Objective To analyze the viral dynamics and clinical significance during the antiviral treatment by a mathematical model.Methods Six chronic hepatitis B patients were evaluated with a kinetic model(Neumann model)during dose of 0.5 mg/d oral entecavir.Blood samples were drawn for HBV DNA measurement at week 0,2,4,12,24.Non-linear modeling was used to fit individual patient data.Results The median effectiveness in blocking viral production was 99.970%(n=6).The median half-life of viral turn-over was 1.6 d(n=6).The median half-life of infected hepatocytes was 21.3 d(n=5).Compared with the other patients,the c(virions are cleared at a rate)、ε(effectiveness)、δ(infected cell are lost at a rate)value of one patient(eg.6)were all lower and the half-life of virus and infected cells were higher,and eg.6 developed viral break-through after 38 weeks of follow-up.Conclusions Viral load decay showed a biphasic pattern during entecavir therapy which can be described with a mathematical model.The model relates processes of viral infection and replication as well as drug efficacy to model parameters.It indicates the prediction of bio-mathematical model during antiviral treatment.

Objective To study the value of SF-36 in evaluating the life quality of Chinese patients with chronic obstructive pulmonary disease(COPD). Methods The SF-36,MRC score and spirometry were collected from 50 patients with COPD,the validity was documented by performing correlation analysis and stepwise multiple regression analysis. Pearson correlation coefficients were calculated. Results The MRC score was significantly correlated with seven of the eight components(P

Objective Following the prognosis of patients with myasthenia gravis(MG) who received both immunosuppressants and thymectomy, to determine whether the sequence and timing of treatment have influences on outcomes of MG and also to select significant predictors of prognosis.Methods It was a retrospective study which reviewed 105 patients with MG who underwent thymectomy and immunosuppressants between Januay, 2000 and December, 2013.All patients were divided into two subgroups based on their order of treatment.Thirty two patients were called as immunosuppressants-first group, and 73 patients were called as thymectomy-first group.The ratios of ideal status of two groups were compared with use of the ChiSquare test.Predictors of ideal status were analyzed by logistic regression.Results (1) After 1 year, 2 years and 5 years of intervention, the proportion of ideal status was significantly higher in the thymectomy-first group than that in the immunosuppressants-first group[(33％-50％) vs.(10％-20％), P ＜0.05].For oMG patients, after 1 year, 2 years and 5 years of treatment, thymectomy-first group had a higher ideal status rates than immunosuppressants-first group[(25％-50％) vs.(11％-18％)].But no significant difference was noted in the rates of ideal status at each follow-up time point.(2)Multivariate logistic regression analysis showed that sequence of treatment (OR =0.154, 95 ％ CI: 0.046-0.518, P =0.002) and symptom-thymectomy interval(OR =0.903,95 ％ CI: 0.835-0.976, P =0.010) were the significant predictors of ideal status.Conclusion Thymectomy prior to immunosuppressants is associated with relatively good prognosis.It is suggested that patients with gMG, or adult patients with oMG who are resistant to drug, will be better to undergo thymecotomy as early as possible.

ObjectiveTo evaluate CT characteristics of fungal ball in paranasal sinus caused by different fungi and to enhance differential diagnosis.MethodsCT results and clinical data of 74 patients with fungal ball arising from the paranasal sinuses proved by histopathology from 2007 to 2009 were analyzed retrospectively.The CT characteristics of fungal ball in paranasal sinus caused by different fungi were compared using x2 test with P ＜ 0.05 considered statistically significant.Results Among 74 mycotic pathogenic agents,aspergillus was found in 58 cases (including 36 cases with aspergilhs flavus,15 cases with aspergillus fumigatus and 7 with aspergillus versicolor),the others including 5 cases with penicillium,6 cases with schizophyllum commune,and 5 cases with scedosporium apiospermum.There were significant differences in the number of sinus involved ( single sinus involvement was seen in 29 cases caused by aspergillus group and 2 cases caused by non-aspergillus-group,respectively,with x2 =7.245,P =0.007 ),the incidence of fungus ball in ethmoid sinus [ 39.7％ ( 23/58 ) of cases caused by aspergillus group and 81.3 ％ ( 13/16 ) of cases caused by non-aspergillus-group,respectively,with x2 =8.685,P =0.003 ] and calcification (40 of 58 cases caused by aspergillus group and 5 of 16 cases caused by non-aspergillus-group,respectively,with x2 =7.485,P =0.006 ),the location of calcification ( 26 of 40 cases with central calcification and 14 of 40 cases with peripheral calcification in cases caused by aspergillus group,while all of 5 cases caused by non-aspergillus-group with peripheral calcification,x2 =7.697,P =0.006).However,there was no significant difference in the incidence of bilateral lesions ( x2 =1.002,P =0.317 ),maxillary sinus involvement ( x2 =0.020,P =0.888 ),sphenoidal sinus involvement ( x2 =0.704,P =0.401 ),frontal sinus involvement ( x2 =0.126,P =0.723 ),bony sclerosis ( x2 =2.024,P =0.155 ),lamellar calcification (x2 =2.045,P =0.153 ),complication of nasal polyps( x2 =0.018,P =0.893) and submucosal cyst( x2 =0.779,P =0.378 ).ConclusionsThe common CT characteristics of fungal ball in paranasal sinus are unilateral sinus involvement with inhomogeneous high-density soft tissue and lamellar calcification.The CT findings of fungal ball caused by non-aspergillus-group are ethmoid sinus involvement and calcification located on the periphery instead of the center of fungal ball.

