Objective:Compared with long-term renal replacement therapy,kidney transplantation is the ideal treatment for end-stage renal disease(ESRD),significantly extending patient life and improving quality of life.Kidney transplant patients need to adhere to lifelong immunosuppressive medication regimens,but their medication adherence is generally poor compared with other organ transplant recipients.Medication adherence is closely related to medication literacy and psychological status,yet related studies are limited.This study aims to investigate the current status of medication adherence,inner strength,and medication literacy in kidney transplant patients,analyze the relationships among these 3 factors,and explore the mediating role of inner strength in the relationship between medication literacy and medication adherence. Methods:A cross-sectional survey was conducted from March to October 2023 involving 421 patients aged≥18 years who visited kidney transplantation outpatient clinics at 4 tertiary hospitals in Hunan Province.The inner strength,medication literacy,and medication adherence of kidney transplant patients were investigated using the Inner Strength Scale(ISS),the Chinese version of the Medication Literacy Assessment in Spanish and English(MedLitRxSE),and the Chinese version of the Morisky Medication Adherence Scale-8(C-MMAS-8),respectively.Univariate analysis was performed to examine the effects of demographic and clinical data on medication adherence.Correlation analysis was conducted to explore the relationships among medication literacy,medication adherence,and inner strength.Significant variables from univariate and correlation analyses were further analyzed using multiple linear regression,and the mediating effect of inner strength was explored. Results:Among the 421 questionnaires collected,408 were valid,with an effective rate of 96.91％.The scores of C-MMAS-8,MedLitRxSE,and ISS were 6.64±1.16,100.63±14.67,and 8.47±4.03,respectively.Among the 408 patients,only 86(21.08％)patients had a high level of medication adherence,whereas 230(56.37％)patients had a medium level of medication adherence,and 92(22.55％)patients had poor medication adherence.Univariate analysis indicated that the kidney transplant patients'age,marital status,education levels,years since their kidney transplant operation,number of hospitalizations after the kidney transplant,and adverse drug reactions showed significant differences in medication adherence(all P＜0.05).Correlation analysis showed that inner strength positively correlated with both medication literacy(r=0.183,P＜0.001)and medication adherence(r=0.201,P＜0.00l).Additionally,there was a positive correlation between medication adherence and medication literacy(r=0.236,P＜0.00l).Inner strength accounted for 13.22％of the total effect in the mediating role between medication literacy and medication adherence. Conclusion:The level of medication adherence among kidney transplant patients needs improvement,and targeted intervention measures are essential.Inner strength mediates the relationship between medication literacy and medication adherence in these patients.Healthcare professionals should focus on enhancing medication literacy and supporting patients'inner strength to improve medication adherence.

Objective To establish a noninvasive diagnostic model for liver fibrosis in chronic hepatitis B(CHB)patients with normal alanine aminotransferase(ALT)and an age of≤30 years by selecting specific indicators from the commonly used noninvasive indicators such as clinical,biochemical,and imaging indicators,to avoid invasive liver biopsy in such patients to some extent,and to guide the timing of antiviral therapy.Methods A total of 251 CHB patients with normal ALT and an age of≤30 years who underwent liver biopsy in Shenzhen Third People's Hospital and The First Hospital of Changsha from January 2019 to January 2022 were enrolled,with 175 patients in the model group and 76 patients in the validation group,and commonly used clinical indicators were obtained based on clinical experience and related articles.The two-independent-samples t test or the two-independent-samples Mann-Whitney U rank sum test was used for comparison of continuous data between groups,and the chi-square test was used for comparison of categorical data between groups.A Spearman rank correlation analysis was used to investigate the correlation between each indicator and liver fibrosis and identify the indicators with correlation(P<0.01,r>0.200);a Logistic regression analysis was used to establish a noninvasive diagnostic model,and the receiver operating characteristic(ROC)curve was used to evaluate its performance and perform validation of the model;this model was then compared with the widely used models of aspartate aminotransferase-to-platelet ratio index(APRI)and fibrosis-4(FIB-4).The Kappa consistency test was used to investigate the consistency of pathological results.Results A total of 17 commonly used clinical indicators were obtained,among which 9 indicators(ALT,aspartate aminotransferase[AST],gamma-glutamyl transpeptidase[GGT],ferritin[FERR],platelet count[PLT],procollagen type Ⅲ amino-terminal peptide[PⅢP],collagen Ⅳ[CⅣ],HBV DNA,and spleen thickness)were correlated with liver fibrosis(P<0.01,r>0.232).Based on the above indicators,the predictive model was established as P=1/(1+e-γ),γ=-1.902+0.106×AST-0.011×PLT-0.265×HBV DNA+0.059×PⅢP,in which P was the probability for predicting≥S2 liver fibrosis and γ was the predictive index.The comparison between each indicator and the model showed that the model had the largest area under the ROC curve of 0.852,with a sensitivity of 92.7%and a specificity of 76.9%.The model was validated in 76 patients and showed an accuracy of 77.600%.The model was compared with APRI and FIB-4,and the results showed that the model has good accuracy.Conclusion Compared with the models of APRI and FIB-4 commonly used in the world,this model can more accurately judge the degree of liver fibrosis in such patients,thereby replacing liver biopsy to some extent and guiding the timing of antiviral therapy.

