Objective:To optimize the flash extraction process of Isatidis Radix by Box-Behnken experimental design. Methods:A flash extraction method was used with the extraction voltage, material-liquid ratio and extraction time as the independent variables. A Hassan’s method was used to calculate the normalized value(OD) of comprehensive evaluation of the dry extract yield and the epi-goitrin extraction rate in order to establish the mathematical relationship between the comprehensive evaluation OD and the independent variables, and the response surface method was used to predict the best process conditions. Results:The optimum process conditions were as follows:voltage of 88 V, material-liquid ratio of 19. 62, and extraction time of 2. 03 min. The rate of dry extract and epigoitrin extraction was 37. 902% and 0. 1887%, respectively. Conclusion:The measured value is close to the predicted one,which indicates the comprehensive flash extraction parameters optimized by Box-Behnken experimental design can be used for the extraction for Isatidis Radix.

There exists a population of myeloid-origin cells that are associated with tumor immune escape in cancer patients,commonly termed as myeloid derived suppressor cells(MDSCs).M DSCs accumulate in the blood,lymph nodes,bone marrow,and inhibit both adptive and innate immunity.Different suppressive mechanisms are used by MDSCs to block tumor immunity.Reducing the numbers of MDSCs or inhibiting the suppressive pathway conducted by MDSCs will bring new highlight to biotherapy in tumor treatment.

Objective To summarize the nursing experience of a child with serious skin problems at the puncturing site of peripherally inserted central catheter (PICC) for methotrexate (MTX) infusion.MethodsA pediatric patient from the Hematology Ward of Beijing University People''s Hospital was found to be with serious skin problems at the puncturing site of PICC for MTX infusion.Local irradiation with ultraviolet, disinfection of local skin with iodine volts and 0.9％ sodium chloride injection, coverage of the broken skin with alginate dressing, and fixation of PICC with sterile gauzes were applied.Results After 22 days of nursing, the pain and itching at the broken skin around PICC disappeared.The skin returned normal, without exudates and prolapse of catheter.Conclusions After MTX use via PICC, the children can easily become irritable due to local symptoms and their own feelings after skin allergy.Meanwhile, prolonged treatment and nursing may make the child cry and increase the stress of parents.Caregivers needs to explain the related factors of allergy to the children and their families, and give the correct nursing intervention, so as to improve local allergy and facilitate the retention of PICC.

Objective To determine the changes of peripheral levels of T helper cell cytokines of patients with chronic hepatitis B (CHB) during antiviral treatment,and to further explore its clinical significance.Methods The plasma levels of interleukin (IL)-2,IL-6,IL-10,interferon (IFN)-γ and tumor necrosis factor(TNF)-α of thirty-three CHB patients during antiviral treatment (entecavir) were measured using enzyme linked immunosorbont assay (ELISA).And their biochemical indicators of liver function were determined.The differences of cytokines levels before and after antiviral treatment were compared using ANOVA.The correlations between the changes of cytokines and alanine transaminase (ALT),hepatitis B virus (HBV) DNA levels were analyzed.Results Levels of IFNγ before and 12,24,48 weeks after treatment were (5.98±2.77),(5.95±3.37),(2.93±2.15) and (9.29±4.65) pg/mL,respectively (F=3.845,P＜0.05),which were positively correlated with ALT levels (r =0.396,P＜0.05).Both TNF-α and IL-10 levels declined after antiviral treatment,which were significantly different at different time points (F=20.156 and 16.695,respectively; both P＜0.05),and both levels of TNF-α and IL-10 were positively correlated with ALT levels (r=0.354and 0.316,respectively; both P＜0.05) and positively correlated with HBV DNA levels (r=0.382and 0.386,respectively; both P＜0.05).While both IL-2 and IL-6 levels were not significantly different between before and after antiviral treatment (F=0.010 and 0.932,respectively; both P＞0.05).The serum levels of ALT and HBV DNA before and after antiviral treatment were all significantly different (F=17.69 and 198.98,respectively; both P＜0.05),which declined gradually during treatment and were positively correlated (r =0.581,P＜0.05).Conclusions IL-10,IFNγand TNF-α may be involved in the pathologic process of CHB,and closely related to the deterioration of the disease.Monitoring plasma levels of these cytokines during antiviral treatment could be useful to understand the immune status and evaluate the efficacy of antiviral drugs.

