Objective To explore effects of different doses of fluvastatin on serum hs -CRP,NT -proBNP in patients with coronary heart disease (CHD)and chronic heart failure (CHF)and its clinical efficacy.Methods 120 CHD patients with CHF were randomly divided into three groups,each group included 50 cases.Each group received the therapy of 20mg/d(20mg group),40mg/d(40mg group),and 80mg/d(80mg group),respectively,three groups were treated for 12 weeks.The related indicators were compared among the three groups before and after treat-ment,and the incidence of major cardiovascular events (MACE )and adverse reactions were recorded.Results There was no statistically significant difference between groups before treatment (P >0.05).The serum hs -CRP and BNP of three groups were significantly different after treatment(F =185.956,16.824,all P <0.05).The hs -CRP and NT -proBNP of 80mg group were lower than those of group 20mg and 40mg group (hs -CRP:LSD -t value =3.143,4.113,all P <0.05;NT -proBNP:LSD -t value =2.986,3.765,all P <0.05).The △hs -CRP,△NT -proBNP of C group were higher than those of 20mg group and 40mg group(LSD -t value =4.783,5.819,all P <0.05).The TC,TG,LDL -C of three groups were significantly different after treatment (F =14.402,10.929, 121.968,all P <0.05).The TC,TG,LDL -C of 80mg group were lower than those of 20mg group and 40mg group (LSD -t value =3.538,4.765,4.387,all P <0.05).The ALT,CPK of three groups had no significant differences before and after treatment (P >0.05).The incidence of MACE in 80mg group was lower than that in 20mg group and 40mg group.However,the incidence of three groups had no significant difference after treatment (P >0.05 ). Conclusion The treatment of high -dose fluvastatin can significantly decrease inflammatory of CHD patients with CHF,and also decreases the NT -proBNP level,effectively control lipid levels,the treatment is safe and worthy of clinical recommendations.

Objective To summarize the experience in nursing locally preserved skin of female patients for neurosurgical cranioctomy. Method The nursing key points were given to 66 female patients undergoing local preparation of skin for cranioctomy as follous preoperative preparation, observation over incision and head nursing. Results The time for skin preparation ranged between 3 to 6 minutes. Postoperatively, no drain tube was placed. No intracranial infections occurred. The incisions in all patients were healed at the first class. Conclusion The nursing measures of good preoperative preparation, close observation of incisions and care to the head for female patients undergoing local preparation of skin for cranioctomy can enhance their satisfaction and propel development of standardized nursing.

Objective To investigate the application of combined detection of three serum markers,anti-cyclic citrullinated peptide antibody (anti-CCP),rheumatoid factor (RF),anti-keratin antibodies (AKA),for the diagnosis of rheumatoid arthritis.Methods This was a prospective study.Serum samples were randomly obtained from 137 RA patients,265 other autoinmmune diease patients,and 111 normal controls.All of the volunteers were outpatients or inpatients of Peking University Third Hospital from January 2011 to September 2013.Levels of AKA,anti-CCP antibody,RF were measured by indirect immunofluorescence,chemiluminescence,and immune turbidimetry,respectively.The values of 3 serum biomarkers and their varied combinations for RA diagnosis were systemically assessed.The results were compared using fourfold table chi-square (x2) test.Results When using one serum marker,anti-CCP had the highest accuracy (80.39％),Youden's index (YI) (0.51),and Kappa (κ) value (0.55) for the diagnosis of RA.While using three serum markers,anti-CCP + (AKA/RF),AKA /(anti-CCP + RF),anti-CCP/(AKA + RF) and (AKA + RF)/(anti-CCP + RF)/(AKA + anti-CCP) had the highest accuracy (80.94,80.94,80.66),YI (0.51,0.51,0.50),and κ value (0.55,0.56,0.54).Conclusion AntiCCP is the vital marker for RA diagnosis.Anti-CCP + (AKA/RF),AKA/(anti-CCP + RF),and (AKA +RF)/(anti-CCP + RF)/(AKA + anti-CCP) are the most ideal combinations for RA diagnosis.

Objective To investigate the features,prevention and treatment of complications of ultrasound-guided hepatic puncture biopsy.Methods One hundred and seventy-five cases underwent ultrasound-guided hepatic puncture biopsy were retrospectively analyzed.Results The incidence of complications was 16 cases (9.1%),including 5 cases with vasovagal episodes(2.9%),4 cases with ache which needed medicine treatment (2.2%),3 cases with hemorrhage in liver capsule(1.7%),3 cases with hypoglycemia(1.7%),1 case with serve hemorrhage in abdominal cavity(0.6%).Hemorrhage limited in liver capsule,vasovagal episodes,hypoglycemia and ache were relieved with corresponding treatments.One case with hemorrhage in abdominal cavity was handled with percutaneous microwave ablation therapy guided by contrast-enhanced ultrasound.Conclusions Ultrasound-guided hepatic puncture biopsy has good value and low complication.The most severe complication is hemorrhage,which can be handled with percutaneous microwave ablation therapy guided by contrast-enhanced ultrasound.

