Objective To explore the identification method,pathogenesis,clinical characteristics and individualized pharmacotherapy of asymptomatic hyperuricemia after renal transplantation.Methods The pharmacist was on duty at the organ transplant outpatient clinic.During this time,they analyzed and sorted out the medications,identified and differentiated a case of asymptomatic hyperuricemia related to spironolactone in a patient who had undergone a renal transplant,and provided comprehensive care throughout the entire process.Results The asymptomatic hyperuricemia in this patient might be associated with spironolactone,and the adverse reactions of the patient were alleviated by pharmacists through optimizing clinical treatment.Up to now,no hyperuricemia occurred.Conclusions Pharmacists are required to collaborate closely with clinicians to establish medication profiles for patients under long-term follow-up and to closely monitor and evaluate drug-related adverse reactions.Additionally,they should assess the renal function and immune status of transplant recipients promptly and formulate individualized treatment plans in order to enhance the long-term survival of both the transplanted kidneys and the recipients.

Objective:To investigate the application and efficacy of personalized expander placement in the single expanded flap auricular reconstruction for microtia.Methods:This study was a prospective cohort study that included patients with microtia who underwent single expanded flap auricular reconstruction in the Plastic Surgery Hospital of Chinese Academy of Medical Sciences between February 2023 and March 2024, according to specific inclusion and exclusion criteria. During the first-stage surgery, the tension and thickness of the skin in the postauricular area were evaluated using a pinch test. The anatomical layer of the expander placement was personalized as follows: (1) for thicker skin, the expander was placed in the subcutaneous layer; (2) for thinner skin, the expander was placed in the subcutaneous layer in the scalp region and in the subfascial layer in the hairless region behind the ear; (3) for areas of thin skin behind the residual ear, the expander was placed in the subfascial layer, with the remainder in the subcutaneous layer. In the second-stage surgery, autologous costal cartilage scaffolds were implanted for ear reconstruction, followed by a third-stage revision surgery. Postoperative follow-up was conducted to record complications. Before the third-stage surgery, two plastic surgeons, who did not participate in the operations, evaluated the aesthetic outcomes of the reconstructed ear using the Likert 4-point scale (1-4 points, with higher scores indicating better aesthetic outcomes).Results:A total of 152 children were included, with 97 males and 55 females; ages ranged from 5 to 13 years old, with a mean age of 6.8 years old. Of these, 89 cases were right-sided microtia, 53 left-sided microtia, and 10 bilateral microtia. In terms of skin characteristics, 35 cases had thick skin, 69 thin skin, and 48 thin skin behind the residual ear. During the first-stage surgery, complications included 15 cases of expander hematoma and 3 cases of expander infection. Both were controlled with symptomatic treatment. No cases of expander exposure occurred. The second-stage follow-up ranged from 6 to 12 months, with a mean of 7.9 months. The thickness of the reconstructed ear skin was appropriate, with well-defined subunits and no exposure of the cartilage scaffold. The aesthetic score for the reconstructed ear was (3.3 ± 0.5) points.Conclusion:The personalized placement of expanders effectively ensured appropriate thickness of the expanded flap in single expanded flap auricular reconstruction, providing good coverage for the rib cartilage framework and significantly enhancing the aesthetic outcomes of the reconstructed ears.

Objective To explore the identification method,pathogenesis,clinical characteristics and individualized pharmacotherapy of asymptomatic hyperuricemia after renal transplantation.Methods The pharmacist was on duty at the organ transplant outpatient clinic.During this time,they analyzed and sorted out the medications,identified and differentiated a case of asymptomatic hyperuricemia related to spironolactone in a patient who had undergone a renal transplant,and provided comprehensive care throughout the entire process.Results The asymptomatic hyperuricemia in this patient might be associated with spironolactone,and the adverse reactions of the patient were alleviated by pharmacists through optimizing clinical treatment.Up to now,no hyperuricemia occurred.Conclusions Pharmacists are required to collaborate closely with clinicians to establish medication profiles for patients under long-term follow-up and to closely monitor and evaluate drug-related adverse reactions.Additionally,they should assess the renal function and immune status of transplant recipients promptly and formulate individualized treatment plans in order to enhance the long-term survival of both the transplanted kidneys and the recipients.

