RESUMO
Objective:To explore health utility value, evaluate health-related quality-of-life(QOL)of pediatric liver transplantation(LT)recipients and examine its influencing factors to provide rationales for related health economic evaluations.Methods:This cross-sectional QOL was conducted through a questionnaire in pediatric LT recipients aged 5-17 years.The interviewees undergoing initial LT from June 2013 to September 2021 were reviewed regularly.Those children and their parents unwilling to participate or failing to understand the contents of questionnaire were excluded.The questionnaire was designed on the basis of Child Health Utility 9D Instrument(CHU9D)and answered online by one of primary caregiver.Chinese score system of CHU9D was employed for converting the responses into health utility values and the influencing factors were analyzed.Univariate analysis was performed by nonparametric tests and multivariate analysis by multiple linear regression model. P<0.05 was deemed as statistically significant. Results:A total of 140 valid questionnaires were obtained.Mean age of pediatric LT recipients was(7.95±2.74)years and mean postoperative time(4.90±2.17)years.Among them, 19 cases had experienced acute rejection and 101(72.1%)cases were living-related LT recipients.CHU9D scale indicated that average health utility value was(0.85±0.14)points.Univariate analysis revealed that age( P=0.008), education level( P<0.001)and primary disease( P=0.010)influenced the postoperative level of QOL.Multivariate analysis indicated that QOL was correlated with education level(behind schedule: 95% CI: -0.146, -0.034, P=0.002; leave of absence: 95% CI: -0.251, -0.068, P=0.001). Conclusions:Health utility of pediatric LT recipients is high with an excellent QOL.Poor QOL is associated with absence from school or dropping out of school.
RESUMO
Objective:To explore the distribution of pathogenic bacteria during perioperative period of kidney transplantation(KT)patients and examine drug resistance of major clinical pathogens to commonly used antibiotics to provide references for empirical medication of pathogenic bacteria infection after KT.Methods:From January 1, 2020 to June 30, 2021, 251 patients undergoing deceased donation KT on kidney transplant ward were selected.Clinical samples were collected and distribution and drug resistance of pathogenic bacteria examined for analyzing the incidence of possible donor-derived infections and predicting prognoses.Results:The detection rate of pathogens was 12.18%(367/3 014). A total of 225 non-repetitive strains were isolated.Gram-positive bacteria, Gram-negative bacteria and fungi accounted for 48.89%(110/225), 43.11%(97/225)and 8.00%(18/225). The proportion of lavage fluid in all isolated bacteria was 49.78%(112/225). And Staphylococcus epidermidis and Klebsiella pneumoniae predominated.Drainage fluid accounted for 24.88%(56/225)and Pseudomonas putida and Staphylococcus haemolyticus predominated.Urine accounted for 18.67%(42/225)with a dominance of Enterococcus faecium; blood accounted for 6.22%(14/225)with a dominance of S. epidermidis.All detected pathogens showed varying degrees of resistance.The resistance rates of E. faecium to ampicillin, vancomycin and linezolid were 93.33%(28/30), 6.45%(2/31)and 38.71%(12/31). The resistance rates of K. pneumoniae and Acinetobacter baumannii to carbapenems were 71.43%(20/28)and 80.00%(12/15). The incidence of possible donor-derived infection was 3.59%(9/251)and there was no mortality.Conclusions:The detection rate of pathogenic bacteria is high in KT patients during perioperative period.There is a diverse distribution of isolates of different specimen types and all detected pathogens show varying degrees of drug resistance.Clinicians should regularly analyze the distribution characteristics and causes of drug-resistant bacteria.And antibiotics should be optimized according to the results of drug sensitivity.
RESUMO
AIM: To evaluate relationship between dosing schedules and safety of voriconazole by analyzing the monitoring results of voriconazole in patients with liver dysfunction, and to provide reference for the clinical individualized medication. METHODS: The blood concentration and safety information of voriconazole in patients with liver dysfunction was searched in PubMed, Cochrane Library, Wanfang, Weipu, and Chinese Journal Full-text Database from the establishment of the databases to December 2019, the dosing schedule and safety range of voriconazole for patients with liver dysfunction was analyzed. RESULTS: A total of 10 literatures were selected, 5 of which were multi-sample retrospective studies and 1 of which was prospective study, and the remaining 4 were case reports. In Child-Pugh grade C liver dysfunction, a maintenance dose of 100 mg q12h is more secure. The incidence of adverse reactions of voriconazole is generally within 7 days. When the target trough concentration is less than 5 mg/L or 5.3 mg/L, the incidence of adverse reactions is still high. The main adverse reactions include neurotoxicity, hallucinations, visual disturbances, gastrointestinal reactions and rash. CONCLUSION: The dose of voriconazole in patients with liver dysfunction should be reduced, and the drug concentration should be monitored in a timely manner. It is recommended that on the basis of ensuring the efficacy, trough concentration can be further reduced to reduce the occurrence of adverse reactions in patients with liver dysfunction.
RESUMO
Objective To determine the concentration of linezolid in human plasma by high performance liquid chromatagra?phy-tandem mass spectrometry(HPLC-MS/MS)so as to provide evidence for the rational administration in clinic. Methods The plas?ma was extracted by acetonitrile with telmisartan as internal standard(IS). The mobile phase was 1 mmol/L ammonium acetate with 0.1%formic acid-acetonitrile with gradient elution. Quantitative analysis of[M+H]+ions was m/z 338.1→m/z 296.3(linezolid)and m/z 515.3→m/z 276.3(telmisartan,the IS). Results Excellent linear relationship was obtained from 0.23 to 46μg/ml with correlation co?efficient value of 0.9993. The lowest limit of quantitation was 46 ng/ml,the extraction recovery was from 87%to 109%. The intra-and inter- day precisions(relative standard deviations)ranged from 2.5% to 8.6%. Conclusion The method is specific,sensitive and simple and can be used to determine the concentration of linezolid in clinic.
