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OBJECTIVE To provide reference for the adjustment of antibiotic treatment regimens， identification of adverse reactions， and individualized pharmaceutical care for melioidosis sepsis （MS）. METHODS Clinical pharmacists participated in the intensive and eradicating therapeutic processes for an MS patient by using blood concentration and gene detection. Based on the literature， antibiotic treatment regimens of MS were adjusted by determining the blood concentrations of β-lactam and trimethoprim/ sulfamethoxazole （TMP/SMZ） and calculating PK/PD parameters. The causes of adverse drug reactions were analyzed and addressed by detecting drug-related gene polymorphisms through high-throughput sequencing. RESULTS Clinical pharmacists used blood concentration and genetic testing methods to propose adjustments to imipenem-cilastatin sodium dosage and analyze the causes of various adverse drug reactions. PK/PD targets were calculated by measuring the blood concentrations of β-lactam and TMP/SMZ. Clinical pharmacists explained to clinical doctors the compliance status of patients with melioidosis in sepsis and non- sepsis stages through reviewing guidelines and literature； the results of blood concentration and genetic test were used to analyze the correlation of neurotoxicity of MS patients with B14） IMP cmin， and it was found that nephrotoxicity was not related to the cmax of TMP/SMZ， but to the patient’s water intake. After whole-process antibiotic treatment， the patient’s condition improved and was discharged， and the adverse reactions were effectively treated. CONCLUSIONS Clinical pharmacists use blood concentration and genetic tests to assist clinicians in formulating MS treatment regimens， and provide whole-course pharmaceutical care for a MS patient. This method has improved the safety and effectiveness of clinical drug therapy.
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Diabetic kidney disease （DKD） is the main cause of end-stage renal disease. Its high prevalence， mortality rate， and medical cost bring a heavy economic burden to society and families， and DKD has become one of the most important public health problems. Intestinal microecology is the most important and complex micro-ecosystem in the human body， which is involved in important life activities such as material and energy metabolism， immune system regulation， and signal transduction， thereby maintaining the dynamic balance of the human internal environment. The dynamic balance between the intestinal microecology and the body is essentially a Yin-Yang balance. Once this balance is broken， intestinal microbiota imbalance， intestinal mucosal barrier damage， immune dysfunction， and reduction of metabolite short-chain fatty acids （SCFAs） will occur， which play an important role in the progression of DKD. From the perspective of the Yin-Yang theory of traditional Chinese medicine （TCM）， the imbalance of intestinal microecology in DKD is equivalent to the excessive or insufficient constraint of Yin and Yang， or Yin deficiency affecting Yang， or Yang deficiency affecting Yin， or waning and waxing of Yin and Yang. For different pathogenesis changes， "Yin disease treated through Yang"， "treating Yin for Yang"， or "treating Yang for Yin" methods are adopted to regulate intestinal microbiota， inhibit immune inflammation， protect intestinal mucosal barrier， and increase SCFAs through TCM， thereby reconciling Yin and Yang to achieve the condition where "Yin is at peace and Yang is compact". Based on the Yin-Yang theory， this paper intended to interpret the scientific connotation of TCM in the treatment of DKD with intestinal microecology as the target and TCM in the treatment of DKD by regulating intestinal microecology as the breakthrough point to provide a novel insight for the occurrence and development of DKD and the mechanism of TCM.
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The acute combination fractures of the atlas and axis in adults have a higher rate of neurological injury and early death compared with atlas or axial fractures alone. Currently, the diagnosis and treatment choices of acute combination fractures of the atlas and axis in adults are controversial because of the lack of standards for implementation. Non-operative treatments have a high incidence of bone nonunion and complications, while surgeries may easily lead to the injury of the vertebral artery, spinal cord and nerve root. At present, there are no evidence-based Chinese guidelines for the diagnosis and treatment of acute combination fractures of the atlas and axis in adults. To provide orthopedic surgeons with the most up-to-date and effective information in treating acute combination fractures of the atlas and axis in adults, the Spinal Trauma Group of Orthopedic Branch of Chinese Medical Doctor Association organized experts in the field of spinal trauma to develop the Evidence-based guideline for clinical diagnosis and treatment of acute combination fractures of the atlas and axis in adults ( version 2023) by referring to the "Management of acute combination fractures of the atlas and axis in adults" published by American Association of Neurological Surgeons (AANS)/Congress of Neurological Surgeons (CNS) in 2013 and the relevant Chinese and English literatures. Ten recommendations were made concerning the radiological diagnosis, stability judgment, treatment rules, treatment options and complications based on medical evidence, aiming to provide a reference for the diagnosis and treatment of acute combination fractures of the atlas and axis in adults.
