Objective:To analyze the effect of carbapenem antibiotics on the blood concentration of valproate(VPA)in elderly patients with epilepsy, while also exploring the potential drug interactions between carbapenem antibiotics and VPA, as well as possible solutions.Methods:This retrospective study included patients aged 80 years and older who were treated with a combination of VPA and carbapenem antibiotics in the Department of Geriatrics at Beijing Hospital from January 2017 to December 2022, as well as older hospitalized patients with epilepsy.Data collected encompassed patients' demographic information, details related to epilepsy, information on infection medications, changes in VPA blood concentration, clinical management, and clinical outcomes.Results:A total of 12 patients were included in the study.The average age of the participants was 92±7.0 years.The baseline dosage of VPA was 1 000 mg(range: 650 to 1 250 mg), and the baseline VPA serum concentration was 56.59 mg/L(range: 38.00 to 61.73 mg/L)during treatment with carbapenem antibiotics.Nine patients experienced seizure recurrence during the combination therapy, representing 75% of the total cohort.The VPA dosage was increased in 10 patients, with a mean increase of 522 mg(range: 200 to 892 mg), and the duration of this dosage increase was 8 days(range: 7 to 9 days).All patients exhibited a decrease in VPA serum concentration, with the lowest concentration decreasing by an average of 71.9%±15.69%.The VPA serum concentration during carbapenem treatment was significantly lower than both the baseline and post-withdrawal concentrations, measuring 12.30 mg/L(range: 10.49 to 22.47 mg/L)compared to 56.59 mg/L(range: 38.00 to 61.73 mg/L)( Z=-3.059, P=0.002)and 43.74 mg/L(range: 41.48 to 73.14 mg/L)( Z=-2.803, P=0.005). Conclusions:Carbapenems can markedly decrease serum concentrations of VPA and heighten the incidence of seizures in elderly patients with epilepsy.Increasing the dose of VPA may not enhance its serum concentration; therefore, we recommend avoiding the concomitant use of VPA and carbapenems.

Objective To explore the value of Delta radiomics based on dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)in the early prediction of pathological complete response(pCR)after neoadjuvant chemotherapy(NAC)for breast cancer.Methods The MRI and clinical data of 107 patients with breast cancer and received NAC treatment were retrospectively collected.The patients were randomly divided into training set(74 cases)and test set(33 cases)in a ratio of 7︰3.The volume of interest(VOI)were marked,and the radiomics features(Pre-features,Post-features)were extracted from the peak images of DCE-MRI before NAC and after the second cycle of NAC.The Delta features were obtained by subtracting Post-features from Pre-features.Subsequently,six machine learning methods including random forest(RF),multi-layer perceptron(MLP),extreme gradient boosting(XGBoost),light gradient boosting machine(LightGBM),K-nearest neighbor(KNN)and logistic regression(LR)were used to consult the model,respectively.The receiver operating characteristic(ROC)curve was used to evaluate the model performance,and the machine learning method and radiomics feature set with the highest area under the curve(AUC)in the test set were selected for further analysis.Univariate and multivariate logistic regression analyses were performed to identify independent clinical predictors and the machine learning method with the best radiomics model was used to construct the clinical model.Combined with tumor radiomics features and independent clinical predictors,the best machine learning method was used to construct a combined model,and the performance of the model was evaluated.Results Progesterone receptor(PR)status was identified as an independent predictor of NAC efficacy in breast cancer.The model established using the RF machine learning method based on the Delta features had the highest AUC of 0.926 in the test set.The AUC of the combined model in the test set was 0.957,which was higher than that of the Pre-radiomics model,Post-radiomics model,Delta-radiomics model,and clinical-features model.Conclusion The combined model of Delta features and clinical features has a good performance in predicting pCR after NAC for breast cancer.

