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ABSTRACT OBJECTIVE：To study the association between CYP3A5，CYP3A4，ABCB1 and POR*28 genetic polymorphisms and drug dosage（D）and steady blood concentration/dosage（c0/D）of tacrolimus in lung transplant recipients after one year of tacrolimus administration. METHODS：By retrospective analysis，a total of 46 recipients who underwent lung transplantation in China-Japan Friendship Hospital during May 2017-May 2018 were selected. The c0 and D of tacrolimus were measured and collected after one year of tacrolimus administration，and c0/D was calculated. Recipients’genotypes of CYP3A5（rs776746）， CYP3A4（rs2242480，rs28371759），ABCB1（rs1045642，rs2032582，rs1128503）and POR*28（rs1057868）were collected. The relationship between genetic polymorphism and D，c0/D was analyzed statistically. RESULTS：The genotype frequency in this study were all in accordance with Hardy-Weinberg equilibrium （P＞0.05）. While maintaining tacrolimus c0 within therapeutic range， genetic polymorphism of CYP3A5（rs776746）and CYP3A4（rs2242480）influenced D and c0/D of tacrolimus significantly（P＜ 0.05）. There was no statistical significance in D or c0/D among different genotypes of other sites（P＞0.05）. There was statistical significance in D or c0/D among extensive metabolism type recipients with CYP3A5（rs776746）*1 and CYP3A4（rs2242480）*1G alleles，normal metabolism type recipients with only CYP3A5 （rs776746） *1 or CYP3A4 （rs2242480） *1G alleles and poor metabolism type recipients without CYP3A5（rs776746）*1 and CYP3A4（rs2242480）* 1G alleles（P＜0.05）. D of tacrolimus was the highest in extensive metabolism type recipient and the lowest in poor metabolism type recipient. CONCLUSIONS：The detection of genetic polymorphism of CYP3A5（rs776746）and CYP3A4（rs2242480）has guiding significance for individualized medication of tacrolimus after one year of tacrolimus administration.
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OBJECTIVE：To analyze the occurrence of acute kidney injury （AKI）after lung transplantation and its possible influential factors . METHODS ：Medical records of 64 patients who received lung transplantation in our hospital from April 2017 to June 2018 were included in this retrospective study. Patients were divided into AKI group （44 cases）and non-AKI group （20 cases），according to whether AKI occurred after operation. According to diagnostic criteria for lung transplantation in our hospital ， all patients were given Methylprednisolone sodium succinate for injection or Methylprednisolone sodium succinate for injection combined with Basiliximab for injection ，and triple immunosuppressive therapy of Tacrolimus capsules+Mycophenolate mofetil dispersible tablets or Mycophenolate mofetil capsules or Mycophenolate sodium enteric-coated tablets+Methylprednisolone tablets or Prednisone acetate tablets were given after operation. The occurrence of AKI in AKI group within a week after operation were recorded. Intraoperative influential factors （operation type ， operation duration ， ECMO support ， immune inhibitor use ， intraoperative blood loss ），postoperative influential factors [days of ICU ，mechanical ventilation and ECMO support ，median value of Scr within one week after operation ，median tacrolimus concentration and the use of potential nephrotoxic drugs （≥4 kinds）， hospitalization days] and survival rate one year after operation were observed in 2 groups. RESULTS ：Within one week after lung transplantation，44 patients（68.8％）had experienced at least one episode of AKI ，among which 19 cases（29.7％）were stage 1， 17 cases（26.5％）were stage 2 and 8 cases（12.5％）were stage 3. The incidence of AKI was the highest on post-operative day 4 （57.4％）. The incidence of AKI at stage 3 exhibited growth trend within the first week after operation ，and reached the highest on median post-operative day 5（8.7％）. Operation duration ，median value of Scr within one week after operation ，median tacrolimus concentration in non-AKI group were significantly shorter or lower than AKI group ；there was no significant difference in operation type， ECMO support ， use of immunosuppressive agents ， intraoperative blood loss ，ICU days ，mechanical ventilation days，ECMO support days ，the utilization rate of potential nephrotoxic drugs （ ≥4 kinds） and hospitalization days between 2 groups （P＞0.05）. There was no statistical significance in the survival rate at stage 1 and 2 one year after operation between AKI group and non-AKI group （P＞0.05）. One year after operation ，survival rate of AKI group at stage 3 was significantly lower than that of non-AKI group （P＜0.05）. CONCLUSIONS：The incidence of AKI is high after lung transplantation. Operation duration ，median value of Scr within one week after operation ，median tacrolimus concentration were possible factors for the occurrence of AKI after operation.
