Objective:Compared with long-term renal replacement therapy,kidney transplantation is the ideal treatment for end-stage renal disease(ESRD),significantly extending patient life and improving quality of life.Kidney transplant patients need to adhere to lifelong immunosuppressive medication regimens,but their medication adherence is generally poor compared with other organ transplant recipients.Medication adherence is closely related to medication literacy and psychological status,yet related studies are limited.This study aims to investigate the current status of medication adherence,inner strength,and medication literacy in kidney transplant patients,analyze the relationships among these 3 factors,and explore the mediating role of inner strength in the relationship between medication literacy and medication adherence. Methods:A cross-sectional survey was conducted from March to October 2023 involving 421 patients aged≥18 years who visited kidney transplantation outpatient clinics at 4 tertiary hospitals in Hunan Province.The inner strength,medication literacy,and medication adherence of kidney transplant patients were investigated using the Inner Strength Scale(ISS),the Chinese version of the Medication Literacy Assessment in Spanish and English(MedLitRxSE),and the Chinese version of the Morisky Medication Adherence Scale-8(C-MMAS-8),respectively.Univariate analysis was performed to examine the effects of demographic and clinical data on medication adherence.Correlation analysis was conducted to explore the relationships among medication literacy,medication adherence,and inner strength.Significant variables from univariate and correlation analyses were further analyzed using multiple linear regression,and the mediating effect of inner strength was explored. Results:Among the 421 questionnaires collected,408 were valid,with an effective rate of 96.91％.The scores of C-MMAS-8,MedLitRxSE,and ISS were 6.64±1.16,100.63±14.67,and 8.47±4.03,respectively.Among the 408 patients,only 86(21.08％)patients had a high level of medication adherence,whereas 230(56.37％)patients had a medium level of medication adherence,and 92(22.55％)patients had poor medication adherence.Univariate analysis indicated that the kidney transplant patients'age,marital status,education levels,years since their kidney transplant operation,number of hospitalizations after the kidney transplant,and adverse drug reactions showed significant differences in medication adherence(all P＜0.05).Correlation analysis showed that inner strength positively correlated with both medication literacy(r=0.183,P＜0.001)and medication adherence(r=0.201,P＜0.00l).Additionally,there was a positive correlation between medication adherence and medication literacy(r=0.236,P＜0.00l).Inner strength accounted for 13.22％of the total effect in the mediating role between medication literacy and medication adherence. Conclusion:The level of medication adherence among kidney transplant patients needs improvement,and targeted intervention measures are essential.Inner strength mediates the relationship between medication literacy and medication adherence in these patients.Healthcare professionals should focus on enhancing medication literacy and supporting patients'inner strength to improve medication adherence.

Objective:To investigate the effect of mindfulness-based cognitive therapy (MBCT) on mindfulness attention awareness, experiential avoidance, and cognitive fusion in individuals with general anxiety disorder(GAD).Methods:A total of 53 patients aged 18-60 years who met the GAD diagnostic criteria of DSM-5 were selected from the Seventh People's Hospital of Hangzhou from May 2021 to September 2022.After receiving routine treatment, patients were randomly assigned to two groups: MBCT group( n=26) for an 8-week mindfulness cognitive therapy and health education group( n=27) for an 8-week health education program. Participants were evaluated using the generalized anxiety disorder scale(GAD-7), acceptance and action questionnaire-2nd edition(AAQ-Ⅱ), cognitive fusion questionnaire(CFQ), and mindful attention awareness scale (MAAS) before and after the intervention.Data were analyzed using SPSS 26.0 software, with the chi-square test, independent sample t-test, and paired sample t-test. Results:(1)There was no significant difference in MAAS score between the two groups before the intervention (42.63±10.18, 47.67±9.52, t=-1.55, P=0.13). However, after the intervention, the MAAS score in MBCT group was significantly higher than that in the health education group(54.42±9.87, 47.83±7.59, t=-2.27, P=0.03). (2) No significant difference was observed in CFQ score between the two groups before the intervention (57.11±15.97, 53.50±12.01, t=-0.77, P=0.45). However, after the intervention, the CFQ score in the MBCT group was significantly lower than that in the health education group(38.32±10.31, 47.11±10.66, t=-2.51, P<0.01). (3) There was no significant difference in AAQ-Ⅱ scores between the two groups before the intervention(33.79±7.90, 30.00±7.23, t=1.52, P=0.14). After the intervention, the AAQ-Ⅱ score in the MBCT group was significantly lower than that in the health education group(21.89±8.69, 30.22±8.68, t=-3.51, P<0.01) . Conclusion:MBCT has a positive effect on enhancing mindfulness attention awareness, reducing cognitive fusion, and mitigating experiential avoidance in GAD patients.

