Objective To explore the risk factors for vancomycin-related acute kidney injury(VA-AKI)in elderly patients.Methods Clinical data of elderly inpatients who used vancomycin at the Inner Mongolia Autonomous Region People's Hospital from January 2021 to June 2024 were retrospectively collected.The incidence of VA-AKI and the situation of treatment drug monitoring(TDM)were statistically analyzed.LASSO regression was used for feature selection,and this process was repeated 10,000 times.In each iteration,75％of the training samples were randomly selected,and the frequency of each feature being selected was counted.Finally,the features with higher frequency in multiple iterations were selected for model training.The data were divided into training set and test set at an 8∶2 ratio.Four machine learning prediction models,including Logistic regression,random forest,extreme gradient boosting(XGBoost),and support vector machine(SVM),were established.The accuracy and area under the receiver operating characteristic curve(AUC)of the above prediction models were calculated in the test set.The minimum depth distribution was used to visualize the importance of the characteristics of the model.Results A total of 305 elderly patients receiving vancomycin were included,among which 49 cases(16.07％)developed VA-AKI.LASSO regression analysis selected 7 characteristic variables to build 4 machine learning models,and finally selected the random forest model as the risk prediction model.The random forest model has an AUC value of 0.91,an accuracy of 0.89,an accuracy of 0.88,a recall rate of 0.98,and an F1 value of 0.93.The predictor importance ranking was in order of post-treatment creatinine level,C-reactive protein(CRP),albumin(Alb),respiratory failure,cardiac insufficiency,trough concentration time,and dose.Conclusion Post-treatment creatinine level,respiratory weakness,trough concentration time,cardiac insufficiency,Alb,CRP,and dosage were the risk factors for VA-AKI.The random forest model is the most effective in predicting the risk of VA-AKI in elderly patients,providing a reference for rational use of vancomycin in elderly patients.

Objective To explore the risk factors for vancomycin-related acute kidney injury(VA-AKI)in elderly patients.Methods Clinical data of elderly inpatients who used vancomycin at the Inner Mongolia Autonomous Region People's Hospital from January 2021 to June 2024 were retrospectively collected.The incidence of VA-AKI and the situation of treatment drug monitoring(TDM)were statistically analyzed.LASSO regression was used for feature selection,and this process was repeated 10,000 times.In each iteration,75％of the training samples were randomly selected,and the frequency of each feature being selected was counted.Finally,the features with higher frequency in multiple iterations were selected for model training.The data were divided into training set and test set at an 8∶2 ratio.Four machine learning prediction models,including Logistic regression,random forest,extreme gradient boosting(XGBoost),and support vector machine(SVM),were established.The accuracy and area under the receiver operating characteristic curve(AUC)of the above prediction models were calculated in the test set.The minimum depth distribution was used to visualize the importance of the characteristics of the model.Results A total of 305 elderly patients receiving vancomycin were included,among which 49 cases(16.07％)developed VA-AKI.LASSO regression analysis selected 7 characteristic variables to build 4 machine learning models,and finally selected the random forest model as the risk prediction model.The random forest model has an AUC value of 0.91,an accuracy of 0.89,an accuracy of 0.88,a recall rate of 0.98,and an F1 value of 0.93.The predictor importance ranking was in order of post-treatment creatinine level,C-reactive protein(CRP),albumin(Alb),respiratory failure,cardiac insufficiency,trough concentration time,and dose.Conclusion Post-treatment creatinine level,respiratory weakness,trough concentration time,cardiac insufficiency,Alb,CRP,and dosage were the risk factors for VA-AKI.The random forest model is the most effective in predicting the risk of VA-AKI in elderly patients,providing a reference for rational use of vancomycin in elderly patients.