Objective:To investigate the application and efficacy of personalized expander placement in the single expanded flap auricular reconstruction for microtia.Methods:This study was a prospective cohort study that included patients with microtia who underwent single expanded flap auricular reconstruction in the Plastic Surgery Hospital of Chinese Academy of Medical Sciences between February 2023 and March 2024, according to specific inclusion and exclusion criteria. During the first-stage surgery, the tension and thickness of the skin in the postauricular area were evaluated using a pinch test. The anatomical layer of the expander placement was personalized as follows: (1) for thicker skin, the expander was placed in the subcutaneous layer; (2) for thinner skin, the expander was placed in the subcutaneous layer in the scalp region and in the subfascial layer in the hairless region behind the ear; (3) for areas of thin skin behind the residual ear, the expander was placed in the subfascial layer, with the remainder in the subcutaneous layer. In the second-stage surgery, autologous costal cartilage scaffolds were implanted for ear reconstruction, followed by a third-stage revision surgery. Postoperative follow-up was conducted to record complications. Before the third-stage surgery, two plastic surgeons, who did not participate in the operations, evaluated the aesthetic outcomes of the reconstructed ear using the Likert 4-point scale (1-4 points, with higher scores indicating better aesthetic outcomes).Results:A total of 152 children were included, with 97 males and 55 females; ages ranged from 5 to 13 years old, with a mean age of 6.8 years old. Of these, 89 cases were right-sided microtia, 53 left-sided microtia, and 10 bilateral microtia. In terms of skin characteristics, 35 cases had thick skin, 69 thin skin, and 48 thin skin behind the residual ear. During the first-stage surgery, complications included 15 cases of expander hematoma and 3 cases of expander infection. Both were controlled with symptomatic treatment. No cases of expander exposure occurred. The second-stage follow-up ranged from 6 to 12 months, with a mean of 7.9 months. The thickness of the reconstructed ear skin was appropriate, with well-defined subunits and no exposure of the cartilage scaffold. The aesthetic score for the reconstructed ear was (3.3 ± 0.5) points.Conclusion:The personalized placement of expanders effectively ensured appropriate thickness of the expanded flap in single expanded flap auricular reconstruction, providing good coverage for the rib cartilage framework and significantly enhancing the aesthetic outcomes of the reconstructed ears.

Objective By analyzing the characteristics of hidden poisoning homicide cases,provide scientific references for grass-roots forensic examination and toxicological screening and provide direction for the efficient discovery of hidden or missed cases of poisoning homicide in non-natural death cases.Methods Poisoning incidents in Hunan Province from 2018 to 2023 were retrospectively analyzed and compiled using Origin and EXCEL software.Results There were a total of 149 poisoning homicide cases,with 15 occurring in urban areas(accounting for 10.1%)and 134 in rural areas(accounting for 89.9%).Out of the 46 cases that led to casualties,rodenticide poisoning was the most prevalent(accounting for 52.2%),followed by cyanide(4.3%),nitrite(4.3%),thallium(2.2%),and other forms of poisoning.These incidents were primarily concentrated in urban areas.The main way of poisoning was to mix poisons into drinking water(accounting for 28.3%),meals(26.1%),and dark or heavy seasoning(8.7%).There was no significant disparity in the gender distribution of suspects,although the number of male victims was notably higher than that of female victims.The suspects were predominantly between the ages of 19 and 45,while the victims were mostly between the ages of 46 and 60.Among the 103 cases that did not result in injury or death,99%occurred in rural areas,with more than 95%of the involved poisons included pungent pesticides or herbicides,while rodenticides accounted for the least(1.9%).Conclusion There are obvious urban-rural differences in the case occurrence areas and types of involved poisons in poisoning homicide cases.Therefore,it is imperative to focus on both urban and rural areas during the investigation and evidence collection process in suspected poisoning cases.

Objective:To observe the occurrence of perioperative adverse events of carotid endarterectomy in patients with carotid artery stenosis, and analyze the influencing factors of perioperative adverse events.Methods:The clinical data of 120 carotid artery stenosis patients underwent carotid endarterectomy from October 2021 to October 2022 in Xuanwu Hospital, Capital Medical University were retrospectively analyzed. Among them, 42 patients experienced perioperative adverse events (adverse events group), and 78 patients did not experience perioperative adverse events (non-adverse events group). The baseline data, imaging findings, laboratory indexes, surgical indexes and postoperative complications were recorded. Multivariate Logistic regression was used to analyze the independent risk factors of perioperative adverse events of carotid endarterectomy in patients with carotid artery stenosis.Results:The rates of history of cerebrovascular disease, severe stenosis or occlusion of anterior cerebral artery, patch repair and plaque ulceration in adverse events group were significantly higher than those in non-adverse events group: 35.71% (15/42) vs. 15.38% (12/78), 52.38% (22/42) vs. 26.92% (21/78), 50.00% (21/42) vs. 20.51% (16/78) and 61.90% (26/42) vs. 24.36% (19/78), and there were statistical differences ( P<0.05 or <0.01). Multivariate Logistic regression analysis result showed that the severe stenosis or occlusion of anterior cerebral artery, patch repair and plaque ulceration were the independent risk factors of perioperative adverse events of carotid endarterectomy in patients with carotid artery stenosis ( OR = 2.874, 2.632 and 3.214; 95% CI 1.421 to 3.654, 1.748 to 3.287 and 2.101 to 4.697; P<0.05 or <0.01). Conclusions:The severe stenosis or occlusion of anterior cerebral artery, patch repair and plaque ulceration are the independent risk factors of perioperative adverse events of carotid endarterectomy in patients with carotid artery stenosis. Identifying and taking effective measures to prevent the perioperative adverse events can effectively reduce disability and mortality rates.

