Alzheimer′s patients bring heavy burden to their family and society, causing potential safety prob-lems unable to escort for a long time with the family, physical constraints between protection and between self-es-teem and the mental health law,the quality of life and life values produce a series of contradiction and ethical is-sues,also make close contact with their nursing staff have to face the moral and ethical dilemma.The suggestions are:Hospital provides professional full-time, professional pension caregivers of alzheimer′s patients for long-term care, Strengthen the communication of nursing staff and patients′families, Reasonable and legitimate use tools, Perfect medical system construction, buildMedical support combinedcare system, Carry out the comprehensive rehabilitation nursing intervention, improve the patients quality of life, Change service concept, strengthening the study of ethical knowledge and application to promote the doctor-patient relationship.

ObjectiveTo analyze the Uridine diphosphoglucuronyl transferase 1 A1 gene (UGT1A1) mutation in non-he-molytic indirect hyperbilirubinemia.MethodsA female patient was diagnosed with type I Crigler-Najjar syndrome (CNS-I) after excluding hemolysis and hypothyroidism. Phototherapy treatment is effective while oral phenobarbital was not. UGT1A1 were ampliifed by polymerase chain reaction and DNA was sequenced.ResultsThe patient was compound heterozygote of c.1070A>G p. (Gln357Arg) and 1091C>T p. (pro364Leu) and diagnosed with CNS-I. Heterozygotes of the mutation were found in her parents.ConclusionsIn patients highly suspected of CNS, the genetic tests should be carried out as soon as possible.

Objective To analyze the gene abnormality and liver pathology in Shwachman-Diamond syndrome (SDS) in a child. Method The clinical data of one child with SDS were analyzed retrospectively. Result A male patient was 1 month old at onset with neutrophil decrease as the first manifestation, accompanied by anemia, elevated transaminase and repeated infection. Exocrine pancreatic dysfunction was atypical. Pathological examination of liver biopsy showed slight damage of liver cells under light microscope. The blood samples of child and parents were collected, and homozygous mutations of SBDS (NM_016038.2) Intron2 c.258+2T>C p.? were detected by two generation gene sequencing. And these mutations were from both his parents. Conclusion Gene testing is helpful in diagnosing SDS and we suggest that liver biopsy should be performed if condition allows.

Objective: To investigate effect of Zhuanggu Granula medicated serum on proliferation and differentiation of bone marrow stromal cells(BMSCs) in vitro. Methods: Isolated BMSCs were cultured in vitro. The cells were treated with Zhuanggu Granula medicated serum, and the blank serum as the control group. The proliferation of cells was detected by MTT assay, the macroscopic histology, HE staining and immunohistoc-hemical examinations. Results: Zhuanggu Granula medicated serum effectively stimulated BMSCs proliferation (P

Objective To observe the feasibility of using bone marrow-derived mesenchymal stem cells (MSCs) as seed cells for tissue-engineering in Otolaryngology. Method MSCs were isolated from bone marrow of human rib and purified by centrifuge and cultured in vitro. The proliferation and growth characteristics of MSCs were observed in primary and passage culture. Result Human bone marrow-derived MSCs showed active proliferation capacity in vitro in primary and passage cultures. Conclusion Human bone marrow-derived MSCs have relatively young biologic age and they can be used as the seed cells for tissue engineering.