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Objective:Due to the circumstances where people being required to home quarantine and eye hospitals being unable to receive patient normally, The application of internet plus technology is explored to build Remote Dedicated Doctor Platform of Ophthalmology (RDDPO) for online consultation, accessing to medication, medical services and advises orderly, and to help to further develop and apply the platform.Methods:In 2018, RDDPO was jointly developed.It has been modified and improved to the formulation of national medical policy and medical insurance policy and the outbreak of COVID-19 at the end of 2019, and it has been carried out comprehensive application verification during the prevention and control of COVID-19 epidemic.With a B/S structure, platform docks the official accounts of Wechat platform.On the server side, three J2EE frameworks of the integrated development, including Struts2, Spring and Hibernate are adopted; on the mobile client side, a combination of development tools including React-Native and Redux is used.Meanwhile, a micro-services Architecture (msA) of RESTful WebAPI is chosen at the business logic layer.The terminal data information is used to summarize the results of the platform's functional services for ophthalmic patients, such as remote diagnosis and treatment, online prescription, medicine delivery and health education, etc., and to make statistics on all kinds of data during the epidemic prevention and control period, so as to verify the operations management capabilities of the platform's functions.Results:During the period of COVID-19 epidemic prevention and control, the number of monthly visits of RDDPO increased from 1063 person times from September 1, 2019 to the end of September to 30 002 person times from February 1, 2020 to February 28, 2020.The proportion of diagnosis and treatment person times of this platform in the total number of diagnosis and treatment person times increased from 19.1% (203/1 063) to 92.3% (277/3 002), which can effectively avoid the risk of personal contact infection and meet the patients' medical needs.95.8% of the patients were very satisfied.95.8% of the patients were very satisfied.Conclusions:The RDDPO establishes a channel for doctor-patient communication during the epidemic, which can be considered as an important way to effectively address the needs of patients for medical treatment.
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Objective:To evaluate the efficacy of Jianpi-Yishen Decoction in treating sarcopenia aged patients with syndrome of spleen-kidney deficiency and cold-dampness. Methods:Eighty-two sarcopenia aged patients admitted to Beijing Longfu hospital from January of 2018 to May of 2019 were selected and divided into the control group and the observation group with 41 patients in each group according to the random number table. Patients in the control group were given routine western treatment such as nutritional support. In the observation group, the patients were given Jianpi-Yishen Decoction based on the control group. Both groups were treated for 12 weeks. Before and after the treatment, the upper limb muscle strength, scores of symptoms of syndrome of spleen-kidney deficiency and cold-dampness, the efficacy of traditional Chinese medicine syndrome, and serum level of 1,25-dihydroxyvitamin D3 were compared between the two groups. Results:During the treatment, one patient in the control group was dropped out. The total effective rate was 95.1% (39/41) in the observation group and 72.5% (29/40) in the control group, and the difference between the two groups was statistically significant ( χ2=6.103, P=0.013). After the treatment, the scores of languid limbs, cold limbs, weak waist and knee, clear urine and loose stool in the observation group were obviously lower than those of the control group ( t values were 9.964, 12.510, 14.103, 13.415, 14.599, respectively, all Ps<0.01). The left hand grip strength (52.75±7.91 kg vs. 46.10 ± 7.22 kg, t=3.954) and the right hand grip strength (53.93 ± 8.09 kg vs. 48.55 ± 7.17 kg, t=3.169) were both higher than those of the control group ( P<0.01). Serum level of 1,25-dihydroxyvitamin D3 (23.90 ± 3.34 ng/L vs. 19.44 ± 3.15 ng/L, t=6.184) were higher than those of the control group ( P<0.01). Conclusions:Jianpi-Yishen Decoction in treating sarcopenia aged patients with syndrome of spleen-kidney deficiency and cold-dampness can effectively relieve the symptoms, up-regulate serum level of 1,25-dihydroxyvitamin D3 with clinical efficacy.