BACKGROUND:Psoralen has a strong anti-osteoporotic activity and may have a restorative effect on chemotherapy-induced osteoporosis. OBJECTIVE:To explore the restorative effect of psoralen on the osteogenic differentiation of bone marrow mesenchymal stem cells in mice inhibited by cyclophosphamide and its mechanism. METHODS:C57BL/6 mouse bone marrow mesenchymal stem cells were isolated and cultured.Effect of psoralen on viability of bone marrow mesenchymal stem cells was detected by MTT assay.Osteogenic induction combined with alkaline phosphatase staining was used to determine the optimal dose of psoralen to restore the osteogenic differentiation of bone marrow mesenchymal stem cells inhibited by cyclophosphamide.The mRNA expression levels of Runx2,alkaline phosphatase,Osteocalcin,osteoprotegerin,and Wnt/β-catenin signaling pathway-related genes Wnt1,Wnt4,Wnt10b,β-catenin,and c-MYC were measured by RT-qPCR at different time points under the intervention with psoralen.The protein expression of osteogenic specific transcription factor Runx2 and Wnt/β-catenin signaling pathway related genes Active β-catenin,DKK1,c-MYC,and Cyclin D1 was determined by western blot assay at different time points under the intervention with psoralen. RESULTS AND CONCLUSION:(1)There was no significant effect of different concentrations of psoralen on the viability of bone marrow mesenchymal stem cells.The best recovery of the inhibition of osteogenic differentiation of bone marrow mesenchymal stem cells caused by cyclophosphamide was under the intervention of psoralen at a concentration of 200 μmol/L.(2)Psoralen reversed the reduction in osteogenic differentiation marker genes Runx2,alkaline phosphatase,Osteocalcin and osteoprotegerin mRNA expression and Runx2 protein expression in bone marrow mesenchymal stem cells caused by cyclophosphamide conditioned medium.(3)Psoralen reversed the decrease in Wnt/β-catenin pathway-related genes Wnt4,β-catenin,c-MYC mRNA and Active β-catenin,c-MYC,and Cyclin D1 protein expression and the increase in DKK1 protein expression in bone marrow mesenchymal stem cells caused by cyclophosphamide conditioned medium.(4)The results showed that cyclophosphamide inhibited osteogenic differentiation of bone marrow mesenchymal stem cells in mice,and psoralen had a restorative effect on it.The best intervention effect was achieved at a concentration of 200 μmol/L psoralen,and this protective effect might be related to the activation of Wnt4/β-catenin signaling pathway by psoralen.

Brucellosis is a zoonotic infectious disease caused by Brucella infection. So far, animal to animal Brucellosis has not been eradicated, and there is a lack of safe and effective human vaccine. Therefore, "early, combined, sufficient, and full course" drug treatment remains an important strategy in the management of human Brucellosis. The goal of treating brucellosis is to alleviate and shorten the symptom period, reduce complications, relapses, and chronicity. At present, although antibiotic treatment is effective for most patients, there are still some patients who experience treatment failure or later recurrence, so the treatment strategy for brucellosis urgently needs to be optimized. This article elaborates on the treatment principles, clinical treatment status, and future development trends of brucellosis, in order to provide references for optimizing drug treatment methods for brucellosis.

