Objective To observe the efficacy of irbesartan combined with metoprolol in the treatment of chronic congestive heart failure.Methods From April 2015 to April 2016,60 patients with chronic congestive heart failure in Central Hospital of Zhuji were randomly divided into the observation group and the control group,30 cases in each group.The two groups were given conventional treatment,the control group was treated with metoprolol,and the observation group was treated with irbesartan combined with metoprolol.The changes of left ventricular ejection fraction (LVEF),left ventricular end systolic diameter (LVESD),left ventricular end diastolic diameter (LVEDD),heart rate,systolic pressure and diastolic pressure before and after treatment in two groups were observed.And the clinical efficacy of the two groups was compared.Results After treatment,compared with the control group,the heart function index of the observation group changed obviously,LVEF increased (t=5.88,P＜0.01),LVESD and LVEDD significantly decreased (t=7.19,4.11,all P＜0.01).The heart rate of the observation group was significantly slowed down (t=2.72,P＜0.01),systolic blood pressure and diastolic blood pressure were also significantly reduced (t=2.93,3.98,all P＜0.01).The total effective rate of the observation group was 93.3％,which of the control group was 73.3％,the difference was statistically significant (χ2=4.32,P＜0.05).ConclusionIrbesartan combined with metoprolol in the treatment of chronic congestive heart failure has significant clinical efficacy,is conducive to ease the clinical symptoms and improve heart function effectively.

Objective To explore the clinical curative effect of ursodeoxycholic acid combined with reduced glutathione for non-alcoholic fatty liver disease.Methods 128 patients with non-alcoholic fatty liver disease in our hospital were selected, and they were randomly divided into control group and research group,64 cases in each group.The control group received ursodeoxycholic acid capsules, the research group received reduced glutathione tablet on the basis of ursodeoxycholic acid capsules,the two groups received treatment of two periods, each period had one and half months.The liver function and blood lipid were detected and compared between the two groups.Results The total clinical effective rate of the research group was 93.75%, which of the control group was 68.75% (x2=20.5,P=0.000),the difference was statistically significant.After treatment, liver function (ALT, AST, TBIL, GGT and ALP) and lipid levels (TG and CHO) of the two groups were improved significantly[the control group:before treatment (138.75±30.63) IU/L,(161.72±55.61) IU/L,(183.65±58.47) μmol/L,(213.65±40.35) IU/L,(82.38±23.15) IU/L,(2.85±0.77) μmol/L,(6.45±0.37) μmol/L, after treatment (66.38±26.31) IU/L,(65.39±22.15) IU/L,(92.38±36.15) μmol/L,(99.68±36.72) IU/L,(30.23±10.36) IU/L,(1.92±0.58) mol/L,(5.39±0.53) μmol/L;the research group before treatment (141.25±32.53) IU/L,(157.56±58.31) IU/L,(190.23±51.27) μmol/L,(223.72±43.18) IU/L,(80.86±21.85) IU/L,(2.92±0.73) μmol/L,(6.43±0.82) μmol/L, after treatment (37.64±11.25) IU/L,(36.25±11.83) IU/L,(47.67±8.32) μmol/L,(70.52±26.31) IU/L,(16.69±7.32) IU/L,(1.32±0.63) μmol/L,(4.31±0.63) μmol/L],the differences were statistically significant(the control group :t=14.3,12.9,10.6,16.7,16.4,7.7,13.1,all P<0.01;the research group:t=24.1,25.4,21.9,24.2,16.1,13.3,16.4,all P<0.01),but these indicators of the research group were improved significantly better than those of the control group, the differences were statistically significant(t=8.0,9.3,9.6,8.5,8.5,5.6,10.5;all P<0.01).Conclusion The clinical curative effect of research group is distinct, safe and has no obvious adverse reactions, which is worthy of clinical application.

