OBJECTIVE To investigate the effect of vitamin D receptor(VDR) genetic polymorphism on the concentration of tacrolimus in renal transplant recipients at early stage after transplantation.METHODS The 360 cases of renal transplant recipients who received tacrolimus, mycophenolic acid, and glucocorticoid were recruited. CYP3A5(rs776746) and VDR(VDR ApaI rs7975232, VDR BsmI rs1544410, VDR FokI rs2228570 and VDR TaqI rs731236) genotypes were determined. The differences of concentration(C), dose(D) and the ratio of concentration to dose(C/D) of tacrolimus were compared among all of the genotype groups at the seventh day after renal transplantation. RESULTS The C and C/D of tacrolimus in CYP3A5 non-expresser(GG genotype) were all significantly higher than CYP3A5 expresser(AA and AG genotype)(P<0.05). When taking the different CYP3A5 genotypes in consideration, it was found that the C/D in patients with VDR ApaI rs7975232 AA genotype was significantly lower than those with AC and CC genotypes for CYP3A5 non-expresser(P<0.05). However, VDR ApaI rs7975232 gene polymorphism had no influence on C and C/D of tacrolimus in CYP3A5 expresser. Besides, no matter in CYP3A5 expresser or in non-expresser, VDR BsmI rs1544410, VDR TaqI rs731236 and VDR FokI rs2228570 had no effect on C, D and C/D of tacrolimus. CONCLUSION During the early stage of renal transplantation, the polymorphism of VDR ApaI rs7975232 show significant relevance with tacrolimus concentration in CYP3A5 non-expresser. The detection of the genotype might be helpful to guide individual therapy.

To investigate the effect of interventional thrombolysis combined with hyperbaric oxygen on the NHISS score and quality of life in patients with acute obstructive cerebral infarction.Methods A total of 97 elderly patients with acute obstructive cerebral infarction admitted to our hospital from January 2018 to January 2021 were selected and randomly divided into the control group and the observation group using the random number table method.The control group received interventional thrombolysis，while the observation group received interventional thrombolysis combined with hyperbaric oxygen therapy.The NHISS score，treatment efficacy，SF36 scale for quality of life，ADL score for daily living ability and satisfaction rate were compared between the two groups.Results There were 49 patients in the control group and 48 in the observation group.The NHISS scores of the observation group were significantly lower than those of the control group at 1 month after admission ［（9.81±1.85） vs （11.24±2.45），P=0.002］ and 6 months after admission［（7.98±1.67） vs （9.94±1.78），P<0.001］.The proportion of cured + effective in the observation group was significantly higher than that in the control group （P=0.04）.The overall health，vitality，mental health，physiological function，physiological limitations，social function and somatic pain scores of the observation group were significantly higher than those of the control group.The ADL scores［（71.31±16.60） vs （39.69±8.75），P<0.001］and satisfaction rate［（97.92% vs 85.71），P=0.03］ of the observation group were significantly higher than those of the control group.Conclusion Interventional thrombolysis combined with hyperbaric oxygen therapy in the treatment of acute cerebral infarction can help improve patients' neurological function，restore daily living ability，and improve their quality of life.

OBJECTIVE:To establish population pharmacokinetics(PPK)model of vancomycin so as to evaluate the effects of cystatin C(Cys C)on the pharmacokinetics parameters of vancomycin. METHODS:Totally 333 times therapeutic drug monitoring (TDM)were retrospectively collected from 225 patients who received vancomycin. Using sex,age,body weight(mT),Scr and Cys C as covariates,PPK model was established by using nonlinear mixed effect model method. Bootstrap method and normal prediction distribution error(NPDE)method were adopted for internal validation of model. Forty times of TDM data were collected from other 27 patients for external validation. Predicted accuracy and precision of model were investigated with mean prediction error (MPE) and root mean square error (RMSE). The effects of Cys C change on pharmacokinetic parameters of vancomycin were evaluated with steady state trough concentration and apparent clearance rate (CL/F) of vancomycin in typical patient (65 year-old,64 kg,Scr 66 μmol/L,1 000 mg,q12 h)forecasted with the final model at different levels of Cys C. RESULTS:CL/F of vancomycin was significantly influenced by age,body weight,the levels of Scr and Cys C. The final model was CL/F(L/h)＝3.68×(Scr/66)－0.431×(mT/64)1.1×(Age/65)－0.368×(Cys C/1.04)－0.693,V/F was equal to 82.5 L. The robust rate verified by Bootstrap method was 100%. Except for the interindividual variation of V/F,the relative bias of other pharmacokinetic parameters was less than 5%,and the estimated parameters of the final model were in the 95% confidence intervals of estimated values of Bootstrap. NPDE results showed that the homogeneity of variance was consistent with normal distribution (P＞0.05). In external validation,MPE and RMSE of the simplest model were －1.52 μg/mL and 6.87 μg/mL. MPE and RMSE of the final model were －0.32 μg/mL and 4.27 μg/mL,the accuracy and precision were improved significantly in the final model. When Cys C levle of typical patient was 0.3-4.0 mg/L,the steady state trough concentration predicted by final model were 5.25-29.97 μ g/mL and CL/F were 1.45-8.71 L/h. CONCLUSIONS:Age,body weight,the levels of Scr and Cys C significantly influence the pharmacokinetic parameters of vancomycin;moreover,the level of Cys C can change blood concentration of vancomycin. Established PPK model is of great predictive performance,which can be used to estimate the individual pharmacokinetics parameters of vancomycin.