OBJECTIVE To study the antitumor activity and underlying mechanisms of Xiaoaiping injection(Xap)combined with gefitinib(Gef)in nude mice bearing resistant non-small cell lung cancer (NSCLC) cells H460 or H975. METHODS BALB/c nude mice were inoculated with human NSLCL cells H460 or H1975 and the drug treatment did not start until the tumor volume reached 50-100 mm3. The tumor bearing mice were divided into four groups:control group,Xap group(5 g · kg-1,ip),Gef group (50 mg · kg-1,ig),and Xap plus Gef group. All the administration lasted for 21 d continuous. Tumor volumes were measured two or three times per week,and the body weight of animals was re-corded. At the end of the test,tumors were weighed after the sacrifice of mice. Tumor inhibition rate and relative tumor proliferation rate were calculated based on tumor weight and tumor volume. The related biomarkers and proteins in tumor tissues were detected by immunohistochemistry and Western blot assay, respectively. RESULTS Compared with the control group,no significant effect was observed on the growth of H460 and H1975 xenografts in groups of Xap or Gef alone in nude mice. However,the two-drug combination significantly suppressed tumor volume,with (1103 ± 340) versus (3020 ± 450) mm3 for H460 and(487 ± 153)versus(1269 ± 161)mm3 for H1975,respectively(P<0.05). The combined Xap and Gef application also significantly reduced the tumor weight,with(1.20±0.52)versus(2.78± 0.93)g for H460 and(0.52 ± 0.32)versus(0.92 ± 0.42)g for H1975,respectively(P<0.05). The relative tumor proliferation rate and inhibition rate in the combination group was 42.1%and 43.5%for H460(P<0.01),43.0%and 52.5% for H1975(P<0.01). Compared with Xap and Gef drug alone,their combination showed significant difference in reducing tumor weight,suppressing tumor proliferation rate and increasing tumor inhibition rate(P<0.05). Immunohistochemistry results showed that each drug alone had no effect on tumor angiogenesis markers of vascular endothelial growth factor(VEGF)and CD105 expression,or on drug resistance related proteins of p-ERK,p-Akt and p-mTOR,whereas the combination of Xap and Gef obviously reduced the expression of these biomarkers in H460 and H1975 tumor tissues. The decreased drug resistance related proteins of p-PI3K and its downstream molecules p-Akt,p-ERK and p-mTOR by the two-drug combination were also confirmed by Western blot results(P<0.01,compared with control), and showed significant difference compared with each single treatment(P<0.05). CONCLUSION The addition of Xap significantly improves the antitumor activity of Gef in H460 and H1975 xenografts,and this synergistic effect may be ascribed to the inhibition of tumor angiogenesis,the down-regulation of PI3K and its downstream signaling molecules which are associated with drug resistance.

Objective To evaluate percutaneous transluminal angioplasty ( PTA) for stenosed arteries of the lower extremities in patients with ischaemic diabetic foot. Methods We retrospectively analyzed the clinical and follow-up data of using PTA to treat diseased infrapopliteal arteries in diabetic patients who were hospitalized from Oct,2006 to May,2008. Results Technical success rate was 87% , procedure related complications developed in 8. 9% of patients, postoperative complications were 11. 1% , perioperative mortality was 2. 5% , limb salvage rate was 90% , pain symptom was significantly mitigated or relieved, ulcer healed well. The median hospitalstay was 10 days. Restenosis rates were 38. 1 % , 50% respectively at 1 year and 2 years. Rest pain and ulcer recurrence rates were 10% and 12% at 1 year and 2 years respectively; Amputation rates were 10% and 15. 3% at 1 year and 2 years. Restenosis ( or occlusion) , rest pain or ulcer recurrence and amputation rate in Fontain Ⅳ group is significantly poorer than that in Fontain Ⅰ - Ⅲ group (P ＜0. 05). Conclusions Percutaneous transluminal angioplasty (PTA) for critical limb ischeamia in patients with ischaemic diabetic foot are feasible, with minimal invasiveness, low complications. Fontain classification predicts PTA thrapeutic results.