Objective:To study the changes in long non-coding RNA C2dat1 expression in kidney tissues of rats at different stages of diabetic kidney disease (DKD) and its relationship with renal interstitial fibrosis.Methods:Forty-eight male SD rats were randomly divided into two groups with 24 rats in each group: control group and DKD group. The rats in the control group were fed with ordinary diet, while those in the DKD group were fed with high-fat diet and drank water freely. After eight weeks of feeding, the rats were fasted for 12 h with free access to water. Then, the DKD group was given a one-time intrabitoneal injection of streptozotocin and the control group was given an equal dose of sodium citrate buffer. After 72 h, the random peripheral blood glucose concentration (≥ 16.7 mmol/L for three consecutive days) and urine sugar (positive) were tested to assess the establishment of the diabetes model. Urine, blood and kidney samples were collected at 3, 6, 9 and 12 weeks. The urinary protein excretion rate within 24 h, urinary creatinine and serum total cholesterol were measured by automatic biochemical apparatus. Pathological changes in kidney tissues were observed by HE staining. The expression of calcium/calmodulin-dependent protein kinase Ⅱ delta (CaMK2D), p65, p50, α-SMA and E-cardherin was detected by immunohistochemistry. Quantitative real-time PCR (qPCR) was used to detect the expression of lncRNA C2dat1 and CaMK2D. The relationship of lncRNA C2dat1 with α-SMA, E-cardherin and CaMK2D was analyzed by correlation analysis. In in vitro experiment, renal tubular epithelial cells HK-2 were induced by high glucose. The expression of lncRNA C2dat1 and CaMK2D in HK-2 cells was detected by qPCR after 24, 48 and 72 h of intervention. Results:The rats in the DKD group showed typical symptoms such as polydipsia, polyphagia, significant weight loss and increased blood glucose as compared with the rats in the control group. Results of the biochemical tests revealed that compared with the control group, the DKD group had increased 24 h excretion rate of urinary protein, decreased urinary creatinine and up-regulated total cholesterol. HE staining showed that the rats in the control group had intact glomeruli, normal basement membrane and no mesangial hyperplasia or inflammatory cell infiltration. However, enlarged glomeruli and evenly thickened basement membrane were observed in the DKD group. Immunohistochemistry indicated that the expression of CaMK2D, p50 and α-SMA was higher in the DKD group than in the control group, while the expression of E-cardherin was lower in the DKD group. qPCR results showed that the expression of lncRNA C2dat1 and CaMK2D at mRNA level was higher in the DKD group than in the control group. In in vitro experiment, the expression of lncRNA C2dat1 and CaMK2D at mRNA level was also higher in HK-2 cells induced by high glucose than in the control group. Correlation analysis indicated that lncRNA C2dat1 was positively correlated with α-SMA and CaMK2D, but negatively correlated with E-cardherin. Conclusions:During the progression of DKD, the high expression of lncRNA C2dat1 might promote diabetic renal interstitial fibrosis by regulating the expression of CaMK2D to activate the NF-κB signaling pathway.

Objective:To explore clinical features, diagnosis, localization, and therapeutic strategy of migratory pharyngeal and cervical esophageal foreign bodies.Methods:A total 23 cases of pharyngeal and cervical esophageal migratory foreign bodies were admitted between January 2015 and December 2021. There were 14 females and 9 males with the age ranged from 35 to 82 (55.0±12.7)years. In all the cases, esophageal CT was taken to confirm the esophageal foreign body. Multiplanar reconstruction (MPR) was performed to locate the foreign body from the horizontal, coronal and sagittal dimensions as well as the corrected reconstructed MPR. According to the location of the foreign body, appropriate surgical method was selected.The symptoms, complications, types of foreign body, positioning, surgical methods, and relevant information were recorded.Data were analyzed using the descriptive method and SPSS 25.0 software.Results:The clinical symptoms of 23 migrating esophageal foreign bodies included pharyngodynia (20/23), foreign body sensation (6/23), hoarsenss (1/23), difficulty in turning neck(1/23), difficulty in opening mouth (1/23), fever (7/23), poor appetite (1/23), and abdominal pain (1/23). The foreign bodies included 19 fish bones, 2 wires, 1 embroidery needle and 1 chicken bone. There were 9 cases (39.1%) of foreign bodies located in extraluminal cervical esophagus, 2 cases (8.7%) of foreign bodies located in the muscular layer of the cervical esophagus and 12 cases (52.2%) of foreign bodies located in pharynx. Twenty-one cases of foreign bodies were removed by cervical lateral incision, in which 11 were removed by cervical lateral incision directly, 10 by the second lateral cervical incision after the foreign bodies were accurately located by MPR and/or corrected MPR, 1 foreign body was removed by incision of the pharyngeal mucosa under suspension laryngoscope, 1 foreign body was removed by tracheoscopy. Compared with patients with intraluminal foreign bodies ( n=308) treated in the same period, intake of fishbone [19 (19/23) vs. 133 (82.6% (43.2%, 133/308), OR=7.31] and first visit was more than 24 hours [20(87.0%, 20/23) vs. 77(25.0%, 77/308), OR=17.2] were the significant risk factors of migratory esophageal foreign bodies. Conclusions:MPR and the corrected MPR can accurately locate the migrating pharyngeal and cervical esophageal foreign bodies, by providing more intuitive imaging evidence for doctors, which provide imaging basis for formulation of surgical programs. Foreign bodies in pharyngeal and cervical esophagus need to be treated as soon as possible, otherwise they are easy to migrate, leading lead to serious complications.