Objective To investigate the mechanism of tumor necrosis factor-α (TNF)-α inhibiting osteo blastdifferentiation of mesenchymal stem cells (BMMSCs) in the pathogenesis of osteoporosis in the mouse model of systemic lupus erythematosus (MRL/lpr). Methods The femurs of MRL / lpr and C3He/HeJ mice were isolated, the bone structure were examined by hematoxylin-eosin (HE) staining. The proteins of TNF-α, NF-κB P50, bone morphogenetic protein -2 (BMP-2) and PSmad1/5/8 were measured by immunohistochemical stain. Bone marrow mesenchymal stem cells (BMMSCs) were isolated. After BMMSCs grew on the cover slips, the proteins on top of it were evaluated by immunohistochemistry stain. Moreover, the alkaline phosphatase (ALP) staining was employed for the measurement of the early osteogenic differentiation. BMMSCs together with hydroxyapatite were embedded subcutaneously in the nude mice and eight weeks later, the ectopic bone formation was evaluated. The recombinant human tumor necrosis factor receptor type Ⅱantibody fusion protein (etanercept) or normal saline was subcutaneous injected to the mice with lupus. After four weeks, the expression of these proteins was observed and the ectopic bone formation was investigated. Image-Pro plus 6.0 software was employed for imagine analysis, and Studentˊs t-test was used to test the differences between 2 independent groups. Results MRL/lpr mice showed decreased volume of cortex and the percentage of cortex to the volume of bone of MRL/lpr mice was significantly lower compared to control groups and with C3He/HeJ mice (13.96±0.25 vs 23.61±0.71, n=3, P<0.01). The protein levels of both TNF-αand NF-κB P50 on the femur of MRL/lprl mice were higher than those of the control group (0.643±0.051 vs 0.405±0.022, 0.917±0.023 vs 0.650±0.032, n=3, P<0.01). The expressions of BMP-2 on the femur of MRL/lpr mice were lower than those of the C3He/HeJ mice (0.52 ±0.03 vs 0.72 ±0.03, n=3, P<0.01). There was no difference in the expression of PSmad1/5/8 on the femur between the two groups by immunohistochemistry detection (1.264 ±0.021 vs 1.301± 0.044, n=3, P>0.05). The expressions of TNF-α and NF-κB P50 in BMMSCs of MRL/lprl mice were higher than those of the C3He/HeJ (0.184±0.021 vs 0.136±0.013, 0.132±0.021 vs 0.097± 0.014, n=3, P<0.01), while BMP-2 and PSmad were lower than those of the control group (0.128±0.013 vs 0.216±0.221, 0.115±0.023 vs 0.196±0.034, n=3, P<0.01). After 7 days of BMP-2 stimulation, the activities of ALP of BMMSCs from MRL/lprl mice were reduced detected by ALP staining and the osteoblast differentiation of these cells were decreased than BMMSCs from the control mice by HE and Masson staining. The percentage of the cortex to the volume of bone of the etanercept injection MRL/lpr mice was higher than that of the control group (21.8±1.0 vs 14.3 ±0.6, n=3, P<0.01). Moreover, the proteins of TNF-α and NF-κB P50 on the femurs of such injected mice were lower than those of the control group (0.540±0.024 vs 0.682±0.031, 0.857±0.023 vs 1.098±0.044, n=3, P<0.05), while the expressions of BMP-2 were higher than the control group (0.99±0.04 vs 0.85±0.04, n=3, P<0.05). There was no difference in the PSmad1/5/8 expression on the bone of the two group of lupus mice (0.88 ±0.08 vs 0.84 ±0.04, n=3, P>0.05). The ectopic bone formation of BMMSCs of the etanercept injected MRL/lpr mice was higher than that of the normal saline injected mice, however, it was lower than that of the C3He/HeJ mice. Conclusion TNF-α inhibits osteoblast differentiation of mesenchymal stem cells by depressing Smad signaling which may contribute to the osteoporosis of the lupus mice.

