This article presents the anti-infective treatment and pharmaceutical care of an elderly patient with liver cirrhosis complicated with severe psittacosis.Based on the pathophysiological characteristics of infection in patients with severe liver diseases and in combination with relevant guidelines,the combined regimen of omadacycline+moxifloxacin was adopted to treat psittacosis.In case of recurrent episodes,Aspergillus fumigata was detected in the metagenomic next-generation sequencing of bronchoalveolar lavage fluid.Initially,voriconazole was administered for treatment,and later switched to posaconazole.Additionally,clinical pharmacists provided pharmaceutical care encompassing adverse reaction monitoring and voriconazole therapeutic drug monitoring.The patient's infection was effectively controlled,body temperature returned to normal,white blood cell counts and platelet counts basically returned to normal range,serum high-sensitive C-reactive protein,procalcitonin,and other inflammatory indicators significantly decreased,and the patient was discharged.Clinical pharmacists assisted clinicians in formulating a reasonable anti-psittacosis treatment plan and provided individualized pharmaceutical care to ensure the effectiveness and safety of clinical drug treatment.

This article presents the anti-infective treatment and pharmaceutical care of an elderly patient with liver cirrhosis complicated with severe psittacosis.Based on the pathophysiological characteristics of infection in patients with severe liver diseases and in combination with relevant guidelines,the combined regimen of omadacycline+moxifloxacin was adopted to treat psittacosis.In case of recurrent episodes,Aspergillus fumigata was detected in the metagenomic next-generation sequencing of bronchoalveolar lavage fluid.Initially,voriconazole was administered for treatment,and later switched to posaconazole.Additionally,clinical pharmacists provided pharmaceutical care encompassing adverse reaction monitoring and voriconazole therapeutic drug monitoring.The patient's infection was effectively controlled,body temperature returned to normal,white blood cell counts and platelet counts basically returned to normal range,serum high-sensitive C-reactive protein,procalcitonin,and other inflammatory indicators significantly decreased,and the patient was discharged.Clinical pharmacists assisted clinicians in formulating a reasonable anti-psittacosis treatment plan and provided individualized pharmaceutical care to ensure the effectiveness and safety of clinical drug treatment.

bjective　To analyze the drug resistance screening status and drug resistance influencing factors of high-risk groups of drug-resistant pulmonary tuberculosis in Qingdao, and to understand the inclusion of rifampicin patients in treatment, so as to provide a reference for the prevention and treatment of drug-resistant pulmonary tuberculosis. Methods　The medical records of 726 cases of drug-resistant pulmonary tuberculosis among high-risk populations registered in Qingdao from 2018 to 2022 were obtained from the National Health Insurance Information System of the China Center for Disease Control and Prevention. The drug resistance to five anti-tuberculosis drugs, namely isoniazid (INH), rifampicin (RFP), ethambutol (EMB), levofloxacin (Lfx), and amikacin (Am), in the high-risk populations of drug-resistant pulmonary tuberculosis was analyzed. Univariate and multivariate logistic regression were used toidentify factors influencing rifampicin resistance, and the detection and inclusion of treatment for rifampicin-resistant patients were evaluated. Results　Of the 726 subjects, 278 were drug-resistant, with a total drug resistance rate of 38.29%. The drug resistance for the five anti-tuberculosis drugs in descending order was: INH 25.90%(188/726), RFP 22.87%(166/726), Lfx 14.19%(103/726), EMB 11.29%(82/726), Am 2.48%(18/726). Analysis of the drug resistance spectrum showed that among those resistant to one drug, RFP was most common, accounting for 13.67% (38/278); among those resistant to two drugs, INH+RFP was predominant, accounting for 15.83% (44/278); among those resistant to three drugs, INH+RFP+Lfx was most frequent, at 7.19% (22/278); and among those resistant to four drugs, INH+RFP+EMB+Lfx was highest, at 6.12% (17/278). Multivariate logistic regression analysis of rifampicin resistance showed that compared with patients under 25 years of age, the risk of developing rifampicin resistance was lower in the groups aged 45 to under 65 and those aged 65 and above (OR=0.356, 95%CI: 0.181-0.700; OR=0.352, 95%CI: 0.170-0.729). Compared with migrant patients in other provinces, local patients from within the same county or district had a lower risk of developing rifampicin resistance (OR=0.599, 95%CI:0.383-0.962). Compared with patients who were smear-positive at the end of the second month of initial treatment, the risk of developing rifampicin resistance was higher in patients with relapse/return, failure of retreatment/chronic, and other categories of patients (OR=9.380, 95%CI:3.717-23.671;OR=25.749, 95%CI:8.037-82.490; OR=36.651, 95%CI:8.438-159.201). Conclusions　The situation of drug-resistant pulmonary tuberculosis in Qingdao cannot be ignored. Individuals under 25 years old, migrants from other provinces, and patients with relapse/return, failure of retreatment/chronic, and other categories are significant risk factors for developing rifampicin resistance in the high-risk groups of drug-resistant pulmonary tuberculosis.