Objective:To perform cross-cultural adaption of the KING′s Parkinson′s Disease Pain Scale (KPPS), explore its reliability and validity in Chinese Parkinson′s disease (PD) patients, and to create the new version of the pain scale which adapts to the Chinese PD patients.Methods:This study enrolled 225 patients, including 121 men and 104 women who were selected from the Outpatient Center of Movement Disorders Clinic of the Second Affiliated Hospital of Soochow University from July 2018 to July 2020. All patients completed the evaluation of the Chinese Version of KPPS (KPPS-CV). According to the preliminary evaluation results, the expert group modified KPPS-CV after discussion, and developed a Modified KPPS-CV (MKPPS-CV). These patients then completed the MKPPS-CV evaluation during the 3-month follow-up. Cross-cultural adaptation was performed according to published international guidelines that include translation, back-translation, expert review, and pretesting. The following psychometric properties were evaluated: basic item analysis; floor and ceiling effects; construct validity; content validity; criterion validity (Spearman′s rho between the KPPS-CV and Numeric Rating Scale); internal consistency reliability (Cronbach′s alpha); test-retest reliability (intra-class correlation coefficient, ICC).Results:In item analysis, 50% of the items had poor discrimination (critical ratio<3.0), and floor effect was found in all domains (proportion of 0 point>15%). The items were reclassified after exploratory factor analysis. The content validity of item 3, item 10 and item 11 was low (item-level content validity index<0.78). Criterion validity showed the highest correlations (Spearman′s rho>0.88) between the KPPS-CV and Numeric Rating Scale. While overall scale reliability was minimally acceptable at 0.46, which showed a poor reliability of this scale. Test-retest reliability was excellent for each item (Spearman's rho>0.85). The Cronbach′s alpha of MKPPS-CV (0.76) was higher than that of KPPS-CV (0.46). It showed a great improvement after the modifying.Conclusions:When using scales that are not developed for local populations, differences in culture and clinical practices should be taken into account. MKPPS-CV is an acceptable, valid measure to evaluate pain in Chinese PD patients, which is more suitable for Chinese people.

