Objective To explore the feasibility and clinical significance of individualized formular administration of tacrolimus after renal transplantation based on the CYP3A5 and MDR1 gene polymorphism.Methods Total 129 renal transplantation recipients from Oct.1,2015 to July 30,2016 were included in this study and divided into 2 groups.In experimental group,tacrolimus was administrated by the individualized formula based on CYP3A5 and MDR1 gene polymorphism;in control group,tacrolimus was administrated by doctors' experience based on patient's body weight.The blood trough level of tacrolimus was determined 3 days after administration.The first blood trough level of tacrolimus,plasma creatinine level,acute rejection rate,and necessity for dialysis were compared between two groups.Results The first blood trough levels of tacrolimus in experimental and control groups were 9.24 ± 2.32 and 9.39 ± 3.47μg/L respectively (P＞0.05).The tacrolimus levels of 7 cases in experimental group and 18 cases in control group were not in normal range (P＜0.05).The plasma creatinine level at day 7 after surgery was 157.36 ± 110.55 μg/L in experimental group,and 174.01 ± 130.68μg/L in control group (P＞0.05).Acute rejection was found in both two groups:2 in experimental group and 5 in control group (P ＞ 0.05).There was significant difference in necessity for dialysis between two groups:4 in experimental group and 10 in control group (P＜0.05).Conclusion The individualized formular administration of tacrolimus based on the CYP3A5 and MDR1 gene polymorphism is more feasible and reasonable than experimental administration,which is more easier to come to an appropriate blood level and would benefit the early recovery of renal function.

Objective To compile nursing guidelines for diabetic patients undergoing ultrasound-guided islet transplantation through percutaneous portal vein puncture and catheterisation,providing valuable insights for the care of such patients during the surgical procedure.Methods Between December 2017 to September 2023,a total of 27 patients underwent 44 surgical procedures for ultrasound-guided islet transplantation via percutaneous portal vein puncture and catheterisation at our hospital.Nursing assistance was provided preoperatively,intraoperatively and postoperatively for all the procedures.Results All 27 patients who had undergone 44 surgical procedures successfully went through the ultrasound-guided islet transplantation via percutaneous portal vein puncture and catheterisation.Among the 44 surgical procedures,3(6.8%)resulted in upper abdominal and liver area pain,nausea and vomiting during surgery,8(18.2%)had transient increase of portal vein pressure during transplantation,and 6(13.6%)encountered active bleeding following the removal of the portal vein catheters.None of the patients developed delayed portal vein bleeding or complication such as portal vein thrombosis after the surgery.Conclusions Nursing interventions play a crucial role in ensuring the successful outcomes of ultrasound-guided islet transplantation.Following measures are the keys and they play an important roles in ensuring the smooth completion of ultrasound-guided islet transplantation:preoperatively,carefully assess the condition of recipients and provide them with psychological supports and patient education.Intraoperatively,closely monitor the vital signs,portal vein pressure and blood glucose as well as to prevent complications.Postoperatively,implement the nursing measures to prevent the recipients from postoperative bleeding of portal vein.

Objective:To compare the pregnancy outcome before the implementation of management specification of cervical ripening with dinoprostone suppository with that after the implementation and explore its safety for cervical ripening .Methods:The clinical data of 612 puerperants ,who received cervical ripening with dinoprostone suppository and delivered in First Mater‐nal and Infant Hospital Affiliated to Tongji University during Sep 2012 and Feb 2014 ,were retrospectively analyzed .The man‐agement specification of cervical ripening with dinoprostone had been implemented since Apr 2013 .The maternal and neonatal outcomes ,as well as the rate of adverse reactions ,before and after the implementation of management specification of cervical ripening with dinoprostone suppository were compared with each other ,so as to explore its effects on pregnancy outcome .Re‐sults:There were 449 puerperants receiving cervical ripening with suppository before the implementation of management speci‐fication in Apr 2013 and 163 cases after that .Totally 413 cases(67 .5% ) were induced labour successfully .The success rates of inducting labor within 48 h ,24 h and 12 h after the implementation of management specification were lower than that before the implementation of management specification ,but there was no significant difference .The cesarean rate was 27 .1% and there was no statistically significant difference between the cesarean rate before the implementation of management specification and that after the implementation .There was no statistically significant difference in Apgar score and admission rate to ICU between the two groups .The incidence rates of tachysystole and hypertonus ,meconium‐stained amniotic fluid after the implementation of specification were significantly lower than that before the implementation ,and the difference was statistically significant(P<0 .05) .There was no statistically significant difference regarding the incidence rates of uterine hyperstimulation and the clinical chorioamnionitis .There was no occurrence of complications as amniotic fluid embolism and severe perineal laceration .Conclusions:Di‐noprostone suppository is a safe and effective method for cervical ripening and labor induction .The implementation of management speci‐fication is conducive to protecting maternal and infant and reducing the adverse pregnancy outcomes .