We investigated the carrying status of the virulence genes of Salmonella from different sources in Shijiazhuang City,China,to provide the basic data for the further risk assessment of Salmonella.A total of 186 isolates of Salmonella from different sources were collected and identified serotypes in the area of Shijiazhuang from 2011 to 2016.PCR was performed for eight virulence genes (invA,sopE,agfA,spvR,hilA,stn,pefA,shdA).These Salmonella bacteria were detected in 13 kinds of serotypes.Enteritidis is a significant advantage of the group.The above 8 virulence genes were analyzed,and the virulence genes hilA,stn and invA were the most frequently carried,their respective carrying rate were 90.3％ (168/186),86.6％ (161/186) and 82.8％ (154/186) respectively.We found the virulence genes of Salmonella from different sources were different.It is necessary to take measures to strengthen the food hygiene supervision and prevention and control of the storage and sale of raw poultry stalls in the morning market in Shijiazhuang area.

Objective To investigate the differences and characteristics of virulence genes carried by Salmonella enteritidis from different sources in Shijiazhuang City.Methods One hundred and twenty-four strains of Salmonella enteritidis isolated from morning markets of raw and poultry stalls,slaughterhouses and food poisoning specimens in Shijiazhuang area were collected.Eight virulence genes (invA,sopE,agfA,spvR,hilA,stn,pefA,shdA) were detected by polymerase chain reaction (PCR).Results Salmonella enteritidis might have different virulence gene profiles.The above eight virulence genes were detected in different strains.The carrying rate of virulence genes invA,sopE,stn,hilA,spvR and pefA in the food poisoning strains was higher than 94％.There was no difference in the carrying rate of 8 virulence gene between the morning raw poultry stalls isolates and the patient strains,but was different with the slaughterhouse strains.Conclusion There were more risks of food poisoning caused by Salmonella enteritidis from morning markets,and the hygiene supervision should be strengthened to prevent and control foodborne disease.

Objective To study the safety of transfusion of itraconazole through PICC and to evaluate the effect of different amount of blood transfusion before and after the infusion. Methods Patients were recruited from January 1, 2014, until December 31, 2015, in the Hematology hematopoietic stem cell transplantation ward. Thiry-two patients were recruited in the control group. Ninety patients wererecruited in the experience group. They were randomly assigned to three groups with 30 cases each, extracting different amounts of itraconazole before infusion, back phlebotomize in group A, B, C respectively was 10.0, 0.5, 1.0 ml. Comparing the phlebitis and obstruction after ten days from the transfusion day on. Results Catheter obstruction was not observed in any case. There was a significant difference between control group (21.9%,7/32) and observation group (0) regarding the incidence of phlebitis (χ2=21.157,P < 0.05). No statistical difference was noted among the observation groups regarding the incidence of phlebitis (P>0.05). Conclusions Drawing a small amount of blood volume before itraconazole injection through PICC can effectively avoid the drug-induced catheterobstruction. What′s more, transfusion through PICC can significantly reduce the incidence of phlebitis compared with peripheral infusion.

Objective To evaluate the association between plasma levels of visfatin and adiponectin with carotid arterial intima-media thickness in patients with type 2 diabetes.Methods A total of 100 elderly patients with type 2 diabetes and 30 healthy elderly controls were recruited from August 2015 to August 2016 at our hospital.Based on carotid arterial intima-media thickness(IMT) assessed via color Doppler ultrasonography,patients with diabetes were further divided into a thickened IMT group (40 cases)and a non-thickened IMT group (60 cases).Plasma levels of visfatin and adiponectin were analyzed and compared,and their associations with carotid arterial IMT were evaluated.Results Compared with the control group,patients in both the thickened IMT group and the non-thickened IMT group had significantly higher serum levels of visfatin(19.1 ± 2.8)μg/L vs.(40.6±3.9)μg/L,(28.9±3.6)μg/L,which was markedly higher in the thickened IMT group than in the non-thickened IMT group(P＜0.05).In addition,compared with the control group,patients in the thickened IMT group and the non-thickened IMT group had significantly lower serum levels of adiponectin(1 590±330)mg/L,(610±170)mg/L,(930±210)mg/L,which was markedly lower in the thickened IMT group than in the non-thickened IMT group (P ＜ 0.05).Furthermore,Pearson's analysis showed that the plasma level of visfatin was positively correlated with carotid arterial IMT(r =0.721,P＜0.05),and the plasma level of adiponectin was negatively correlated with carotid arterial IMT(r=-0.688,P＜0.05).Conclusions Plasma levels of visfatin and adiponectin are closely related to carotid arterial IMT in patients with type 2 diabetes,andmay be used as plasma markers for the prediction of early atherosclerosis.

