Objective:To explore the safety and efficacy of intraosseous regional administration (IORA) of vancomycin for preventing infection in primary total knee arthroplasty (TKA).Methods:A total of 124 patients with knee osteoarthritis undergoing TKA between February 2024 and May 2024 at nine hospitals were enrolled. Preoperative infection prophylaxis involved either IORA (0.5 g vancomycin administered via intraosseous regional infusion before incision) or intravenous infusion (1 g vancomycin via peripheral vein). The IORA group included 15 males and 47 females with a median age of 66.5 years (range, 60.0-70.0 years), while the intravenous group included 14 males and 48 females with a median age of 66.0 years (range, 61.8-70.3 years) years. Intraoperative samples were collected including fat and synovium tissues after incision, before prosthesis placement, and after tourniquet release; distal femoral cancellous bone during femoral osteotomy; proximal tibial cancellous bone during tibial osteotomy; proximal intercondylar cancellous bone before prosthesis placement; and peripheral blood from non-infused arms at surgery initiation and after tourniquet release. Vancomycin concentrations were measured using liquid chromatography-tandem mass spectrometry. Vital sign changes were recorded from admission to 5~10 minutes post-IORA (IORA group) or post-incision (intravenous group). Follow-ups were conducted on postoperative day 1 and 3, and at 1 and 3 months, to document complications including IORA-related adverse events, periprosthetic joint infections, surgical site infections, red man syndrome, acute kidney injury, deep vein thrombosis and so on.Results:Vancomycin concentrations in bone, fat, and synovial tissue samples were significantly higher in the IORA group than in the intravenous group ( P<0.05), while vancomycin concentrations in blood samples were significantly lower in the IORA group than in the intravenous group ( P<0.05). Only 7.3%(41/558) of tissue samples in the IORA group had vancomycin concentrations below 2.0 μg/g (the minimum inhibitory concentration of vancomycin against coagulase-negative staphylococcus), compared to 59.3%(331/558) in the intravenous group (χ 2=11.285, P<0.001). In the intravenous group, 16.9%(21/124) of blood samples had vancomycin concentrations exceeding 15.0 mg/L (the threshold associated with a significantly increased risk of nephrotoxicity), while all concentrations in the IORA group were below this threshold, the difference was statistically significant (χ 2=22.943, P<0.001). There were no statistically significant difference ( P>0.05) in vital signs changes before and after vancomycin administration between the two groups. Two patients in the intravenous group experienced incision exudate, while no other related complications occurred in either group. Conclusions:Compared to the traditional intravenous infusion of 1 g vancomycin, intraosseous injection of a low dose (0.5 g) of vancomycin achieves higher local tissue concentrations in the knee joint with a lower incidence of adverse reactions and is safe for infection prophylaxis. Despite guidelines not recommending the routine use of vancomycin for preventing infection after primary TKA, intraosseous injection of 0.5 g vancomycin may be considered intraoperatively for primary TKA in the following scenarios: patients in medical institutions with a high prevalence of methicillin-resistant staphylococcus aureus (MRSA) infections, patients with potential preoperative MRSA colonization, or patients with cephalosporin allergy.

Objective To establish a rapid and accurate droplet digital PCR(ddPCR)detection method for detecting Staphylococcus aureus(SA)in laboratory animals and the environment.Methods Using the heat-stable nuclease gene(nuc)of SA as the target gene,a pair of specific primers and probes are designed within its conserved region.Optimize the reaction conditions,test the dynamic range,and evaluate the specificity and stability of the method.Using the same template,test reactions were performed with both ddPCR and real-time quantitative PCR(qPCR)method to assess the interchangeability between the two approaches.Finally,the method is applied to the detection of various clinical samples.Results The kinetic range of the established SA ddPCR method is 100～15 000 copies/μL,with a detection limit of 2.5 copies and a quantification limit of 10 copies;The specificity of this method was tested,and only SA showed positive droplets,while no positive droplets were found for other pathogens;After measuring three parallel samples,the standard deviation and relative standard deviation were calculated.It was found that within the dynamic detection interval of ddPCR,as the target copy number gradually decreased,the relative standard deviation showed an upward trend,but remained below 25％.This result indicates that the detection method has good stability.Conclusions The established ddPCR method for detecting SA has the advantages of high sensitivity,strong specificity,good stability,and good reproducibility.This method can be applied for the detection of SA in laboratory animals.

