Objective:To investigate the therapeutic range of tacrolimus and effects of tacrolimus on liver and re- nal functions and blood routine in renal transplant recipients.Method:The whole blood tacrolimus concentration was meas- ured by micro-particle enzyme immunoassay(MEIA).Blood tacrolimus concentrations in 390 cases of renal transplant re- cipients were analyzed.The effects of tacrolimus on liver and renal function and blood routine were also studied.Result: The blood tacrolimus concentrations in 377 of 390 cases were within the range from 3 to 15?g?L~(-1).Their blood tacrolimus concentration differed greatly in renal transplant recipients within 6 months after transplantation.Their blood tacrolimus concentration was gradually decreased as time went on.Tacrolimus with therapeutic dosage had no effects on liver and renal function and blood routine.Conclusion:The therapeutic ranges of tacrolimus with MEIA were as follows:5 to 15?g?L~(-1) within 3 months after transplantation,5 to 10?g?L~(-1)between 4 to 6 months after transplantation,3 to 10?g?L~(-1)6 months after transplantation.The administration of tacrolimus had no effects on the liver and renal function and blood routine in re- nal transplant recipients.

Objective To investigate the effect of nutritional counseling combined with oral high-fat, high-protein nutritional supplement (Ensource) on nutritional status and clinical outcomes of esophageal cancer patients under radiotherapy treatment.Methods Totally 80 esophageal cancer patients under radiotherapy treat-ment who were able to take oral feeding and with Nutritional Risk Screening 2002 (NRS 2002) score≥3 were se-lected and divided into a study group (n=41, nutritional counseling combined with oral nutritional supplements) and a control group ( n=39, nutritional counseling) with a random number table.Energy intake, nutritional sta-tus, and incidences of radiotherapy complications of the two groups before and after radiotherapy were compared. Results Energy intakes in the study group increased significantly during radiotherapy compared with the control group [ (2 445 ±686) kJ vs.(1 747 ±456) kJ, P=0.003];and the level of prealbumin and transferrin were increased significantly compared with before radiotherapy [ (17.35 ±5.83) mg/L vs.(20.15 ±6.02) mg/L, P=0.008;(213.74 ±52.66) mg/L vs.(264.19 ±43.78) mg/L, P=0.002].Besides, compared with the control group, incidence of radiation esophagitis ( GradeⅢ) and radiation skin injury ( GradeⅢ) in the study group decreased significantly (24%vs.38%, P=0.000;27%vs.41%, P=0.000).Conclusion Nutritional counseling combined with oral nutritional supplements in esophageal cancer patients could help improve the patients'nutritional profile and decrease the incidence of complications related with radiotherapy.

Objective:To investigate the causes of the outbreak of Candida Pelliculosa catheter-related bloodstream infection in the neurosurgical intensive care unit (ICU), find out the source of infection and the route of transmission, and provide evidence for the prevention and control of nosocomial infection. Methods:An epidemiological investigation and environmental hygiene monitoring were made in patients with Candida Pelliculosa catheter-related bloodstream infection who received treatment in March and April 2019 in Houma People's Hospital, China. Comprehensive measures were taken to control the outbreaks of Candida Pelliculosa catheter-related bloodstream infection. Results:There were four patients with Candida Pelliculosa catheter-related bloodstream infection in the ICU of Neurosurgery Department of Houma People's Hospital, China. Eight samples were collected from these four patients. Ten strains were isolated and identified positive for Candida Pelliculosa. Drug sensitivity test revealed identical results: the minimum inhibitory concentration (MIC) of 5-fluorocytosine, amphotericin B, fluconazole, itraconazole and voriconazole was ≤ 4 mg/L, ≤ 0.5 mg/L, < 1 mg/L, ≤ 0.12 mg/L and ≤ 0.06 mg/L, respectively. No target bacteria were detected from the environment. Candida Pelliculosa infection was not observed after taking comprehensive control measures such as strengthening hand hygiene supervision in medical staff and thorough disinfection of the environment. Conclusion:Poor hand hygiene compliance in medical staff in neurosurgical ICU and non-sufficient environmental disinfection may be the main causes for the outbreak of Candida Pelliculosa catheter-related bloodstream infection.