Objective To study the diarrhea causes and nursing care after kidney transplantation from donation after cardiac death(DCD).Methods The clinical data of 91 patients undergoing kidney transplantations from DCD were retrospectively analyzed from November 2011 to May 2013 in our department,to investigate the incidence of diarrhea and the causes.Results Eighty three cases contracted diarrhea in 91 recipients,with the incidence of diarrhea 91.2%.The use of immunosuppressive agents,intestinal flora,infection and bowel movement dysfunction were all related to the diarrhea.Conclusions The incidence of diarrhea is high and the causes are complex after kidney transplantation from DCD.So nurses should take the appropriate care measures to improve the quality of nursing,avoiding complications and ensuring transplant results based on a different cause of diarrhea.

OBJECTIVE:To screen the method for extracting total flavonoids in persimmon leaves and optimize extraction tech-nology. METHODS:Using extract quality and flavonoids content as indexes,the effects of extracting total flavonoids in persim-mon leaves by ethanol refluxing method,enzyme method(cellulase,β-glucanase and complex enzyme mixed by equal amounts of both),semi-bionic method and semi-bionic-enzyme method (the same enzymes) were compared. Using flavonoids content as in-dex,solid-liquid radio,reflux temperature,reflux time as factors,orthogonal test was designed to optimize the extraction technolo-gy conditions of flavonoids in persimmon leaves by semi-bionic-enzyme method,and the verification test was conducted. RE-SULTS:The extract quantity and flavonoids content by semi-bionic-enzyme method was the highest among the 4 extraction meth-ods,and the complex enzyme was the most suitable;the optimized extracting condition of semi-bionic-enzyme method were as fol-lows as solid-liquid radio of 1:14,reflux temperature of 50 ℃,reflux time of 2.0 h;extraction rates of flavonoids in 3 verification tests were 5.9%,5.8%,5.9%(RSD=0.98%,n=3). CONCLUSIONS:The optimized semi-bionic-enzyme method is efficient and stable in extracting flavonoids in persimmon leaves.

Objective To evaluate the efficacy and safety of a superpulse-mode fractional carbon dioxide(CO2) laser for the treatment of onychomycosis. Methods Patients with typical clinical manifestations of onychomycosis and positive for direct microscopic examinations of fungi were enrolled into this study, and treated with a superpulse-mode fractional CO2 laser for eight sessions. The scoring clinical index for onychomycosis (SCIO)and onychomycosis severity index (OSI)were calculated according to patients′ age, clinical type of onychomycosis, thickness of nails, area and length of nail involvement before the treatment, at the end of treatment, 1 month and 3 months after completion of treatment. Mycological clearance was also evaluated according to direct microscopy and fungal culture results. Adverse reactions to laser therapy were recorded. Statistical analysis was carried out by using the chi-square test and Wilcoxon signed-rank sum test with the SPSS 17.0 software. Results Totally, 20 patients with onychomycosis were enrolled into this study, and 75 affected nails were treated. Finally, 18 patients with 71 target nails completed the treatment and follow-up. The SCIO and OSI were 13.07 ± 6.47 and 21.11 ± 11.94 in these patients at baseline respectively, both significantly different from those at the end of treatment(9.03 ± 6.14 and 13.63 ± 12.10, respectively, both P < 0.05), 1 month((8.51 ± 6.99 and 14.18 ± 13.65, respectively, both P < 0.05)and 3 months(7.89 ± 7.26 and 13.70 ± 13.93 respectively, both P <0.05)after completion of treatment. No significant differences were observed in mycological clearance rates between the posttreatment time points(57.75%(41/71)at the end of treatment vs. 59.15%(42/71)at 1 month vs. 61.97%(44/71) at 3 months after completion of treatment, P > 0.05). The SCIO and OSI decreased from 12.48 ± 5.41 and 16.44 ± 9.89 at the baseline to 5.01 ± 5.56 and 6.44 ± 8.26 at 3 months after the treatment, respectively, in patients with distal and lateral subungual onychomycosis (DLSO), and from 17.86 ± 3.98 and 34.05 ± 2.56 to 15.88 ± 4.10 and 31.00 ± 7.28 respectively in patients with total dystrophic onychomycosis (TDO). During the treatment, several patients felt transient mild pain, but no subungual hemorrhage or other adverse reactions occurred. Conclusions The fractional CO2 laser in superpulse mode shows a reliable efficacy for the treatment of mild to moderate onychomycosis such as DLSO, especially when the nail plate is superficially invaded and grows rapidly. It directly inhibits and kills fungi, and treatment duration should be prolonged according to conditions.

