Objective To study the efficacy and safty of low dose rituximab therapy in elderly patients with chronic refractory immune thrombocytopenia(ITP) .Methods 36 elderly patients with chronic refractory ITP were collected from Xingtai People′s Hospital of Hebei ,the patients were given intravenous injection of intravenous rituximab at the dose of 100 mg once weekly for 4 consecutive weeks ,observing the efficacy and adverse reaction and following up for 12 months .Difference of platelet (PLT ) ,white blood cell (WBC) ,cluster differentiation 8 + (CD8 + ) ,CD19 + eukomonocyte number and immunoglobulin (IgG ,IgM ,IgA )were compared before and after treatment .Results The responses of complete remission (CR)were 17 casese(47 .2% ) ,remission (R) were 11 casese (30 .6% ) and no remission (NR) 8 casese (22 .2% ) respectively ,2 patients experienced mild dizziness and chest tightness ;PLT were significantly increased ( P = 0 .001) after treatment ,CD19 + lymphocyte count decreased significantly (P =0 .001) ,WBC ,CD8 + lymphocyte and serum immunoglobulin IgG ,IgM ,IgA showed no significant difference before and after treat-ment(P> 0 .05) .Conclusion Low dose rituximab had better clinical efficacy for the treatment of elderly patients with chronic re -fractory ITP ,low dose rituximab may be a effective treatment in elderly chronic refractory ITP patients with minor adverse reac -tions .

Objective To explore the current research status and existing problems in severe burn nursing by reviewing relevant literature of severe burn nursing published in 6 kinds of nursing core journals. Methods Search 6 kinds of nursing core journals using the following key words: severe burn critical burn serious burn large area burn intensive burn and nursing. Applying bibliometrics to conduct descriptive analysis of the external and internal characteristics of these papers. Results Two hundred and nine papers were included;the main literature research type of thess articles was clinical experience summary, the content of these literature was extensive. Conclusions Severe burn nursing research focus on clinical symptomatic nursing; clinical nurse scientific research ability needs to be strengthened, and subject aspects should be paid more attention to children, the elderly, and clinical nurse physical and psychological conditions.

The rise of advanced nursing practice in the developed countries promotes the development of nursing science, nursing postgraduate education arises at the historic moment. Professional nursing postgraduate education started late in our country and its development is not mature, there exists some problems in the training plan and professional positioning, such as training process not realizing the training objectives, unreasonable curriculum setting and evaluation system, unclear professional direction, disconnection of vocational orientation and the professional qualification and specialist nurse certification. Therefore, nursing professional degree graduate education mode needs further exploration and unity.

Objective:To predict and analyze the T/B combined epitope of EM10 protein in Echinococcus multilocularis, and identify the expressed products of the biosynthetic EM10 multi epitopes. Methods:The gene-related information of EM10 protein was obtained through NCBI GenBank public database. Bioinformatics technique was used to predict and analyze the T/B binding epitopes of EM10 protein. The prokaryotic expession recombinant plasmid pET30a-EM10 (epitope) was synthesized, and transformed into host bacteria Ecoli. BL21 (DE3). The expression of EM10 recombinant multi-epitope protein was identified by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and Western blotting after induced expression by isopropyl thiogalactopyranoside (IPTG). Results:The total length of EM10 gene was 1 759 bp (GenBank registration number: U05573), and its protein amino acid sequence (GenBank registration number: AAA50580.1) was 559 amino acids. By using Phyre software for homology modeling, the tertiary structure of EM10 protein was obtained, and the T/B combined epitope of EM10 protein was successfully predicted, the dominant epitope was located at 46 - 61, 133 - 183, 239 - 255 and 442 - 475 amino acid sites. The (GGGGS)n linker sequence was used to connect the epitopes to form an EM10 recombinant multi-epitope protein with a total of 206 amino acid. The size of the DNA fragment was 618 bp and the relative molecular weight of the protein was 22.66 × 10 3. The prokaryotic expession recombinant plasmid was validated by enzyme digestion, the results showed that the plasmid size was between 5 000 and 6 000 bp, which was consistent with the length of the constructed plasmid (5 854 bp). SDS-PAGE showed that the target protein was expressed in the supernatant induced by IPTG at 37 ℃ and the effect was the best. The relative molecular weight of the protein was 22.66 × 10 3 by Western blotting, which was consistent with the constructed plasmid. Conclusions:The combined epitope of EM10 T/B is successfully designed and predicted using bioinformatics technology. A prokaryotic expression recombinant plasmid is constructed, the expression of EM10 recombinant multi-epitope protein is verified through experiments, providing an experimental basis for the construction of an EM10 dominant epitope diagnostic kit.