS1 and the induction of S-IgAs in infected mice were assayed. The experimental results showed that the expression quantity of the reconstructed rLTB approached upto 35.4% of the total bacterial proteins after induction with 1 mmol/L IPTG for pET32a-rLTB-E. coliBL21DE3 and to be 12.6 times higher than that of the un-reconstructed rLTB (2.8 %). In addition, both the abilities of the recombinant reconstructed LTB and the un-reconstructed rLTB to bind with bovine GM1 could be demonstrated by GM1-ELISA. The immune protection rate of the recombinant urease subunit B in the infected mice was 66.7%; and it could reach up to 91.7% with a significantincrease of the specific S-IgA level, when it was immunized with the reconstructed or the un-reconstructed rLTB. It is concluded that the reconstructed LTB gene in the present study shows a remarkable increased outputs of expression of this gene with a strong immune adjuvant activity on mucosa.

Objective: To investigate the influence of angiotensinreceptor neprilysin inhibitor(ARNI) and angiotensin converting enzyme inhibitor (ACEI) on clinical efficacy and safety of elderly patients with ischemic cardiomyopathy. Methods: From January 2017 to December 2018, 120 elderly patients with ischemic cardiomyopathy in the Third People′s Hospital of Cixi were divided into 2 groups according to treatment methods, 59 patients treated with ACEI (control group) and 61 patients treated with ARNI (observation group) on the basis of conventional intervention. The levels of blood lipid index, blood pressure index, B-type brain natriuretic peptide (BNP), 6- minute walking test (6MWT) and echocardiographic index, endothelium-dependent diastolic function of brachial artery (FMD) and carotid intima-media thickness (CIMT) before and after treatment were compared. The adverse reactions incidence of 2 groups were compared. Results: The levels of blood lipid index and blood pressure index after treatment of 2 groups were significantly lower than those before treatment, and the differences had statistical significant (P<0.05). There were no significant differences in the levels of blood lipid index and blood pressure index after treatment between 2 groups (P>0.05). After treatment of 12 weeks, the levels of BNP, 6MWT, left ventricular ejection fraction (LVEF), left ventricular end-diastolic dimension(LVEDD) of observation group were significantly better than those of control group [(103.50 ± 23.95) ng/L vs. (175.20 ± 37.24) ng/L, (493.47 ± 92.54) m vs. (411.42 ± 61.09) m, (44.95 ± 5.89)% vs. (41.54 ± 4.21)%, (149.59 ± 33.26) mm vs. (143.24 ± 34.25) mm](P<0.05). The level of brachial artery FMD after treatment of observation group was significantly higher than that of control group [(15.14 ± 2.52)% vs. (9.25 ± 1.12)%](P<0.05). The level of CIMT after treatment of observation group was significantly lower than that of control group [(1.01 ± 0.28) mm vs. (1.32 ± 0.25) mm](P<0.05). There was no significant difference in the adverse reactions incidence between 2 groups (P>0.05). Conclusions ARNI in assisted treatment of elderly patients with ischemic cardiomyopathy can efficiently improve cardiac function, increase exercise endurance, enhance vasodilation function and dose not aggravate adverse drug reactions.