Objective To explore the pharmacodynamic action of the extract from raw materials of Rhizoma Anemarrhenae and Cortex Phellode ndri, a classic herb pair in traditional Chinese medicine, on mice with diabetic peripheral neuropathy(DNP). Methods The mice were administrated with intraperitoneal injection of streptozotocin (STZ, 30 mg/kg) and fed with high-fat diet to establish the DNP mouse model. One hundred and sixty male C57BL/6j mice were divided into normal group, model group, metfomin group(130 mg/kg), Xuezhikang group(200 mg/kg), high- and low-dose Rhizoma Anemarrhenae extract group(360, 90 mg/kg) , high-and low-dose Cortex Phellodendri extract group(135, 45 mg/kg), 20 mice in each group. The medication lasted for 24 weeks. On medication week 8, 16 and 24, the plasma levels of glucose (GLU), total cholesterol (TC), triglyceride(TG), low density lipoprotein-cholesterol(LDL-C) and insulin(INS) were determined respectively. On medication week 10, oral glucose tolerance test(OGTT)was carried out. On medication week 24, the plasma nuclear factor kappa B(NF-κB) activity and the plasma levels of transforming growth factor-beta 1(TGF-β1), superoxide dismutase(SOD) and reduced glutathione(GSH) were detected. Results Five weeks after injection of STZ, the body mass of the model group was firstly increased and then decreased, and FBG was increased(P<0.05 compared with the normal group). Compared with the normal group, FBG, TC, TG, LDL-C and INS levels were increased(P<0.01 or P<0.001), plasma NF-κB activity, TGF-β1 and SOD levels were enhanced, and GSH level was decreased in the model group, the difference being statistically significant (P<0.01 or P<0.001). Contrasted with the model group, FBG, TC, TG, LDL-C and INS levels in high-and low-dose Rhizoma Anemarrhenae extract group and in high-and low-dose Cortex Phellodendri extract group were decreased to various degrees. After continuous medication, plasma NF-κB activity and TGF-β1 and SOD levels in high-dose Rhizoma Anemarrhenae extract group and in high-dose Cortex Phellodendri extract group were reduced(P<0.05 or P<0.001), and plasma GSH level was increased(P<0.01). Conclusion Extract from raw materials of Rhizoma Anemarrhenae and Cortex Phellodendri has obvious hypoglycemic effect and protective effect on experimental mice with DPN.

Objective To evaluate morphological structure of uterosacral ligament (USL) and cardinal ligament (CL) in patients with severe pelvic organ prolapse (POP) by MRI technology, and to analysis and discuss its clinical significance. Methods From November 2013 to February 2014 in Peking University People′s Hospital, 26 elderly patients withⅢ-Ⅳdegree of POP were selected as the POP group and 18 healthy elderly volunteers were selected as the control group during the same period. Pelvic MRI examination were performed in the two groups. The morphological characteristics of left and right side of the uterosacral-cardinal ligament on MRI and the attachment site of the starting and ending points between two group were described and compared. Results In POP group, 25 cases of left USL starting point were located in the sacrospinous ligament/coccygeal muscle complex [58% (15/26)] or coccygeal muscle [38%(10/26)], ending point were located in the cervix and vagina [58%(15/26)] or cervix [38%(10/26)];24 cases of right USL starting point were located in the sacrospinous ligament/coccygeal muscle complex [31%(8/26)]or coccygeal muscle [62%(16/26)], 26 cases of right USL ending point were located in the cervix and vagina [62% (16/26)] or cervix [38% (10/26)]; the left and right CL in the POP group and the control group were both from the sacroiliac joint at the top of the greater sciatic foramen from the ipsilateral pelvic side wall;1 case (4%, 1/26) of left CL in the POP group completely connected to the bladder, 10 cases (38%, 10/26) partly connected to the bladder;14 cases (54%, 14/26) of right CL partly connected to the bladder, the rest ending points of left and right CL were located in cervix and (or) vagina. In the control group, 17 cases of left USL starting point were located in the sacrospinous ligament/coccygeal muscle complex (10/18) or coccygeal muscle (7/18), ending point were located in the cervix and vagina (12/18) or cervix (6/18);18 cases of right USL starting point were located in the sacrospinous ligament/coccygeal muscle complex (10/18) or coccygeal muscle (8/18), ending point were located in the cervix and vagina (13/18) or cervix (5/18);8 cases (8/18) of left CL partly connected to the bladder;15 cases (15/18) of right CL partly connected to the bladder, the rest ending points of left and right CL were located in cervix and (or) vagina. There was no significant difference between the two groups on the starting and ending points (P>0.05). Conclusions The observation of MRI could be consistent with the clinical anatomy on the starting and ending points, direction of travel in the uterosacral-cardinal ligament. The starting and ending points of the left and right side USL and the ending points of the left and right side CL are not completely symmetrical, the variation degree is large, some CL could be completely or partly inserted to the bladder.