Objective    To summarize the surgical experience of infants with transposition of the great arteries (TGA) and intramural coronary artery (IMCA) in our center, and analyze the early and mid-term outcomes. Methods    We retrospectively analyzed the clinical data of 384 infants with TGA undergoing arterial switch operation (ASO) from June 2010 to December 2018 at Fuwai Hospital. According to operative records, 21 (5.5%) infants had IMCA, among whom 20 were males, with a median age of 33 (9-319) d. Coronary transfer using double coronary buttons with unroofed intramural course was performed in all 21 infants. Results    There was no statistical difference in the early mortality after ASO between infants with IMCA and infants with normal coronary anatomy (9.5% vs. 3.0%, P=0.15). In the IMCA group, 2 dead patients presented inadequate coronary artery perfusion after first aortic unclamping. In addition, 1 patient underwent extracorporeal membrane pulmonary support for myocardial dysfunction. The follow-up was available for all 19 survivors, with an average follow-up time of 29.0-120.0 (74.8±27.3) months. During the follow-up, all patients had no obvious symptoms, death, reoperation, or coronary complications. One patient developed moderate pulmonary valve regurgitation and another patient developed distal stenosis of the right pulmonary artery. Conclusion    For infants with TGA and IMCA, coronary transfer using double coronary buttons with unroofed intramural course is a safe and reliable technique, with satisfactory early and mid-term outcomes.

Objective    To investigate the best anatomical classification, surgical timing, procedure and clinical outcomes of congenital vascular ring. Methods    The clinical data of 58 patients who underwent congenital vascular ring surgery in Pediatric Surgery Center, Fuwai Hospital between 2014 and 2019 were retrospectively analyzed. There were 32 (55.2%) males and 26 (44.8%) females with a median age of 16.5 (2-73) months. Preoperative symptoms, imaging examinations, anatomical classifications, surgical procedures and postoperative recovery were assessed. Results    There were 20 (34.5%) patients of double aortic arch, 22 (37.9%) patients of right aortic arch with left arterial duct or ligament, 15 (25.9%) patients of left aortic arch with aberrant right subclavian artery, and 1 (1.7%) patient of circumflex aorta with cervical aorta arch. The median ventilator supporting time was 6.0 (0-648) h, and the median hospital stay time was 14.5 (7-104) d. One patient with coarctation of aorta died of severe pulmonary infection during perioperative period, and the others survived without symptoms and reoperation after discharge. The median follow-up time was 7.0 (1-62) months. Conclusion    For children with unexplained dyspnea and dysphagia, or with right aortic arch, preoperative imaging examinations such as computed tomography or magnetic resonance imaging are required to confirm the diagnosis of vascular ring. Surgical correction of congenital vascular ring is safe and reliable, and can effectively relieve symptoms. The mortality rate and reoperation rate are low, and the follow-up results are satisfactory.