Objective:To evaluate the efficacy and safety of endoscopic stricturotomy (EST) under balloon-assisted enteroscopy (BAE) in treatment of benign jejuno-ileal stenosis.Methods:From December 2015 to August 2021, at the Air Force Medical Center, 41 patients who were diagnosed with benign jejuno-ileal stenosis underwent BAE deep small bowel EST and/or surgery due to ineffective or ineffective drug treatment were retrospectively analyzed. Twenty-one patients were treated with EST (EST group) and 20 patients were treated with surgery (surgery group). The etiology and follow-up time were analyzed, the general conditions (male proportion and age), the immediate technical success rate (the percentage of the stenosis that the enteroscope could pass through after EST in the total number of treated stenoses), the incidence of complications (including perforation, bleeding, etc.), the symptom remission rates at 3-month, 6-month, and 1-year after treatment (the percentage of patients with complete or partial remission in the total number of patients), cumulative symptom-free survival rate (no obstruction-related symptoms after EST or surgery till the last follow-up) and cumulative surgery-free survival rate of two groups were compared. Chi-square test, independent t-test, Fisher′s exact probability method and Kaplan-Meier analysis were used for statistical analysis. Results:The main etiology of stricture of EST group and surgery group was Crohn′s disease (71.4%, 15/21 and 60.0%, 12/20, respectively), and the median follow-up time was 12 months (6 to 46 months) and 45 months (14 to 73 months), respectively. There were no significant differences in male proportion, age, immediate technical success rate and incidence of complication between EST group and surgery group (57.1%, 12/21 vs. 65.0%, 13/20; (45.2±17.4) years old vs. (43.1±20.3) years old; 95.3%, 41/43 vs. 100.0%, 30/30; 26.9%, 7/26 vs. 10.0%, 2/20, all P>0.05). In the EST group, 9.5% (2/21) of the patients received surgery because of perforation during EST, 76.2% (16/21) of the patients did not need surgery after EST, and the median symptom-free survival time of patients without symptoms in EST group was 13.3 months. There was no significant difference in the symptom remission rate at 3-month after treatment between EST group and the surgery group (17/19 vs. 100.0%, 20/20, P>0.05). The symptom remission rate at 6-month and 1-year of EST group were lower than those of the surgery group (15/19 vs. 100.0%, 20/20; 8/11 vs. 100.0%, 20/20), and the differences were statistically significant (both were Fisher′s exact probability method, P=0.047 and 0.037). The cumulative symptom-free survival rates at 3-month, 6-month and 1-year of EST group and surgery group were 66.0% vs. 90.0%, 61.0% vs. 85.0% and 54.0% vs. 80.0%, respectively.The results of Kaplan-Meier analysis indicated that there was no significant difference in the symptom-free survival curve between two groups ( P>0.05). The 3-month, 6-month and 1-year cumulative surgery-free survival rates after treatment in EST group were 90.0%, 81.0% and 73.0%, respectively. The 3-month, 6-month and 1-year cumulative surgery-free survival rates after treatment in surgery group were all 100.0%. Conclusion:EST under BAE is technically feasible, and safe in the treatment of benign jejuno-ileal stenosis, and can effectively relieve clinical obstruction symptoms and avoid or delay surgery in the short term.

Objective:To analyze the relationship between renin-angiotensin-aldosterone system (RAAS) gene polymorphisms and susceptibility to essential hypertension (EH) in military secret service personnel.Methods:In October 2019, military secret service personnel (162 people) who were recuperating in a sanatorium from January to December 2017 were selected as the research subjects, all of whom were Han and male. The patients (79 people) who were diagnosed with EH according to the diagnostic criteria of hypertension in the "Chinese Guidelines for the Prevention and Treatment of Hypertension" (2016 Revised Edition) were the case group, and the people with normal blood pressure (83 people) were the control group. Occupational epidemiological investigation was conducted, 5 ml of fasting cubital venous blood was collected, genomic DNA was extracted by phenol-chloroform method, and RAAS gene polymorphism was detected by polymerase chain reaction-restriction fragment length polymorphism method. The distribution differences of genotype and allele frequency between groups were compared, and the relationship between genotype, allele frequency and EH was analyzed.Results:The average age of military secret service personnel was (38.2±5.3) years old, and there was no statistical significance in the average age and the age distribution over 40 years old of the case group and the control group ( P>0.05) . There were significant differences in the distribution of AGT gene M235T locus, ACE gene I/D polymorphism genotype and allele between the case group and the control group ( P<0.05) . The TT genotype with AGT gene M235T locus ( OR=3.28, 95% CI: 1.21-8.91) and DD genotype with ACE gene ( OR=2.86, 95% CI: 1.17-7.00) were risk factors for EH in military secret service personnel. Conclusion:The TT genotype of AGT gene M235T and the DD genotype of ACE gene may be the susceptibility genotypes of military secret service personnel for EH.