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Ankylosing spondylitis (AS) combined with spinal fractures with thoracic and lumbar fracture as the most common type shows characteristics of unstable fracture, high incidence of nerve injury, high mortality and high disability rate. The diagnosis may be missed because it is mostly caused by low-energy injury, when spinal rigidity and osteoporosis have a great impact on the accuracy of imaging examination. At the same time, the treatment choices are controversial, with no relevant specifications. Non-operative treatments can easily lead to bone nonunion, pseudoarthrosis and delayed nerve injury, while surgeries may be failed due to internal fixation failure. At present, there are no evidence-based guidelines for the diagnosis and treatment of AS combined with thoracic and lumbar fracture. In this context, the Spinal Trauma Academic Group of Orthopedics Branch of Chinese Medical Doctor Association organized experts to formulate the Clinical guideline for the diagnosis and treatment of adult ankylosing spondylitis combined with thoracolumbar fracture ( version 2023) by following the principles of evidence-based medicine and systematically review related literatures. Ten recommendations on the diagnosis, imaging evaluation, classification and treatment of AS combined with thoracic and lumbar fracture were put forward, aiming to standardize the clinical diagnosis and treatment of such disorder.
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Primary biliary cholangitis (PBC), also known as primary biliary cirrhosis, is an autoimmune-mediated chronic intrahepatic cholestatic disease, which is more common in middle-aged and elderly women. Cholestasis can be secondary to hepatic osteodystrophy, with osteoporosis (OP) being the most prominent. OP in PBC patients can increase the risk of fracture and seriously affect the survival and quality of life of patients, thus affecting the prognosis of the disease. In recent years, a large number of studies have shown that with the increase of the incidence and prevalence of PBC, the incidence and prevalence of OP are also on the rise. Therefore, in order to improve the survival and quality of life of patients with PBC combined with OP, how to effectively treat it has become the focus of more and more attention and research.
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Brain edema could be secondary to cerebral lesion caused by a variety of reasons, severe cases may result in brain herniation or even death. Accurate real-time monitoring of cerebral edema, rational application of dehydrating drugs, and timely treatment of cerebral edema were very important for patients. However, there were defects in the monitoring methods commonly used in clinical practice. Noninvasive brain-edema monitoring was a new method, which can quantify the degree of brain edema by electromagnetic disturbance and directly reflect the state of brain edema. This article reviews the application of noninvasive brain-edema monitoring in the treatment of in critically ill patients with traumatic brain injury.
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Objective To evaluate clinical efficacy and safety of ABO-incompatible (ABOi) living-related kidney transplantation. Methods Clinical data of 23 recipients undergoing ABOi living-related kidney transplantation were retrospectively analyzed. According to the initial blood group antibody titers in the recipients before surgery, different individualized pretreatment regimens were adopted, including oral intake of immunosuppressive drugs plus rituximab, or oral intake of immunosuppressive drugs plus plasma exchange and/or double filtration plasmapheresis plus rituximab. The blood group antibody titers before and after pretreatment, before and after kidney transplantation, and perioperative renal function and related complications were monitored. Renal allograft function and related complications were observed during postoperative follow-up. Results Among 23 recipients undergoing ABOi living-related kidney transplantation, except for one case presenting with hyperacute rejection during operation, the serum creatinine levels of the remaining 22 recipients were restored normal. Perioperative complications included lymphatic fistula in 4 cases, 1 case of urinary fistula, 1 case of perirenal hematoma complicated with T cell-mediated rejection, 6 cases of urinary system infection, 1 case of acute tubular necrosis, 1 case of acute pancreatitis, 1 case of blood group antibody titer rebound, and 1 case of primary disease recurrence, and all of these complications were cured after corresponding treatment. During postoperative follow-up, the graft and recipient survival rates of 22 recipients were 100%, and renal allograft function was normal. The blood group antibody titer were all ≤1:8 during follow-up. Complications during follow-up included 2 cases of severe lung infection, 1 case of antibody-mediated rejection, 2 cases of primary disease recurrence, 1 case of lymphocyst, 1 case of urinary system infection, 1 case of herpes zoster, 1 case of BK viruria and 2 cases of abnormal blood glucose levels. Conclusions ABOi living-related kidney transplantation may be safely performed by selecting individualized pretreatment regimens according to antibody titers by different blood groups. However, high-dose rituximab or combined use of rabbit anti-human thymocyte immunoglobulin may cause severe infectious complications in highly sensitized recipients.