Objective To explore the value of Delta radiomics based on dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)in the early prediction of pathological complete response(pCR)after neoadjuvant chemotherapy(NAC)for breast cancer.Methods The MRI and clinical data of 107 patients with breast cancer and received NAC treatment were retrospectively collected.The patients were randomly divided into training set(74 cases)and test set(33 cases)in a ratio of 7︰3.The volume of interest(VOI)were marked,and the radiomics features(Pre-features,Post-features)were extracted from the peak images of DCE-MRI before NAC and after the second cycle of NAC.The Delta features were obtained by subtracting Post-features from Pre-features.Subsequently,six machine learning methods including random forest(RF),multi-layer perceptron(MLP),extreme gradient boosting(XGBoost),light gradient boosting machine(LightGBM),K-nearest neighbor(KNN)and logistic regression(LR)were used to consult the model,respectively.The receiver operating characteristic(ROC)curve was used to evaluate the model performance,and the machine learning method and radiomics feature set with the highest area under the curve(AUC)in the test set were selected for further analysis.Univariate and multivariate logistic regression analyses were performed to identify independent clinical predictors and the machine learning method with the best radiomics model was used to construct the clinical model.Combined with tumor radiomics features and independent clinical predictors,the best machine learning method was used to construct a combined model,and the performance of the model was evaluated.Results Progesterone receptor(PR)status was identified as an independent predictor of NAC efficacy in breast cancer.The model established using the RF machine learning method based on the Delta features had the highest AUC of 0.926 in the test set.The AUC of the combined model in the test set was 0.957,which was higher than that of the Pre-radiomics model,Post-radiomics model,Delta-radiomics model,and clinical-features model.Conclusion The combined model of Delta features and clinical features has a good performance in predicting pCR after NAC for breast cancer.

Objective:To analyze the effect of carbapenem antibiotics on the blood concentration of valproate(VPA)in elderly patients with epilepsy, while also exploring the potential drug interactions between carbapenem antibiotics and VPA, as well as possible solutions.Methods:This retrospective study included patients aged 80 years and older who were treated with a combination of VPA and carbapenem antibiotics in the Department of Geriatrics at Beijing Hospital from January 2017 to December 2022, as well as older hospitalized patients with epilepsy.Data collected encompassed patients' demographic information, details related to epilepsy, information on infection medications, changes in VPA blood concentration, clinical management, and clinical outcomes.Results:A total of 12 patients were included in the study.The average age of the participants was 92±7.0 years.The baseline dosage of VPA was 1 000 mg(range: 650 to 1 250 mg), and the baseline VPA serum concentration was 56.59 mg/L(range: 38.00 to 61.73 mg/L)during treatment with carbapenem antibiotics.Nine patients experienced seizure recurrence during the combination therapy, representing 75% of the total cohort.The VPA dosage was increased in 10 patients, with a mean increase of 522 mg(range: 200 to 892 mg), and the duration of this dosage increase was 8 days(range: 7 to 9 days).All patients exhibited a decrease in VPA serum concentration, with the lowest concentration decreasing by an average of 71.9%±15.69%.The VPA serum concentration during carbapenem treatment was significantly lower than both the baseline and post-withdrawal concentrations, measuring 12.30 mg/L(range: 10.49 to 22.47 mg/L)compared to 56.59 mg/L(range: 38.00 to 61.73 mg/L)( Z=-3.059, P=0.002)and 43.74 mg/L(range: 41.48 to 73.14 mg/L)( Z=-2.803, P=0.005). Conclusions:Carbapenems can markedly decrease serum concentrations of VPA and heighten the incidence of seizures in elderly patients with epilepsy.Increasing the dose of VPA may not enhance its serum concentration; therefore, we recommend avoiding the concomitant use of VPA and carbapenems.

