OBJECTIVE:To evaluate the quality of solid lipid nanoparticle of the skin extract of Bufobufo gargarzans. METH-ODS:The morphology of solid lipid nanoparticle of the skin extract of B. gargarzans was observed by TEM. The particle size was determined by laser scattering particle size analyzer. The contents of cinobufagin and resibufogenin, encapsulation efficiency, drug-loading amount and accumulative release rate of cinobufagin were determined by HPLC. The stability of nanoparticle was in-vestigated within 24 h at 60,25 and 4 ℃. RESULTS:The solid lipid nanoparticle of the skin extract of B. gargarzans were uni-form in particle size and showed round and spheroidicity shape;average particle size was(138.5±4.2)nm,The encapsulation effi-ciency of cinobufagin and resibufogenin were 90.60% and 91.51%,and drug-loading amount were 35.82% and 44.15%. The accu-mulative release rate of cinobufagin was 50%at 4 h and reached 88%at 48 h,which was in line with Weibull equation(r=0.9438). Under 3 kinds of temperature conditions,encapsulation efficiency decreased gradually as the holding time of nanoparticle pro-longed;the decrease degree was the smallest at 4 ℃.CONCLUSIONS:The quality evaluation results of solid lipid nanoparticle of the skin extract of B. gargarzans are in line with the standard,and prepared nanoparticles show sustained-release effects and should be kept under low temperature.

AIM:To compare the therapeutic effect，adverse reactions and the costs between GM-CSF and G-CSF in treating leucopenia in chemotherapy of cancer.METHODS:Using pharmacoeconomic cost-effectiveness analysis，GM-CSF was compared with G-CSF in treatment of leucopenia in chemotherapy of cancer.RESULTS:The effective rate of GM-CSF was 80％ with an average cost of 1 008 yuan in a therapeutic course，the cost-effective ratio being12.6，and that of G-CSF was 85.7％ with an average cost of 2 304 yuan，the cost-effective ratio being 26.88.CONCLUSION:GM-CSF can effectively treat leucopenia in chemotherapy of cancer，and its cost-effective ratio ia superior to that of G-CSF.GM-CSF is worthy to be used clinically.

Objective To study the pathogenesis of osteoporosis in patients with liver cirrhosis following hepatitis B virus(HBV) infection(HBV-liver cirrhosis).Methods Bone mineral density(BMD) was measured by NM-300 sigle-energy X-ray acsorptiometry system for 61 patients with HBV-liver cirrhosis and 30 age-matched healthy controls.Serum levels of calcium regulatory hormones(CRH),1,25-dihydroxycholecalciferol [1,25(OH)_2D_3],parathyroid hormone(PTH),calcitonin(CT),osteocalcin(BGP),interleukin-1?(IL-1?),interleukin-6(IL-6) and tumor-necrosis factor-?(TNF-?),and urine level of crosslaps were measured in these patients and controls.Patients with HBV-liver cirrhosis were divided into two groups,osteoporotic and non-osteoporotic,based on their BMD in the ulna and radius,for comparison.Results BMD of the ulna and radius in patients with HBV-liver cirrhosis were significantly lower than those in controls.Serum levels of 1,25(OH)_2D_3 and BGP in patients with HBV-liver cirrhosis were significantly lower than those in controls,and much lower in osteoporotic group than that in non-osteoporotic one.While urine level of crosslaps increased significantly in patients with HBV-liver cirrhosis than in controls, much more increased in the those with osteoporosis than those without osteoporosis.Serum level of 1,25(OH)_2D_3 correlated with serum levels of BGP and BMD of the ulna and radius.Urine level of crosslaps correlated inversely with BMD of the ulan and radius in osteoporotic patients,but not in non-osteoporotic ones.Serum levels of IL-1?,IL-6 and(TNF-?) and urine level of crosslaps increased significantly in patients with HBV-liver cirrhosis than in controls,as well as increased significantly in those with osteoporosis than in those without osteoporosis.Serum levels of IL-1?,IL-6 and TNF-? and urine level of crosslaps correlated inversely with BMD of the ulna,particularly more significantly in those with osteoporosis than those without osteoporosis.Conclusions Two factors,less osteogenesis and more osteolysis,existed in patients with HBV-liver cirrhosis.Serum level of 1,25(OH)_2D_3 and serum levels of IL-1?,IL-6 and(TNF-?) played an important role in weakened bone formation and in increased bone resorption,respectively.Adequate supplementation of vitamin D_3 and reducing serum levels of IL-1?,IL-6 and TNF-? may be very important for prevention and treatment of hepatic bone disease.