Objective:To explore the safety and efficacy of intraosseous regional administration (IORA) of vancomycin for preventing infection in primary total knee arthroplasty (TKA).Methods:A total of 124 patients with knee osteoarthritis undergoing TKA between February 2024 and May 2024 at nine hospitals were enrolled. Preoperative infection prophylaxis involved either IORA (0.5 g vancomycin administered via intraosseous regional infusion before incision) or intravenous infusion (1 g vancomycin via peripheral vein). The IORA group included 15 males and 47 females with a median age of 66.5 years (range, 60.0-70.0 years), while the intravenous group included 14 males and 48 females with a median age of 66.0 years (range, 61.8-70.3 years) years. Intraoperative samples were collected including fat and synovium tissues after incision, before prosthesis placement, and after tourniquet release; distal femoral cancellous bone during femoral osteotomy; proximal tibial cancellous bone during tibial osteotomy; proximal intercondylar cancellous bone before prosthesis placement; and peripheral blood from non-infused arms at surgery initiation and after tourniquet release. Vancomycin concentrations were measured using liquid chromatography-tandem mass spectrometry. Vital sign changes were recorded from admission to 5~10 minutes post-IORA (IORA group) or post-incision (intravenous group). Follow-ups were conducted on postoperative day 1 and 3, and at 1 and 3 months, to document complications including IORA-related adverse events, periprosthetic joint infections, surgical site infections, red man syndrome, acute kidney injury, deep vein thrombosis and so on.Results:Vancomycin concentrations in bone, fat, and synovial tissue samples were significantly higher in the IORA group than in the intravenous group ( P<0.05), while vancomycin concentrations in blood samples were significantly lower in the IORA group than in the intravenous group ( P<0.05). Only 7.3%(41/558) of tissue samples in the IORA group had vancomycin concentrations below 2.0 μg/g (the minimum inhibitory concentration of vancomycin against coagulase-negative staphylococcus), compared to 59.3%(331/558) in the intravenous group (χ 2=11.285, P<0.001). In the intravenous group, 16.9%(21/124) of blood samples had vancomycin concentrations exceeding 15.0 mg/L (the threshold associated with a significantly increased risk of nephrotoxicity), while all concentrations in the IORA group were below this threshold, the difference was statistically significant (χ 2=22.943, P<0.001). There were no statistically significant difference ( P>0.05) in vital signs changes before and after vancomycin administration between the two groups. Two patients in the intravenous group experienced incision exudate, while no other related complications occurred in either group. Conclusions:Compared to the traditional intravenous infusion of 1 g vancomycin, intraosseous injection of a low dose (0.5 g) of vancomycin achieves higher local tissue concentrations in the knee joint with a lower incidence of adverse reactions and is safe for infection prophylaxis. Despite guidelines not recommending the routine use of vancomycin for preventing infection after primary TKA, intraosseous injection of 0.5 g vancomycin may be considered intraoperatively for primary TKA in the following scenarios: patients in medical institutions with a high prevalence of methicillin-resistant staphylococcus aureus (MRSA) infections, patients with potential preoperative MRSA colonization, or patients with cephalosporin allergy.

Objective To establish a rapid and accurate droplet digital PCR(ddPCR)detection method for detecting Staphylococcus aureus(SA)in laboratory animals and the environment.Methods Using the heat-stable nuclease gene(nuc)of SA as the target gene,a pair of specific primers and probes are designed within its conserved region.Optimize the reaction conditions,test the dynamic range,and evaluate the specificity and stability of the method.Using the same template,test reactions were performed with both ddPCR and real-time quantitative PCR(qPCR)method to assess the interchangeability between the two approaches.Finally,the method is applied to the detection of various clinical samples.Results The kinetic range of the established SA ddPCR method is 100～15 000 copies/μL,with a detection limit of 2.5 copies and a quantification limit of 10 copies;The specificity of this method was tested,and only SA showed positive droplets,while no positive droplets were found for other pathogens;After measuring three parallel samples,the standard deviation and relative standard deviation were calculated.It was found that within the dynamic detection interval of ddPCR,as the target copy number gradually decreased,the relative standard deviation showed an upward trend,but remained below 25％.This result indicates that the detection method has good stability.Conclusions The established ddPCR method for detecting SA has the advantages of high sensitivity,strong specificity,good stability,and good reproducibility.This method can be applied for the detection of SA in laboratory animals.

Humans ; Arthroplasty, Replacement, Knee ; Follow-Up Studies ; Cohort Studies ; Treatment Outcome ; Minimally Invasive Surgical Procedures ; Knee Joint/surgery* ; Knee Prosthesis ; Osteoarthritis, Knee/surgery*

The biogenic monoamine 5-hydroxytryptamine (5-HT) is an ancient intracellular signaling molecule widely distributed in all animals with nervous systems, and has been implicated in principal behaviors. Tryptophan hydroxylase (TRH) induces a highly specific catalytic reaction that converts L-tryptophan (tryptophan) to 5-hydroxy-L-tryptophan (5-HTP) that is subsequently used as a substrate by aromatic L-amino acid decarboxylase (DDC) to form 5-HT. Five-HT is an ancient intracellular signaling molecule that is widely distributed in the animal kingdom and has been implicated in regulating the behaviors of animals with nervous systems. However, the role of TRH in Lepidoptera is not well understood. In this study, we cloned 1 667 bp cDNAs of Bombyx mori TRH (BmTRH), which contains a 1 632 bp open reading frame (ORF). Homology analysis revealed that BmTRH shared high amino acid identity with Homo sapiens TPH and Drosophila TRH (DmTRH). The high homology (70%) of BmTRH with DmTRH suggested that BmTRH could have a function similar to DmTRH. Gene expression analysis revealed that BmTRH was mainly expressed in head and central nervous (CNS). Moreover, immunohistochemistry and Western blotting analyses showed that BmTRH was detected only in larval nervous tissues. Taken together, our results indicate that BmTRH could likely function in the regulation of neural activities in B. mori. The transcripts of B. mori decarboxylase (BmDDC) and B. mori phenylalanine hydroxylase (BmPAH) whose proteins had TRH activity, were also expressed in the CNS tissues, indicating that unlike in Drosophila, two distinct mechanisms likely regulate 5-HT synthesis in silkworm.
Amino Acid Sequence ; Animals ; Bombyx ; Cloning, Molecular ; DNA, Complementary ; Insect Proteins ; Phenylalanine Hydroxylase ; Tryptophan Hydroxylase