Objective    To summarize the clinical characteristics and outcome of tricuspid valve replacement (TVR) in children aged no more than 14 years, and to discuss the selection of prosthesis. Methods    From September 2002 to August 2019, 14 patients aged no more than 14 years who received TVR were included in our study. There were 9 males and 5 females, with a mean age of 9.8±4.3 years. Results    Mechanical prosthesis was implanted in 8 patients, and bioprosthesis in 6 patients. The mean cardiopulmonary time and aortic-clamp time was 170.3±109.8 min and 95.1±63.1 min, respectively. The mortality within 30 days after surgery was 21.4% (3/14), and all 3 patients died of severe low cardiac output syndrome. Eleven patients were followed up for 34-199 (100.1±57.4) months. During the follow-up, mechanical prosthesis dysfunction occurred in 3 patients, 2 of whom received secondary TVR. One patient died during the follow-up. Conclusion    The bioprosthesis is the first choice for TVR in children. Some long-term complications may occur after TVR, and close follow-up and timely intervention are needed.

Objective To summarize the echocardiographic findings and clinical characteristics of Kawasaki disease(KD) complicated with coronary artery thrombosis (CAT).Methods Thirty-five patients with KD combined with CAT were enrolled,who were admitted to Beijing Children's Hospital,Capital Medical University between July 2005 and August 2016.The clinical characteristics and echocardiographic findings during follow-ups were retrospectively studied.According to whether the childrenhad been complicated with myocardial ischemia,the patients were divided into 2 groups:ischemic group and non-ischemic group.The duration of fever,the time when the intravenous immunoglobulin(IVIG) was first injected,the time when coronary artery aneurysms (CAA) was formed,the maximum diameter of CAA and inflammatory index inthe acute phase were compared between 2 groups.Results All of the 35 children diagnosed as KD combined with CAT suffered firom CAA,and the coronary thrombosis was detected in all the cases with aneurysms.Thirty-five patients had 99 branches of CAA,of which the maximum diameter of CAA was (9.6 ± 3.1) mm(4.0-19.0 mm).Fifty-four plots of CAT were detected in the aneurysms.The diameter of CAA that thrombosis located was larger than that of which the thrombosis was not located[(10.9 ± 2.8) mm vs.(7.9 ± 2.6) mm],and the difference was significant(P ＜0.01).During 4 months to 10 years and 8 months [(39.2 ±29.5) months] follow-ups,CAA regressed in 32 branches [32.3％ (32/99 branches)],of which 4 branches [4.0％ (4/99 branches)] completely regressed to the normal diameter.The maximum diameter of CAA regressed was smaller than the maximum diameter of CAA consistence [(7.3 ± 1.9) mm vs.(10.6 ± 3.0) mm],and the difference was significant (P ＜ 0.01).Out of 35 patients,15 cases [42.9％ (15/35 cases) had myocardial ischemia,while the other 20 cases[57.2％ (20/35 cases)] didn't have.Among 15 cases with myocardial ischemia,6 cases[17.1％ (6/35 cases)] had myocardial infarction,4 cases [11.4％ (4/35 cases)] had heart failure,and 1 case[2.9％ (1/35 cases)] died of acute heart failure complicated with severe ventricular arrhythmia.Compared with non-ischemic group,the children in the ischemic group had longer duration of fever[(19.1 ± 7.8) d vs.(12.1 ± 3.3) d],higher white blood cell account in the acute phase[(24.8 ± 13.5) × 1012/L vs.(19.7 ±4.0) × 1012/L],later treatment of IVIG [(13.9 ± 5.5) d vs.(9.8 ±3.8) d],and earlier CAA formation [(16.0 ±4.9) d vs.(20.9 ± 14.5) d],and the differences were statistically significant (all P ＜ 0.05).Conclusions CAT of children with KD commonly originates from CAA.Patients who have more serious inflammatory reaction in the acute phase,earlier formation,heavy severity and longer consistence of CAA are prone to have myocardial ischemia.Echocardiographic study plays an important role in monitoring CAA,detecting the CAT and finding the early left ventricle dysfunction,which is of clinical significance.

