AIM:To analyze the Pharmaceutical Care Network Europe(PCNE)classification system used for evaluating the drug related problems(DRPs)of tacrolimus concentration fluctuations in kidney transplant recipients.METHODS:Kidney transplant recipients were selected as the study subjects,who experienced fluctuations in tacrolim-us blood concentrations and clinical pharmacist in-tervention during outpatient follow-up.PCNE(9.0)classification system was used to evaluate the DRPs of tacrolimus.And the DRP problems,causes,inter-vention plans,acceptance and status were ana-lyzed.RESULTS:A total of 700 kidney transplant re-cipients were enrolled from July 2019 to December 2021,and 1014 DRPs were found.The problems of DRPs included the occurrence of adverse drug events(P2.1,60.16％)and poor treatment out-comes(P1.2,39.84％);The main reasons included dosage selection(C3,43％),others(C9,38.4％),and drug selection(C1,9.41％);Clinical pharmacists ac-tively intervened at the recipient level(I2,98.92％)and drug level(I3,1.08％);The acceptance rate of the intervention plan(A1.1+A1.3)reached 98.62％,and the complete implementation rate(A1.1)reached 72.09％;79.29％of DPRs were fully or par-tially resolved(O1.1 and O2.1).CONCLUSION:Clini-cal pharmacists can use PCNE to evaluate tacrolim-us therapeutic drug monitoring(TDM)related DRPs,help standardize TDM pharmaceutical ser-vice models,standardize TDM abnormal result in-terpretation and intervention workflows,and pro-mote safe and rational drug utilization.

AIM:In this study,bioinformatics tech-nology was used to explore the differentially ex-pressed genes in antibody-mediated rejection after renal transplantation,and to screen out the possi-ble mechanisms and potential therapeutic targets of AMR-related miRNAs after renal transplantation,in order to provide new idea for the targeted thera-py of AMR after transplantation.METHODS:The dataset GSE115816 was downloaded from the GEO database,and the differential expression of miR-NAs in stable renal transplantation(SGF)group and the antibody-mediated rejection(AMR)group after renal transplantation was analyzed online by using DESeq 2R software.TargetScan software predicted the related targets of miRNAs,and the differential-ly expressed genes(DEGs)were analyzed through through gene ontology(GO)enrichment analysis and Kyoto gene and genome encyclopedia(KEGG)enrichment analysis,then key genes were screened by String database and Cytoscape,and finally veri-fied by TargetScan online analysis.RESULTS:A total of 10 differentially expressed miRNAs were identi-fied in the AMR group by comparison with the SGF group,with the most significant difference in ex-pression of miR-144-5p.A total of 143 miR-144-5p related targets were predicted by Targetscan soft-ware.GO analysis showed that DEGs were mainly involved in angiogenesis,synaptic signaling,and transcriptional co-activator regulation.KEGG analy-sis showed that DEGs were mainly enriched in the thyroid hormone signaling pathway,human papillo-mavirus infection,and PI3K-AKT signaling pathway.The 10 Hug genes were screened by PPI network.Based on the 6 algorithms in cytoHubba,5 key genes were obtained by taking the intersection of the top 10 Hug genes of each algorithm,which were NCOA2,NCOA1,FOXO1,PAX3,and PPARGC1A.After the literature review,we found that FoxO1 plays an essential role in immune sys-tem diseases and kidney diseases.In our study,we chose FoxO1 as a potential target protein for miR-144-5p.Finally,TargetScan online analysis showed that miR-144-5p has a targeted binding site with the 3'UTR region of FoxO1.CONCLUSION:MiR-144-5p plays an important role in AMR after Kidney transplantation.MiR-144-5p targeting FoxO1 may be a potential therapeutic target and prognostic biomarker for AMR.

AIM:To analyze the Pharmaceutical Care Network Europe(PCNE)classification system used for evaluating the drug related problems(DRPs)of tacrolimus concentration fluctuations in kidney transplant recipients.METHODS:Kidney transplant recipients were selected as the study subjects,who experienced fluctuations in tacrolim-us blood concentrations and clinical pharmacist in-tervention during outpatient follow-up.PCNE(9.0)classification system was used to evaluate the DRPs of tacrolimus.And the DRP problems,causes,inter-vention plans,acceptance and status were ana-lyzed.RESULTS:A total of 700 kidney transplant re-cipients were enrolled from July 2019 to December 2021,and 1014 DRPs were found.The problems of DRPs included the occurrence of adverse drug events(P2.1,60.16％)and poor treatment out-comes(P1.2,39.84％);The main reasons included dosage selection(C3,43％),others(C9,38.4％),and drug selection(C1,9.41％);Clinical pharmacists ac-tively intervened at the recipient level(I2,98.92％)and drug level(I3,1.08％);The acceptance rate of the intervention plan(A1.1+A1.3)reached 98.62％,and the complete implementation rate(A1.1)reached 72.09％;79.29％of DPRs were fully or par-tially resolved(O1.1 and O2.1).CONCLUSION:Clini-cal pharmacists can use PCNE to evaluate tacrolim-us therapeutic drug monitoring(TDM)related DRPs,help standardize TDM pharmaceutical ser-vice models,standardize TDM abnormal result in-terpretation and intervention workflows,and pro-mote safe and rational drug utilization.

