Objective To compare the safety and efficacy of vancomycin in obese patients guided by trough concentration and AUC24h/MIC,and to provide data for individualized administration of vancomycin in obese patients.Methods We retrospectively collected the data of obese adult patients(BMI 30 kg/m2)who had severe infection caused by gram-positive cocci and treated with vancomycin intravenously in two Grade A tertiary hospitals in Shanghai from 2012 to 2024.The patients were assigned to trough concentration monitoring group or AUC24h/MIC monitoring group according to the therapeutic drug monitoring(TDM)method at the time of admission.Nephrotoxicity and efficacy were compared between the two groups of patients.Results A total of 22 obese patients were included in this study,including 12 in the trough concentration monitoring group and 10 in the AUC24h/MIC monitoring group.No significant difference was found between the two groups in gender,age,BMI,creatinine clearance before treatment,underlying disease,site of infection,pathogen type,or concomitant medications.The proportion of ICU admission was higher in AUC24h/MIC monitoring group.The length of ICU stay,vancomycin treatment duration,bacterial clearance rate and comprehensive efficacy rate did not show significant difference between the two groups.The average daily dose of vancomycin in trough concentration monitoring group was significantly lower than that in A UC24h/MIC monitoring group[(1.63±0.59)g vs(2.29±0.72)g,P=0.026].The average treatment duration was not significantly different between the two groups[(15.33±10.28)d vs(14.90±6.92)d,P=0.911].Compared with the trough concentration monitoring group,the initial peak concentration[(30.99±16.22)mg/L vs(19.41±5.42)mg/L,P=0.025]and overall peak concentration[(33.67±16.53)mg/L vs(22.08±3.96)mg/L,P=0.045]of vancomycin were lower in theAUC24h/MIC monitoring group,but the initial trough concentration[(11.03±8.66)mg/L vs(6.33±4.45)mg/L,P=0.139]and overall trough concentration[(13.75±9.74)mg/L vs(9.74±4.24)mg/L,P=0.218]were similar in the two groups.Vancomycin-associated nephrotoxicity did not occur in any group,but 41.7％of the patients in the trough concentration monitoring group reached the threshold of renal toxicity,i.e.trough concentration ≥15 mg/L.Conclusions Vancomycin treatment with conventional dosing regimen still have good clinical efficacy in obese adult patients.Vancomycin therapy guided by A UC24h/MIC can achieve the target value at lower concentration or exposure,which is promising for reducing vancomycin-associated nephrotoxicity.

Aim To analyze the correlation between serum retinol-binding protein 4(RBP4),low density lipo-protein cholesterol to albumin ratio(LDLC/Alb),monocyte to high density lipoprotein ratio(MHR)and plaque stability in carotid atherosclerosis population and their predictive value for acute ischemic stroke(AIS).Methods A total of 197 patients with asymptomatic carotid atherosclerosis admitted to our hospital from September 2021 to January 2023 were selected for a prospective cohort study,and they were categorized into occurred group and non-occurred group according to whether AIS occurred within 12 months.Baseline information at time of visit,results of the cervical ultrasonography and serum RBP4,LDLC/Alb,MHR levels were compared between the two groups.Spearman/Pearson and receiver operating characteristic(ROC)curve were used to analyze the corr-elation of RBP4,LDLC/Alb and MHR with carotid atherosclerosis and plaque stability,and the value of predicting AIS in carotid atherosclerosis population.Hosmer-Lemeshow goodness of fit test was used to evaluate the calibration ability of serum RBP4,LDLC/Alb and MHR to jointly predict AIS in carotid atherosclerosis population.Results The carotid intima-media thickness(IMT)was higher in occurred group than that in non-occurred group.There were more soft plaques and mixed plaques in occurred group than in non-occurred group(P＜0.05).Serum levels of RBP4,LDLC/Alb and MHR were higher in occurred group than those in non-occurred group(P＜0.05).The correlation analysis showed that the levels of serum RBP4,LDLC/Alb and MHR were positively correla-ted with IMT(r=0.803,0.740,0.710)and plaque properties(r=0.736,0.685,0.703)(P＜0.001).ROC curve a-nalysis showed that the AUC of serum RBP4,LDLC/Alb and MHR in predicting AIS in carotid atherosclerosis population was 0.796,0.821 and 0.828,respectively,and the AUC of MHR was the largest;the AUC of the combination of serum RBP4,LDLC/Alb and MHR was 0.936,which was higher than that of MHR(Z=2.978,P＜0.05),the predictive sensi-tivity and specificity were 88.24％and 87.40％.Hosmer-Lemeshow goodness of fit test showed that there was no signifi-cant difference between serum RBP4,LDLC/Alb and MHR in predicting AIS and the actual observation value in carotid atherosclerosis population(P＞0.05),and the prediction model had good calibration ability.Conclusion Serum RBP4,LDLC/Alb,and MHR are positively correlated with carotid atherosclerosis and plaque stability,and can predict the occurrence of AIS.Combined detection of the three can be used as a method for early identification of potential high-risk populations for AIS,providing a new,quantifiable guidance scheme for the prevention and treatment of AIS in carotid ath-erosclerotic population.