Objective:To analyze the relationship between renin-angiotensin-aldosterone system (RAAS) gene polymorphisms and susceptibility to essential hypertension (EH) in military secret service personnel.Methods:In October 2019, military secret service personnel (162 people) who were recuperating in a sanatorium from January to December 2017 were selected as the research subjects, all of whom were Han and male. The patients (79 people) who were diagnosed with EH according to the diagnostic criteria of hypertension in the "Chinese Guidelines for the Prevention and Treatment of Hypertension" (2016 Revised Edition) were the case group, and the people with normal blood pressure (83 people) were the control group. Occupational epidemiological investigation was conducted, 5 ml of fasting cubital venous blood was collected, genomic DNA was extracted by phenol-chloroform method, and RAAS gene polymorphism was detected by polymerase chain reaction-restriction fragment length polymorphism method. The distribution differences of genotype and allele frequency between groups were compared, and the relationship between genotype, allele frequency and EH was analyzed.Results:The average age of military secret service personnel was (38.2±5.3) years old, and there was no statistical significance in the average age and the age distribution over 40 years old of the case group and the control group ( P>0.05) . There were significant differences in the distribution of AGT gene M235T locus, ACE gene I/D polymorphism genotype and allele between the case group and the control group ( P<0.05) . The TT genotype with AGT gene M235T locus ( OR=3.28, 95% CI: 1.21-8.91) and DD genotype with ACE gene ( OR=2.86, 95% CI: 1.17-7.00) were risk factors for EH in military secret service personnel. Conclusion:The TT genotype of AGT gene M235T and the DD genotype of ACE gene may be the susceptibility genotypes of military secret service personnel for EH.

Objective:To evaluate the application effect of a personalized nutritional program based on nutrition risk screening in kidney transplant patients.Methods:Using the convenient sampling method, a total of 90 patients who completed kidney transplantation in the Second Xiangya Hospital of Central South University from November 2020 to May 2021 were selected as the research objects. Envelopes were used to draw lots, and patients were randomly divided into the control group (45 cases) and the test group (45 cases) . The control group was given routine basic treatment and nursing care, while the test group was given a personalized nutrition plan based on nutritional risk screening at basis of the control group. The changes of nutritional indexes such as total protein, albumin, prealbumin, retinol-binding protein, serum iron, total iron-binding capacity, and hemoglobin were observed before operation and on the 3rd, 7th, and 14th days after operation in the two groups. The changes of renal function indicators (such as serum creatinine level, endogenous creatinine clearance rate, glomerular filtration rate) were compared between the two groups, and the incidence of readmission within 3 months of discharge was compared between the two groups.Results:The levels of retinol-binding protein in the experimental group on the 3rd, 7th, and 14th days of intervention were better than those in the control group, while the serum creatinine level and glomerular filtration rate were lower than those in the control group, and the differences were statistically significant ( P<0.05) . On the 14th day of intervention, the levels of total protein, hemoglobin, total iron binding capacity and serum iron in the test group were higher than those in the control group, and the clearance rate of endogenous creatinine was lower than that in the control group, and the differences were statistically significant ( P<0.05) . Repeated measures analysis of variance showed that time had an effect on the recovery of nutritional and renal function indexes of patients in both groups ( P<0.05) . There were statistically significant differences in the levels of total protein, hemoglobin, retinol-binding protein, serum creatinine and the main effect of glomerular filtration rate intervention between the two groups ( P<0.05) . And there was an interaction between intervening factors and time of hemoglobin, retinol-binding protein and serum iron levels ( P<0.05) . After 3 months of follow-up, the readmission rate of patients in the experimental group was 0, and that in the control group was 13.6% (6/44) , and the difference was statistically significant ( P<0.05) . Conclusions:Nutritional risk screening combined with personalized nutrition program can effectively improve the nutritional status of kidney transplant patients, promote the recovery of transplanted kidney function, reduce the readmission rate and improve the clinical outcome of patients.