The fungus Trichophyton schoenleinii (T. schoenleinii) is the causative agent of Trichophytosis and Tinea favosa of the scalp in certain regions of Eurasia and Africa. Human innate immune system plays an important role in combating with various pathogens including fungi. The inflammasome is one of the most critical arms of host innate immunity, which is a protein complex controlling maturation of IL-1β. To clarify whether T. schoenleinii is able to activate the inflammasome, we analyzed human monocytic cell line THP-1 for IL-1β production upon infection with T. schoenleinii strain isolated from Tinea favosa patients, and rapid IL-1β secretion from THP-1 cells was observed. Moreover, applying competitive inhibitors and gene specific silencing with shRNA, we found that T. schoenleinii induced IL-1β secretion, ASC pyroptosome formation as well as caspase-1 activation were all dependent on NLRP3. Cathepsin B activity, ROS production and K⁺ efflux were required for the inflammasome activation by T. schoenleinii. Our data thus reveal that the NLRP3 inflammasome plays an important role in host defense against T. schoenleinii, and suggest that manipulating NLRP3 signaling can be a novel approach for control of diseases caused by T. schoenleinii infection.
Animals ; Bone Marrow Cells ; cytology ; Carrier Proteins ; metabolism ; Caspase 1 ; metabolism ; Cell Line ; Dendritic Cells ; cytology ; metabolism ; microbiology ; Enzyme Activation ; Hot Temperature ; Humans ; Inflammasomes ; metabolism ; Interleukin-1beta ; biosynthesis ; metabolism ; Lysosomes ; metabolism ; Mice ; Monocytes ; cytology ; metabolism ; microbiology ; NLR Family, Pyrin Domain-Containing 3 Protein ; Potassium ; metabolism ; Reactive Oxygen Species ; metabolism ; Signal Transduction ; Trichophyton ; physiology

Objective:To investigate whether the nutrition support team (NST) benefits esophageal carcinoma (EC) patients who are concurrently undergoing chemoradiotherapy. Methods: Between June 2012 and December 2013, 40 EC patients undergoing chemoradiotherapy were divided into the NST group and routine treatment (RT) group, with 20 patients in each group. At the end of chemoradiotherapy, the nutritional status, incidence of complications, and completion rates of radiotherapy were evaluated. The length of hospital stay (LOS) and cost were also compared between the two groups. Results:The nutrition and blood parameter values of the NST group were better (P<0.05) than those of the RT group. The incidence of complications was lower in the NST group (P<0.05) than that in the RT group. In addition, all patients in the NST group achieved the treatment plan, whereas five of the patients in the RT group interrupted or delayed the plan (P<0.05). The average LOS decreased by 3.8 d (P<0.05), and the hospitalization costs were reduced to 6300 RMB person-times (P>0.05) for the patients of the NST group. Conclusion: NST could maintain the nutritional status and improve the treatment compliance and tolerance of EC patients undergoing chemoradiotherapy, thereby shortening the LOS time and reducing the costs.

Objective To analyze retrospectively the results of single-patch with elevation of the left-sided atrioventricular valve repair for complete atrioventricular septal defect(CAVSD) in therapeutic effects and safety.Methods Fourteen consecutive patients (2 males and 12 females) with CAVSD were enrolled in the study from April 2012 to December 2017.All patients underwent single-patch with the elevation of left-sided atrioventricular valve repair for CAVSD by regular sternotomy.The median age at operation was 12.5 months(range,11.7 months to 63 months) and the duration of follow-up was(3.27 ± 2.02)years.Echocardiography and electrocardiogram were used during follow-up according to the protocol.Results Compared with pulmonary arterial pressure(PAP) during pre-and post-operation (65.92 ± 6.91 and 62.97 ± 17.29) mmHg (1 mmHg =0.133 kPa),PAP(53.29 ± 20.99) mmHg decreased significantly during follow-up period.There were significant difference during post-operation and follow-up for LAVVR and RAVVR.The extent of regurgitation of atrioventricular valve statistically decreased during follow-up period.None of patients suffered from atrioventricular block and reoperation during follow-up.Conclusion Single-patch with elevation of the left-sided atrioventricular valve repair for CAVSD yields good outcomes,without occurrence of severe LAVVR,during early and mid-term follow-up period.