Objective To discuss the clinical value of coronary artery imaging using 64-slice spiral CT in patient with atrial fibrillation.Methods The images of 31 patients with atrial fibrillation who underwent contrast-enhanced CT coronary angiography were evaluated.The presence of stenosis on each segment of coronary arteries was recorded and their degree of stenosis was measured using the vessel analysis software.Ten patients additionally underwent conventional coronary angiography.The results of conventional coronary angiography were compared with CT coronary angiography of the 10 patients.Results Image reconstruction was based on absolute timing.The image quality of 364 coronary vessel segments on the images from 31 patients was evaluated and defined as excellent,fine,moderate or poor.The image quality was excellent,fine,moderate and poor in 85,41,5,and 8 vessel segments respectively in patient group with heart rate between 47 beat per minent(bpm)and 69 bpm;and in 63,16,13,and 15 vessel segments respectively in patent group with heart rate between 70 bpm and 79 bpm;and in 46,25,23,and 24 vessel segments in patient group with heart rate between 80 bpm and 105 bpm.There was significant difference among the three patient groups(H=22.08,P＜0.01).Comparison was carried out between CT angiographic findings and conventional angiographic findings of the 125 segments of the coronary arteries in the 10 patients who underwent conventional coronary angiography.The sensitivity and specificity of CT angiography for diagnosing vessel with significant coronary stenosis(≥50% narrowing)was 85.0%(17/20)and 95.2%(100/105),respectively.Positive predictive value was 77.3%(17/22),and negative predictive value was 97.1%(100/103).Coronary CTA underestimated the lesions of 3 vessel segments and overestimated the lesions of 5 vessel segments.Conclusion Coronary artery imaging with 64-slice row CT had clinical value for patients with atrial fibrillation.

[Objective] To evaluate the diagnostic values of multi-detector spiral computed tomography (MDCT) in pediatric sacrococcygeal tumors (SCT) and to improve the diagnostic ability.[Methods] 54 children (22 male and 32 female,age between 1 day and 16 years old) with pathologically confirmed SCT were involved in our study.All of them received 64-row spiral Computed Tomography before surgery,CT characteristics and clinical data were retrospectively analyzed.[Results] Pediatric SCT are more common in female children under four years old,with the germ cell tumors most common,followed by neurogenic tumors.Among the 54 SCT,39cases were malignant and 15 were benign (malignant∶ benign =2.60∶1).In CT image findings,37 cases (68％) were mainly solid mass,with 31 cases confirmed malignant by pathology.8 cases (15％) were mainly cystic,with all of them confirmed benign by pathology.9 cases (17％) were cystic-solid or with obvious necrosis in solid mass,with 8 cases confirmed malignant by pathology.[Conclusion] Malignant pediatric SCT are more common than benign SCT.Most malignant SCT are mainly solid mass or cystic-solid or with obvious necrosis in solid mass,and most benign tumors are mainly cystic.Combined with clinical data,MDCT can help to correctly diagnose SCT before surgery.