Objective:To establish and validate reference intervals of serum vitamin K for healthy children in China.Methods:A cross-sectional study was conducted from January 2020 to May 2023, involving 807 healthy children aged 0 to 14 years, selected by stratified random sampling based on the population distribution of children in eastern, central, western, and northeastern China. Sample collection was carried out in 16 hospitals across 12 provinces, autonomous regions, and municipalities. Basic information of the children was collected using a standardized self-design questionnaire. Serum levels of vitamin K 1 and vitamin K 2 (menaquinone-4 (MK-4), menaquinone-7 (MK-7)) were measured using liquid chromatography-tandem mass spectrometry. The reference intervals was established by direct approach. The children were divided into different groups by age. Inter-group comparisons were conducted using the Kruskal-Wallis non-parametric test, and the reference intervals ( P2.5- P97.5) were determined using non-parametric methods. Screening 40 healthy children for small sample validation based on age groups within the reference range(25 from eastern, 10 from central, and 5 from western regions). Results:The age of the 807 children was 5.00 (2.00, 9.81) years, and 495 (61.3%) were males and 312 (38.7%) females. Reference intervals were established for 795 children, of whom 303 children were aged 1 month to 3 years and 492 were aged 4 to 14 years. The reference intervals for serum vitamin K 1 were 0.09-4.54 μg/L for children aged 1 month to 3 years, and 0.10-1.73 μg/L for 4-14 years. For MK-7, the intervals were 0.07-1.42 μg/L for 1 month to 3 years and 0.19-2.03 μg/L for 4-14 years. The reference intervals for MK-4 in children aged 1 month to 14 years were 0-0.42 μg/L. The measured values of serum vitamin K 1, MK-4, and MK-7 in the validation samples did not exceed the reference limit in more than 2 samples. Conclusion:Reference intervals for vitamin K 1, MK-4, and MK-7 in healthy children aged 1 month to 14 years have been established and validated, and can be used to assess vitamin K nutritional status in children.

【Objective】 To analyze the clinical characteristics of stone culture and preoperative urine culture of patients with renal calculi in Songjiang area of Shanghai and the relationship with postoperative infection. 【Methods】 The clinical data of 213 patients with kidney stones treated at our hospital during Jan.2020 and Jun.2022 were retrospectively analyzed. All patients underwent preoperative clean midcourse urine culture, drug sensitivity test and stone culture. The gender difference between male and female patients and the difference in postoperative infection between stone/bacterial culture positive and negative patients were analyzed. 【Results】 Among the 213 patients, 47(22.1%) had positive urine culture, and the most common bacterium was Escherichia coli (20 strains, 42.6%). The proportion of Escherichia coli was significantly higher in female patients than in male patients [12 strains (48.0%) vs.8 strains (36.4%), P<0.05], while the proportion of Klebsiella pneumoniae was significantly higher in male patients than in female patients [5 strains (22.7%) vs. 3 strains (12.0%), P<0.05]. Drug sensitivity results showed the main Gram-negative bacteria were highly resistant to ampicillin/sulbactam, cefazolin and cefuroxime, but sensitive to imipenem, kanamycin and piperacillin/tazobactam. The main Gram-positive bacteria were highly resistant to clindamycin, erythromycin and levofloxacin, but sensitive to vancomycin, teicoplanin and linezolid. Stone culture was positive in 31 cases (14.6%), and the most common bacterium was Proteus mirabilis (9 strains, 29.0%). However, there was no significant difference in the main bacterial spectrum between male and female patients. The positive rate of urine culture/stone culture in patients with postoperative fever/urosepsis was significantly higher than that in patients with negative urine culture/stone culture (P<0.05). 【Conclusion】 Escherichia coli is the main urinary spectrum of patients with kidney stones in Songjiang area, which is greatly different from the stone culture results. In clinical practice, etiological detection and antibiotics are necessary to reduce the occurrence of postoperative infection.

