Blood concentration monitoring of tacrolimus in patients with nephrotic syndrome and establishment of MLP prediction model / 中国药房

OBJECTIVE To investigate the monitoring of tacrolimus blood concentration in patients with nephrotic syndrome （NS），and to establish a prediction model for tacrolimus blood concentration. METHODS Data from 509 concentration monitoring sessions of 166 NS patients using tacrolimus were collected from January 1， 2020 to August 31， 2023 in Zhongshan Hospital Affiliated to Xiamen University. The relationship of efficacy and adverse drug reaction（ADR） with blood concentration was analyzed. A multilayer perceptron （MLP） prediction model was established by using the blood concentration monitoring data of 302 times from 109 NS patients with genetic information， and then verified. RESULTS In terms of efficacy， the median blood concentration of tacrolimus in the non-remission group was 2.20 ng/mL， which was significantly lower than that in the partial remission group （4.00 ng/mL， P＜0.001） and the complete remission group （3.60 ng/mL， P＝0.002）. In terms of ADR， the median blood concentration of tacrolimus in the ADR group was 5.01 ng/mL， which was significantly higher than that in the non-ADR group （3.37 ng/mL） （P＝0.001）. According to the subgroup analysis of the receiver operating characteristic curve， when the blood concentration of tacrolimus was ≥6.65 ng/mL， patients were more likely to develop elevated blood creatinine [area under the curve （AUC） was 0.764， P＜0.001）； when the blood concentration of tacrolimus was ≥6.55 ng/mL， patients were more likely to develop blood glucose （AUC＝0.615， P＝ 0.005）. The established MLP prediction model has a loss function of 0.9， with an average absolute error of 0.279 5 ng/mL between the predicted and measured values. The determination coefficient of the validation scatter plot was 0.984， indicating an excellent predictive performance of the model. CONCLUSION Tacrolimus blood concentration has an impact on both efficacy and ADR in NS patients. The use of the MLP model for predicting blood concentration exhibits high accuracy with minimal error between predicted and measured values. The model can be used as an important tool in clinical individualized medication regimens.

Cloning and characterization of a thermostable urate oxidase from Microbacterium sp. strain ZZJ4-1 / 生物工程学报

In order to characterize a thermostable urate oxidase (Uox) from Microbacterium sp. strain ZZJ4-1, we cloned its gene (uox). The open reading frame of uox contained 894 base pairs and encoded a protein with 297 amino acids. Alignment of gene sequences indicated there was no obvious identity with the most reported uox and that 72% identity was found with uox from Arthrobacter globiformis. We inserted the gene into the plasmid pET-15b to construct an expression vector pET-15b-uox and got it induced expression in Escherichia coli BL21 (DE3). After the purification of the recombinant Uox by the HisBind column, we studied some properties of it. It was composed of subunits with a molecular mass of about 35 kDa. The optimal temperature and pH was 30 degrees C and pH 7.5. It was stable below 65 degrees C and from pH 8.5 to 11.0. The Km value was 0.22 mmol/L with the uric acid as the substrate. Ag+, Zn2+, CU2+ and SDS could totally inhibit its activity while Tween 20, Tween 80 and Triton X-100 had a slight promotion effect. The thermal stability of this enzyme was the most excellent among the reported recombinant Uox. Based on this property, it would be very useful in the application.

Study on the change of ECG after chemotherapy and radiotherapy in treatment of patients with breast cancer / 中国基层医药

Objective To explore the change of ECG after chemotherapy and radiotherapy in treatment of patients with breast cancer. Methods 58 patients with breast cancer were treated with surgery,after operation the observation group were treated with chemotherapy and radiotherapy,and the control group was given chemotherapy singly.The change of ECG was compared between two groups. Results In the observation group,11 patients had abnormal ECG(37.93%),In the control group,2 patients had abnormal ECG(9.52%)(x2=8.03,P ＜0.05＝.In addition,in the observation group the incidence of abnormal ECG in the patients with left breast cancer(7/15)was slightly higher than that with right breast cancer(4/14)(x2=1.01,P ＞ 0.05). Conclusion The treatment of chemotherapy combined with radiation could significantly increase cardiac toxicity in the patients with breast cancer.

Centralized Management of Medical Instrument / 中华医院感染学杂志

OBJECTIVE To conduct the centralized management of the medical instrument in the supply room,and to assure the quality and validation of the clinical nursing and the patient safety. METHODS The cleaning and packing procedures of the instrument were standardized.The reusable instrument would be concentrated to clean,pack,and sterilize.To create a photograph management system,and use the photos to distinguish specialized instrument. RESULTS The instrument was reprocessed in the supply room instead of the clinical departments by the method of the centralized management of the instrument,which provided better instrument care and reprocessing. CONCLUSIONS The supply room conducts the centralized management of the medical instrument and enhances the quality of the instrument reprocessing.