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Objective: To study the relationship between compassion fatigue and overall happiness among firefighters, and the mediating role of psychological stress and positive psychological capital. Methods: A total of 894 firefighters in Shandong Province were selected as the research subjects using purposive sampling method. Questionnaires including the Professional Quality of Life Scale, the Military Psychological Stress Self-Assessment Scale, the Positive Psychological Capital Scale, and the Overall Happiness Scale were used for data collection. Results: The scores of compassion fatigue, psychological stress, positive psychological capital and overall happiness among firefighters were (40.1±13.5), (13.9±3.9), (133.0±26.4) and (84.9±15.2), respectively. There were correlations between compassion fatigue, psychological stress, positive psychological capital and overall happiness (all P<0.01). Psychological stress partially mediated the relationship between compassion fatigue and overall happiness, and the mediating effect accounted for 27.0% of the total effect. Positive psychological capital moderated the front half path and the direct path between compassion fatigue and overall happiness (all P<0.01). Conclusion: Compassion fatigue can directly or indirectly affect the firefighters' overall happiness. Psychological stress plays a partial mediating role and positive psychological capital plays a moderating role between compassion fatigue and overall happiness.
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Objective:To evaluate the status of T, B and NK lymphocytes in peripheral blood of patients with chronic hepatitis B virus(HBV) infection and low-level viremia after nucleos(t)ide analogue (NA) treatment and to provide ideas for solving low-level viremia.Methods:This retrospective study involved 344 patients with chronic HBV infection who had been treated with NAs. They were divided into two groups: low-level viremia group (LLV group) and complete virological response group (CVR group). Clinical data including basic information, biochemistry and coagulation test results, HBV DNA, peripheral blood lymphocyte counts, PD1 and CD28 expression by T lymphocytes, and perforin and granzyme B expression by NK lymphocytes were collected and compared between the two groups. Propensity matching analysis was performed to verify the accuracy of the results.Results:Among the 344 cases, 162 were in the LLV group and 182 in the CVR group. There were no significant differences in disease diagnosis, alanine aminotransferase (ALT), aspartate aminotransferase (AST) or albumin (ALB) level between the two groups ( P>0.05), but the differences in gender and age were statistically significant ( P<0.05). The differences in the counts and percentages of peripheral blood CD3 +, CD4 + and CD8 + T lymphocyte and CD4 + /CD8 + ratios between the two groups were not statistically significant ( P>0.05), but the expression of PD1 and CD28 by peripheral blood CD3 +, CD4 + and CD8 + T lymphocytes was higher in the LLV group than in the CVR group ( P<0.05). The count of peripheral blood CD19 + B lymphocytes in the LLV group was higher than that in the CVR group ( P>0.05), and the percentage of peripheral blood CD19 + B lymphocytes was also higher in the LLV group ( P<0.05). The count of peripheral blood CD16 + CD56 + NK lymphocytes and the expression of perforin in the LLV group were lower than those in the CVR group ( P>0.05). The percentage of peripheral blood CD16 + CD56 + NK lymphocytes and the expression of granzyme B in the LLV group were lower than those in the CVR group ( P<0.05). After propensity score matching, 108 cases in the LLV group and 108 cases in the CVR group showed no significant differences in basic information ( P>0.05); the percentage of CD4 + T lymphocytes and CD4 + /CD8 + ratio in peripheral blood T lymphocyte subsets were higher in the LLV group than in the CVR group, while the percentage of CD8 + lymphocytes was lower in the LLV group ( P<0.05); the expression of PD1 and CD28 by CD3 +, CD4 + and CD8 + T lymphocytes remained higher in the LLV group ( P<0.05); the differences in the counts and percentages of peripheral blood CD19 + B lymphocytes as well as CD16 + CD56 + NK lymphocytes between the two groups were not statistically significant ( P>0.05); no significant difference in the expression of perforin by CD16 + CD56 + NK lymphocytes was found between the two groups ( P>0.05), and the expression of granzyme B remained lower in the LLV group ( P<0.05). Conclusions:Abnormal number and function of T lymphocytes and decreased function of NK lymphocytes might be related to the development of LLV in patients with chronic HBV infection after treatment. Therefore, in addition to adjusting NAs, targeting of T and NK lymphocytes might also be a feasible measure for future LLV treatment.