Objective To investigate the predictive value of mild renal insufficiency on the endpoint events in patients with acute coronary syndrome (ACS).Methods A total of 552 patients with ACS were enrolled in the present study.According to the levels of estimated glomerular filtration rate (eGFR),patients were divided into two groups,normal renal function (eGFR≥90 ml · min-1 · 1.73 m-2) and mild renal insufficiency (60≤eGFR ＜90 ml · min-1 · 1.73 m-2).The primary and secondary events were collected and analyzed through the present prospective follow-up study.Results The patients in mild renal insufficiency group had a higher incidence of the primary endpoint events than normal renal function group [31 cases (12.6％) vs 15 cases (4.9％),P =0.001].There was no difference of the secondary endpoint events incidence in the two groups.The incidence rate of all-cause mortality [8.9％ (22 cases) vs 2.2％ (7 cases),P ＜0.001] and cardiac death [6.5％ (16 cases) vs 1.3％ (4 cases),P =0.001] was higher in mild renal insufficiency group,but there was no statistical difference of incidence rate of no fatal stroke and myocardial infarction in the two groups.The results of COX regression analysis showed that the incidence of primary endpoint events in patients with mild renal dysfunction was 2.265 folds (95％ CI 1.076-4.771,P=0.031) of patients with normal renal function.Further analysis indicated that the predictive value of mild renal insufficiency was only for all-cause mortality (HR 3.118,95％ CI 1.197-8.125,P =0.020),not for heart failure and revascularization.According to the Kaplan-Meier curves results,the incidences of the primary endpoint events (P =0.004) and all-cause mortality (P =0.001) were higher in mild renal insufficiency group than in normal renal function group.Conclusion Mild renal insufficiency has important predictive value for primary endpoint events in patients with ACS.

Objective To investigate treatment of meditation training for elderly patients with cogni-tive disorder recovering from operation for valvular heart disease( VHD) . Method 67 elderly patients who were up to the inclusion criteria were divided into experiment group( n=34)and control group( n=33),by dropping coins according to the admission time.Both of the two groups accepted regular health education and mental nursing.Besides,the experiment group accepted meditation training 5 times a week. Montreal Cogni-tive Assessment (MoCA) was used to evaluate cognitive function before and after the treatment. Results ( 1) Ridit analysis showed the intervention effect of the experimental group was better than that of the control group( R=2.12, t=-2.48, u=0.02),and the difference was statistically significant(P<0,05).The total effec-tive rate of experiment group is 90.32%,while the rate of control group is 62.89%. (2)The score of MoCA for the experiment group(25.79±1.23)was higher than that of the control group(23.85±1.82)after 6 weeks intervention,and the difference was statistically significant( t=5.14,P<0.01).(3) The score of MoCA of the experiment group before the intervention (23.91±2.22)was lower than after 6 weeks intervention(25.79±1. 23),and the difference was statistically significant( t=-4.30,P<0.01).Conclusion Meditation training can effectively improve cognitive function of elderly patients recovering from operation for VHD.

Objective To evaluate the correlation between seram interleukin-10 (IL-10) and testosterone with coronary heart disease (CHD). Methods 387 patients were divided into CHD group (n = 239) and control group ( n = 148 ) according to the results of coronary angiography. CHD patients were divided into subgroups accord-ing to the numbers, Gensini score of lesions in the coronary arteries and clinical severity ( statue of stable coronary artery disease, unstable angina or acute myocardial infarction). Serum IL-10 and testosterone levels were measured by ELASA. Logistic regression and partial correlation were used to evaluate the correlation of serum IL-10 and testoster-one with CHD. Results IL-10 was significantly lower in the CHD group than in the control group[ (39.08 ± 14.22) ng/L vs (49.27 ± 24.67)ng/L, P < 0. 001 ]. The partial correlation analysis results in subgroups showed that the correlation coefficient of IL-10 with number of lesions,gensini score and clinical severity of CHD was - 0.25, P < 0.001, -0.25 ,P <0.05 and -0.25 ,P <0.001 ,respectively. Serum testosterone had no difference in control group and CHD group (P >0.05 ). Logistic regression analysis found that only smoking (OR = 3.79,95% CI 2.09～ 6.84,P<0.01) ,diabetes mellitus (OR =2.48,95% CI 1.05 ～5.88,P <0. 05) ,apoB ( OR = 14.3,95% CI 4.29～46.61 ,P <0.01 ) and IL-10 ( OR =0.74,95%, CI 0.57～0.89 ,P <0.01 ) entered the model. Conclusions Serum IL-10 is not only significantly correlated with CHD but also with its severity. IL-10 is an independent pro-tective factor for CHD.

