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Objective:To evaluate the diagnostic value of metagenomics next-generation sequencing (mNGS) in detecting pathogens in bronchoalveolar lavage fluid (BALF) for pulmonary infection in solid organ transplant patients in intensive care unit (ICU).Methods:A retrospective study was conducted, the BALF samples from 46 patients with post organ transplant pneumonia/suspected pneumonia admitted to the Department of Critical Care Medicine of the First Affiliated Hospital of University of Science and Technology of China from August 2018 to August 2021 were collected, all tested by simultaneous mNGS and conventional comprehensive microbial test (CMT), and the results of CMT were used as the reference standard to compare the differences in the diagnostic value of mNGS and CMT for pulmonary infections in solid organ transplant patients, and to analyze the diagnostic value of mNGS for mixed infections.Results:① Pneumonia pathogens: a total of 31 pathogens were detected in 35 patients, including bacteria (16 species), fungi (9 species) and viruses (6 species). Among them, 25 pathogens were detected by mNGS and CMT, and only 19 pathogens were detected by mNGS. Among the microorganisms isolated by mNGS method, the detection rates of Pseudomonas aeruginosa, Acinetobacter baumannii and Klebsiella pneumoniae were higher [51.4%(18/35), 42.9% (15/35), 31.4% (11/35), respectively]; Candida albicans, Aspergillus and Pneumocystis carinii were the most commonly detected fungi [31.4% (11/35), 22.9% (8/35), 22.9% (8/35), respectively]; 20 patients were positive for the virus, and the most commonly detected viruses were cytomegalovirus, herpesvirus and EB virus [28.6% (10/35), 20.0% (7/35), 17.1% (6/35), respectively]. In addition, one case of Brucella was detected by mNGS.② Diagnostic efficiency: as far as bacterial detection is concerned, 20 cases of negative results were obtained by CMT detection of 35 samples included in the study, and a total of 10 cases of positive results were obtained by mNGS detection of negative samples; the percentage of mNGS positive samples was significantly higher than that of CMT positive samples [odds ratio ( OR) = 5.5, 95% confidence interval (95% CI) = 1.2-24.8, P = 0.02]. When compared with CMT, the sensitivity and specificity of mNGS were 93.3% and 50.0%, and the positive predictive value (PPV) and negative predictive value (NPV) were 58.3%, 91.1%. As far as fungal detection was concerned, there was no significant difference in the percentage of positive samples between the two methods ( OR = 1.5, 95% CI = 0.5-4.2, P = 0.60); the sensitivity and specificity of mNGS were 72.2% and 64.7%, and the PPV and NPV were 68.4%, 68.8%; CMT test of the 35 included samples produced 17 negative results, and mNGS test of the negative samples produced 6 positive results. A total of 20 patients tested positive for the virus by mNGS. In addition, 23 patients (65.7%) were diagnosed with pulmonary mixed infection. Conclusion:The use of mNGS to detect pathogens in BALF can improve the sensitivity and specificity of bacterial identification of pulmonary infection in critically ill organ transplant patients, and mNGS has obvious advantages in detecting virus and identifying mixed infections.
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Organ transplantation is an effective treatment for end-stage organ failure. However, organ shortage has always been a common problem faced by countries around the world. The recognition and active participation of intensive care unit (ICU) medical staff in organ donation contributes to promoting the development of organ donation, thereby alleviating the shortage of donor organ. In this article, the key strategies of ICU donor management to promote organ donation and the key strategies of ICU medical staff management to promote organ donation were summarized, aiming to provide reference for organ donation practitioners (especially ICU medical staff) and jointly facilitate the professional development of organ donation.
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OBJECTIVE To explore the mechanism of Aurora kinase A (Aurora-A) promoting cancer cell chemotherapy resistance in nasopharyngeal carcinoma. METHODS The expression of Aurora-A in nasopharyngeal carcinoma tissues and adjacent tissues were detected by Western bolt and Q-PCR. The highexpressing Aurora A cell line CNE2 was used to detected the cell apoptosis and the expression of key pathway marker protein after Aurora-A inhibitor VX680 and cisplatin treatment by using Flow cytometry and WB. RESULTS The expression of Aurora-A in nasopharyngeal carcinoma tissues was significantly higher than that in adjacent tissues. Comparing to normal nasopharyngeal cells NP69, Aurora-A was significantly highly expressed in all of nasopharyngeal carcinoma cells and was highest in CNE2. Inhibiton of Aurora-A increased the cell apoptosis and the expression of p-AKT, p21 and Cleaved-Caspase-3 after using cisplatin or the Aurora-A inhibitor VX680 treatment. CONCLUSION The results shown that Aurora-A confer chemoresistance to cisplatin treatment through p-AKT/p21/Cleaved-Caspase-3 pathway.