Objective Bevacizumab ( BM ) is an angiogenesis inhibitor widely used in cancer therapy, but its off-target effect of proteinuria may lead to discontinuation of treatment.This study was to explore the mechanisms of BM inducing proteinuria in mice. Methods Twenty-four healthy mice were randomly divided into four groups, saline control, low-dose BM, medium-dose BM, and high-dose BM, treated by injection of normal saline and BM at 10, 35, and 60 mg per kg of the body weight, respectively, though the tail vein.At 4 weeks after injection, 24-hour urine was collected to determine the total urine protein and blood obtained from the eyeballs for biochemical analysis.Then all the mice were sacrificed and the kidneys harvested for observation of pathologic changes in the glomeruli as well as for immunohistochemistry, Western blotting, and real-time PCR analysis. Results Compared with normal saline,BM obviously elevated the level of 24-hour urine protein, with statistically significant differences between the control and the medium-and high-dose BM groups (0.23 ±0.02 vs 1.14 ±0.13 and 1.43 ±0.10, P<0.01), but not between the control and the low-dose BM (0.23 ±0.02 vs 0.29 ±0.07, P>0.05).No significant differences were observed among the four groups in the levels of Cr, BUN, AST and ALT (P>0.05).Under the optical microscope, the kidneys showed normal structures in the control group, no signifi-cant pathologic changes in the low-dose BM, and vacuolus-like alteration with atrophic glomerular endothelial cells in the medium-and high-dose BM groups.Immunohistochemical analysis demonstrated the expressions of VEGF and podocin were moderately or strongly positive in the control and low-dose BM groups, by weakly positive or negative in the medium-and high-dose BM groups.Compared with the control group, the expression of the VEGF protein in the renal tissue was significantly decreased in the high-dose BM group (0.76 ±0.09 vs 0.39 ±0.05, P<0.01) but had no remarkable difference from that in the low-dose (0.81 ±0.10) or medium-dose BM (0.64 ±0.08) group (P>0.05), and the expression of the podocin protein was significantly reduced in the medium-dose BM (0.67 ±0.07 vs 0.43 ±0.10, P<0.05) and high-dose BM (0.67 ±0.07 vs 0.19 ±0.04, P<0.01), but not in the low-dose BM group (0.67 ±0.03) (P>0.05).The mRNA expressions of VEGF and podocin were not significantly changed in the low-dose BM group as compared with the control (1.07 ±0.61 and 1.12 ±0.09 vs 1.23 ±0.25 and 1.17 ±0.19, P>0.05) but remarkably de-creased in the medium-dose (0.82 ±0.38 and 0.71 ±0.18) and high-dose BM groups and (0.47 ±0.64 and 0.42 ±0.09) groups (P<0.01). Conclusion Bevacizumab damages glomerular filtration membrane and induce proteinuria partially by down-regulating the protein and mRNA expressions of VEGF and podocin.

Objective To investigate healthcare-associated infection(HAI)in different departments in a children’s hos-pital,and provide scientific basis for effective prevention and control of HAI in children.Methods By bed-side visiting and medical record reviewing,survey on HAI prevalence rate was conducted among hospitalized patients in a given day in 2012, 2013,and 2014 respectively,and surveyed data of three years were analyzed.Results HAI prevalence rates in 2012,2013, and 2014 were 6.52%,5.59%,and 5.85% respectively,there was no significant difference (χ2 =1.02,P =0.60);the average HAI prevalence rate in three years was 5.98%,there was significant difference in average HAI prevalence rate among different departments(χ2 =291.83,P <0.001 ),the top 4 departments of HAI prevalence rate was hematology (27.49%),cardiothoracic surgery (21.13%),neonatal intensive care unit (16.43%),and pediatric intensive care unit (12.76%);the main infection sites were lower respiratory tract (58.44%),upper respiratory tract (22.63%),and gas-trointestinal tract (6.58%);the main pathogens causing HAI was Klebsiella pneumoniae (n=32,28.32%),followed by Acinetobacter baumannii (n=9,7.96%),Escherichia coli (n=9,7.96%),and Pseudomonas aeruginosa (n=7,6.19%). Conclusion Strengthening prevention and control intervention of HAI in high risk departments has important significance to reduce the incidence of HAI in children’s hospital.

Objective To design and use the disposable puncture set in order to control the catheter related infection and implement conveniently the ultrasound-guided PICC catheter .Methods The disposable puncture set for PICC catheter was designed according to the operating process of ultrasound -guided PICC catheter.Results All tools in the puncture set had been arranged as the operation process , and was easy to use, and shielded completely the external pollution , and met the requirements of central venous catheter cluster intervention strategies .No case of infection was occurred in the 2 868 cases.Conclusions The disposable puncture set for ultrasound-guided PICC catheter is convenient to use , and can save time , and is worthy of clinical promotion .

Objective To assess the effect of meal replacements on body weight control and blood glucose and lipid profile by adjusting their nutrients intake with a meal replacement approach.Methods One hundred and thirty subjects were randomly divided into intervention group (100 subjects) and control group (30 subjects).Besides dietary consulting and health education,all subjects in intervention group received a dietary treatment with 2 meal replacements each day over a shot-term (3 months).All subjects were evaluated by recording the body measurements and laboratory data every 2 weeks.Results Compared with the baseline,mean percentages of BMI loss and decrease in waist circumference were 7.2 ％ and 6.5％ for intervention group(P＜0.01) by week 12.Meanwhile,systolic blood pressure,diastolic blood pressure,fasting plasma glucose,and triglyceride levels were significantly reduced (P＜0.01),showing significant difference compared with control group at the same period(all P＜0.01).Conclusion The meal replacement approach evaluated is an effective strategy to control body weight,and thus to achieve great improvement in the prevention of obesity-related diseases.