Objective: To investigate the clinical efficacy of transurethral 450 nm blue laser vaporization of prostate (BVP) and transurethral plasmakinetic resection of the prostate (PKRP) in the treatment of frail elderly patients with benign prostatic hyperplasia (BPH). Methods: A retrospective analysis was conducted on the clinical data of 62 frail elderly BPH patients undergoing BVP (n=32) or PKRP (n=30) in our hospital during Jan.2023 and Jun.2024.The two groups were compared in terms of postoperative hemoglobin drop, operation time, hospital stay, catheter indwelling time, bladder irrigation time, preoperative and postoperative 3-month postvoid residual (PVR), maximum urinary flow rate (Qmax), international prostate symptom score (IPSS), quality of life score (QoL), and postoperative complications. Results: The postoperative hemoglobin drop was lower in the BVP group than in the PKRP group [(1.62±1.04) g/L vs.(7.37±2.37) g/L, P＜0.001].The operation time [(24.53±7.52) min vs. (47.77±11.12) min], hospital stay [(2.78±1.62) d vs. (8.13±0.82) d], catheter indwelling time [(1.84±0.99) d vs. (5.40±0.81) d], and bladder irrigation time [(7.37±2.35) h vs. (51.60±19.72) h] were significantly shorter in the BVP group than in the PKRP group (all P＜0.001).At 3 months postoperatively, both groups showed significant improvements in IPSS, QoL, Qmax, and PVR compared to preoperative levels (P＜0.05), but there were no significant differences between the two groups (P>0.05).The overall incidence of early postoperative complications in the BVP group was lower than that in PKRP group (18.75% vs. 43.33%, P＜0.05).After 3 months of follow-up, there was no significant difference in the incidence of complications between the BVP group and PKRP group(3.13% vs. 13.33%, P=0.14). Conclusion: BVP for the treatment of frail elderly BPH patients is safe and reliable, associated with minimal bleeding, short operation time, catheterization time and hospital stay, and there is no need to discontinue anticoagulant drugs.

OBJECTIVE: To explore the risk factors of acute respiratory distress syndrome (ARDS) in patients with sepsis and to construct a risk nomogram model. METHODS: The clinical data of 234 sepsis patients admitted to the intensive care unit (ICU) of Tianjin Hospital from January 2019 to May 2022 were retrospectively analyzed. The patients were divided into non-ARDS group (156 cases) and ARDS group (78 cases) according to the presence or absence of ARDS. The gender, age, hypertension, diabetes, coronary heart disease, smoking history, history of alcoholism, temperature, respiratory rate (RR), mean arterial pressure (MAP), pulmonary infection, white blood cell count (WBC), hemoglobin (Hb), platelet count (PLT), prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB), D-dimer, oxygenation index (PaO₂/FiO₂), lactic acid (Lac), procalcitonin (PCT), brain natriuretic peptide (BNP), albumin (ALB), blood urea nitrogen (BUN), serum creatinine (SCr), acute physiology and chronic health evaluation II (APACHE II), sequential organ failure assessment (SOFA) were compared between the two groups. Univariate and multivariate Logistic regression were used to analyze the risk factors of sepsis related ARDS. Based on the screened independent risk factors, a nomogram prediction model was constructed, and Bootstrap method was used for internal verification. The receiver operator characteristic curve (ROC curve) was drawn, and the area under the ROC curve (AUC) was calculated to verify the prediction and accuracy of the model. RESULTS: There were no significant differences in gender, age, hypertension, diabetes, coronary heart disease, smoking history, alcoholism history, temperature, WBC, Hb, PLT, PT, APTT, FIB, PCT, BNP and SCr between the two groups. There were significant differences in RR, MAP, pulmonary infection, D-dimer, PaO₂/FiO₂, Lac, ALB, BUN, APACHE II score and SOFA score (all P < 0.05). Multivariate Logistic regression analysis showed that increased RR, low MAP, pulmonary infection, high Lac and high APACHE II score were independent risk factors for sepsis related ARDS [RR: odds ratio (OR) = 1.167, 95% confidence interval (95%CI) was 1.019-1.336; MAP: OR = 0.962, 95%CI was 0.932-0.994; pulmonary infection: OR = 0.428, 95%CI was 0.189-0.966; Lac: OR = 1.684, 95%CI was 1.036-2.735; APACHE II score: OR = 1.577, 95%CI was 1.202-2.067; all P < 0.05]. Based on the above independent risk factors, a risk nomograph model was established to predict sepsis related ARDS (accuracy was 81.62%, sensitivity was 66.67%, specificity was 89.10%). The predicted values were basically consistent with the measured values, and the AUC was 0.866 (95%CI was 0.819-0.914). CONCLUSIONS Increased RR, low MAP, pulmonary infection, high Lac and high APACHE II score are independent risk factors for sepsis related ARDS. Establishment of a risk nomograph model based on these factors may guide to predict the risk of ARDS in sepsis patients.
Humans ; Retrospective Studies ; Alcoholism ; Prognosis ; Respiratory Distress Syndrome ; Pneumonia ; Sepsis ; Intensive Care Units ; Procalcitonin ; Fibrinogen ; ROC Curve