ABSTRACT OBJECTIVE：To systematically evaluate the efficacy and safety of echinococcins in the prevention of invasive candidiasis，and to provide evidence-based reference for clinical treatment. METHODS：Retrieved from PubMed，Embase， Medline，Cochrane library，CJFD，VIP and Wanfang database，randomized controlled trials（RCTs）about the effectiveness and safety of echinococcins （trial group） versus conventional fungal drugs （amphotericin B and triazole antifungal agents，control group）in the prevention of invasive candidiasis were collected during database establishment to Jul. 2019. After data extraction of clinical studies met inclusion criteria and quality evaluation with Cochrane system evaluator manual 5.0.2，Meta-analysis was performed for breakthrough invasive fungal infection rate，fungal infection mortality rate，all-cause mortality rate and the incidence of drug withdrawal due to adverse reactions by using Rev Man 5.2 statistical software. RESULTS：Totally 7 RCTs were included， involving 3 219 patients. Results of Meta-analyses indicated that the incidence of breakthrough invasive fungal infection [OR＝0.58， 95％CI（0.40，0.85），P＝0.004]，fungal infection mortality rate[OR＝0.68，95％CI（0.51，0.92），P＝0.01] and the incidence of drug withdrawal due to adverse reactions [OR＝0.52，95％CI（0.40，0.67），P＜0.001] in trial groups were significantly lower than control group，with statistical significance. There was no statistical significance in the all-cause mortality rate [OR＝0.84，95％CI（0.67， 1.05），P＝0.13]. CONCLUSIONS：Compared with amphotericin B and triazole antifungal agents，echinococcins used for the prevention of invasive candidiasis can reduce the incidence of breakthrough invasive fungal infection，fungal infection mortality rate and the incidence of drug withdrawal due to adverse reactions

In order to solve the problems of feeble research foundation and inadequate experiment skills,the central laboratory for science and technology at general hospital introduced a series of minilectures with different styles for research-oriented graduate students in Chinese Traditional Medicine,including basic strengthening style,tailored style,leading innovated style and academic salon style.The minilecture contents covered biomedical basic research,the commonly used experimental technologies of cell culture,molecular biology,histochemistry and some others,and the latest research advances.According to the needs of postgraduate research projects,the mini-lectures were also organically combined with the laboratory self-produced micro videos and scientific research training,which aroused the enthusiasm of medical science postgraduates for scientific research participation,and explored a new way to improve the quality of experimental teaching.

The laboratory of science and technology center at general hospital explored the appli-cation of PDCA cycle in the bio-safety training for research-oriented medical postgraduates, and then analyzed the effect of the training. The laboratory applied the PDCA cycle (Plan-Do-Check-Act) into the bio-safety training practice based on its own characteristics. The 4 links of bio-safety practice including bio-safety factors analysis, training plan implementation, training effectiveness evaluation and problems feed-back were integrated with 4 processes of PDCA cycle management. In view of the problems existing in the laboratory bio-safety training, the PDCA cycle model was applied to bio-safety training. Though the PDCA cycle, the laboratory can establish a bio-logical safety quality monitoring mechanism and achieve the system-atization, standardization and normalization of biosafety training.

The paper presented the thoughts and steps taken by the National Center for Cardiovascular Diseaes in biobank quality management system.By means ofprocess approach,the organizational structure,identification and analysis process were established,along with the management mechanism and normalized documentation.Centering onPlan,Do,Check and Act(PDCA),a complete set of quality management system was established.This system enables normalized management of biobanks in China,and provides practice guidelines for development industry standards of the country as well.