Objective:To study the biological traits and mutations of the influenza A (H3N2) virus in order to produce a vaccine and offer references for controlling and preventing influenza epidemics.Methods:Four strains of the influenza A(H3N2) virus were chosen from the Huai′an surveillance network laboratory. Nucleic acid extraction, library building, and sequencing (CridION x5 MKI Nanopore) were used to produce the whole-genome sequences. Using homologous alignments of whole-genome sequences, phylogenetic tree construction, and amino acid variant screening, bioinformatics analysis was carried out.Results:The nucleotide identity between 8 gene segments ranged from 97.1% to 100.0%. The gene that differed the most from the reference sequences was HA (97.1%-99.9%), and the gene that differed the least was MP (98.6%-99.9%). The HA gene (3.06%) and MP gene (1.43%) were the regions with the greatest and lowest frequencies of nucleotide site change, respectively. The rates of nucleotide change varied significantly between the genes ( χ2=14.293, P=0.046). Four influenza A(H3N2) virus strains′ whole-genome phylogenies from each of the eight gene segments maintained a roughly consistent topological structure. One strain was linked to the 3C.2a1b.1b clade, which was lost at the 142NWT, 149NGT(HA1), and 436NLS(NA). Three strains were linked to the 3C.2a1b.2a.1a clade lineage. Amantadine and NA inhibitors were effective against all Huai′an strains. Conclusions:The antigenicity of one strain of Huai'an strain changed and its matching with the vaccine strain of that year was low. It is suggested that the genetic surveillance of H3N2 influenza virus should be continuously strengthened to provide scientific basis for influenza prevention and control and influenza vaccine screening.

Objective:To analyze the risk factors for postoperative cardiovascular events (PCE) after renal transplantation and their impact on transplant kidney function.Methods:The clinical data of 120 patients who underwent kidney transplant at Xuanwu Hospital, Capital Medical University from March 2020 to March 2022 were retrospectively analyzed. Among them, 23 cases occurred PCE (PCE group), and 97 cases did not occur PCE (non-PCE group). The relevant preoperative and postoperative data were recorded. Multivariate Logistic regression was used to analyze the independent risk factors of PCE in kidney transplant patients.Results:The incidence rate of PCE in kidney transplant patients was 19.17% (23/120). There were no statistical differences in the gender composition, preoperative dyslipidemia rate, preoperative hypertension rate and immunosuppressant use between two groups ( P>0.05); the age, preoperative body mass index>30 kg/m 2 rate, preoperative dialysis time>12 months rate, preoperative diabetes rate, preoperative cardiovascular disease rate, preoperative diabetic nephropathy rate, cadaver kidney transplant rate, postoperative dyslipidemia rate, postoperative serum creatinine >200 μmol/L rate, postoperative new-onset diabetes rate, postoperative delayed failure rate and postoperative acute reaction rate in PCE group were significantly higher than those in non-PCE group, and there were statistical differences ( P<0.01 or <0.05). Multivariate Logistic regression analysis showed that age, preoperative diabetes, preoperative cardiovascular disease, preoperative diabetic nephropathy, postoperative serum creatinine >200 μmol/L and postoperative acute reaction were independent risk factors of PCE in kidney transplant patients ( OR = 2.40, 3.42, 3.85, 1.98, 2.62 and 2.11; 95% CI 1.67 to 3.58, 1.61 to 7.05, 2.61 to 5.55, 1.05 to 3.85, 1.25 to 4.52 and 1.20 to 4.78; P<0.01 or <0.05). There was no statistically significant difference in serum creatinine 3 months after surgery between two groups ( P>0.05); the serum creatinine 6 and 12 months after surgery in PCE group was significantly higher than that in non-PCE group: (139.58 ± 31.54) μmol/L vs. (105.36 ± 21.05) μmol/L and (198.32 ± 40.12) μmol/L vs. (107.63 ± 24.64) μmol/L, and there were statistical differences ( P<0.01). Conclusions:The incidence of PCE in kidney transplant patients is higher, and there are many risk factors for PCE. If relevant measures are taken to correct or remove risk factors, it may reduce the incidence of PCE and prolong survival time in kidney transplant patients.