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Objective To observe the variation tendency of laboratory indexes after delivery in pregnant women with acute fatty liver of pregnancy (AFLP) and the effects of plasma exchange (PE) on the patients prognoses and those parameters. Methods The data of 37 patients with AFLP admitted to the Department of Intensive Care Unit (ICU) of Anhui Provincial Hospital from January 2009 to June 2017 were retrospectively analyzed and the authors tried to clarify the natural course of AFLP; all the selected patients met the Swansea criteria of the AFLP diagnosis. The patients were divided into a PE group (9 cases) and a non-PE group (28 cases) according to whether they were treated with PE or not. At the same time, the effects of PE on liver function and coagulation parameters in the patients were analyzed. Results The most common clinical symptoms of 37 AFLP patients were as follows: nausea and vomiting (21 cases, incidence 56.8%), jaundice (21 cases, 56.8%), upper abdominal pain (14 cases, 37.8%), and more than 90% of patients had more than one symptom. All 37 patients with AFLP had abnormal liver function, their differences in the severity degrees were great, and the level of aspartate aminotransferase (AST) was (271.65±265.90) U/L;the levels of creatinine (SCr) of 72.9% patients (27 cases) were more than 140 mmol/L; the prothrombin times (PT) of 72.97% patients (27 cases) were more than 15 seconds; all patients had received blood product transfusion. Liver function and blood coagulation parameters mostly returned to normal within 1 week after delivery: AST rapidly decreased on the 1 - 2 days after delivery and then continued to decrease; all the cholesterol levels in the two groups decreased to the lowest levels within 3 - 4 days after delivery and then began to rise; the total bilirubin (TBil) levels kept on basically unchanging after delivery; in the patients with levels of platelet counts (PLT) on admission ≥ 150×109/L, on the second day after delivery, their counts returned to approximately 100×109/L, while in patients with PLT < 150×109/L on admission, on the sixth day after delivery, the counts began to slowly increase to about 100×109/L; the patients with fibrinogen (Fib) levels > 1.5 g/L on admission, the levels slightly decreased 2 days before delivery, then gradually recovered and stabilized after delivery, while the patients with Fib < 1.5 g/L, the levels began to rise slowly on the second day after delivery; prothrombin time (PT) and activated partial thromboplastin time (APTT) were basically return to the normal reference ranges on the fifth day after delivery. The PE therapy could significantly improve the patients' laboratory indexes: the levels of AST, TBil, PLT, PT were significant lower immediately and on the second day after PE compared with those levels before the PE [AST (U/L): 197 (114, 383), 116 (65, 311) vs. 239 (125, 430), TBil (μmol/L):109 (67, 126), 125 (103, 178) vs. 164 (99, 198), PLT (×109/L): 96.44±33.10, 89.89±33.03 vs. 126.22±40.83, PT (s): 17.82±5.93, 18.36±3.19 vs. 22.67±8.44, all P < 0.05]. Conclusion After terminating the delivery in time for about one week, the AFLP patients' various indexes may basically return to normal; PE therapy can improve the patients' liver function and coagulation indexes.
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Objective: To explore value of exercise stress test guiding aerobic exercise rehabilitation in patients with myocardial infarction.Methods: A total of 102 patients with myocardial infarction in recovery were selected.According to random number table, they were randomly and equally divided into routine rehabilitation group (received routine rehabilitation guidance) and aerobic exercise rehabilitation group (received aerobic rehabilitation exercise in guidance of exercise stress test).Amount of exercise, hemodynamic parameters and psychological state were compared between two groups.Results: After treatment, amount of exercise: compared with routine rehabilitation group, there were significant rise in amount of exercise[(6.79±0.58)METs vs.(7.42±0.69)METs], maximum heart rate[(126.27±5.26) beats/min vs.(138.18±5.81) beats/min], heart rate blood pressure product[(221.87±21.46) vs.(244.85±23.09)]and exercise duration[(10.36±1.36) min vs.(11.18±1.45) min]in aerobic rehabilitation group, P<0.05 or <0.01;hemodynamic parameters: compared with routine rehabilitation group, there were significant rise in cardiac output[(5.36±0.57) L/min vs.(5.72±0.68) L/min], cardiac index[(2.96±0.53) L min-1 m-2 vs.(3.25±0.52) L min-1 m-2], stroke volume[(73.16±8.47) ml vs.(78.12±9.14) ml]in aerobic exercise rehabilitation group, P<0.05 all;psychological state: compared with routine rehabilitation group, there were significant reductions in scores of Hamilton rating scale for anxiety[HAMA, (9.74±3.26) scores vs.(6.35±1.18) scores]and Hamilton rating scale for depression[HAMD, (14.83±4.58) scores vs.(10.56±3.27) scores]in aerobic exercise rehabilitation group, P<0.05 both.Conclusion: Exercise stress test guiding aerobic exercise rehabilitation can help to improve exercise function and hemodynamic indexes, alleviate the negative mood, then promote patients recover.
