Objective To investigate the significance and characteristics of T lymphocyte subsets and co-stimulatory CD28 in peripheral blood of patients with primary biliary cirrhosis. Methods Tri-colour flow-cytometry was used to detect the levels of T lymphocyte subsets in peripheral blood in 98 patients with primary biliary cirrhosis and 30 age and gender matched healthy controls. Results Compared to control group the percentage of CD4+ T increased and CD8+ T lymphocyte decreased in the PBC group. The CD4+/CD8+ ratio in the PBC group was higher than that in the control group (P<0.05). And the percentage of CD4+CD28- T cells and CD8+CD28- T cells increased, too (P<0.05). Conclusion There are immunological abnormalities in PBC and the expression of co-stimulator CD28 is significantly decreased. CD8+CD28-T lymphocytes may have immune regulatory effect in PBC.

Objective To report a case of toxic epidermal necrolysis associated with geotrichosis due to Geotrichum silvicola. Methods The exudates from the body surface, blood and urine of the patient were examined by microscopy and simultaneously inoculated onto the Sabouraud dextrose agar (SDA) medium. The isolate was examined by microscopy, PCR which amplified the D1/D2 domain of 26S rDNA, and gene sequencing. Homologous sequences were searched in the GenBank/EMBL/DDBJ/PD nucleotide sequence library, and the genetic relationship was analyzed with the genealogical tree. Results Microscopy of pus from the abscess on the dorsa of left hand revealed a lot of spores and a few hyphae, which were not observed in the blood or urine specimens. Meanwhile, whitish colonies were grown in all the three successive cultures of blood and urine specimens, rather than the exudates on the body surface. After itraconazole and garlicin were administered for one week, both microscopic exam and fungus culture were negative. Microscopic exam of the isolate showed arthrospores arranged in chains, budding spores and a few of hyphae. It was found that there was a one-base difference between our isolate (Hebei-1) and the isolate from kerion -like eruptions (Changzheng-1), and a four-base difference between our isolate and the reference Geotrichum silvicola strain as well, in the D1/D2 domain of 26S rDNA. This isolate was identified to be most close to Changzheng-1 in the phylogenetic tree. Conclusion The patient with toxic epidermal necrolysis is associated with geotrichosis due to Geotrichum silvicola.

Small scale restricted online course (SPOCs)+flipped classroomteaching is expected to become an important complement to the traditional teaching of dermatology. In this teaching mode, first of all knowledge nodes are divided separately according to the syllabus and for each node, 7 to 10 minutes of micro video or micro-lecture is made, which enables students to make best use of fragmented time through the network to master relevant knowledge independently before the trainee. In the flipped classroom, based on the difficulties and misunderstandings of learning reflected from the network monitor data, teacher can make full use of time on demonstrating typical cases, organizing discussion, grouping students to take diag-nostic and therapeutic exercise, answering targeted questions, teaching clinical thinking, experience and doctor-patient communication skills. Through this teaching mode, the new teaching idea can be imple-mented that students are in dominant position while teachers are in leading position, which contributes to deepening the understanding , absorption and application of knowledge and improving students' ability of communication, cooperation, diagnosis and treatment.

OBJECTIVE:To establish the method for rapid quality evaluation of Astragali Radix.METHODS:The moisture of medicinal material was determined by oven drying method;the content of astragaloside Ⅳ was determined by HPLC-ELSD;the content of isoflavone glucoside was determined by HPLC (as reference value).The partial least squares (PLS) method combined with acousto-optic turnable filter-NIDRS was adopted to build quantitative model of above indexes in Astragali Radix (as predict value).According to reference value,60 batches of sample were collected.The spectra pretreatment was conducted by first derivative method combined with Savitzky golay.The optimal bands of moisture,astragaloside Ⅳ and isoflavone glucoside were 1 100-2 300 nm,1 080-2 160 nm,1 170-2 230 nm,respectively.RESULTS:The content determination of moisture,astragaloside Ⅳ and isoflavone glucoside in samples were all in line with methodology requirements.The corrected mean square root deviation of quantitative model for moisture,astragaloside Ⅳ,calycosin glucoside were 0.132 3,0.006 6,0.002 5,respectively;predicted mean square root deviation were 0.237 1,0.016 3,0.004 7;internal cross validation coefficient of correction set were 0.975 9,0.953 3,0.968 0;internal verification deviation of quantitative model were 1.43％,1.90％,1.84％;external verification deviation were 1.73 ％,2.68 ％,2.71％,respectively.CONCLUSIONS:The method is rapid,accurate,simple,pollution-free,and can be used for rapid quality evaluation of Astragali Radix.