AIM:In this study,bioinformatics tech-nology was used to explore the differentially ex-pressed genes in antibody-mediated rejection after renal transplantation,and to screen out the possi-ble mechanisms and potential therapeutic targets of AMR-related miRNAs after renal transplantation,in order to provide new idea for the targeted thera-py of AMR after transplantation.METHODS:The dataset GSE115816 was downloaded from the GEO database,and the differential expression of miR-NAs in stable renal transplantation(SGF)group and the antibody-mediated rejection(AMR)group after renal transplantation was analyzed online by using DESeq 2R software.TargetScan software predicted the related targets of miRNAs,and the differential-ly expressed genes(DEGs)were analyzed through through gene ontology(GO)enrichment analysis and Kyoto gene and genome encyclopedia(KEGG)enrichment analysis,then key genes were screened by String database and Cytoscape,and finally veri-fied by TargetScan online analysis.RESULTS:A total of 10 differentially expressed miRNAs were identi-fied in the AMR group by comparison with the SGF group,with the most significant difference in ex-pression of miR-144-5p.A total of 143 miR-144-5p related targets were predicted by Targetscan soft-ware.GO analysis showed that DEGs were mainly involved in angiogenesis,synaptic signaling,and transcriptional co-activator regulation.KEGG analy-sis showed that DEGs were mainly enriched in the thyroid hormone signaling pathway,human papillo-mavirus infection,and PI3K-AKT signaling pathway.The 10 Hug genes were screened by PPI network.Based on the 6 algorithms in cytoHubba,5 key genes were obtained by taking the intersection of the top 10 Hug genes of each algorithm,which were NCOA2,NCOA1,FOXO1,PAX3,and PPARGC1A.After the literature review,we found that FoxO1 plays an essential role in immune sys-tem diseases and kidney diseases.In our study,we chose FoxO1 as a potential target protein for miR-144-5p.Finally,TargetScan online analysis showed that miR-144-5p has a targeted binding site with the 3'UTR region of FoxO1.CONCLUSION:MiR-144-5p plays an important role in AMR after Kidney transplantation.MiR-144-5p targeting FoxO1 may be a potential therapeutic target and prognostic biomarker for AMR.

Objective:To investigate the application effect of the best evidence for prevention of perioperative delirium in elderly patients with hip fracture.Methods:Using the convenient sampling method, a total of 62 elderly patients with hip fractures admitted to the Trauma Department of Provincial Hospital Affiliated to Shandong First Medical University from January to August 2021 were selected as the control group, and 62 elderly patients with hip fractures admitted from September 2021 to April 2022 were selected as the observation group. At the same time, 17 nurses from the same department were selected as the research objects. According to the standard procedures and clinical conversion system application methods of the Evidence Based Clinical Evidence Practice System at the Joanna Briggs Institute in Australia, the best evidences were applied to the prevention of delirium in elderly hip fracture patients during the perioperative period. Before and after the application of evidence, the compliance rates of the review indicators, the scores of knowledge and attitude on prevention of delirium in elderly patients with hip fracture and the occurrence of delirium in patients were compared.Results:After the application of evidence, the compliance rates of review indicators were higher than those before the application, and the differences were statistically significant ( P < 0.05). The knowledge accuracy and attitude scores of delirium prevention in elderly nurses with hip fractures during perioperative period were higher than those before application, and the differences were statistically significant ( P<0.05). The number of delirium cases in the observation group was lower than that in the control group, and the duration of delirium was shorter than that in the control group, and the differences were statistically significant ( P<0.05) . Conclusions:The clinical application of the best evidence for perioperative delirium prevention in elderly hip fractures can improve nurses' awareness and attitude towards perioperative delirium prevention in elderly hip fractures, and reduce the occurrence of delirium in patients.

Posterior cruciate ligament (PCL) plays an important role in maintaining the stability of knee. PCL injury is often accompanied by serious axial and rotational instability, and severe PCL injury is likely to be combined with injuries to the anterior cruciate ligament, medial collateral ligament and other tissues which are often repaired by necessary posterior cruciate ligament reconstruction (PCLR) to restore their physiological functions. However, PCLR research is not as common as the research into the anterior cruciate ligament reconstruction, not only due to controversies in the anatomy and mechanics of PCL but also due to a higher failure rate and more complications following PCLR. This situation is closely related to the anatomical characteristics of the PCL tibial insertion. The present review deals with the anatomy, mechanics and clinical research of the PCL tibial insertion in order to provide more references for PCLR operators.