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Objective:To summarize the survival rate, complications, and outcomes of 32 periviable extremely preterm infants (PEPIs) born at ≤23 gestational weeks.Methods:This was a retrospective observational study involving PEPIs born at the Shenzhen Maternity & Child Healthcare Hospital from January 1, 2015, to December 31, 2021. Clinical data of all subjects were collected and analyzed. The survival rates of PEPIs born from 2015 to 2019 and 2020 to 2021 were compared. Chi-square (or Fisher's exact) test was used for statistical analysis. Results:(1) During the study period, 32 PEPIs were admitted, accounting for 0.024% (32/132 534) of all newborns born in the same hospital during the study period. The median gestational age of the 32 PEPIs was 23 weeks (21 +4-23 +6 weeks), and the birth weight was 480 g (350-720 g). (2) The survival rate of PEPIs born between 2020 and 2021 was 10/19, which appears to be a trend higher than that between 2015 and 2019 (3/13, χ2=2.79, P=0.095), while the rate of withdrawal of treatment was 8/13 and 3/19, respectively, with a statistically significant difference ( χ2=7.16, P=0.007). (3) Thirteen of the 32 PEPIs survived on discharge, including four born at 22 weeks and nine at 23 weeks. The birth weights of these surviving infants were 300-<400 g in one case, 400-<500 g in five cases, 500-<600 g in four cases, 600-<700 g in one case, and ≥700 g in two cases. (4) The most common complication was moderate and severe bronchopulmonary dysplasia (10/13), followed by retinopathy of prematurity requiring surgical intervention (5/13), patent ductus arteriosus requiring ligation (4/13), late-onset sepsis (2/13), necrotizing enterocolitis (stage Ⅱa or above) (2/13) and grade Ⅲ-Ⅳ intraventricular hemorrhage or periventricular leukomalacia (2/13). The median duration of follow-up was ten months (6-69 months), and motor retardation occurred in three infants. Conclusions:The overall survival rate of PEPIs in our hospital is relatively high, with a lower incidence of complications during hospitalization and relatively better outcome. However, further studies are required for the long-term prognosis in this group of infants.
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Objective:To investigate the urinary virology and clinical characteristics of female overactive bladder (OAB) patients.Methods:Catheterized urine samples were collected from 55 women with OAB and 18 control individuals between January 2021 and August 2021. Inclusion criteria were: female with age>18, diagnosed as OAB, OABSS total score≥3 and item Urgency score≥2, informed consent signed. Exclusion criteria were: Urine culture positive, urinary catheter indwelling status, antibiotic usage in recent 30 days, other disease leading to OAB-like symptoms, pelvic organ prolapse and current pregnancy, immunosuppressive therapy or status. Clinical characteristic and history were collected. OAB symptoms were assessed via both OABSS (overactive bladder symptom score) and OAB-V8 (8-item overactive bladder questionnaire). The urine specimens were analyzed using mNGS for identifying viral infections. The correlation between the disease and JC virus infection was analyzed by t test, chi-square test, binary logistic regression analysis and Spearman correlation matrix, and the Nomogram map for predicting the risk of viral infection was constructed. Results:In total, 55 women with OAB and 18 healthy controls were recruited in the study. There are significant difference in terms of UTI history, pelvic surgery history and the habit of holding urine [60.0%(n=33)to 16.7%(n=3), P=0.002; 43.6%(n=24)to 0.0%(n=0), P<0.01; 36.4%( n=20)to 5.6%( n=1), P=0.015]. Based on mNGS results, OAB patients were identified with more positive viral infection [47.3%(n=26)to 33.3%(n=6)] and more JC virus infection. In the OAB group, subtype 7B of JCV ( n=8) was identified, while in the control group, subtype 7A(n=2) was identified. Pairwise Spearman correlation analysis indicated high correlations between viral infection and OABSS ( r=0.58), age and pausimenia ( r=0.68), hypertension and age ( r=0.53), respectively. Estimates from binary logistic regression model indicated risk factors for virus infection in OAB patients including age ( OR=1.99, 95% CI 0.02-2.61), holding urine habit( OR=2.16, 95% CI 0.18-3.85) and pelvic surgery ( OR=2.53, 95% CI 0.54-4.27). Conclusions:Urinary viral infections appear to be associated with more severe OAB symptoms and JC virus may be a potential therapeutic target for OAB.
