OBJECTIVE:To investigate the influence of CYP3A5*3 (rs776746) genetic polymorphism on blood concentration of tacmlimus (TAC) and renal function in renal transplant recipients during the stable period.METHODS:A total of 98 renal transplant recipients during the stable period receiving TAC-based triple anti-rejection scheme (TAC + sodium mycophenol +predrnisone acetate) after surgery and regular follow-up were selected from our hospital during Jan.1995-Dec.2014.The follow-up information during Jan.-Dec.2016 was also collected.Trough concentration of TAC in renal transplant recipients was determined by chemiluminescence microparticle immuno assay.Standard blood concentration (C/D) was calculated after corrected with body weight and daily dose.Scr level was detected with dry chemistry method.CYP3A5*3 genotype was detected by PCR-RFLP and direct sequencing.The relationship of CYP3A5*3 genetic polymorphism with TAC C/D value and Scr level was determined by Kruskal Wallis H or Mann-Whitney U assay.RESULTS:Among 98 renal transplant recipients,there were 9 cases of CYP3A5*3 *1/*1(AA) genotype,37 cases of *1/*3 (AG) genotype and 52 cases of *3/*3 (GG)genotype.The gene frequencies were 9.18％,37.76％,53.06％,which were all in line with Hardy-Weinberg equilibrium (P＞0.05).There was no statistical significance in trough concentration of TAC among different genotypes (P＞0.05).There was statistical significance in TAC dose and C/D value among different genotypes (P＞0.05).TAC dose of CYP3A5*3 *3/*3 genotype recipients was significantly lower than those of *1/*3 and *1/*1 genotype recipients;that of *1/*3 genotype recipients was significantly lower than that of *1/*1 genotype recipients.C/D value of *3/*3 genotype recipients was significantly higher than those of *1/*3 and *1/*1 genotype recipients;that of *1/*3 genotype recipients was significantly higher than that of *1/*1 genotype recipients,with statistical significance (P＜0.05).There was no statistical significance in Scr levels among different genotypes (P＞0.05).CONCLUSIONS:CYP3A5*3 genetic polymorphism significantly influences blood concentration of TAC in renal transplant recipients during the stable period,and *3 allele carriers have higher C/D values and need smaller TAC daily dose.CYP3AS*3 genetic polymorphism may be not associated with Scr level.

Objective To explore the clinical characteristics of late-onset ornithine carbamoyltransferase deficiency (OTCD) in order to improve the clinicians' understanding of this disease.Methods The clinical,therapeutic and follow-up data of two patients with late-onset OTCD diagnosed in the Department of Neurology,Qilu Hospital of Shandong University from November 2017 to February 2018 were collected and analyzed.Results Case 1 is a 17-year-old male who was admitted into Qilu Hospital with recurrent dizziness and vomiting for 4 months,sudden mental abnormality and convulsion for 3 days.The liver dysfunction,respiratory alkalosis and hyperammonemia (434 μmol/L) had been found before his admission.His blood ammonia fluctuated obviously from 180 μ mol/L to 2998 μmol/L,though he was given hemodialysis and arginine infusion,and died on the fourth day after admission.Case 2 is a 15-year-old male,complained with recurrent dizziness,vomiting,bluntness and somnolence for 20 days.He was found with hyperammonemia (600 μmol/L) and liver dsyfunction in a local hospital.He was getting better after intravenous administration of arginine and liver protective drugs.After admission,the blood ammonia,liver function and amino acids,acylcarnitine profiling in dried blood spots,and organic acid analysis in urine were normal,and he has not recurred since restriction of protein diet.Brain magnetic resonane imaging of both patients showed cytotoxic edema of bilateral frontal lobe and insular cortex,and their genetic detection both showed c.119G＞A(p.R40H) hemizygous pathogenic mutation of OTC gene inherited from their respective mothers.Conclusion Unexplained hyperammonemia and acute encephalopathy with insular and frontal cortical involvement should be on the alert to the urea cycle disorders,especially OTCD.Early diagnosis and reasonable treatment are the key to changing the prognosis.

Objective To study the efficacy and adverse reactions for renal transplant patients conversed from cyclospo-rine A to tacrolimus .Methods The follow-up data of renal transplant patients conversed from cyclosporine A to tacrolimus were collected .The clinical therapeutic outcomes including drug induced diseases (DIDs) and acute rejection (AR) induced by cyclosporine A were analyzed during the first year after conversion with SPSS 17 .0 software .Results The levels of Scr and BUN were significantly decreased during the first year after conversion for renal transplant patients with CScr and AR (P<0.05 or P<0 .01) .The levels of direct bilirubin (DB) and total bilirubin (TB) were also significantly lowed (P<0.05 or P<0 .01) during the first year for drug-induced liver injury (DILI) patients .The average level of ALT was significantly decreased in 12 months after conversion (P<0.05) .The complications of gingival overgrowth (GO) stopped with the medication replace-ment .However ,the fasting blood glucose (FBG) level increased significantly in 12 months after conversion (P<0.05) .Con-clusion For renal transplant patients suffered from AR or the serious DIDs induced by cyclosporine A ,conversion from cyclos-porine A to tacrolimus could be considered .However ,it should be aware of the high blood glucose or the new diabetes caused by tacrolimus .

Objective: To explore the application and effect evaluation of the new teaching mode of medical nursing based on mobile teaching platform. Methods: Taking 110 nursing undergraduates from 2015 grade as the control group, 105 nursing undergraduates from 2016 grade were selected as the experimental group. On the basis of the traditional classroom teaching method, the "teaching online" mobile teaching platform was designed and constructed by using WeChat. At the same time, the instructors of internal science theory were invited to join the platform to simultaneously synchronize online teachers, teachers and students, and upload teaching resources. The final examination results of the two groups were compared, and the satisfaction of nursing undergraduates with the teaching of internal medicine nursing was investigated at the end of the semester, and the difference between the new teaching mode and the traditional teaching mode was demonstrated through a comparative study. At the same time, through questionnaires, we can understand the satisfaction of teachers and students in assisting teaching on mobile teaching platforms. Results: The teachers and students had a positive attitude towards the application of mobile teaching platform to assist teaching and platform functions. 6/7 of teachers and 94.3% (99/105) of students supported the promotion of this auxiliary teaching mode. All teachers and most students (92.4%, 97/105) evaluated the participation of teachers in internal medicine theory to improve the teaching effect. After the application of "teaching online" mobile teaching platform, the satisfaction of nursing undergraduates with internal medicine nursing teaching was obviously improved, the overall evaluation of teaching satisfaction in the control group and the experimental group were (4.00±0.42) and (4.83±0.42) points (t =-22.306, P<0.01). The average scores of the final exam in the experimental group (80.90±5.11) points was significantly higher than (74.86±7.37) points in the control group (t=-7.000, P<0.05). Conclusion The interdisciplinary joint teaching model based on mobile teaching platform can stimulate the students′ enthusiasm for learning and improve teaching satisfaction and learning effect.