Objective:To explore the application effect of nursing based on transtheoretical model in patients with oral surgery.Methods:A total of 120 patients with oral surgery who were admitted to Department of Stomatology of the First Affiliated Hospital of Xinxiang Medical University from October 2019 to January 2020 were selected as research objects by the convenient sampling method. According to random number table, they were divided into the control group and the observation group, with 60 cases in each group. Patients in the control group were given routine nursing while patients in the observation group were given transtheoretical model-based nursing at basis of the control group. The amount of dental plaque, comfort of oral cavity, score of psychological state and degree of oral cleanliness before and after nursing were compared between the two groups.Results:After intervention, the amount of dental plaque and the score of oral comfort in the observation group were lower than those in the control group, and the differences were statistically significant ( P<0.05) . After intervention, SAS and SDS scores in the observation group were lower than those in the control group, and the differences were statistically significant ( P<0.05) . The degree of oral cleanliness of the observation group was better than that of the control group after intervention, and the difference was statistically significant ( P<0.05) . Conclusions:Nursing based on transtheoretical model can effectively reduce postoperative amount of oral plaque of patients with oral surgery, improve comfort of oral cavity and oral cleanliness and correct bad mood of patients, which is worthy of clinical application.

Objective:To compare the in vitro susceptibility of fluconazole-resistant Candida albicans strains from superficial and deep infections to 8 antifungal drugs, and to compare drug resistance mutations in these strains. Methods:According to the Clinical and Laboratory Standards Institute (CLSI) protocol M27-A4, 26 deep infection-derived and 33 superficial infection-derived drug-resistant Candida albicans strains were tested for in vitro susceptibility to 8 antifungal drugs (fluconazole, voriconazole, itraconazole, posaconazole, amphotericin B, fluorocytosine, terbinafine, and micafungin) alone or in combination. DNA was extracted from all drug-resistant strains, and mutations in 3 drug resistance genes, including ERG3, ERG11 and FUR1, were detected by PCR. Normally distributed measurement data with homogeneous variance were compared between two groups by using two-independent-sample t test, non-normally distributed measurement data with non-homogeneous variance were compared using Mann-Whitney U test, and enumeration data were compared using chi-square test. Results:The minimum inhibitory concentrations (MICs) of fluconazole, itraconazole, voriconazole, posaconazole and fluorocytosine all significantly differed between the superficial infection group and deep infection group (all P < 0.05) , while there was no significant difference in the MIC of amphotericin B or micafungin between the two groups (both P > 0.05) . The MIC of terbinafine was >64 μg/ml in 96.6% of the above strains, so could not be compared between groups. As combination drug susceptibility testing revealed, the combination of terbinafine with azoles (fluconazole, voriconazole, itraconazole or posaconazole) showed synergistic inhibitory effects against 15 Candida albicans strains (7 strains from deep infections, 8 strains from superficial infections) , with fractional inhibitory concentration (FIC) indices being 0.033 to 0.187; no marked synergistic effect was observed in the combinations between fluorocytosine and azoles, between fluorocytosine and amphotericin B, or between amphotericin B and fluconazole, with the FIC indices being 0.56 to 1.125. The missense mutation V351A in the ERG3 gene was identified in all the 33 (100%) superficial infection-derived strains, as well as in 13 (50%) deep infection-derived strains, and the mutation A353T in the ERG3 gene was identified in 4 (15%) deep infection-derived strains; as for the ERG11 gene, missense mutations identified in the superficial infection-derived strains included I437V (32 strains, 97%) , Y132H (23 strains, 70%) , T123I (16 strains, 48%) , K128T (6 strains, 18%) , D116E (5 strains, 15%) , A114S (4 strains, 12%) , E266D (2 strains, 6%) , G448E (2 strains, 6%) , and G465S (2 strains, 6%) , while missense mutations identified in the deep infection-derived strains included I437V (23 strains, 88%) , E266D (13 strains, 50%) , E260G (5 strains, 19%) , and V488I (4 strains, 15%) ; the missense mutation R101C in the FUR1 gene was identified in 11 (33%) superficial infection-derived strains, but not identified in deep infection-derived strains. Conclusion:The drug susceptibility and drug resistance mutations differed to some extent between superficial infection- and deep infection-derived fluconazole-resistant Candida albicans strains.