Objective:To observe the effects of miR-146a on human retinal endothelial cell (HREC) under high glucose condition.Methods:Total of 57 cases diagnosed as diabetic mellitus and 40 cases with diabetic retinopathy (DR) in Wuxi People's Hospital Affiliated to Nanjing Medical University from October to December 2013.Forty-one healthy volunteers were enrolled and served as control group.The clinical data and venous blood samples of subjects were collected.HRECs were cultured in normal glucose (5.5 mmol/L) or high glucose medium (30 mmol/L). Real-time PCR was used to detect the expression of miR-146a.The cultured HRECs were transfected with miR-146a mimic, mimic negative control, inhibitor and inhibitor negative control by lipofectamine2000, respectively.The expression of miR-146a and intercellular cell adhesion molecule-1 (ICAM-1) mRNA was examined by real-time PCR and the expression of nuclear factor-кB (NF-кB) p65 and NF-кB p65 Ser536 was detected by Western blot assay. Results:The relative expression of miR-146a mRNA in the diabetic mellitus group and DR group was 0.36±0.08 and 0.27±0.08, respectively, which were significantly lower than 1.00±0.16 in the control group (both at P<0.01). The expression of miR-146a mRNA was 0.37±0.11 in the high glucose group, which was lower than 1.00±0.18 in the normal control group ( t=5.57, P<0.01). The relative expression of miR-146a mRNA in the miR-146a mimic group was 2 540.00±105.00, which was significantly higher than 61.00±17.90 in the miR-146a mimic control group; The relative expression of miR-146a mRNA in the miR-146a inhibitor group was 0.04±0.01, which was significantly lower than 0.88±0.04 in the miR-146a inhibitor control group ( t=23.23, 17.12; both at P<0.01). The relative expression of ICAM-1 mRNA in the miR-146a mimic group was 0.35±0.12, which was significantly lower than 1.00±0.13 in the miR-146a mimic control group; The relative expression of ICAM-1 mRNA in the miR-146a inhibitor group was 2.74±0.48, which was significantly higher than 1.00±0.16 in the miR-146a inhibitor control group ( t=3.58, 3.37; both at P<0.05). The relative expression of NF-кB p65 Ser536 in the miR-146a mimic group was 0.43±0.03, which was significantly lower than 1.07±0.09 in the miR-146a mimic control group ( t=6.74, P<0.01). The relative expression of NF-кB p65 Ser536 in the miR-146a inhibitor group was 2.08±0.12, which was significantly higher than 1.00±0.01 in the miR-146a inhibitor control group ( t=8.76; P<0.01). Conclusions:miR-146a can reduce inflammation of HREC in high glucose condition through inhibiting ICAM-1 expression and NF-кB phosphorylation.

Objective: To study changes of peripheral blood lymphocyte calcineurin/ nuclear factor of activated T cells (CaN/NFAT) signaling pathway and calcium activated potassium channel (KCa3.1) expression in Kazak hypertensive patients with high high sensitive C reactive protein (hsCRP) level from Xinjiang, and explore the mechanism of lymphocyte potassium channel involving in inflammation of hypertension.Methods: Kazak hypertensive patients from Xinjiang, who were first diagnosed in our heart center without antihypertensive therapy from Feb 2014 to Nov 2014, were selected.According to detected hsCRP level, a total of 50 hsCRP≥3mg/L patients were enrolled as high hsCRP group, and 50 hsCRP<3mg/L patients were enrolled as normal hsCRP group.Gene and protein expression levels of KCa3.1 and tumor necrosis factor (TNF)-α, and activities of lymphocyte CaN and NFAT were measured and compared between two groups.Results: Compared with normal hsCRP group, there were significant rise in expression levels of lymphocyte KCa3.1 mRNA [(0.86±0.16) vs.(2.48±0.22)], TNF-α mRNA [(1.02±0.15) vs.(2.90±0.13)], KCa3.1 protein [(1.00±0.02) vs.(2.46±0.04)] and TNF-α protein [(1.01±0.02) vs.(2.04±0.06)], and activities of CaN [(1.04±0.15) vs.(2.83±0.08)] and NFAT [(0.96±0.06) vs.(2.65±0.07)] in high hsCRP group, P<0.01 all.Conclusion: In Kazak hypertensive patients with inflammatory reaction from Xinjiang, KCa3.1 and CaN-NFAT signaling pathway expression rises, suggesting that lymphocyte KCa3.1 may be involved in occurrence and development of hypertension via CaN/NFAT signaling pathway.

Objective To investigate the solutions to the comfort problem caused by traditional batch produc‐tion that cannot satisfy everyone's request .Methods The both objective and subjective evaluations were put forward to the assessment of ear comfort .The accurate data about the pinna was acquired through reverse engineering and extracting key points of the pinna by image detection method .The headphone model was built by the semi-parame‐ter design .Through the FESA study ,headphones - pinna contact pressure was assessed and relevant parameters were improved .Comfort was analyzed by contact pressure .Results The simulation contact pressure was compared before and after optimizing parameters .The results showed that the contact area of the augment cymba conchae could obtain more uniformity pressure .Conclusion The example verification shows this delivers better comfort than traditional one .The research has some reference value for the design and option comfortable headphones .