Objective To compare the safety and efficacy of vancomycin in obese patients guided by trough concentration and AUC24h/MIC,and to provide data for individualized administration of vancomycin in obese patients.Methods We retrospectively collected the data of obese adult patients(BMI 30 kg/m2)who had severe infection caused by gram-positive cocci and treated with vancomycin intravenously in two Grade A tertiary hospitals in Shanghai from 2012 to 2024.The patients were assigned to trough concentration monitoring group or AUC24h/MIC monitoring group according to the therapeutic drug monitoring(TDM)method at the time of admission.Nephrotoxicity and efficacy were compared between the two groups of patients.Results A total of 22 obese patients were included in this study,including 12 in the trough concentration monitoring group and 10 in the AUC24h/MIC monitoring group.No significant difference was found between the two groups in gender,age,BMI,creatinine clearance before treatment,underlying disease,site of infection,pathogen type,or concomitant medications.The proportion of ICU admission was higher in AUC24h/MIC monitoring group.The length of ICU stay,vancomycin treatment duration,bacterial clearance rate and comprehensive efficacy rate did not show significant difference between the two groups.The average daily dose of vancomycin in trough concentration monitoring group was significantly lower than that in A UC24h/MIC monitoring group[(1.63±0.59)g vs(2.29±0.72)g,P=0.026].The average treatment duration was not significantly different between the two groups[(15.33±10.28)d vs(14.90±6.92)d,P=0.911].Compared with the trough concentration monitoring group,the initial peak concentration[(30.99±16.22)mg/L vs(19.41±5.42)mg/L,P=0.025]and overall peak concentration[(33.67±16.53)mg/L vs(22.08±3.96)mg/L,P=0.045]of vancomycin were lower in theAUC24h/MIC monitoring group,but the initial trough concentration[(11.03±8.66)mg/L vs(6.33±4.45)mg/L,P=0.139]and overall trough concentration[(13.75±9.74)mg/L vs(9.74±4.24)mg/L,P=0.218]were similar in the two groups.Vancomycin-associated nephrotoxicity did not occur in any group,but 41.7％of the patients in the trough concentration monitoring group reached the threshold of renal toxicity,i.e.trough concentration ≥15 mg/L.Conclusions Vancomycin treatment with conventional dosing regimen still have good clinical efficacy in obese adult patients.Vancomycin therapy guided by A UC24h/MIC can achieve the target value at lower concentration or exposure,which is promising for reducing vancomycin-associated nephrotoxicity.

Aim To analyze the correlation between serum retinol-binding protein 4(RBP4),low density lipo-protein cholesterol to albumin ratio(LDLC/Alb),monocyte to high density lipoprotein ratio(MHR)and plaque stability in carotid atherosclerosis population and their predictive value for acute ischemic stroke(AIS).Methods A total of 197 patients with asymptomatic carotid atherosclerosis admitted to our hospital from September 2021 to January 2023 were selected for a prospective cohort study,and they were categorized into occurred group and non-occurred group according to whether AIS occurred within 12 months.Baseline information at time of visit,results of the cervical ultrasonography and serum RBP4,LDLC/Alb,MHR levels were compared between the two groups.Spearman/Pearson and receiver operating characteristic(ROC)curve were used to analyze the corr-elation of RBP4,LDLC/Alb and MHR with carotid atherosclerosis and plaque stability,and the value of predicting AIS in carotid atherosclerosis population.Hosmer-Lemeshow goodness of fit test was used to evaluate the calibration ability of serum RBP4,LDLC/Alb and MHR to jointly predict AIS in carotid atherosclerosis population.Results The carotid intima-media thickness(IMT)was higher in occurred group than that in non-occurred group.There were more soft plaques and mixed plaques in occurred group than in non-occurred group(P＜0.05).Serum levels of RBP4,LDLC/Alb and MHR were higher in occurred group than those in non-occurred group(P＜0.05).The correlation analysis showed that the levels of serum RBP4,LDLC/Alb and MHR were positively correla-ted with IMT(r=0.803,0.740,0.710)and plaque properties(r=0.736,0.685,0.703)(P＜0.001).ROC curve a-nalysis showed that the AUC of serum RBP4,LDLC/Alb and MHR in predicting AIS in carotid atherosclerosis population was 0.796,0.821 and 0.828,respectively,and the AUC of MHR was the largest;the AUC of the combination of serum RBP4,LDLC/Alb and MHR was 0.936,which was higher than that of MHR(Z=2.978,P＜0.05),the predictive sensi-tivity and specificity were 88.24％and 87.40％.Hosmer-Lemeshow goodness of fit test showed that there was no signifi-cant difference between serum RBP4,LDLC/Alb and MHR in predicting AIS and the actual observation value in carotid atherosclerosis population(P＞0.05),and the prediction model had good calibration ability.Conclusion Serum RBP4,LDLC/Alb,and MHR are positively correlated with carotid atherosclerosis and plaque stability,and can predict the occurrence of AIS.Combined detection of the three can be used as a method for early identification of potential high-risk populations for AIS,providing a new,quantifiable guidance scheme for the prevention and treatment of AIS in carotid ath-erosclerotic population.