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Objective:To analyze the value of laminin γ2 (LAMC2) in the diagnosis of hepatocellular carcinoma (HCC) and the difference in patients with different types of microvascular invasion (MVI).Methods:A cohort of 100 patients with HCC who underwent surgical treatment at the Faculty of Hepato-Pancreato-Biliary Surgery, Chinese PLA General Hospital from January 2021 to March 2022 were prospectively enrolled. There were 80 males and 20 females, aged (55.7±11.1) years. The data of 17 patients with hepatic hemangioma without cirrhosis who underwent operation at the same hospital during the study period were collected to serve as the control group (6 males, 11 females), aged (42.8±9.8) years. LAMC2 in serum was determined by enzyme linked immunosorbent assay. The levels of alpha-fetoprotein (AFP) and LAMC2 were compared between the two groups, and receiver operating characteristic (ROC) curves were drawn to compare these two markers in the diagnosis of HCC. The LAMC2 of different MVI patients were compared.Results:The levels of LAMC2 and AFP were 1 334.2(838.9, 2 656.0) pg/ml and 19.0(4.6, 778.6) μg/L in the HCC group, which were significantly higher than 375.2(221.2, 691.7)pg/ml and 3.3(2.5, 3.5) μg/L in the control group ( Z=-4.32, -4.63, both P<0.001). The areas under the ROC curve were 0.829(95% CI: 0.748-0.892) for LAMC2 and 0.852(95% CI: 0.769-0.910) for AFP, and was 0.949(95% CI: 0.911-0.988) for using both in the diagnoses. The diagnostic efficacy of combining LAMC2 and AFP was significantly better than that of LAMC2 alone and AFP alone (area under ROC: Z=3.15, 3.07, P=0.002, 0.002). When the patients were divided into the M0 group (61 patients), the M1 Group (25 patients) and the M2 Group (14 patients) based on MVIs, the concentrations of LAMC2 were 1 168.6(834.3, 2 521.4) pg/ml, 942.2(614.0, 2 056.6) pg/ml and 3 128.4(1 852.7, 7 191.3) pg/ml, respectively. The level of LAMC2 in the M2 group was significantly higher than that in the M0 and M1 groups ( Z=-3.46, -3.32, P=0.001, 0.004). Conclusion:The diagnostic efficacy of LAMC2 combined with AFP for HCC was significantly higher than that of either LAMC2 alone or AFP alone. Serum LAMC2 levels were significant different among the groups of HCC patients with different types of MVI.
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Objective:To study the early use of inhaled nitric oxide (iNO) as a rescue therapy in extremely premature infants (EPIs) with refractory hypoxic respiratory failure (HRF).Methods:Between January 2021 and December 2021, EPIs with refractory HRF receiving iNO within the first week of life in our NICU were enrolled. Their clinical characteristics and outcomes were retrospectively analyzed.Results:A total of 11 EPIs were included with 5 males and 6 females. The median gestational age (GA) was 24(22.6, 25.2) weeks. The median birth weight (BW) was 580(490, 770) g. The most common primary diagnoses were moderate/severe respiratory distress syndrome (RDS) (5/11) and early-onset sepsis (3/11). The median age starting iNO therapy was 6.5(4.5, 34.0)h and the median duration of iNO was 24(12, 36)h. The median iNO starting dose was 5(5, 8) ppm and the therapeutic range was 5-20 ppm. Therapeutic efficacy was defined as ≥30% FiO 2 reduction after 6 h of iNO treatment. The treatment was effective in 8 cases. The oxygenation index (OI) decreased more than 10% from baseline 1 h after initiation in 9 patients and in all 11 patients after 12 h of iNO. The reduction of OI was more prominent in EPIs with a higher OI at baseline. Of the 11 patients, 8 survived, 1 died and 2 abandoned further treatments. Conclusions:As an early rescue therapy for EPIs with refractory HRF, iNO can improve oxygenation without obvious short-term adverse effects.