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We obtained recombinant ferritin from Dermatophagoides f arinae ,and analyzed the characterization of the pro‐tein .A pair of primers was designed according to the known sequence of ferritin gene .The live mites identified and cultured lo‐cally were picked and the total RNA was extracted .The ferritin gene fragment was amplified by RT‐PCR ,and cloned into pET32a vector ,and then transferred into E .coli Top10 .The target gene obtained from the recombinant plasmid by digestion with Bam HⅠand Hind Ⅲ was connected to the prokaryotic expression vector pET‐32a .The expressed recombinant plasmid containing ferritin gene was constructed by cloning target gene into pET‐32a and transferred into E .coli Bl21 (DE3) .The ex‐pressed recombinant protein was analyzed by SDS‐PAGE ,and was purified by immobilized metal ion affinity chromatography (IMAC) .The ferritin expressed by dust mite was analyzed by the method of bioinformatics .The recombinant plasmid pET32a‐ferritin was constructed .SDS‐PAGE showed a correct molecular weight of the recombinant ferritin protein .After purification by affinity chromatography ,the protein showed only one strip on SDS‐PAGE gel .SDS‐PAGE showed a band at 20 kD .Dust mite ferritin contains 8 serine kinase ,7 threonine kinase ,7 tyrosine kinase ,and 0 histidine kinase phosphorylation sites .Hy‐drophilic region is larger than the hydrophobic region and it is an unstable protein .In conclusion ,the ferritin gene has been cloned and expressed .The purified ferritin has high purity . The study provides a basis for further study of composition and physicochemical properties of house dust mite allergen .
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Objective To discuss the effect of group counseling for medical students in reducing academic procrastination,and explore effective means to improve learning efficiency.Methods 24 students identified as voluntary research subjects were divided into the experimental group and the control group,male and female ratio was 1:1.The experimental group received counseling activities for eight times,the control group members did not receive any intervention.This thesis took use of Procrastination Assessment Scale-Students (PASS) as an evaluation tool in before and after test and tracing test,and did the significance test,as a quantitative analysis of this study.Results The quantitative study showed that the difference between the experimental group and the control group in pre-test was insignificant,indicating these research subjects belong to homogeneous research subjects; differences in pre-test and post-test of the experimental group were significantly greater than the differences of pre-test and post-test in the control group,indicating the group counseling producing an effect on learning procrastination.In order to verify the effect's continuity of the group psychological counseling,a tracking test was conducted on the members three months later.After three months,the tracking test scores of the experimental group and the control group were not significantly lower than the pre-test score.In tracking tests,the experimental group's scores were lower than before-test,indicating the effect of group psychological counseling was sustainable.Conclusions Group psychological counseling activities can reduce academic procrastination of medical school students and the group psychological counseling scheme has effectiveness and feasibility.
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Objective To study the clinical effect and safety of Dinoprostone suppositories for cervical ripening and labor induction.Methods 50 primiparas with sinsle cephalic term pregnancy.cervical Bishop score≤6 points,with vaginal delivery conditions,no previous uterine scar or prostaglandin allergies or other contraindications were randomly divided into two groups:the dinoprostone suppositories group(observation group)and the sulfuric pula group(control group).The primiparas were administered sulfuric pula keto 200mg/day via intravenous injection for 3 days.Bishop score was assayed in both groups before treatment and 6h.12h after treatment to compare the effect of cervical ripening,labor rates,the total time of labor,mode of delivery,postpartum hemorrhage,neonatal outcomes and adverse reactions.Results Cervical scores were(3.85±0.72)point and(6.79±0.63)point in the observation group 6h and 12h after administration,which were significantly higher than those of control group[(2.85±0.41)point,(4.26±0.52)point](t=6.034,15.485,all P＜0.05).Labor rates of 12h and 24h in the observation group were signitlcandy higher than control group.There Was no significant difference between two groups of neonatal outcomes and postpartum hemorrhage.Conclusion Dinoprostone suppositories sas safe and effective for cervical ripening and labor induction,without adverse effects on mothers and children.