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OBJECTIVE： To study the correlation of tacrolimus concentrations among transplant patients’ whole blood， plasma and blood cells， analyze the effects of transplant types and ages on the their correlation， and to provide reference for rational drug use in clinic. METHODS： Totally 20 patients receiving tacrolimus anti-rejection therapy after transplantation and undergoing therapeutic drug monitoring （TDM） were randomly selected. According to the type of transplantation， they were divided into renal transplantation group and lung transplantation group （10 cases for each group）. According to age， they were divided into three groups： 20-40 years old group， 41-60 years old group and 61-80 years old group （4， 9， 7 cases for each group）. Their residual blood after TDM was collected. Chemiluminescence microparticle immuno assay （CMIA） was used to detect the concentration of tacrolimus in whole blood. UPLC-MS/MS was used to measure the concentrations of tacrolimus in plasma and blood cells. Pairs plots and Spearman rank correlation analysis were used to analyze the correlation of tacrolimus between whole blood and plasma， between whole blood and blood cells， between plasma and blood cells as well as the effects of transplant types and ages on tacrolimus concentrations among tansplant patient’s whole blood， plasma and blood cells. RESULTS： The correlation of tacrolimus concentrations in whole blood and plasma （r＝0.623，P＜0.01） was slightly stronger than that of whole blood and blood cells （r＝0.591， P＜0.01）； while the correlation of tacrolimus concentration in plasma and blood cells was relatively weak （r＝0.497，P＜0.05）. Transplant type and age had an effect on the correlation of tacrolimus concentrations among patients’ whole blood， plasma， blood cells. The correlation of tacrolimus concen- tration in whole blood， blood cells and plasma in renal transplantation group was also weak （all r＜0.5）， and was weaker than that in lung transplantation group. The correlation of tacrolimus concentration among whole blood， plasma and blood cells was weak in patients of aged 20-40 years old group （all r＜0.3）， and was weaker than that of patients of aged 41-60 years old group and 61-80 years old group. CONCLUSION： Post-transplantation patients’ tacrolimus concentrations in whole blood， plasma and blood cell have a weak correlation. Rejections and adverse effects should be monitored in these patients， especially those renal transplantation patients or those patients aged 20 to 40.
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OBJECTIVE： To investigate pharmaceutical care of cancer pain therapy in medical institutions from Beijing area， and to provide reference for improving the quality of pharmaceutical care for cancer pain in medical institutions and formulating cancer pain therapy decision by public health administration departments at different levels. METHODS： Inspection results of standardized diagnosis and treatment for cancer pain were analyzed retrospectively in Beijing Pain Therapy Quality Control and Improvement Center during Feb.-Mar. 2018. Scoring results of pharmaceutical care （20 points） and its 5 sub-items （personnel participation， drug supply， drug management， outpatient prescription comment and inpatient prescription comment， 4 points each item） were analyzed statistically and classified according to hospital level and pharmaceutical care inspection results. RESULTS： A total of 64 hospitals in Beijing participated in the inspection， including 27 tertiary A hospitals （42.19％）， 21 tertiary B hospitals （32.81％）， 16 secondary hospitals or first-level hospitals （25.00％）. Pharmaceutical care in all hospitals met the inspection requirements with qualified rate of 100％. 52 hospitals performed excellently （81.25％）， and 12 hospitals were qualified for pharmaceutical care （18.75％）. Among 5 sub-items of personnel participation， drug supply， drug management， outpatient prescription comment and inpatient prescription comment， the average score of drug supply item was the highest （3.83±0.05）； the lowest was the personnel participation item （2.93±0.13）. The results of pharmaceutical care inspection in tertiary A hospitals （17.80±0.28） and tertiary B hospitals （17.78±0.30） were significantly better than those in secondary hospitals or first-level hospitals（16.16±0.50）（P＜0.01 or P＜0.05）； there was statistical significance only in the score of outpatient prescription comment among 5 sub-items（P＝0.026）. Total scores of the hospitals with excellent pharmaceutical care were significantly higher than those of the hospitals with qualified pharmaceutical care in terms of personnel participation， outpatient prescription comment and inpatient prescription comment （P＜0.01 or P＜0.05）. There was significant difference in the inspection results of pharmaceutical care among the excellent group， the qualified group and the unqualified group classified by the results of personnel participation item （P＜0.01 or P＜0.05）. CONCLUSIONS： The quality of pharmaceutical care for cancer pain therapy in medical institutions from Beijing area has reached the qualified level， but the participation of clinical pharmacists in cancer pain therapy and outpatient prescription comment still need improvement in further. The training of clinical pharmacists and information construction of narcotic drug management should be strengthened so as to improve the overall quality of pharmaceutical care for cancer pain.