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Objective:Based on the core competence of stroke certified registered nurses, this study construct the theoretical raining curriculum system for stroke certified registered nurses and made a preliminary evaluation.Methods:Using Delphi expert consultation method and based on literature research, the first draft of training course for stroke certified registered nurses was formed. In the form of Email, 14 experts in the field of stroke care who met the selection criteria were sent a questionnaire, and two rounds of consultation were conducted. The theoretical raining curriculum system for the training of stroke specialist nurses was constructed; the purpose sampling method was used to evaluate the application effect of the stroke specialist nursing theoretical training curriculum system through the theoretical performance and satisfaction evaluation of 127 trainees who participated in the first phase of the stroke specialist nursing theoretical training curriculum.Results:The recovery rate and effective rate of the two rounds of expert consultation questionnaire were 14/14, the authority coefficient of the second round of expert consultation was 0.94, and the expert Kandall coordination coefficients of the first, second and third-level indexes were 0.356, 0.216, 0.207 respectively ( P<0.05). The training curriculum of stroke specialist nurses finally formed included 5 primary indicators (Professional practice concept, general nursing knowledge, stroke diagnosis and treatment, acute stroke nursing management, secondary prevention of cerebrovascular disease), 21 secondary indicators and 63 tertiary indicators. The Analytic hierarchy process was used to determine the weight coefficients of all levels of indicators, and the consistency Ratio <0.1. Based on the curriculum system as the content framework, theoretical courses were set up to train stroke specialist nurses. 109 trainees completed the post-training assessment. Before training, the qualified rate of theoretical performance of stroke certified registered nurses was 77.95% (99/127), and after training, the qualified rate of theoretical performance of stroke certified registered nurses was 100% (109/109). The difference was statistically significant ( χ 2=27.60, P<0.01). The excellent rate of theoretical performance of stroke certified registered nurses before training was 35.43% (45/127), and 100% (109/109) after training, the difference was statistically significant ( χ 2=24.17, P<0.01).The average score of the trainees′ satisfaction was (38.90±2.55) points. Conclusions:The theoretical raining curriculum system for stroke certified registered nurses setting constructed in this study standardizes the training system of stroke nurses to a certain extent, and provides a basis for the construction of homogeneous training courses in China in the future.
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Objective:To sinicize the Gerontological nursing competence (GeroNursingCom) scale and test its reliability and validity.Methods:This was a cross sectional investigation. The Brislin translation model was used for normal translation and back-translation, cultural adjustment and pre-investigation. The Chinese version of the GeroNursingCom scale was formed according to expert comments. From September to October 2021, a questionnaire survey was conducted by convenient sampling method on 312 nursing undergraduates from 3 undergraduate medical schools in Kunming to test its reliability and validity.Results:The Chinese version of the GeroNursingCom scale included 11 dimensions and a total of 50 items. The overall Cronbach′s α coefficient of the scale was 0.909, the Cronbach′s α coefficient of each dimension was 0.625-0.912, the split-half reliability coefficient was 0.768, and the test-retest reliability was 0.845. The scale-level content validity value was 0.930, and the item-level content validity value was 0.830-1.000. Exploratory factor analysis extracted a total of 11 common factors with eigenvalues>1, and the common interpretation of the results was 68.374%.Conclusions:The Chinese version of GeroNursingCom scale has good reliability and validity, and can be used as a tool to evaluate nursing interns' geriatric nursing ability.