Objective:To explore the application of 4C teaching combined with case simulation teaching in the practice teaching of respiratory and critical care medicine nursing students.Methods:Eighty nursing practice students from 2019 to 2021 in the Department of Respiratory and Critical Care Medicine of Beijing Chaoyang Hospital Affiliated to Capital Medical University were selected as the research objects, and they were randomized into control group ( n=40) and observation group ( n=40). The control group adopted traditional teaching, and the observation group adopted 4C teaching combined with case simulation teaching. The nursing comprehensive ability and self-directed learning ability of the two groups of nursing students were compared, and the evaluation of teaching methods between the two groups was assessed. SPSS 22.0 was used for Chi-square test and t-test. Results:The scores of theoretical knowledge, ward management, prevention and control of hospital infection, basic nursing, standardized writing of nursing documents, and critical care of nursing students in the observation group were higher than those in the control group ( P<0.05); the scores and total scores of learning awareness, learning behavior, learning strategies, interpersonal relationships, and learning evaluation in the observation group were higher than those in the control group ( P<0.05). The observation group believed that their teaching method was better than the control group in terms of mobilizing learning initiative, improving basic nursing practices, promoting clinical communication skills, improving the ability to analyze and solve problems, enhancing the concept of humanistic care, helping to understand and master knowledge, and improving the overall quality ( P<0.05). Conclusion:The 4C teaching combined with case simulation teaching can improve the comprehensive nursing ability and self-directed learning ability of nursing students in department of respiratory and critical care medicine, and the nursing students have a high opinion of the teaching method.

Traumatic cerebrospinal fluid leakage commonly presents in traumatic brain injury patients, and it may lead to complications such as meningitis, ventriculitis, brain abscess, subdural hematoma or tension pneumocephalus. When misdiagnosed or inappropriately treated, traumatic cerebrospinal fluid leakage may result in severe complications and may be life-threatening. Some traumatic cerebrospinal fluid leakage has concealed manifestations and is prone to misdiagnosis. Due to different sites and mechanisms of trauma and degree of cerebrospinal fluid leak, treatments for traumatic cerebrospinal fluid leakage varies greatly. Hence, the Craniocerebral Trauma Professional Group of Neurosurgery Branch of Chinese Medical Association and the Neurological Injury Professional Group of Trauma Branch of Chinese Medical Association organized relevant experts to formulate the " Chinese expert consensus on the diagnosis and treatment of traumatic cerebrospinal fluid leakage in adults ( version 2023)" based on existing clinical evidence and experience. The consensus consisted of 16 recommendations, covering the leakage diagnosis, localization, treatments, and intracranial infection prevention, so as to standardize the diagnosis and treatment of traumatic cerebrospinal fluid leakage and improve the overall prognosis of the patients.