Non-invasive respiratory support（NIRS）has developed rapidly in the field of pediatric respiratory support.It is increasingly popular in sequential treatment after acute respiratory failure and adjuvant extubation withdrawal.It reduces the need for invasive mechanical ventilation and the occurrence of related complications,which improves the compliance and comfort of the children.NIRS contains high flow nasal catheter oxygen inhalation (HFNC) and non-invasive ventilation (NIV).The selection and comparison between these two methods has become a hot research topic in recent years.We introduced the advantages and disadvantages of HFNC and NIV as initial respiratory support treatment options in different clinical situations.

Objective:To evaluate the effect of exogenous interleukin-18 (IL-18) binding protein (IL-18BP) on sepsis-associated lung injury and the role of NOD-like receptor family pyrin domain-containing 3 (NLRP3) inflammasomes in rats.Methods:This study was performed in two parts. Experiment Ⅰ Thirty-six SPF-grade healthy male Sprague-Dawley rats, aged 6-8 weeks, weighing 200 g, were allocated into 3 groups ( n=12 each) using a random number table method: sham operation group (S group), sepsis-associated lung injury group (SLI group), and sepsis-associated lung injury+ IL-18BP group (SI group). The rat model of sepsis-associated lung injury was developed using cecal ligation and puncture. The rats in group S underwent laparotomy without the subsequent ligation and puncture procedures. IL-18BP 1.5 mg/kg was intraperitoneally injected immediately after surgery in group SI. Experiment Ⅱ The aforementioned 36 rats were allocated into 3 groups ( n=12 each) using a random number table method: sepsis-associated lung injury + IL-18BP + vehicle group (SIV group), sepsis-associated lung injury + IL-18BP + MCC950 group (SIM group), and sepsis-associated lung injury + IL-18BP + nigericin group (SIN group). In SIV group, SIM group and SIN group, solvent, MCC950 (NLRP3 inhibitor, 5 mg/kg) and nigerin (NLRP3 agonist, 2 mg/kg) were intraperitoneally injected at 30 min before surgery respectively, and IL-18BP 1.5 mg/kg was intraperitoneally injected after operation. HE staining was used to observe the lung injury at 24 h after operation. The left lung tissues were obtained for calculation of the wet/dry weight (W/D) ratio. The concentrations of IL-18 and IL-18BP in broncho-alveolar lavage fluid (BALF) were determined by enzyme-linked immunosorbent assay. The percentage of NLRP3 positive cells in lung tissues was detected by immunofluorescence. The expression of IL-18, IL-18BP, cl-caspase-1 and gasdermin D (GSDMD) in lung tissues was detected by Western blot. Results:Experiment Ⅰ Compared with group S, the injury score of lung tissues, W/D ratio, concentrations of IL-18 and IL-18BP in BALF, and percentage of NLRP3 positive cells were significantly increased, and the expression of IL-18, IL-18BP, cl-caspase-1 and N-GSDMD was up-regulated in group SLI ( P<0.05). Compared with group SLI, the injury score of lung tissues, W/D ratio, concentrations of IL-18 and IL-18BP in BALF, and percentage of NLRP3 positive cells were significantly decreased, the expression of IL-18, cl-caspase-1 and N-GSDMD was down-regulated, and the expression of IL-18BP was up-regulated in group SI ( P<0.05). Experiment Ⅱ Compared with group SIV, the injury score of lung tissues, W/D ratio, concentrations of IL-18 in BALF, and percentage of NLRP3 positive cells were significantly decreased, and the expression of IL-18, cl-caspase-1 and N-GSDMD was down-regulated in group SIM, and the injury score of lung tissues, W/D ratio, concentrations of IL-18 in BALF, and percentage of NLRP3 positive cells were significantly increased, and the expression of IL-18, cl-caspase-1 and N-GSDMD was up-regulated in group SIN ( P<0.05). Conclusions:Exogenous IL-18BP can reduce sepsis-associated lung injury, and the mechanism is related to inhibition of activation of NLRP3 inflammasomes in rats.

OBJECTIVE:To establish rapid method for content determination of cryptotanshinone in Salvia miltiorrhiza. METHODS:The content of cryptotanshinone in sample was determined by HPLC(as reference value). AOTF-NIDRS combined with PLS was used to establish quantitative correction model for the content of cryptotanshinone in S. miltiorrhiza. According to the results of content determination of cryptotanshinone in samples,35 samples of medicinal material were collected. First-order derivative combined with smoothing filter coefficient method was used to pretreat spectrum,and optimal band range for content determination of cryptotanshinone in sample ranged 1 250-2 150 nm. RESULTS:Methodology validation of content determination of cryptotanshinone in sample was in line with the requirements. Correction mean square deviation of quantitative correction model of cryptotanshinone was 0.014 6,and predicted mean square deviation was 0.022 3,coefficient of association was 0.976 6. The internal verification deviation was 2.41% and the external verification deviation was 4.06%. CONCLUSIONS:This method is rapid,accurate,simple and pollution-free.It can be used for rapid content determination of cryptotanshinone in S.miltiorrhiza.