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Objective:To investigate the correlation between serum uric acid to albumin ratio (UAR) and large-artery atherosclerosis (LAA), its severity and short-term outcome.Methods:Patients with acute ischemic stroke admitted to the Department of Neurology, the Affiliated Hospital of Qingdao University from September 2017 to August 2022 were retrospectively enrolled. They were classified into LAA and non-LAA according to the TOAST etiological criteria. Patients with LAA were further divided into mild stroke group (≤8) and moderate to severe stroke group (>8) according to the National Institutes of Health Stroke Scale score at admission, and good outcome group (≤2) and poor outcome group (>2) according to the modified Rankin Scale score at discharge. Multivariate logistic regression analysis was used to determine the correlation between UAR and LAA, its severity and short-term outcome. The predictive value of UAR for poor outcomes in patients with LAA was evaluated by receiver operating characteristic (ROC) curve. Results:A total of 4 178 patients with acute ischemic stroke were enrolled, including 2 751 males (65.8%), aged 61.95±10.73 years. There were 2 000 (47.9%) patients with LAA, including 1 112 (55.6%) mild stroke and 888 (44.4%) moderate to severe stroke; 813 (40.65%) had good short-term outcomes and 1 187 (59.35%) had poor outcomes. UAR in the LAA group was significantly higher than that in the non-LAA group ( P<0.05). In patients with LAA, the UAR of the moderate to severe stroke group and the short-term poor outcome group were significantly higher than that of the mild stroke group and the short-term good outcome group, respectively (all P<0.05). Multivariate logistic regression analysis showed that the UAR was an independent risk factor for LAA (odds ratio [ OR] 1.043, 95% confidence interval [ CI] 1.016-1.071; P=0.002), its severity ( OR 2.000, 95% CI 1.860-2.151; P<0.001), and short-term poor outcomes ( OR 1.456, 95% CI 1.379-1.537; P<0.001). ROC curve analysis showed that the area under the curve of UAR for predicting short-term poor outcomes in patients with LAA was 0.727 (95% CI 0.704-0.750; P<0.001). The optimal cutoff value was 6.62, and the sensitivity and specificity were 86.6% and 56.7%, respectively. The area under the curve of UAR for predicting short-term poor outcomes in patients with LAA was greater than that predicted solely by uric acid and albumin. Conclusions:UAR is associated with LAA, its severity and poor prognosis, and has higher predictive value for poor outcomes in patients with LAA.
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ObjectiveTo investigate the clinical appropriateness and application value of the peroxidase （POD） method for the detection of unbound bilirubin （UB） in neonatal serum. MethodsHydrogen peroxide （0.33 mol/L） and three different final concentrations （0.019， 0.038， 0.075 μg/mL） of horseradish peroxidase （HRP） were added to standard bilirubin solution （1， 2， 3 μmol/L） to obtain a standardized HRP primary rate constant Kp. Then 25 μL of neonatal serum was diluted by 41.6 fold， and measured with 2.4 and 4.8 μg/mL HRP at 37 ℃ under the dark， to determine the UB concentration. The accuracy， precision， and stability of the methodology were validated. The clinical characteristics of 33 jaundiced neonates were collected， including total serum bilirubin （TSB）， indirect bilirubin （IDB）， albumin （ALB）， bilirubin to albumin molar ratio （BAMR）， etc. The experimental data were analyzed by Graphpad Prism 8.0. ResultsA standardized Kp of （7.20±1.08） mL·μg-1·min-1 was determined at pH 7.4±0.2， 37 ℃ in the dark. The HRP activity and UB concentrations remained stable at -20 ℃ for 3 weeks and a week， respectively. The mean intra-day and inter-day coefficients of variation of the serum samples with different UB concentrations were less than 10%. In this study， the UB concentrations in 33 jaundiced neonates （gestational age ≥35 weeks） were measured by the POD method in the range of （0.32～1.20） μg/dL， which was positively correlated with TSB， IDB and BAMR. Of the five infants whose UB concentrations measured more than 1 μg/dL， three received intensive phototherapy （60%）. ConclusionsThe POD method combined with a standard equipment spectrophotometer to detect serum UB concentrations in neonates is easy to operate， rapid to detect， and low cost. This method has good accuracy and precision， which is convenient for clinical implementation. Moreover， the measurement of serum UB may assist us in better management of neonatal jaundice in clinical practice.