RESUMO
[ABSTRACT]AIM:ToestablishandevaluateahyperbilirubinemiaandkernicterusmodelinneonatalSDrats. METHODS:Three-day-old SD rats were randomly divided to 7 experimental groups by litter and body weight , and were in-traperitoneally injected with physiological saline (control group), and 6.25μg/g (T1), 12.5μg/g (T2), 25μg/g (T3), 50μg/g (T4), 100μg/g (T5) and 200μg/g (T6) bilirubin, respectively, twice every day for 3 d.All rats were photo-graphed , weighed and killed 12 h after the last injection .The contents of the stomach were drawn and weighed , and the index was calculated .The liver/body weight ratio was determined , the total and unconjugated bilirubin in the serum and total bili-rubin in the brain were calculated , and the contents of ATP and water in the brain were measured .HE and Nissl staining were used to observe the pathological changes .RESULTS:Along with the increase in bilirubin , gradual exacerbation of the general performance of the rats , and yellowish discoloration of the skin and mucous membranes were observed .The degree of the activity gradually reduced , and the weight gain was suppressed .The weight of T6 group showed negative growth , and the 72 h mortality rate was close to 100%.The mortality rate in T4 and T5 groups continued to rise 1 week after injection .Com-pared with control group , the weight of stomach contents and stomach content index in T 3~T5 groups significantly decreased (P<0.01).The liver/body weight ratio in T5 group was significantly higher (P<0.05).The concentrations of serum total and unconjugated bilirubin and brain bilirubin levels in T 1~T5 groups were gradually increased , while the brain water con-tent had no difference among groups .The brain ATP content in T1~T5 groups increased at the beginning and reached its peak in T3 group, but compared with control group , that in T4 group and T5 group significantly reduced (P<0.05).HE re-sults showed that , with the increase in bilirubin concentration , the number of the neurons in the cerebral cortex of the rats de-creased.In T4 group and T5 group, the neuronal structural disorder , cell swelling, nuclear pyknosis, fragmentation and dis-solution, increase in non-homogeneous structure of the material dyed red , and disappearance of nuclear staining were ob-served.Nissl staining showed that , compared with control group , in T1 group and T2 group, the cortical neurons became smaller, Nissl bodies decreased , and cytoplasmic staining changed little .The cortical neuronal tigroid body color became light gradually, neuron cells become small , and Nissl bodies decreased obviously in T 3, T4 and T5 groups.The T4 and T5 rat ce-rebral cortical neurons dissolved or even disappeared .CONCLUSION:Newborn 3-day-old SD rats receiving intraperitoneal injection of bilirubin at doses of 12.5, 25, 50 and 100μg/g, 2 times a day, can induce hyperbilirubinemia , and 50 and 100μg/g can cause bilirubin encephalopathy .
RESUMO
In order to better construct important diseases of traditional Chinese medicine ( TCM ) clinical re-search base , and strengthen the construction of medical and clinical research of TCM information sharing sys-tem, Hubei Provincial Hospital of Traditional Chinese Medicine has constructed research type clinic. The con-struction idea of research type clinic is the mode of real world TCM clinical research . The construction of research type clinic mode was from three aspects, which were the clinical research, health management and distinctive diagnosis and treatment .
RESUMO
Objective To explore the generalization effect of a semantic navigation strategy(SNS)on naming in patients with aphasia.Methods Fourteen patients with aphasia were randomly divided into an SNS group (n =7)and an unrelated semantic(US)group(n =7).One hundred and twenty-two words chosen from Chinese word association norms were used in this study.The presentation sequence of words was generated automatically with network analysis techniques for the SNS group and randomly without network analysis techniques for the US group.After baseline tests using the western aphasia battery(WAB)and the mini-mental status examination(MMSE),all patients received language training once a day for 10 consecutive days.The amount of correct responses was recorded every day in order to draw the learning curve.The generalization effect was evaluated with 46 untrained items before and after training with all patients.Results The average learning curve of the SNS group was steeper than that of the US group.Correct responses on trained items were significantly more frequent in the SNS group than in the US group after the 6th day of training.After 10 days the frequency of correct responses on untrained items in the SNS group was significantly higher than it had been before training,and higher than the frequency after training in the US group.The frequency of no response on untrained items in the SNS group had declined,and it had declined more than in the US group.Conclusion A semantic navigation strategy may promote significant generalization while improving the learning curve in naming among patients with aphasia.
RESUMO
Crystal power/epoxy resin composite was made with refined crystal power as filling material in different composition. The shearing strength and coefficient of thermal expansion of the crystal powder/epoxy resin composite was studied. The sectional morphology was observed under a scanning electron microscope. The results of the study indicate that the shearing strength of crystal powder/epoxy resin composite is improved while the coefficient of thermal expansion decreases with increase of the amount of crystal powder, and a well-proportioned three-dimensional structure is obtained. The augmentation of shearing strength exhibits no linear relationship to the amount of crystal powder, and there is an optimal amount for crystal powder filling. The coefficient of thermal expansion is decreased with increase of crystal powder filling, and three-dimensional structure optimization exhibits the' similar inflexion.