OBJECTIVE:To establish the method for rapid judgement of blending endpoint of Jingqi shuangshen capsules and content determination of astragaloside Ⅳ. METHODS:AOTF-NIR combined with principal component analysis and Moving Block Standard Deviation method was used to identify the blending endpoint. First derivative combined with savitzky-golay filter method were used to spectrum pretreatment. The partial least square method was used to establish quantitative analysis model of the content of astragaloside Ⅳin mixed endpoint sample. The content of astragaloside Ⅳ in mixed endpoint sample was determined by HPLC-ELSD to validate the model. RESULTS:Methodology validation of content determination of astragaloside Ⅳ in mixed material sample and mixed endpoint sample was in line with the requirements. NIR monitoring results showed that the product reached the blending endpoint after 30 min. The results of NIR monitoring were generally consistent with the results of HPLC-ELSD. The principal component dimension of the quantitative model was 9;determination coefficients was 0.954 9;Root Mean Square of Calibration of the model was 0.039 2;Root Mean Square Error of Prediction of the model was 0.042 6. Predicted average value of astragaloside Ⅳ by NIR was 11.74 mg/g,and measured average value of astragaloside Ⅳ by HPLC-ELSD was 11.38 mg/g;average deviation was 3.16%. CONCLUSIONS:AOTF-NIR can rapidly judge the blending endpoint sample of Jingqi shuangshen capsules,rapidly determine the content of astragalosideⅣin mixed endpoint material,improve the quality control level of blending process and shorten blending cycle.

Objective:To investigate the morphological feature and clinical significance of MRI around tumor after drug-eluting bead transcatheter arterial chemoembolization (DEB-TACE) of primary hepatocellular carcinoma.Methods:We reviewed and analyzed the data of hepatocellular carcinoma patients admitted from January 2017 to December 2018 in the Department of Radiological Intervention of the First Affiliated Hospital of Zhengzhou University. A total of 42 patients were enrolled, including 35 males and 7 females, aged (57.0±11.9) years. For the first time after operation, MRI enhancement showed peri-tumor margin enhancement as the starting point of follow-up. Follow-up and measure enhanced edge thickness, delayed enhancement, progression or remission data.Results:A total of 49 tumors and 84 peritumoral enhancement margins were included in 42 patients, with 30 sharp type , 40 rough type and 14 nodular type. The thickness of sharp type is less than that of rough type and nsodular type, and the differences were statistically significant (all P<0.05). The sharp type is the majority of the tumors with maximum diameter <5 cm, rough type and nodule type are the majority of tumors with maximum diameter ≥5 cm. Most of the sharp type are continuously enhanced, while the rough type and nodular type are not. Most sharp type relief (93.3%, 28/30), while rough type (80.0%, 32/40) and nodular type ( n=12) are mostly of deterioration, the differences are statistically significant (all P<0.05). Conclusion:Compared with the rough type and nodular type, the sharp type usually occurs in smaller tumors and more prone to local mitigation in the enhanced morphology around MRI after DEB-TACE in primary hepatocellular carcinoma.

Objective To explore the clinical effect of the application of 4R crisis management theory in skin care of ICU patients .Methods Totals of 1 937 cases of ICU surgical patients from September 2009 to December 2010 in our hospital , who received the traditional management method , were set to be the control group.The other 2 129 cases of ICU surgical patients from January 2011 to April 2012, who received the 4R crisis management theory in skin care based on the traditional management method , were set to be the experiment group .The occurrence of complications such as eczema , pressure ulcer , frostbite and empyrosis and the recovery of the pressure ulcer outside hospital of the two groups were observed and compared .Results In the control group , there were sixty-three cases of eczema , twenty-five cases of pressure ulcer ( five were caused by nasogatric tube , one by blood pressure cuff , eighteen by nasotracheal intubation , one by prominence of sacra) , and ten cases of skin damage caused by adhesive plaster or electrode pads ;In experiment group , there were twenty-one cases of eczema , eleven cases of pressure ulcer ( eleven by nasotracheal intubation ) , one case of scald, three cases of skin damage caused by adhesive plaster .The experiment group in improvement of eczema, pressure ulcer, and skin damage was statistically significantly better than those in the control group (χ2 =25.74, 6.92,4.48, respectively;P<0.05).In the control group, seven cases appeared pressure ulcer from outside the hospital, among which no one healed, five improved, and two not improved.While pressure ulcer from outside the hospital were nine in the experiment group , among which four healed and five improved , with a statistically significant difference between the two groups (χ2 =5.45, P<0.05).Conclusions The application of 4R crisis management theory in skin care of ICU patients will effectively prevent and reduce the complications related to the skin so that the purpose of improving nursing quality and safeguarding the patients can be achieved.