Objective Hepatitis-associated aplastic anemia( HAAA) is a rare and severe disease that can be fatal,if left untreated. In the childhood,it is a syndrome in which marrow failure follows the develop-ment of hepatitis. The aim of this study was to summary clinical characteristic of children with HAAA. Methods We retrospectively reviewed the hospital records of 7 children with HAAA from 2001 to 2010,and summarized and classified the clinical features of HAAA,the laboratory characteristics in 7 patients with com-bined aplastic anemia and severe hepatits,the immune status of those patients,the pathogen of those patients and the results of treatment. Results The average age of patients was 11. 1 years old(8~14 years old). The clinical features were similar in all cases. The early stage of disease,all the children had markedly elevated liver enzyme levels and peripheral blood count was normal. After symptomatic treatment,the hepatic function began to recover but appeared pancytopenia. Bone marrow biopy showed hypoplasia. The median time from onset of hepatic symptoms until diagnosis of aplasic anemia was 43. 3 days. All the children had immune dis-order. Only one boy showed parovirus B19-IgM positive and another girl was diagnosed as acute HAV hepati-tis,the pathogen results of other children were negative. All the patients were treated by immunosuppressive therapy,one patient gave up due to some reasons and others had completed remission. Conclusion HAAA is a life-threatening hematologic disorder in which an episode of hepatitis precedes AA by a period of weeks or months. Characteristically,the HAAA syndrome is more prevalent among young men. It is reported that it is in a higher frequency of patients with non-A,non-B hepatitis. Clincal features and experimental results strong-ly suggest a central role for an immune-mediated pathogenesis. The main treatment is immunosuppressive therapy,which include hormone,antithymocyte glubulin and cyclosporine.

In constructing the system of medical functional teaching and enhancing the quality and ability of students,we adjust the content and method of teaching in practice,and try to find students'problems in study through questionnaire survey and promote teaching reform and disciplines construction.

Objective To investigate the underlying mutation in a late-onset Chinese patient with classic Bartter syndrome. Methods The mutation analysis of CLCNKB gene was performed by the PCR direct sequencing. The patient's parents and siblings were studied as well. Fifty normal volunteers were analyzed as control group. Results The heterozygous deletion mutation cDNA 753delG and heterozygous missense mutation G433E were detected in the patient. Her father was found to carry heterozygous G433E and her mother to carry cDNA 753delG mutation respectively. Her brother carried heterozygous G433E and her sister was normal. Conclusions Two mutations of the CLCNKB gene in this Chinese patient with late-onset classic Bartter syndrome are identified. The cDNA 753delG mutation has not been reported previously.

This study aimed to investigate the drug susceptibility of wild-type and mutant avian influenza A (H7N9) virus neuraminidase (NA) to oseltamivir and zanamivir. Codon optimized DNA of H7N9 (A/ Hangzhou/1/2013) NA was synthesized and constructed into the pcDNA3.1/His vector (NA(H7N9-WT)). Mutant NA(H7N9-H274Y) and NA(H7N9-R292K) plasmids were constructed by directed mutagenesis PCR using NA(H7N9-WT) plasmid as the template followed by sequencing. NA plasmids were transfected into 293T cells and cell lysates containing NAs were collected 48 h post-transfection. Wild-type and mutant NAs were analyzed by Western blotting and their activities were tested by the 4-MUNANA-based assay. All three NAs were expressed and enzymatic activities were confirmed. The effects of oseltamivir and zanamivir on all three NAs were then tested. It showed that the half maximal inhibitory concentrations (IC50s) of oseltamivir carboxylate on NA(H7N9-WT), NA(H7N9-H274Y) and NA(H7N9-R292K) were 1.6 nM, 15.1 nM, and > 1 000 nM with fold changes of 9 and > 625, respectively. The IC50 values of zanamivir on NA(H7N9-WT), NA(H7N9-H274Y), and NA(H7N9-R292K) were 1.1 nM, 1.4 nM, and 38.0 nM with fold changes of 1.3 and 34, respectively. These results indicated that oseltamivir and zanamivir could significantly inhibit NA(H7N9-WT). NA(H7N9-R292K) showed high-level resistance to both drugs (34-fold and 625-fold) and NA(H7N9-H274Y) was sensitive to both (1.3-fold and 9-fold). These results indicated that both oseltamivir and zanamivir could be used for patients infected with the H7N9 virus. However, when patients carried the H7N9 virus with a NA R292K mutation, other medications would be preferred over oseltamivir or zanamivir.
Antiviral Agents ; pharmacology ; Humans ; Influenza A Virus, H7N9 Subtype ; drug effects ; enzymology ; genetics ; Influenza, Human ; virology ; Microbial Sensitivity Tests ; Mutation ; Neuraminidase ; antagonists & inhibitors ; genetics ; metabolism ; Oseltamivir ; pharmacology ; Viral Proteins ; antagonists & inhibitors ; genetics ; metabolism ; Zanamivir ; pharmacology

