Objective To investigate the therapeutic methods of hyperpotassemia induced by excessively high blood concentration of tacrolimus (FK506) caused by drug use after renal transplantation. Methods Clinical data of 10 patients diagnosed with hyperpotassemia induced by excessively high blood concentration of FK506 after administration of antifunga l medication following renal transplantation were collected and retrospectively analyzed. Results At 1-2 months after renal transplantation, 10 patients suffered from pulmonary infectiono r pneumonia complicated with pulmonary fungal infection . An appropriate dose of compound sulfamethoxazole, micafungin, cefoperazone sodium-sulbactam sodium and moxifloxacin was administered for antifungal infection. After potassium-lowering therapy, termination of antifungal medication and FK506 dose adjustment (replaced by cyclosporin for certain cases), the serum level of potassium was declined and maintained within normal range for 10 cases. The serum concentration of FK506 was within normal range. No sign of excessively high level of potassium was observed without any potassium-lowering intervention. Conclusions Postoperative administration of drugs is likely to cause excessively high level of FK506 and hyperpotasesmia. Potassium-lowering therapy, termination of drug use and adjustment of immunosuppressive agents should be adopted to avoid the incidence of adverse pharmacologic interaction.

Objective To summarize clinical characteristics, prevention and treatment of postoperative chronic hyponatremia after liver transplantation(LT). Methods Clinical data of 26 patients presenting with chronic hyponatremia after LTwereretrospectivelyanalyzed.BaselinedataandmaincomplicationsofpatientswithhyponatremiaafterLTwererecorded. Thecorrelationbetweenpostoperativelengthofhospitalstayandthedurationofhyponatremiawasanalyzed.Clinicaltreatment and prognosis were summarized. Results Among 26 patients, the median blood sodium concentration was 131 mmol/L (range 125 to 133 mmol/L). Al patients were diagnosed with mild or moderate degree of hyponatremia. Main complications included pulmonary infection (n=13, 50%), acute rejection of liver graft (n=7, 27%) and digestive tract hemorrhage (n=7, 27%). Postoperative length of hospital stay was correlated with the duration of hyponatremia. After ful evaluation of patient's conditionandexcludingthepotentialinducers,aportionof3%ofhypertonicsalinewasadministeredviagastro-intestinaltract and/or vein. After positive treatment, 23 cases (88%) were healed and 3 (12%) died from infection complicated with multiple organ failure. Conclusions After LT, the incidence of chronic hyponatremia is low with mild severity. Postoperative length of hospitalstayiscorrelatedwiththedurationofhyponatremia.Thekeyoftreatmentistotimelyexcludetheinducers,correctthe low level of sodium based upon the individual principles and prevent the incidence of postoperative complications.

Objective To explore the effects of the perioperative nursing pathway on physiological and mental status, and risk of infection in Tibetan patients with limb fractures. Methods A total of 86 Tibetan patients with limb fractures who were treated in Ganzi Tibetan Autonomous Prefecture People's Hospital in 2016 were collected in this study. The participants were divided into two groups according to the random number table, with 43 cases in each group. Based on the routine treatment, the control group received conventional perioperative nursing pathway. In contrast, the intervention group received modified nursing pathway tailored for Tibetan patients which included faith support, language assistance, and custom acceptance. Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD) were used to evaluate patients' anxiety and depression status at different time (i. e. before the admission, preoperative day, postoperative day, and on the day of discharge). The peripheral blood sample was collected to investigate patients' C-reactive protein level (CPR). The healthcare associated infection (HAI) was compared between two groups. Results The HAMA scores were (21.3±2.1), (15.7±2.5), (13.1±2.4) and (11.8±1.8) for the intervention group, and (20.7±2.3), (18.1±2.0),(15.8±2.0) and (13.4±1.3) for the control group, which significantly decreased in both groups (F=131.511, 82.510; P<0.001). The intervention group had significantly lower HAMA scores at any evaluate time compared with the control group (t=4.916, 5.667, 4.725; P<0.001). The HAMD scores were (28.7±2.8), (23.6±2.4), (18.5±1.8) and (15.6±2.0) in the intervention group, and (28.4±2.3), (25.6±2.7), (22.6±2.2) and (19.4±2.3) in the control group. Both groups had significant reduction (F=153.582, 102.618; P<0.001) and the intervention group had significantly lower HAMD scores at any evaluate time compared with the control group (t=3.630, 9.458, 8.175; P< 0.01). The serum CPR were (10.2±1.3), (7.8±1.5), (31.7±4.2), and (5.4±1.5) mg/L in the intervention group and (10.1±1.5), (9.8±1.2), (39.2±3.8) and (6.8±1.0) mg/L in the control group, which significantly decreased in both groups (F=139.315, 213.158; P<0.001). The intervention group had significantly lower serum CPR at any evaluate time compared with the control group (t=6.747, 8.582, 5.033;P< 0.001). The intervention group had significantly lower incidence rate of HAI (18.6% vs. 39.5%; χ2=4.568,P<0.05) and less infection duration [(6.4±1.1) d vs. (11.5±2.0) d;t=6.701,P<0.001] compared with the control group. Conclusions The modified clinical perioperative nursing pathway can help patients' physiological and mental status, and reduce the risk of HAI in Tibetan patients with limb fractures.

Bibenzyls, a kind of important plant polyphenols, have attracted growing attention for their broad and remarkable pharmacological activities. However, due to the low abundance in nature, uncontrollable and environmentally unfriendly chemical synthesis processes, these compounds are not readily accessible. Herein, one high-yield bibenzyl backbone-producing Escherichia coli strain was constructed by using a highly active and substrate-promiscuous bibenzyl synthase identified from Dendrobium officinale in combination with starter and extender biosynthetic enzymes. Three types of efficiently post-modifying modular strains were engineered by employing methyltransferases, prenyltransferase, and glycosyltransferase with high activity and substrate tolerance together with their corresponding donor biosynthetic modules. Structurally different bibenzyl derivatives were tandemly and/or divergently synthesized by co-culture engineering in various combination modes. Especially, a prenylated bibenzyl derivative ( 12) was found to be an antioxidant that exhibited potent neuroprotective activity in the cellular and rat models of ischemia stroke. RNA-seq, quantitative RT-PCR, and Western-blot analysis demonstrated that 12 could up-regulate the expression level of an apoptosis-inducing factor, mitochondria associated 3 (Aifm3), suggesting that Aifm3 might be a new target in ischemic stroke therapy. This study provides a flexible plug-and-play strategy for the easy-to-implement synthesis of structurally diverse bibenzyls through a modular co-culture engineering pipeline for drug discovery.