OBJECTIVES: To summarize the emergency management of the kidney transplantation for a large tertiary first-class hospital in response to the epidemic of coronavirus disease 2019 (COVID-19). METHODS: The clinical data of inpatients in the Department of Kidney Transplantation from January 24, 2020 to February 29, 2020 were retrospectively analyzed. Since the outbreak of COVID-19, we conducted telephone, Wechat follow-up, and online education for kidney transplant recipients and patients on waiting-list for kidney transplantation one by one. We also strictly screened for COVID-19 in outpatients. To guarantee the security of medical staff and recipients and to reduce the transmission risk of COVID-19, we have made detailed approaches to prevent COVID-19, which mainly included 6 aspects of preventive approaches, such as kidney transplant clinic, kidney transplant ward, patients on waiting-list for kidney transplantation, kidney transplant operation, medical staff self-protection, and postoperative follow-up of kidney transplant recipients. RESULTS: There were altogether 47 inpatients which included 20 recipients who had just received kidney transplantation in the meantime, 2 577 kidney transplant recipients, 1 689 patients on waiting-list for kidney transplantation, and 794 outpatients in our hospital. No case of COVID-19 occurred in this period. CONCLUSIONS Through strictly implementing proactive and preventive approaches, we avoid the occurrence of COVID-19 in carrying out kidney transplantation in the epidemic period.
Betacoronavirus ; Coronavirus Infections ; epidemiology ; prevention & control ; Humans ; Kidney Transplantation ; Pandemics ; prevention & control ; Pneumonia, Viral ; epidemiology ; prevention & control ; Retrospective Studies ; Tertiary Care Centers ; Transplant Recipients ; Waiting Lists

Objective To explore the mechanism and clinical significance of left atrioventricular interval abnormality in the patients with coronary artery disease.Methods A total of 48 patients with coronary artery disease were selected and divided into the left interval atrioventricular shortening group(AV≤100 ms) and the left atrioventricular interval normal group(AR＞100 ms) according to the left atrioventricular interval measured by the esophageal electrocardiogram.The clinical features,cardiac echocardiography and coronary vessel lesions were compared between the two groups.Results The age in the AR≤ 100 ms group was higher than that in the AR＞10 ms group(P=0.018);the proportion of right coronary arterial lesion in the AR ≤ 100 ms group was higher in that in the AR＞10ms group(P=0.038);the left atrial diameter in the AR ≤100ms group was enlarged compared with that in the AR＞ 100 ms group(P=0.041).Conclusion The cardiac electric transduction abnormality exists in the patients with coronary heart disease,the majority of the patients with left atrioventricular interval shortening have the right coronary artery lesion.

Objective: To investigate the incidence rate of transjugular intrahepatic portosystemic shunt (TIPS) complications in the treatment of cirrhotic portal hypertension, and analyze the cause of complication to management methods. Methods: Data of 116 patients obtained from Zhongnan Hospital of Wuhan University were retrospectively analyzed. Portal venous pressure, routine blood test, coagulation test, liver and kidney function test, ammonia blood test, imaging and endoscopy reports were collected before and after procedure. The incidence rate of hepatic encephalopathy, gastrointestinal bleeding, ascites and shunt dysfunctions were observed. Data were expressed as mean ± Standard deviation and analyzed by t-test. A chi-squared test was used for comparison between categorical variables. Results: The success rate of TIPS operation was 97.41% (113/116). Two patients underwent prompt TIPS procedure due to active bleeding. Bleeding was successfully stopped. Portal venous pressure of 113 patients decreased from (42.73 ± 7.64) cmH₂O to (24.92 ± 7.60) cmH₂O, and the difference was statistically significant (P < 0.01). Twenty cases were of hepatic encephalopathy. Preoperative level of Child-pugh class C patients was more susceptible to hepatic encephalopathy within 3 months after procedure than class A and B. After TIPS procedure, there were 22 cases of gastrointestinal bleeding, 18 cases of shunt dysfunctions and 26 cases of disease related death. Conclusion Rational patient selection strategies can effectively reduce portal venous pressure, incidence of hepatic encephalopathy, improve mid-and long-term therapeutic effects, and provide opportunities for liver transplantation.