Objective To evaluate the efficacy of Sacubitril/Valsartan in the treatment of chronic heart failure in elderly patients with dilated cardiomyopathy.Methods A total of 126 elderly patients with dilated cardiomyopathy induced chronic heart failure who were treated in Beijing Anzhen Hospital from January 2017 to December 2017 were enrolled and randomly divided into the experimental group(n=62)and the control group(n=64).All patients were given a standard heart failure treatment,and the experimental group underwent sacubitril/valsartan(100 mg Bid)and the control group received benazepril (10 mg Qd)additionally for 12 months.Left ventricular ejection fraction(LVEF),N-terminal pro-brain natriuretic peptide(NT-proBNP),six-minute walk test(6MWT) and major adverse cardiovascular events(mortality and readmission for heart failure)were compared between the two groups.Results Of 126 elderly patients,73 patients(57.9％)were male,and 53were female,with a mean ± SD age of (67.2 ± 5.8) years.Basic characteristics,including age,gender,clinical history of hypertension and diabetes,LVEF,NT-proBNP and 6MWT,showed no significant difference between two groups (P ＜ 0.05).After 12 months of treatment,symptomatic hypotension occurred in one cases in each group.In the control group,NT-proBNP level was decreased after treatment as compared with before treatment[(983.3± 326.1) ng/L vs.(1 779.1 ± 478.1) ng/L,P ＜0.05],and no significant difference was found in LVEF and 6MWT at post-treatment versus pretreatment(P ＞ 0.05).In the experimental group,LVEF,NT-proBNP level and 6MWT were significantly improved in post-treatment versus pre-treatment (P ＞ 0.05).And LVEF,NT-proBNP level and 6MWT were significantly better in the experimental group than in the control group[(38.5 ±3.1)％ vs.(36.9±3.0)％,(744.5±246.7) ng/L vs.(983.3±326.1) ng/L,(323.4±60.5) m vs.(283.5±45.9)m,P＜0.05].The readmission rate for heart failure was lower in the experimental group than in the control group(26.6％ or 19 cases vs.46.8％ or 30 cases,P＜0.05),while no significant difference was found in mortality between the two groups (P ＞ 0.05).Conclusions Compared with benazepril,sacubitril/valsartan can improve the left ventricular function and exercise tolerance,and reduce the readmission rate due to chronic heart failure in patients with dilated cardiomyopathy.However,more studies are needed to assess the effects of sacubitril/valsartanthe on the prognosis of advanced elderly patients(＞88 years old)who have a preserved LVEF and a chronic end-stage heart failure(NYHA Ⅳ),and start the drug administration at different time points(before or after discharge).

Objective To investigate the effects of percutaneous coronary intervention(PCI)on life quality and cardiac events in elderly patients with stable angina owing to chronic coronary total occlusion(CTO).Methods Patients with stable angina due to CTO hospitalized in Beijing Anzhen Hospital from January 2015 to January 2018 were consecutively recruited in this prospective study,and were randomly divided into the combined treatment group(n=44)and the control group (n=43).Patients in the combined treatment group were treated with PCI and optimal medical therapy,and those in the control group were treated with optimal medical therapy alone.Patients followed up for 6 months after treatment.Cardiac function,life quality(Seattle angina questionnaire,SAQ)and adverse cardiovascular events were compared before and after treatment.Results A total of 87 patients were involved,with a mean age of (69.5 ± 7.2) years.Basic characteristics,including age,sex ratio,previous history,left ventricular ejection fraction,coronary artery lesions and SAQ scores,were similar between the groups(P＞0.05).After a 6 month post treatment follow up,SAQ scores improved in all patients,compared with those before treatment(P＜0.05).Moreover,patients in the combined treatment group had higher SAQ scores on physical limitation(86.3 ± 11.6 vs.76.3 ± 21.3),angina stability(67.3 ±24.5 vs.57.3±21.2)and angina frequency(93.3±4.3 vs.86.4±8.3)than those in the control group (P ＜0.05).There was no significant difference in major adverse cardiovascular event rate between the groups[18.2％(8 cases) vs.16.3％(7 cases),X2 =0.055,P＞0.05].Conclusions Combined with optimal medical therapy,PCI can improve the life quality in elderly patients with stable angina due to CTO,but has no significant influence on the short-term major adverse cardiovascular event rate.

OBJECTIVE: To explore the genetic basis for a child with infantile liver failure syndrome type 2 (ILFS type 2). METHODS: Clinical features of the child were analyzed. Next generation sequencing was also carried out for him. RESULTS: The child was found to harbor compound heterozygous variants of the NBAS gene, which included a novel nonsense c.2746A>T (p.R916X, 1456) variant in exon 24 and a missense c.3596G>A (p.C1199Y) mutation in exon 31, which has been associated with ILFS type 2. The two variants were respectively inherited from his father and mother. CONCLUSION The compound heterozygous variants of c.3596G>A and c.2746A>T of the NBAS gene probably underlay the ILFS type 2 in this child.
Child ; Exons/genetics* ; Genetic Testing ; High-Throughput Nucleotide Sequencing ; Humans ; Liver Failure ; Male ; Mutation