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An open reading frame (ORF) of isopentenyl-diphosphate delta isomerase gene (FuIPI) was cloned from Fritillaria unibracteata Hsiao et K. C. Hsia. (F. unibracteata). Furthermore, the bioinformatics and functional analyses of FuIPI were performed in this study. The result showed that, the ORF of FuIPI gene was 825 bp, encoding a polypeptide of 274 amino acids in length, with a relative molecular mass of about 31 kD and a theoretical isoelectric point of 5.61. Sequence analysis showed that FuIPI contained conserved structural domains and key residues involved in the catalyzing process. The phylogenetic analysis exhibited that FuIPI was closely related to IPIs of Dendrobium officinale and Musa acuminate. Real-time PCR analysis showed that FuIPI was distributed in different tissues of F. unibracteata, but had the highest transcriptional level in leaves, followed by stems, bulbs, and flowers. Furthermore, the FuIPI protein was successfully expressed in Escherichia coli BL21(DE3). The purified FuIPI protein successfully catalyzed the conversion from isopentenyl diphosphate (IPP) to dimethylallyl pyrophosphate (DMAPP). The above results provided a theoretical basis for further investigation of the molecular role of FuIPI in the biosynthesis of alkaloids.
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OBJECTIVE To investigate the effects of Wenyang jieyu decoction on phosphoinositide 3-kinase （PI3K）/protein kinase B （Akt） signaling pathway and neurotransmitters in rats with kidney-yang deficiency depression. METHODS The SD rats were divided into blank group， model group， fluoxetine group （positive control of western medicine， 4.17 mg/kg）， Xiaoyao powder group （positive control of TCM， 1.88 g/kg） and Wenyang jieyu decoction low-dose， medium-dose and high-dose groups （1.25， 2.50， 5.00 g/kg）， with 15 rats in each group. Except for blank group， the other groups were treated with corticosterone 20 mg/kg subcutaneously to induce kidney-yang deficiency depressed model， meanwhile the mice were given relevant medicine intragastrically， once a day， for 28 consecutive days. The general conditions of rats were observed. The sucrose preference rate and the static time of forced swimming were detected， and organ indexes of rats were calculated. The levels/contents of neurotransmitters in serum were detected， the expressions of PI3K/Akt pathway-related proteins in hippocampus were detected， and the number of dendritic spines was determined. RESULTS Compared with blank group， model group suffered from the symptoms such as hair loss， fear of cold， curling up； sucrose preference rate， indexes of adrenal gland， thymus gland and spleen，serum levels of cyclic adenosine phosphate （cAMP）， brain-derived neurotrophic factor and gamma-aminobutyric acid， the ratio of cAMP to cyclic guanosine monophosphate， the contents of norepinephrine， dopamine and 5-hydroxy-tryptamine， the expressions of PI3K， Akt， mammalian target of rapamycin， and the number of dendritic spines in the hippocampus were significantly decreased （P＜0.01）. The time of immobility， level of glutamic acid and protein expression of glycogen synthetase kinase-3β were prolonged and increased （P＜0.01）. Compared with model group， depression symptoms of rats in each administration group were improved， and the above indexes were mostly reversed （P＜0.05 or P＜0.01）. CONCLUSIONS Wenyang jieyu decoction can improve depression-like behavior and the deficiency of kidney-yang， regulate the secretion of neurotransmitters， and activate PI3K/Akt signaling pathway， thus playing a role in protecting hippocampal neurons.
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Objective To compare the effect of ARIMA models with and without covariates in predicting the number of HIV infections among young students in Dalian. Methods First, univariate correlation analysis was performed on the network, STD sequence and HIV sequence to understand whether there was a correlation and lag relationship between them. Secondly, variables with the strongest correlation and predictive value and HIV infection numbers were used as the baseline data to establish an ARIMA model with covariates and a general ARIMA model without covariates, and to predict the HIV number from 2019 to 2021. The average absolute errors were used as evaluation indexes to compare the prediction effects of the two models. Results A total of 841 cases of HIV infection among young students were reported in Dalian from 2013 to 2021. The results of univariate correlation analysis showed that the search index of the keyword AIDS in the Baidu Index in a given month from 2013 to 2019 was significantly positively correlated with the number of HIV infections in that month (r=0.302, P=0.006), and gonorrhea was negatively correlated with the number of HIV infections with a lag of 2 months (r=-0.250, P =0.024). Using gonorrhea incidence number and HIV infection number as the basic data, an ARIMA model with covariates and a general ARIMA model without covariates were established to predict the number of HIV infection among young students from 2019 to 2021, and the average absolute errors were 17.621% and 66.17%, respectively. Conclusion Compared with the general ARIMA model without covariates, the ARIMA model based on the combined use of STD incidence and HIV infection is more suitable for predicting the number of HIV infections among young students in Dalian, but the average absolute error of the model is still large, which needs further improvement in the future research.