Objective To explore the effect of transcranial direct current stimulation(tDCS)based on music therapy on insomnia. Methods From July,2023 to April,2024,70 patients with insomnia in the Fourth Affiliated Hospital of Soochow Univer-sity were randomly divided into control group(n=35)and observation group(n=35).Both groups accepted mu-sic therapy;moreover,the observation group accepted tDCS,and the control group accepted sham tDCS,for four weeks.They were assessed with Pittsburgh Sleep Quality Index(PSQI)total score and sub-score,Hamilton De-pression Scale 17-item(HAMD-17),Hamilton Anxiety Scale(HAMA),Chinese version of Stress Perception Scale(CPSS);and the relative power of resting-state electroencephalography(EEG)and mean blood flow veloci-ty(Vm)of each cerebral artery with transcranial Doppler were measured before and after treatment. Results Five cases dropped down in the control group,and four in the observation group.PSQI total score and sub-score,HAMD-17 score,HAMA score and CPSS score(|t|>3.503,P<0.01)in the observation group decreased after treatment,and were less in the observation group than in the control group(|t|>2.304,P<0.05),except sleep duration,sleep efficiency and CPSS scores.The relative power of δ and θ increased in the observation group,and decreased in α,β and γ(|t|>6.468,P<0.001),and were better in the observation group than in the control group(|t|>2.395,P<0.05).The Vm of each artery increased in the observation group(|t|>4.624,P<0.001),and were more in the observation group than in the control group(|t|>2.147,P<0.05). Conclusion tDCS based on music therapy may further improve sleep quality and EEG activity,increase cerebral blood flow velocity,and reduce adverse emotions in insomnia patients.

BACKGROUND:Bone marrow mesenchymal stem cells have been widely used to treat neurological diseases.However,due to limitations of the blood-brain barrier,low survival rate and differentiation rate of stem cells at damaged sites,the therapeutic effect is limited. OBJECTIVE:To investigate the effects of Shexiang Huangqi compound dripping pills on proliferation,migration and astrocyte differentiation of bone marrow mesenchymal stem cells. METHODS:Male SD rats were treated with Shexiang Huangqi compound dripping pills for 5 days after continuous gavage.Blood was collected from the abdominal aorta and serum was separated for later use.The effect of 5%,10%and 20%drug-containing serum on the proliferation of bone marrow mesenchymal stem cells was detected by CCK-8 assay.The effect of 10%drug-containing serum on lateral migration of bone marrow mesenchymal stem cells was observed by scratch test.Bone marrow mesenchymal stem cells were cultured in Transwell cells.The effects of 10%drug-containing serum on longitudinal migration of bone marrow mesenchymal stem cells were observed by crystal violet staining and DAPI nuclear staining.Differentiation of bone marrow mesenchymal stem cells into astrocytes was observed by inducing solution with 10%drug-containing serum or co-culture with astrocytes. RESULTS AND CONCLUSION:(1)10%and 20%drug-containing serum promoted cell proliferation more significantly on days 2 and 3,and there was no statistical difference between the two concentrations.(2)At 30 and 48 hours,bone marrow mesenchymal stem cell migration in 10%drug-containing serum group was significantly higher than that in the control group.(3)The number of bone marrow mesenchymal stem cells filtered through Transwell cells in 10%drug-containing serum group was higher than that in the control group.(4)10%drug-containing serum might promote the differentiation of bone marrow mesenchymal stem cells to astrocytes,but the differentiation effect was weak,and astrocytes might further promote the differentiation of bone marrow mesenchymal stem cells into astrocytes induced by drug-containing serum.(5)The results exhibited that the 10%drug-containing serum could promote the proliferation and migration of bone marrow mesenchymal stem cells in vitro.Co-culture with astrocytes may promote the differentiation of bone marrow mesenchymal stem cells towards astrocytes.