AIM: To investigate the effect of an effective component total sterone (TSR) of Echinops latifolius Tausch, the main component of a Chinese patent medicine Cuiru Keli (national drug standard WS3-413 (Z-085)-2003 (Z), on lactation and its possible mechanism. METHODS: After mating between male and female SD rats, 60 female rats were randomly divided into normal control group, model group, TSR low-dose and high-dose groups and prolactin granule positive control group, with 12 female rats in each group and 8 newborn rats in each nest. In addition to the normal control group, the rats in each group were intraperitoneally injected with levodopa 2 mg/kg once a day for 7 days from the second day of delivery. The rats in the normal control group were given normal saline by gavage once a day for 14 days. From the beginning of self-sufficiency, the single lactation of the female rats was measured every day until the 14th day, and then the female rats in each group were killed. Pathological HE staining was used to observe the morphological changes of mammary gland tissue in each group. ELISA was used to detect the levels of serum prolactin (PRL) and 5-hydroxytryptamine (5-HT). Immunohistochemistry was used to detect the distribution of PRL in mammary gland tissue of each group. Furthermore, Real-time qPCR was used to detect the expression of milk protein, milk fat related genes β-casein, FAS, ACC and the expression of canonical Wnt signaling pathway related genes β-catenin, c-Myc, CCND1, SFRP4, DNMT1, MeCP2 in mammary gland of each group. RESULTS: Both low and high dose TSR could significantly increase the single lactation volume, improve the pathological morphology of mammary gland, and increase the serum levels of PRL and 5-HT. TSR increased the distribution of PRL and up-regulated the expression of milk protein, milk fat related genes β-casein, FAS, ACC and canonical Wnt signaling pathway related genes β-catenin, c-Myc, CCND1, SFRP4, DNMT1, MeCP2.CONCLUSION: TSR can significantly promote lactation in lactation deficient rats, and its mechanism may be related to promoting the release of PRL and 5-HT in serum, increasing the distribution of PRL in mammary gland, up-regulating the milk protein and milk fat related genes and activating the canonical Wnt signal.

Objective:To verify the value of whole genomic copy number variation (WGCNV) detection and scoring system in the diagnosis and prognosis of lung adenocarcinoma.Methods:Seventy-six lung adenocarcinoma specimens including ninety-one tumor samples and twenty adjacent non-tumor lung tissue samples were collected using Laser capture microdissection (LCM). Whole genomic amplification (WGA) was used to enrich DNA and construct a sequencing library for next generation sequencing (NGS). Changes of larger than 5Mb CNV in this study were analyzed and scored. The nuclear grading and score of tumor cells in the surgery and pleural effusion cytology of lung adenocarcinoma specimens were evaluated separately. For each case, we evaluated (1) nuclear size, (2) mitotic counts, (3) nuclear atypia, (4) atypical mitoses. The data of disease-free survive (DFS) and overall survive (OS) were collected for assessing the prognostic value of WGCNV score. Meanwhile, receiver operating characteristic (ROC) and area under curve (AUC) were used to define a cut-off value and evaluate the diagnostic significance in lung adenocarcinoma.Results:The WGCNV scores of twenty adjacent non-tumor lung tissue samples were treated as normal control and all of WGCNV scores of tumor samples range from 0 to 9.95, the median score was 2.7. The WGCNV scores were divided into three groups: low score group <1.74, medium score grade 1.74~4.23, high score grade >4.23. The WGCNV score was positively associated with the nuclear grade scoring ( r=0.780 90, P<0.001). The result for evaluation of prognostic value of the WGCNV scores showed that comparing with low WGCNV score group, Hazard Ratio (HR) of medium score group was 4.11 (95% CI=0.72~23.57) and high score group was 2.07 (95% CI=0.30~14.12). These results suggested that the risks of the medium and high WGCNV score group elevated. According to the analysis results of ROC curve, when the cut off value was 0.01, the sensitivity and specificity for lung adenocarcinoma diagnosis were 97.8% and 95.0% respectively, the positive predictive value (PPV) and negative predictive value (NPV) were 99.0% and 90.1%, respectively, the AUC was 0.981. In the differentiation of adenocarcinoma in situ (AIS) and minimally invasive adenocarcinoma (MIA) group and invasive adenocarcinoma group, when the cut off value was 1.8, the sensitivity and specificity between the two groups were 78.1% and 94.4%, and the PPV and NPV were 98.0% and 52.0%, respectively, the AUC was 0.896. Conclusion:This study verifies that WGCNV scoring system has a potential diagnostic and prognostic value in lung adenocarcinoma.