Objective To explore the expressions of Toll-like receptors (TLRs) 2 and 4 in mouse skin during early immune responses against Sporothrix.Methods A total of 60 BALB/c mice were randomly and equally divided into an experimental group and a control group to be intracutaneously injected with Sporothrix conidium suspensions at a concentration of 1 × 106 cfu/ml and sodium chloride physiological solution respectively.Five mice were sacrificed before the injection,and at 6,12,24,48,and 96 hours after the injection in each group,blood samples were obtained from the mice before sacrifice,and skin tissue specimens were resected from the area around the injection sites after sacrifice.Realtime fluorescence-based quantitative PCR was performed to quantify the mRNA expressions of TLR2 and TLR4,and immunohistochemical staining to observe the protein expressions of TLR2 and TLR4 in mouse skin specimens.Enzymelinked immunosorbent assay (ELISA) was conducted to determine the levels of interleukin 12 (IL-12) and tumor necrosis factor α (TNFα) in serum samples from the mice.Results After injection of Sporothrix conidium suspensions,the mRNA expression level of TLR2 gradually increased and peaked at 24 hours,which was 18.8 times that in the control group at 6 hours and 34 times at 24 hours.In addition,the mRNA expression level of TLR4 in the experiment group reached a peak,and was 56.7 times that in the control group at 6 hours after injection,then gradually decreased and reached the nadir at 96 hours.As immunohistochemical staining revealed,TLR2 and TLR4 were apparently expressed in both keratinocytes and macrophages in skin specimens from the experimental group,but not obviously in those from the control group.No significant differences were observed between the experimental group and control group in serum levels of IL-12 or TNF-α at any of the sampling time points.Conclusion TLR2 and TLR4 may play a favoring role in immunological defense by participating in the recognition of Sporothrix by keratinocytes and macrophages in mouse skin.

Objective To strengh the awareness of acute T-B cell biphenotypic leukemia.Methods Four new cases of acute T-B cell biphenotypic leukemia were reported and the related literature were reviewed.Results Fourteen patients with acute T-B cell biphenotypic leukemia.including 4 diagnosed at our hospital and other 10 cases reported in literature,were retrospectively analyzed.Similar clinical fleatures as the typical acute lymphocytic leukemia(ALL) were presented.Ten of 14 cases were male and were within 17 to 46 years old.The disease were refactory to the conventional ALL chemotherapy regimens and deteriorated progressively.Six patients died within 12 months after their diagnosed with the median survival time of ten months. Conclusion Acute T-B cell biphenotypic leukemia is one of the most rare type of leukemia.A better understanding of the clinical and hematological features of this type of leukemia and new therapeutic strategies are needed.

We evaluated the differential expression and function of chitinase 3‐like‐1 in macrophage stimulated by Sporothrix schenckii and Candida albicans fungicidal ability of macrophage after stimulation with Sporothrix schenckii and Candida albi‐cans separately was detected .The expression of CHI3L1 gene in macrophage stimulated by Sporothrix Schenckii and Candida albicans was evaluated with real‐time PCR .The function of CHI3L1 protein in macrophages against the reproduction of Sporo‐thrix schenckii and Candida albicans was detected in vitro .Results showed that macrophages could engulf and kill Sporothrix Schenckii and Candida albicans in vitro .The expression of CHI3L1 gene in macrophage stimulated by Candida albicans was increased obviously .At the same time ,CHI3L1 protein can damper the reproduction of Candida albicans .However ,the ex‐pression of CHI3L1 gene was not elevated when macrophage was stimulated by Sporothrix schenckii and CHI3L1 protein played little role in reproduction of Sporothrix schenckii .The expression of CHI3L1 gene in macrophage was elevated after stimulation with Candida albicans ,but was not elevated with Sporothrix Schenckii .In correspondence with differential ex‐pression ,CHI3L1 in macrophages could impair the reproduction of Candida albicans but had a weak function on Sporothrix schenckii which might contribute to the pathogenesis of spo‐rotricosis .