Objective This study aims to investigate the feasibility and safety of Da Vinci robotic-assisted thoracoscopy for resecting mediastinal tumors in pediatric patients.Methods From November 2020 to June 2023,a total of 80 pediatric patients undergoing mediastinal tumor resection at Wuhan Children's Hospital were randomly assigned into two groups,with each group consisting of 40 participants.The control group underwent conventional thoracoscopy,while the observation group underwent Da Vinci robotic-assisted thoracoscopy.This study aimed to compare perioperative indicators between the two groups and establish learning curves based on surgical duration and intraoperative blood loss.Additionally,it assessed levels of pain mediators and stress response markers before surgery and at 24 hours post-surgery,as well as postoperative complications.Inflammatory marker levels were evaluated one month after surgery,and the children's quality of life was measured using the Pediatric Quality of Life Inventory(PedsQL)Generic Core Scales before surgery and one month post-surgery.Results The surgical duration for the observation group and the control group was(1.76±0.33)hours and(2.82±0.62)hours,respectively,and the intraoperative blood loss was(49.83±6.39)mL and(71.55±8.19)mL,respectively.Furthermore,the post-operative drainage time,drainage volume,and hospital stay for the observation group were all lower than those for the control group(P<0.05).After surgery,the levels of BK,5-HT,NPY,and PGE2 in the observation group were(8.06±1.06)mg/L,(170.20±13.21)ng/L,(201.82±13.52)mg/L,and(241.82±15.32)ng/L,respectively,indicating lower levels of pain mediators,stress response markers,and inflammatory factors compared to the control group(P<0.05).he overall incidence of complications was 2.50%in the observation group as opposed to 20.00%in the control group.Moreover,there was a statistically significant improvement in quality of life after surgery within the observation group when compared to that within the control group(P<0.05).Conclusion Da Vinci robotic-assisted thoracoscopy demonstrates enhanced feasibility and safety in pediatric mediastinal tumor resection,thereby justifying its clinical promotion.

Objective:To establish an irritant contact dermatitis(ICD)model induced by sodium dodecyl sulfate(SDS)in mice,and explore its endotype to provide an experimental and theoretical basis for subsequent precise treatment.Methods:Mice were randomly divided into two groups(model group and control group),4%SDS was topically applied to induce ICD in mice,saline was used on control group,the dose and frequency were consistent with model group,and the skin lesions of mice were observed.Epidermal thickness and inflammatory cell infiltration were analyzed by HE staining,toluidine blue staining and immunofluorescence staining.Real-time quantitative PCR was performed to investigate mRNA expression levels of cytokines.Results:Compared with control group,mice in ICD model group showed epidermal thickness on the back of neck,and the numbers of inflammatory cells were increased in dermis.The number of neutrophils,macrophages and T cells were increased.Expressions of Il17a and Il17f mRNA levels were increased.Conclusion:SDS-induced ICD model is successfully established,with the elevated infiltration of neutrophils,macrophages and T cells,and secretion of type 17 cytokines.

Objective:To observe the clinical effect of adjustable silicone strap suspension in the treatment of myasthenia gravis ptosis.Methods:From January 2019 to January 2020, 60 patients with myasthenia gravis ptosis (35 males, 25 females, age distribution from 25 to 58 years, with average of 35.63 years) were collected from the Department of Ophthalmoplasty of Aier Eye Hospital affiliated to Wuhan University. They were divided into control group and observation group, with 30 cases in each group. The observation group was treated with adjustable silicone band suspension, and the correction effect, satisfaction, recovery status, ocular surface function index, recurrence rate and complications of the two groups were compared.Results:The excellent rate of operation in the observation group was 93.33% (28/30), which was significantly higher than 63.33% (19/30) in the control group (χ 2=6.29, P<0.05), and the satisfaction of patients in the observation group was 100% (30/30), which was significantly higher than 76.67% (23/30) in the control group (χ 2=5.82, P<0.05). The preoperative corneal curvature and fluorescein staining in the observation group and the control group were significantly lower than those in the postoperative state ( t=6.17, 21.48, P<0.05). The corneal curvature and fluorescein staining score of the observation group were significantly higher than those of the control group at 3 months after surgery ( t=3.00, 9.06, P<0.05). There was no significant difference between the two groups in the incidence of complications such as eyelid imclosure, upper eyelid inversion and unnatural upper eyelid curvature (χ 2=0.19, P>0.05). Follow up at 3 months after surgery, the recurrence rate in the observation group was lower than that in the control group (χ 2=4.63, P<0.05). Conclusions:Surgery is an option for patients with myasthenia gravis ptosis who are not responding well to medical treatment and whose condition is stable. Adjustable silicone strap suspension for the treatment of myasthenia gravis ptosis can significantly improve the surgical success rate and patient satisfaction, with low postoperative complication rate and recurrence rate, which is suitable for clinical application.

Humans ; Amyotrophic Lateral Sclerosis/drug therapy* ; Benzofurans/therapeutic use* ; Double-Blind Method ; Treatment Outcome