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OBJECTIVE:To investigate the utilization of the most used splitting drugs in the inpatients of our hospital,and to promote rational use of splitting drugs. METHODS:The medical orders of oral tablets in the inpatients of our hospital in Jan. 2016 were analyzed statistically in respects of consumption quantity,classification dosage,department dosage and the proportion of scored tablets. RESULTS & CONCLUSIONS:There were 217389 medical orders of tablets in the inpatients of our hospital in Jan. 2016. There were 12792 medical orders of splitting drugs,with utilization rate of 5.88%. The most used splitting tablet were car-diovascular drugs and drug for nervous system,accounting for 53.31% and 20.72% of total. The splitting tablets were mostly used in respiratory and critical care medicine department. Top 10 departments in the list of the number of splitting drug medical orders prescribed 8993 splitting drug medical orders,accounted for 70.30% of total. Top 20 drugs in the list of the number of splitting drugs were involved in 8971 medical orders,accounting for 70.13%of total;there were 14 kinds of scored drugs and 7506 medi-cal orders of splitting scored drugs,accounting for 83.67% of top 20 medical orders of splitting drugs. Among splitting drugs,49 types had scored-line,which were prescribed in 9265 medical orders of splitting drug,accounting for 72.43% of all medical or-ders of splitting drug. Lacking of information in most package inserts about the tablet can or can not split,it is suggested to note this information in package inserts by pharmaceutical enterprises. For commonly used splitting drugs without scored-line,it is pro-posed to produce small-size drugs or add scored-line.
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Objective To explore the clinical significance and gene mutation profiles of renal transplant patients with unconjugated hyperbilirubinemia (Gilbert's syndrome).Methods Genomic DNA was extracted from peripheral blood samples of 8 renal transplant patients with Gilbert'S syndrome.UGT1A1 * 6 and UGT1A1 * 28 genotypes were identified through digital fluorescence molecular hybridization and DNA sequencing.Results There are 2 cases of UGT1A1 * 28 heterozygous mutant,3 cases of UGT1A1 * 6 homozygous mutant,2 case of UGT1A1 * 6 heterozygous mutant,1 case of UGT1A1 * 28 heterozygous mutant combined with UGT1A1 * 6 heterozygous mutant.Conclusion There is a higher heterozygous or homozygous gene mutation rate of UGT1A1 * 6 and UGT1A1 * 28 in renal transplant patients with Gilbert's syndrome.Genetic mutation of UGT1A1 * 6 and UGT1A1 * 28 may be the reason of Gilbert's syndrome after renal transplant.
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Abdominal aortic aneurysm (AAA) is an inflammatory vascular disorder with high mortality. Accumulating evidence shows that toll-like receptor 2 (TLR2) plays a critical role in the regulation of wound-repairing process after tissue injury. We wondered if TLR2 signaling contributed to the pathogenesis of AAA and that targeting TLR2 would attenuate AAA development and progression. In this study, enhanced expression of TLR2 and its ligands were observed in human AAA tissue. Neutralization of TLR2 protected against AAA development and caused established AAA to regress in mouse models of AAA. In addition, TLR2-deficient mice also failed to develop AAA. The prophylactic and therapeutic effects of blocking TLR2 were accompanied by a significant resolution of inflammation and vascular remodeling, as indicated by the decreased expression or activity of MMP-2/9, α-SMA, inflammatory cytokines, and transcription factors NF-κB, AP-1 and STAT1/3 in AAA tissue. Mechanistically, blocking TLR2 decreased the expression and interaction of TLR2 and several endogenous ligands, which diminished chronic inflammation and vascular remodeling in the vascular tissue of AAA. Our studies indicate that the interactions between TLR2 and its endogenous ligands contribute to the pathogenesis of AAA and that targeting TLR2 offers great potential toward the development of therapeutic agents against AAA.
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Objective To develop a Scoring System for Academic Conference Papers,in order to achieve real-time paper scoring in large academic conference with the information technology and network.Methods Based on Microsoft.Net technology,an information system Was developed,supporting multimeeting.multi-client and dynamic screen show.Results In this system,the conference inforrnation,meeting name and scoring standards Call be customized;the doctor information,papers information,used time,score detail and dynamic list Can be displayed in the screen.This system has been applied in national ophthalmic conferences several times and gained praise from the organizing committee and judges.Conclusions The scoring system for Academic Conference Papers can significantly improve efficiency,help to promote the standardization of paper scoring,and manifest the open,fair and just principles.It is worth of spreading.
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Objective To find convenient methods for remote consultation of images of ocular fundus diseases. Methods A remote consultation system composed of internet was set up.The consultation information,including images,words and figures,was published on internet as web pages,so that the consultants would get the notice and the appointment by e mail.After reading the information on line,the consultants gave their opinions back to internet. Results The remote consultation system of images of ocular fundus diseases was setted up and managed successfully,and 23 patients had been diagnosed by this system. Conclusion The system which has clinical practicality is a simple,quick,effective and economic method for remote consultation of images of ocular fundus diseases. [