Background and purpose: The literature on dose-volume parameters and pneumonitis is extensive. The results are inconsistent, both for the best predictive metrics and significant comorbid factors. This study aimed to investigate a prospective functional equivalent uniform dose (fEUD) with perfusion single photon emission computed tomography (SPECT) images as predictors of radiation pneumonitis (RP) in patients undergoing curative radiotherapy (RT). Methods: Functional lung imaging was performed using SPECT for perfusion imaging. Perfusion factors were defined as the mean percentile perfusion levels of the 4 areas, top to 75%, 75% to 50%, 50% to 25%, 25% to 0%, re-spectively. fEUD was calculated from perfusion factors and standard dose-volume parameters extracted from treatment planning computed tomography (CT) scans. Total lung (TL), ipsilateral (IL) and contralateral lung (CL) volumes minus gross tumor volume (GTV), whole-lung V5, V20, whole lung fEUD, IL and CL fEUD, and general equivalent uniform dose (gEUD) were analyzed to evaluate correlations between RP using Common Terminology Criteria for Adverse Events (CTCAE) version 4.03. Statistical significance was defined as P<0.05. Results: A total of 15 patients treated with intensity modulated RT or 3D conformal RT were analyzed, grades≥3 RP were observed in 6 patients. There was only a trend toward significance for unilateral (UL) fEUD of higher dose side (P=0.007). Whole-lung V5, V20 were almost identical between patients who developed pneumonitis and patients who did not, as the values were below the recommended thresholds from published papers. Unilateral fEUDs were linear with unilateral gEUDs (t=0.815, P=0.000). Conclusion: SPECT-based equivalent uniform dose appears to be a better predictor of RP compared to stan-dard dose-volume parameters. Planning constraints should aim to keep unilateral fEUD below 21 Gy.

Objective To investigate changes in serum levels of antinuclear antibody(ANA), anti?double?stranded DNA(dsDNA)antibody and anti?extractable nuclear antigen(ENA)antibody before and after anti?tumor necrosis factor?α(TNF?α)therapy in psoriatic patients. Methods Clinical data obtained from 32 patients with psoriasis were analyzed retrospectively. Of the 32 patients, 13 received intravenous injection of 5 mg/Kg infliximab at week 0, 2, 6 for 3 sessions, then once every 8 weeks(infliximab group), while other 19 received subcutaneous injection of 25 mg etanercept twice every week(etanercept group). The treatments in the 2 groups both lasted more than 3 months. Serum levels of ANA, anti?dsDNA antibody and anti?ENA antibody and changes of clinical symptoms were detected and observed respectively before each treatment in the infliximab group, as well as every 3- 6 months in the etanercept group. The 75%reduction in psoriasis area and severity index(PASI75)and disease activity score of 28 joints(DAS28) were used to evaluate clinical efficacy. Serum levels of ANA, anti?dsDNA antibody and anti?ENA antibody were measured by indirect immunofluorescence(IIF)assay, Western blot analysis combined with enzyme?linked immunosorbent assay(ELISA), and Western blot analysis, respectively. Results After 3?month treatment, the 32 patients achieved clinical remission to different extents. Of 32 patients receiving anti?TNF?αtherapy, 7(21.9%)developed new autoantibodies. Concretely speaking, 4 patients in the infliximab group developed autoantibodies in 8.3 ± 5.1 months, including 3 cases positive for ANA and 3 for anti?ENA antibody. Three patients in the etanercept group developed autoantibodies in 9.0 ± 3.0 months, including 3 cases positive for ANA and 1 for anti?ENA antibody. Conclusion Partial patients with psoriasis may develop autoantibodies after anti?TNF?αtherapy.

To explore one-step method for the preparation of Ganoderma lucidum multicomponent microemulsion, according to the dissolution characteristics of triterpenes and polysaccharides in Ganoderma lucidum, formulation of the microemulsion was optimized. The optimal blank microemulsion was used as a solvent to sonicate the Ganoderma lucidum powder to prepare the multicomponent microemulsion, besides, its physicochemical properties were compared with the microemulsion made by conventional method. The results showed that the multicomponent microemulsion was characterized as (43.32 +/- 6.82) nm in size, 0.173 +/- 0.025 in polydispersity index (PDI) and -(3.98 +/- 0.82) mV in zeta potential. The contents of Ganoderma lucidum triterpenes and polysaccharides were (5.95 +/- 0.32) and (7.58 +/- 0.44) mg x mL(-1), respectively. Sonicating Ganoderma lucidum powder by blank microemulsion could prepare the multicomponent microemulsion. Compared with the conventional method, this method is simple and low cost, which is suitable for industrial production.