Objective:To evaluate the application effect of a personalized nutritional program based on nutrition risk screening in kidney transplant patients.Methods:Using the convenient sampling method, a total of 90 patients who completed kidney transplantation in the Second Xiangya Hospital of Central South University from November 2020 to May 2021 were selected as the research objects. Envelopes were used to draw lots, and patients were randomly divided into the control group (45 cases) and the test group (45 cases) . The control group was given routine basic treatment and nursing care, while the test group was given a personalized nutrition plan based on nutritional risk screening at basis of the control group. The changes of nutritional indexes such as total protein, albumin, prealbumin, retinol-binding protein, serum iron, total iron-binding capacity, and hemoglobin were observed before operation and on the 3rd, 7th, and 14th days after operation in the two groups. The changes of renal function indicators (such as serum creatinine level, endogenous creatinine clearance rate, glomerular filtration rate) were compared between the two groups, and the incidence of readmission within 3 months of discharge was compared between the two groups.Results:The levels of retinol-binding protein in the experimental group on the 3rd, 7th, and 14th days of intervention were better than those in the control group, while the serum creatinine level and glomerular filtration rate were lower than those in the control group, and the differences were statistically significant ( P<0.05) . On the 14th day of intervention, the levels of total protein, hemoglobin, total iron binding capacity and serum iron in the test group were higher than those in the control group, and the clearance rate of endogenous creatinine was lower than that in the control group, and the differences were statistically significant ( P<0.05) . Repeated measures analysis of variance showed that time had an effect on the recovery of nutritional and renal function indexes of patients in both groups ( P<0.05) . There were statistically significant differences in the levels of total protein, hemoglobin, retinol-binding protein, serum creatinine and the main effect of glomerular filtration rate intervention between the two groups ( P<0.05) . And there was an interaction between intervening factors and time of hemoglobin, retinol-binding protein and serum iron levels ( P<0.05) . After 3 months of follow-up, the readmission rate of patients in the experimental group was 0, and that in the control group was 13.6% (6/44) , and the difference was statistically significant ( P<0.05) . Conclusions:Nutritional risk screening combined with personalized nutrition program can effectively improve the nutritional status of kidney transplant patients, promote the recovery of transplanted kidney function, reduce the readmission rate and improve the clinical outcome of patients.

Objective:To investigate the correlation between thyroid function index and serum visfatin in patients with acute pancreatitis (AP).Methods:Using a prospective design, 65 patients with AP treated in Binzhou People's Hospital from December 2017 to December 2019 were selected as the research subjects. They were divided into mild acute pancreatitis (MAP) group ( n = 35) and severe acute pancreatitis (SAP) group ( n = 30) according to the acute physiology and chronic health Ⅱ (APACHE Ⅱ) score ( < 8, ≥8 scores). At the same time, 40 healthy people were selected as the control group. The serum levels of free thyroxine (FT 4), free triiodothyronine (FT 3) and thyrotropin (TSH) were measured by chemiluminescence immunoassay. Radioimmunoassay was used to measure serum reverse triiodothyronine (rT 3) level, and enzyme-linked immunosorbent assay was used to measure serum visfatin level. Pearson method was used to analyze the correlation between thyroid function index and serum visfatin in patients with AP. Results:The FT 4 [(14.02 ± 3.63), (15.68 ± 3.05) pmol/L], FT 3 [(2.34 ± 0.80), (3.66 ± 0.65) pmol/L], and TSH levels [(2.78 ± 0.85), (3.10 ± 0.57) mU/L] in SAP and MAP groups were significantly lower than those in control group [(17.03 ± 3.96), (6.04 ± 1.55) pmol/L, (4.88 ± 2.30) mU/L, P < 0.05], but the rT 3 levels [(1.63 ± 1.12), (1.23 ± 0.26) nmol/L] were significantly higher than that in control group [(0.97 ± 0.28) nmol/L, P < 0.05]. There was significant difference in serum FT 3 levels between SAP and MAP groups ( P < 0.05). The serum visfatin levels of SAP, MAP and control groups were (10.75 ± 2.92), (3.70 ± 1.73), (2.30 ± 1.31) ng/ml, the difference between the three groups was statistically significant ( F = 67.174, P < 0.05). The serum visfatin levels in SAP and MAP groups were higher than that in control group, and that in SAP group was higher than that in MAP group ( P < 0.05). There were negative correlations between serum FT 3 level and visfatin level in SAP and MAP groups ( r = - 0.672, - 0.610, P < 0.05). Conclusions:The serum visfatin level and thyroid function index of AP patients are abnormal. The levels of FT 3 and visfatin are correlated with the severity of AP patients, and there is a negative correlation between the levels of FT 3 and visfatin. Detection of thyroid function index is helpful to judge the AP patient's condition.