Objective To evaluate the schistosomiasis control effect of the measures of replacing cattle with machine for cul?tivation and forbidding depasturage of livestock on marshlands in marshland and lake regions. Methods The retrospective re?view and field survey were implemented in the Jiangling and Gongan counties of Hubei Province where were implemented with the measure of replacing cattle with machine for cultivation,and Yuanjiang and Huarong counties of Hunan Province where were implemented with the measure of forbidding the depasturage of livestock on marshlands. The schistosome infection status of hu?man,cattle,and Oncomelania hupensis snails,and schistosome?infested field excreta were surveyed from 2007 to 2013. The ef?fects of the interventions were compared before and after their implementations. Results The 6 villages of Hubei Province were implemented with the measure of replacing cattle with machine for cultivation,and 7 villages of Hunan Province were imple? mented with the measure of forbidding the depasturage of livestock on marshlands. From 2007 to 2013,the schistosome infection rates of residents declined from 3.95%to 0.70%(χ2 =128.376,P<0.05),with the descend range of 82.53%. The descend ranges of the measures of replacing cattle with machine for cultivation and forbidding the depasturage of livestock on marshlands were 83.081%and 81.62%respectively,and there was no significant difference between the two measures(χ2 =0.132,P>0.05). The infection rate of cattle decreased from 3.66%in 2007 to 0.65%in 2013,and the descend range was 82.24%(χ2=13.692,P<0.05). The field excreta was surveyed in the snail breeding place in 2013. The investigated area was 157.435 hm2, and 625 samples of field feces of cattle were collected with the density of field excreta of 3.97/hm2,and the positive rate was 1.12%(7/625). The schistosome infection rate of snails and the density of infected snails decreased successively from 2007, and no infected snails were detected from 2011 to 2013. Conclusions The schistosomiasis endemic situation are decreased sig?nificantly after the interventions of replacing cattle with machine for cultivation and forbidding the depasturage of livestock on marshlands. Therefore,schistosomiasis control effect of these measures is notable in the marshland and lake regions.

BACKGROUNDGefitinib, an orally active epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI), has shown targeted antitumor activity in patients with advanced non-small cell lung cancer (NSCLC). The aim of this study is to evaluate the efficacy and tolerance of gefitinib on brain metastasis in patients with NSCLC.

METHODSThe clinical characteristics, response to treatment and outcome of survival were retrospectively reviewed in eighteen NSCLC patients with brain metastasis. All these patients received gefitinib of 250mg/d after brain metastasis was diagnosed. They would discontinued the targeted treatment because of disease progression or other reasons. Twelve of them received intracranial irradiation (group A), while the other six patients didn't (group B).

RESULTSThe overall response rate and disease controlled rate of gefitinib for brain lesions were 27.8% and 88.9% respectively (one complete remission, 4 partial remission, 11 stable disease, 2 progressive disease). No correlation among gender, smoking status, intracranial irradiation and the response of gefitinib was observed. There was no survival difference between the two groups (P=0.192), with the median follow-up time of 6 months (range 1-24 months). Rash and diarrhea were the most common adverse events.

CONCLUSIONSGefitinib is active in patients with brain metastasis from NSCLC. It is feasible to conduct randomized clinical trials to demonstrate the role of targeted treatment for NSCLC patients with metastatic brain lesions.