Objective To investigate the effect of Zidan decoction containing serum on endometrial receptivity in uterine immunity environment,and then to discuss if it's effect on endometrial receptivity through its controlling the expression of cell factors which related to endometrial receptivity.Methods Mice's endometrium tissue samples and uterine Natural Killer (UNK) cells were obtained from pregnant mice on gd 4.5 days and gd 12.5 days.After endometrial glandular epithelial cells,endometrial stromal cells and UNK cells were separated through primary culture,epithelial cells and endometrial stromal cells at rate of 1 ∶ 1 a certain concentration UNK were mixed together and highly purified-cultured.Different concentrations of Zidan decoction was acted on the culture solution.FBS,black and aspirin control group were setup for contrast.The expression of LIF and VEGF which influenced by Zidan decoction in the immunity environment was assayed by Realtime-PCR.Results The expression of LIF and VEGF was significantly increased in the immunity environment of uterine (in 10％ Zidan decoction group,10％ aspirin group and 10％ blank control group:LIF was 2.10±0.20,1.98±0.14,0.90±0.05 separately,and VEGF was 3.17±0.31,2.52±0.09,0.92±0.06respectively,P＜0.05).Conclusion Zidan decoction could improve endometrial receptivity by increasing the expression of cell factor which related to endometrial receptivity with the help ofUNK paracrine.

Objective To summarize the clinical features of neonatal lower respiratory tract infection of respiratory syncytial virus (RSV). Methods Data of newborns admitted into Deparrment of Neonatology of Yuying Children Hospital of Wenzhou Medical College from January to December 2010 with RSV lower respiratory tract infection were retrospectively analyzed. The characteristics of clinical manifestation,examination,treatment and prognosis were studied.Factors affecting the duration of hospitalization were analyzed with x2 test. Results Of 354 cases of neonatal lower respiratory tract infection,75 (21.2％) were RSV positive,whose attack time was from 5 to 25 days with an average of 13.2 days; and there were two preterm infants (2.7％).The chief clinical manifestations were cough (100.0％,75/75),followed by shortness of breath (56.0％,42/75),spittle (52.0％,39/75) and fever with temperature ≥38.0 ℃ (25.3％,19/75).The white blood cell count of one newborn was higher than 20.0× 109/L; 52 cases (69.3％) had higher blood lymphocyte percentage (＞ 0.48) ; eight cases (10.7％) had higher level of C-reactive protein (≥ 8 mg/L).Among the 58 patients who underwent blood gas analysis,28 (48.3％) had carbon dioxide retention (partial pressure of carbon dioxide≥ 45 mm Hg). Chest X-ray results within 48 hours after hospitalization suggested that 52.0％ patients (n =39) had pneumonia and 20.0％ (n=15) had bronchitis.Among 69 patients who had sputum cultures,20 cases were positive.And for the 11 cases who had blood cultures,three were positive for Staphylococcus epidermidis.Finally,73 cases were cured,two were improved and no death was reported.The duration of hospitalization was from 3 to 17 days with an average of 8.4 days.Neonates with RSV lower respiratory tract infection who had higher C-reactive protein (≥8 mg/L),carbon dioxide retention,nasal oxygen catheter or assisted ventilation had higher percentage of longer hospital stay (≥7 days). Conclusions Compared with infants,the clinical characteristics of RSV lower respiratory tract infections in neonates are atypical,which are mainly menifested by cough,shortness of breath,spittle,but rare wheezing.There are no effective interventions against RSV infection except for supportive therapy.