OBJECTIVES: To summarize the emergency management of the kidney transplantation for a large tertiary first-class hospital in response to the epidemic of coronavirus disease 2019 (COVID-19). METHODS: The clinical data of inpatients in the Department of Kidney Transplantation from January 24, 2020 to February 29, 2020 were retrospectively analyzed. Since the outbreak of COVID-19, we conducted telephone, Wechat follow-up, and online education for kidney transplant recipients and patients on waiting-list for kidney transplantation one by one. We also strictly screened for COVID-19 in outpatients. To guarantee the security of medical staff and recipients and to reduce the transmission risk of COVID-19, we have made detailed approaches to prevent COVID-19, which mainly included 6 aspects of preventive approaches, such as kidney transplant clinic, kidney transplant ward, patients on waiting-list for kidney transplantation, kidney transplant operation, medical staff self-protection, and postoperative follow-up of kidney transplant recipients. RESULTS: There were altogether 47 inpatients which included 20 recipients who had just received kidney transplantation in the meantime, 2 577 kidney transplant recipients, 1 689 patients on waiting-list for kidney transplantation, and 794 outpatients in our hospital. No case of COVID-19 occurred in this period. CONCLUSIONS Through strictly implementing proactive and preventive approaches, we avoid the occurrence of COVID-19 in carrying out kidney transplantation in the epidemic period.
Betacoronavirus ; Coronavirus Infections ; epidemiology ; prevention & control ; Humans ; Kidney Transplantation ; Pandemics ; prevention & control ; Pneumonia, Viral ; epidemiology ; prevention & control ; Retrospective Studies ; Tertiary Care Centers ; Transplant Recipients ; Waiting Lists

Objective:To investigate and analyze the clinical characteristics of chronic liver injury and glutathione treatment in patients with coal-burning-borne arsenism.Methods:A total of 71 patients with liver injury caused by coal-burning-borne arsenism admitted to Binzhou People's Hospital from March 2017 to December 2018 were randomly divided into observation group (37 cases) and control group (34 cases) by lottery. Both groups of patients were given routine treatment, including intravenous infusion of compound amino acids, oral administration of B vitamins, etc., and intravenous infusion of 5.0 g of vitamin C mixture dissolved in 250 ml of 5% glucose, once a day, treatment for 4 weeks. In addition, the observation group was given an intravenous infusiondrip of 1.8 g of glutathione dissolved in 250 ml of 5% glucose, once a day, for 4 weeks. The clinical characteristics of the patients were observed, and the changes of liver function [alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), direct bilirubin (DBIL)], serum antioxidant indexes [malondialdehyde (MDA), superoxide dismutase (SOD), glutathione peroxidase (GSH-Px)], and clinical efficacy before and after the treatment were compared between the two groups.Results:In 71 coal-burning-borne arsenism patients with liver injury, the abnormal rate of electrocardiogram (ECG) examination was 64.79% (46/71), and the abnormal rate of chest X-ray examination was 26.76% (19/71). After treatment, the liver function indexes ALT, AST, TBIL and DBIL decreased in both groups [observation group before treatment: (131.82 ± 25.62), (109.84 ± 26.28) U/L, (81.47 ± 20.93), (57.38 ± 15.25) μmol/L; observation group after treatment: (58.93 ± 12.03), (51.20 ± 10.57) U/L, (25.66 ± 7.94), (16.49 ± 4.92) μmol/L; control group before treatment: (128.95 ± 31.20), (107.39 ± 29.81) U/L, (83.21 ± 17.95), (55.39 ± 16.30) μmol/L; control group after treatment: (76.42 ± 15.73), (74.33 ± 14.80) U/L, (36.72 ± 9.32), (23.74 ± 7.35) μmol/L, P < 0.05], and the liver function indexes in the observation group were significantly lower than those in the control group after treatment ( P < 0.05). The serum antioxidant indexes MDA, SOD and GSH-Px in the two groups were significantly increased after treatment [observation group before treatment: (25.47 ± 3.98) μmol/L, (85.72 ± 23.54), (1 729.84 ± 379.50) U/L; observation group after treatment: (46.31 ± 7.49) μmol/L, (122.31 ± 28.53), (2 410.29 ± 512.31) U/L; control group before treatment: (26.02 ± 4.11) μmol/L, (84.95 ± 21.03), (1 749.52 ± 405.28) U/L; control group after treatment: (38.92 ± 6.27) μmol/L, (103.12 ± 25.68), (2 097.42 ± 478.52) U/L, P < 0.05], and the serum antioxidant indexes in the observation group were significantly higher than those in the control group after treatment ( P < 0.05). The total effective rate of the observation group was significantly higher than that of the control group [91.89% (34/37) vs 76.47% (26/34), χ 2 = 4.254, P < 0.05]. Conclusions:Coal-burning-borne arsenism patients with chronic liver injury may have multiple system injury at the same time. Glutathione can effectively improve the clinical symptoms and liver function of patients. Its effect may be related to the improvement of antioxidant function, which is worthy of clinical promotion.