ABSTRACT
BACKGROUND: Caspofungin, a novel echinocandins systemic antifungal agent, has been shown to exert broad-spectrum antibacterial effect on deep fungal infections, which is superior to or equivalent with the role of amphotericin B, but there is no report on its application for preventing fungal infection after renal transplantation.OBJECTIVE: To analyze the difference in high risk factors of fungal infection after kidney transplantation using donation after cardiac death donors and living-related donor kidney transplantations, and to explore the feasibility and safety of caspofungin to prevent fungal infection after kidney transplantation using donation after cardiac death donors.METHODS: This was a prospective, single-center, controlled trial finished at the Department of Kidney Transplantation,the First Affiliated Hospital of Zhengzhou University, Henan Province, China. Totally 188 patients undergoing primary kidney transplantation without history of fungal infection and use of antifungal drugs between January 2012 and August 2013 were enrolled, including kidney transplantation with donation after cardiac death donors (n=102, trail group), and kidney transplantation with living-related donors (n=86, control group). The CYP3A5 genotype was determined preoperatively. All patients received tacrolimus+mycophenolate mofetil+prednisone triple immunosuppression after transplantation. The trial group was subjected to caspofungin therapy for 2 weeks. The risk factors for fungal infection in the two groups were compared, and the effects of caspofungin on the tacrolimus concentration, tacrolimus concentration/dose were detected in the recipients with same CYP3A5 genotype recipients at 1 and 2 weeks, and 1, 3 and 6 months postoperatively. The liver and kidney function, adverse events and fungal infections were recorded at different time points. This trial was registered with the Chinese Clinial Trial Registry (Regitration number:ChiCTR-OON-17013342).RESULTS AND CONCLUSION: The survival rate of patient/kidney was 98.4% and 97.3% respectively, 97 cases in the trial group and 86 controls competed 6-month follow-up. Preoperative hemodialysis time, hemoglobin value, cold ischemia time, warm ischemia time, intraoperative blood transfusion volume, time of central venous catheter kept in situ,methylprednisolone usage, ATG usage, serum creatinine reduced level at 1 week, thrombocytopenia and duration of postoperative body temperature > 38 ℃ were the risk factors for fungal infection in the trail group relative to the control group. The fungal infection rate in the trial and control groups was 0% and 2.3%, respectively, at 6 months of follow-up.The serum creatinine level in the trail group was significantly higher than that in the control group at 1 month postoperatively (P < 0.05), and the level showed no significant difference between two groups at other time points (P >0.05). After 2 weeks of caspofungin treatment, the concentrations of tacrolimus and tacrolimus concentration/dosage did not differ significantly in different CYP3A5 genotype recipients (P > 0.05). Caspofungin might induce some adverse reactions, especially electrolyte disturbance with an incidence of 21.6%, but there was no significant difference between two groups (P > 0.05). These findings imply that kidney transplantation using donation after cardiac death donors presents with various risk factors for fungal infection compared with living-related donor kidney transplantation.Furthermore, caspofungin is effective and safe for preventing fungal infection and has no effect on tacrolimus concentration; therefore, it can be used as a new anti-fungal agent after kidney transplantation.
ABSTRACT
Objective To investigate the effects of Xiaoyu Sanjie Yi'ai Enema on the expression level of phosphatase and tensin homolog deleted on chromosone 10(PTEN)gene of nude mouse model of prostate cancer, and to explore its anticancer mechanism. Methods Nude mouse model of prostate cancer was established by neck subcutaneous injection of suspension of human prostate cancer cells PC-3. Thirty tumor-bearing nude mice were randomly divided into control group and treatment group , 15 mice in each group. Ten days after modeling, the treatment group was treated with enema of Xiaoyu Sanjie Yi'ai Enema, and the control group was treated with enema of the same volume of normal saline,once every other day,for 30 continuous days. At the end of medication, the tumors were extracted completely, and then the tumor mass of the two groups was detected before and after treatment to calculate the tumor-inhibition rate. The mRNA and protein expression levels of PTEN gene were detected by the method of reverse transcription real-time quantitative polymerase chain reaction(RT-qPCR)and western blotting method,respectively. Results Tumor mass in the treatment group was reduced as compared with that in the control group (P < 0.05). The tumor-inhibition rate of the treatment group was 18.71%. RT-qPCR results showed that the relative expression level of the PTEN mRNA in the treatment group was higher than that in the control group, the difference being statistically significant (P < 0.001). Western blotting result showed that the relative protein expression level of PTEN in treatment group was (0.55 ± 0.13)and that in the control group was(0.32 ± 0.09)separately,the difference being statistically significant(P<0.001). Conclusion Xiaoyu Sanjie Yi'ai Enema has therapeutic effects on prostate carcinoma,and the molecule mechanism may be related with the up-regulation of PTEN gene mRNA expression and protein translation,thus to inhibit PC-3 cell proliferation and metastasis.
ABSTRACT
Objective To establish a nursing performance evaluation indicator system in military hospitals,so as to provide reference for standardized nursing performance management. Methods Based on literature review,group discussion and qualitative interviews,two rounds of consultation were conducted among 19 experts using Delphi method. Results The nursing performance evaluation indicator system in military hospitals included 3 first-level in-dicators,13 second-level indicators and 60 third-level indicators. Experts' authority coefficient,judgment coefficient and familiarity coefficient were 0.930,0.960,0.900,respectively. The coordination coefficients of the first-level,sec-ond-level and third-level were 0.517,0.490 and 0.459. Variation coefficients were 0~0.113. Conclusion The nurs-ing performance evaluation indicator system in military hospitals based on Delphi method is scientific and reliable, which provides references for nursing performance in clinical units and makes significant contributions to nursing performance management in military hospitals.