BACKGROUND:In recent years, endoplasmic reticulum stress-caused apoptosis plays a crucial role in ischemia impairment and has become the hotspot of studies addressing myocardial ischemia/reperfusion (I/R) injury. The lower limb ischemic preconditioning (LIP) has the obvious protective effect on the immature myocardium, but until now, no study reports whether LIP effects on endoplasmic reticulum stress apoptosis in immature myocardial cells. OBJECTIVE:To investigate the effect of LIP on endoplasmic reticulum stress and apoptosis.
METHODS:Langendorff-perfused isolated rabbit hearts were used in this study. Twenty-four immature rabbits were randomized into three groups. Control group:Isolated rabbit heart was only perfused with Krebs-Henseleit for 180 minutes. I/R group:Isolated rabbit heart was perfused 20 minutes, and then ischemia for 60 minutes fol owed by reperfusion 100 minutes. LIP group:Limbs were repeatedly obstructed 5 minutes and relaxed 5 minutes for three times, to establish Langendorff models, and then repeated the method of ischemia/reperfusion in I/R group. The myocardial apoptosis was assayed with TUNEL method. The expression of glucose-regulated protein 78, Bcl-2, Bax and Fas was detected with western blot analysis.
RESULTS AND CONCLUSION:Compared with I/R group, apoptosis rate was significantly lower, the expression of Bcl-2 was significantly higher, and the expression of glucose-regulated protein 78, Bax and Fas was significantly lower in LIP group. This study demonstrated that LIP regulates myocardial cellapoptosis through reducing the expression of endopasmic reticulum stress GRP78, Bax and Fas and increasing the expression of Bcl-2.

BACKGROUND: How to successfully obtain compact endothelium layers on smooth muscle cells is the most crucial part for the tissue-engineered vessels. OBJECTIVE: To explore the effects of different cell implantation concentrations on the construction of the complete biological tissue-engineered blood vessels.METHODS: Different concentrations of porcine vascular smooth muscle cells (5×105, 5×107 cells/L) were implanted on the porcine acellular vascular matrix to culture for 3 days. Then different concentrations of endothelial progenitor cells (5×105, 5×107 cells/L) were implanted on the smooth muscle cell-vascular matrix composite to construct lamellar complete biological tissue-engineered blood vessels.RESULTS AND CONCLUSION: The growth curves of high concentrations of smooth muscle cells on the acellular vascular matrix were similar to that of low concentrations. Moreover, the growth curves of cells implanted in the culture plates were similar to that implanted on the acellular matrix. However, cells in the low concentration groups have relatively low proliferation activity and low coverage rate. The cell coverage rate decreased as follows: high concentrations of endothelial progenitor cells+acellular matrix containing high concentrations of smooth muscle cells > high concentrations of endothelial progenitor cells+acellular matrix containing low concentrations of smooth muscle cells > low concentrations of endothelial progenitor cells+acellular matrix containing high concentrations of smooth muscle cells > low concentrations of endothelial progenitor cells+acellular matrix containing low concentrations of smooth muscle cells. Moreover, high concentrations of endothelial progenitor cells form relatively compact layers on the acellular matrix and show cobble-like growth. These findings indicate that an increase in the cell implantation concentrations is beneficial to the rapid formation of compact cell layers on the material surface.

BACKGROUND: Heart valve tissue engineering is aimed to construct heart valve grafts with the physiological function and biological activity by using engineering and life science principles and methods, but still in the animal experiment stage.OBJECTIVE: To summarize the commonly used tissue engineered heart valve, and to evaluate the reliability of different types of heart valve biomaterials.METHODS: Using "biological materials, heart valve, scaffolds, reviews, tissue engineering" in Chinese as the key words, a computer retrieval was performed for articles published from January 2000 to December 2010. Articles regarding the biomaterials in tissue engineered heart valve were included; the duplicated research or meta-analysis were excluded.RESULTS AND CONCLUSION: A total of 20 papers about the biomaterials and tissue engineering heart valve were screened out. Due to the superior biocompatibility and three-dimensional conformation, natural scaffold materials exhibit unparalleled bionic property compared with other materials. Synthetic biodegradable polymer materials with good mechanical properties and controllability has thus been highly favored by researchers, while the composite scaffold materials of natural materials and polymer materials provides a new strategy and direction for the investigations of tissue engineered heart valve, and has broad application prospects.