OBJECTIVE:To provide reference for pharmacy staff to choose different drug label databases according to different needs.METHODS:The information organization mode of the three open access drug label databases that included Drugs@FDA,FDA Online Label Repository and DailyMed had been collected and analyzed comparatively from three aspects:retrieval function settings,search results display,data resources and service targets.RESULTS & CONCLUSIONS:In respect of retrieval function,DailyMed provided the most abundant retrieval functions than others.In respects of search results display,DailyMed provided the highest degree of formatted data,followed by FDA Online Label Repository,while Drugs@FDA provided semi-formatted data.Three databases provided the functions of page replication and printing,among which the interface of DailyMed was friendlier and the content of DailyMed was more open;it provided all the download functions.In respects of data resources and service targets,developers of Drugs@FDA and FDA Online Label Repository were FDA,and that of DailyMed was National Library of Medicine (NLM).The data sources used by Drugs@FDA were the drug labels after strict approval by FDA,and the description of drug information by Drugs@FDA was the most comprehensive.FDA Online Label Repository was the original drug labels submitted by the manufacturer to FDA,which was the latest content,and even included unlisted drugs.The data sources of DailyMed were from the information listed on the drug package,and included the information of drug label which was listed but not approved strictly;it covered most comprehensive drugs.

Objective To explore the effect of quality control circle on the prevalence of incontinence-associated dermatitis.Methods We set up a quality control circle group,analyzing the current situations,set the goals and analysed the causes of the high incidence of incontinence-associated dermatitis in the ICU after deciding a specific subject and then we developed strategies.The two groups were compared in terms of knowledge on the dermatitis,assessment of the dermatitis risks,the dermatitis-related management and the incidence of incontinence-associated dermatitis.Results After manipulation of the quality control circle,the aims of incontinence dermatitis related knowledge,risks assessment and management process were all achieved.The scores on nurses knowledge on the dermatitis,ability in solving problems,quality control operation,confidence,ability in coordination,and team work spirits were all significantly higher than those before the manipulation of the circle (P＜0.01) and the incidence of incontinenceassociated dermatitis was statistically significantly lower (P＜0.001).Conclusion The management based on the quality control in the ICU of neurology department can effectively reduce the neurology incidence of incontinence-associated dermatitis and improve the nurses professional skills.

Objective To explore the use of queuing theory model combined with the dynamic allocation of nursing staff in the management of blood collection room in outpatient. Methods Queuing theory model combined with dynamic allocation of nursing staff were applied to scientifically allocate nurses in blood collection room. Three months before and after allocation, nursing staff, inspection personnel and patients were investigated through satisfaction questionnaire and the management effect was evaluated. Results Patients′satisfaction degree toward blood collection staff was increased from 80% to 95%; inspection personnel′s satisfaction degree toward blood collection staff was increased from 62.5% to 87.5%;nurses′satisfaction degree toward themselves was increased from 70% to 95% (χ2=20.571,13.333,5.22;P<0.05) . Patients′waiting time before blood collection was shorten to 20 min from 30 min. Conclusions The application of queuing theory model combined with dynamic allocation of nursing personnel can improve the rational use of blood collection personnel in outpatient and nursing quality, and it also can improve the satisfaction of inspection personnel to nurses, of patients and nurses to themselves.

Objective To evaluate the clinical application effect of transparent film dressing in fistula nursing of patients with percutanueous nephrostomy (PCN).Methods By using before-after self control study method,40 patients with pelvic tumor that caused by postrenal renal failure,and needed long-term fistula remained after PCN surgery were selected as the research object.Conventional sterile gauze and tape were used to nurse the fistula before intervention and transparent film dressing was used after intervention.Results Patents always worried about trachea cannula exodus and infection before intervention.After intervention,the comfort degree of their daily life (like showering,sleeping and daily activities) was obviously higher than that before intervention (P＜0.01).The incidence of renal fistula local adverse effect after intervention is relatively low.And the difference was statistically significant (P＜ 0.01).Before intervention,the tape was loosing in (5.47 ± 1.48) days,there were three cases of accidental trachea cannula exodus;and after intervention,transparent film dressing hemmed in (14.22±1.99) days,and no accidental trachea cannula exodus occurred (P＜0.01);and no hyper-sensitive cases happened with the transparent film dressing.Conclusions The transparent film dressing has the advantages of stable viscosity,waterproofing,fungi-proofing,breathability and hypoallergenic,etc.It can well protect and fix the fistula,and it is suitable for nursing care of patients with long-term renal fistula.