【Objective】 To analyze the related factors of emotional and behavioral abnormalities in children with overactive bladder (OAB). 【Methods】 OAB children (aged 6 to 16 years) in a survey of 5 032 children from a county in Henan Province during Sep.2022 and Dec.2022 were identified and surveyed with Overactive Bladder Symptom Score (OABSS), Strength and Difficulties Questionnaire (SDQ) and Pediatric Sleep Questionnaire (PSQ). According to the SDQ score, they were divided into abnormal group (SDQ≥20) and normal group. 【Results】 There were 35.7%(137/385) cases in the abnormal group and 64.3% (248/385) in the normal group. Gender, education level of caregivers, body mass index (BMI), age, constipation, enuresis and severity of OAB were significantly associated with emotional and behavioral abnormalities (P<0.05). Children in the abnormal group showed significant differences in emotional symptoms, conduct problems, hyperactivity symptoms, peer interaction and sleep (P<0.001). Multivariate regression analysis revealed significant differences in gender, educational level of caregi-vers, BMI, age, constipation, enuresis, severity of OAB and PSQI between the two groups (P<0.05). 【Conclusion】 The prevalence of emotional and behavioral abnormalities is high in children with OAB, which is related to female gender, high BMI, puberty, constipation, enuresis and severity of OAB.

Objective: To explore the changes of mechanosensitive channels Piezos (Piezo 1 and Piezo 2) in neurogenic bladder (NB) of young rats and their effects，so as to provide reference for clinical search of new therapeutic targets. Methods: A total of 30 female young SD rats were divided into 5 groups based on random number table method：sham operation group (sham)，2-week nerve transection group (NB-2W)，6-week nerve transection group (NB-6W)，2-week nerve transection + Piezos inhibitor group (NB-P-2W) and 6-week nerve transection + Piezos inhibitor group (NB-P-6W)，with 6 rats in each group.The NB models were constructed by transecting the L6 and S1 spinal nerves of young rats.The NB-2W and NB-6W groups were not intervened after modeling，while the NB-P-2W and NB-P-6W groups were intraperitoneally injected with Piezos inhibitor GsMTx4 (10 mg/kg) every 2 days after modeling.Bladder cystometry and ultrasound were performed after 2 and 6 weeks of transection.The expressions of Piezos and fibrosis-related indexes (Collagen Ⅰ and α-smooth muscle actin) were detected in bladder tissues. Results: The results of bladder cystometry showed that the basal bladder pressure in NB-2W group was significantly increased，while it was slightly decreased but was still higher in NB-6W group than in the sham group (P<0.05).Basal bladder pressure was lower in NB-P-2W group than in NB-2W group，but was higher than that in the sham group; basal bladder pressure was lower in NB-P-6W group than in NB-6W group，but higher than that in the sham group (P<0.05).Compared with the sham group，the NB-2W and NB-6W groups had firstly increased and then decreased maximum cystometric capacity (MCC) (P<0.05).Compared with NB-2W group，NB-P-2W group had lower bladder leakage point pressure (BLPP)，but higher MCC and bladder compliance (BC) (P<0.05).Compared with NB-6W group，NB-P-6W group had significantly lower BLPP but higher MCC and BC (P<0.05).HE and MASSON staining and ultrasound results showed that，with the extension of nerve transection time，bladder fibrosis gradually worsened，the bladder wall became rough and thickened，calculi were visible inside，and hydronephrosis gradually appeared; the degree of fibrosis in NB-P-2W and NB-P-6W groups was less than that in NB-2W and NB-6W groups，and no hydronephrosis was observed in the upper urinary tract.In addition，Western blotting and immunohistochemical results showed that NB-2W and NB-6W groups had significantly higher relative expression levels of Piezos，Collagen Ⅰ and α-SMA than the sham group (P<0.01)，while NB-P-2W and NB-P-6W groups had lower relative expression levels of Piezos,Collagen Ⅰ and α-SMA than NB-2W and NB-6W groups (P<0.01). Conclusion: The increased expressions of mechanosensitive channels Piezos in NB young rats may be involved in the progression of bladder fibrosis，but its mechanism needs further study.