Objective To study the changes of serum NO, TGF-β1, IL-10 and IL-17 Levels and study of the efficacy of Bismuth - containing quadruple and standard triple therapy for patients with Hp positive peptic ulcer. Methods 109 cases of peptic ulcer treated in our hospital were retrospectively selected, and Hp test was positive. According to different dosing regimen, the patients were divided into two groups. There were 54 patients in the control group, using standard triple therapy, and the regimen was lansoprazole, amoxicillin, and metronidazole. 55 patients in the study group were treated with bismuth-based western therapy with bismuth potassium citrate, rabeprazole, amoxicillin, and furazolidone. Two weeks after treatment were regarded as the observation period, and the levels of serum NO, TGF-β1, IL-10 and IL-17 in the two groups were compared before and after treatment. The effective rate of ulcer healing, Hp clearance rate and incidence of adverse reactions were compared. Results The level of serum NO, TGF-β1, IL-10 and IL-17 was significantly lower than that in the control group (P <0.05). The effective rates of ulcer healing and Hp clearance in the study group were significantly higher than those in the control group (P <0.05). There was no significant differences between the study group and the control group in the incidence of adverse reactions. Conclusion Western medicine with bismuth in the treatment of Hp peptic ulcer patients, the serum NO, TGF-β1, IL-10 and IL-17 levels of indicators have significantly improved, and has obvious advantages in clinical treatment, and it is a reasonable dosing regimen of high efficiency and low recurrence.

AIM:To investigate peripapillary vessel density and its relationship with other ocular parameters in highly myopic eyes with peripapillary intrachoroidal cavitation (PICC), and to analyze risk factors for PICC.METHODS:Cross-sectional study.A total of 35 highly myopic eyes with PICC, 40 highly myopic eyes without PICC and 35 normal eyes were included in this study.All participants underwent fundus photography and spectral-domain optical coherence tomography (SD-OCT).OCT angiography was also performed to image the retinal vasculature in the peripapillary areas of different sectors, including the radial peripapillary capillaries (RPC) and optic nerve head (ONH) layer.The difference of morphology changes in optic disc and peripapillary vessel density between these three groups were compared.Correlations between peripapillary vessel density and PICC and risk factors for the presence of PICC were analyzed.RESULTS: Significant differences were found among the three groups in spherical equivalent refraction (SER), best-corrected visual acuity (BCVA), axial length, peripapillary atrophy β-zone (β-PPA) area, retinal nerve fiber layer (RNFL) thickness and the presence of tilted optic disc, posterior staphyloma and myopic maculopathy (MMD) (P<0.05).There were significant differences among the three groups in the peripapillary vessel density both in RPC (54.34±5.58, 57.54±7.44, 64.42±3.50) and ONH (51.24±7.43, 52.75±9.96, 61.25±4.15) layers (P<0.001).In highly myopic eyes, vessel density was significantly lower in eyes with PICC than in those without in inferotemporal area both in the RPC (56.76±6.62,63.84±6.02,67.52±4.78) and ONH (56.47±5.79,60.38±4.72,64.18±4.37) layers.The vessel density was significantly correlated with the presence of MMD, β-PPA area and RNFL thickness in the RPC layer, whereas correlated with the presence of MMD, PICC and RNFL thickness in the ONH layer (P<0.05).Tilted optic disc and posterior staphyloma were independent risk factors for the presence of PICC (OR=8.007, 95%CI: 2.045-31.348;OR=7.558, 95%CI: 1.398-50.026).CONCLUSION:Highly myopic eyes with PICC had relatively lower peripapillary vessel densities, especially in the temporal area, than those without.Tilted optic disc and posterior staphyloma were independent risk factors for the presence of PICC.