Aim To investigate the mechanism of dia-betes changing the hepatic CYP1 A2 through in vitro cell culture study.Methods The function of CYP1 A2 in HepG2 and Fa2N-4 cells were evaluated by determi-ning the level of phenacetin metabolism,and the mR-NA expression of CYP1 A2 in cells was detected by real time PCR.HepG2 cells were co-cultured with serum of diabetic rats(type 1 and type 2)and normal rats,then the CYP1 A2 function in cells were evaluated.Then, the HepG2 and Fa2N-4 cells were co-cultured with a series of concentrations of saturated (including palmitic acid and stearic acid)and unsaturated fatty acids(in-cluding oleic acid and linoleic acid)for 48 h,and the function and expression of CYP1 A2 in the cells were compared.Results It was found that the activities of CYP1 A2 were higher in cells incubated with diabetic serum of both type.All high concentration of fatty acids could increase the function and expression of CYP1 A2 in both HepG2 and Fa2N-4 cells.Conclusion It is speculated that the abnormal level of fatty acids under diabetic state might be part of the reasons why diabetes change the hepatic CYP1 A2,which provides the basis for future study.

Objective:To investigate the correlation of the blood concentration of tacrolimus ( Tac) and serum cystatin C ( SCysC) and serum creatinine (Scr) in the patients with renal transplantation. Methods:Totally 84 cases of renal transplantation patients (67 male/17 female) treated with Tac were involved. The blood concentration of Tac, SCysC and Scr were monitored after the operation. Data results were categorized according to the postoperative time and the blood concentration. The correlations of Tac blood concentra-tion,SCysC and Scr were analyzed and compared by using Pearson correlation analysis. Results: The blood concentration of Tac was not significantly associated with SCysC and Scr in different postoperative time groups and different drug concentration groups ( P >0. 05). As the extension of time,the blood concentration of Tac showed a gradual declining trend, while SCysC and Scr levels de-creased first, and then increased gradually after two years of the operation. Conclusion:The blood concentration of Tac has no effect on the function evaluation of transplanted kidney by the biochemical indicators such as SCysC and Scr.

Background The introvitreal injection of triamcinolone acetonide (TA) before vitrectomy for retinal with choroidal detachment (RD/CD) can alleviate inflammatory response,but it easily lead to complications under the low intraocular pressure.The study on the efficiency and safety of subtenon injection of TA for treatment of RD/CD is lack.Objective This study was to evaluate the efficiency and safety of subtenant injection of TA with vitrectomy for treatment of RD/CD.Methods A retrospective study was adopted.The data of 22 eyes of 22patients who received subtenon injection of TA with vitrectomy for RD/CD were collected and analyzed in Affiliated Eye Hospital of Wenzhou Medical University from May 2010 to June 2014.TA of 40 mg in 0.4 ml was administered subtenantly 5 days before RD repair surgery.After initiating the treatment,the therapeutic effects on uvitis were analyzed.Intraocular pressure was monitored and CD height and range were determined by B type ultrasonography before injection and 5 days after injection respectively.In addition,blood glucose and blood pressure of the patients were evaluated.Results Ocular inflammation alleviated to some degree after TA injection in all 22 eyes.The mean intraocular pressure was (5.4±2.9) mmHg (1 mmHg =0.133 kPa) in pre-injection and (8.2±4.3) mmHg in postinjection,showing a significant difference between them (t =3.430,P ＜ 0.01).The mean maximum CD height was 5.2 (3.1,6.6)mm in pre-injection and 0.9 (0,3.8)mm in post-injection,with a significant difference between the before and after injection (Z=-4.198,P＜0.01).The mean CD range was 12 (10,12) clock before injection and 3(0,6) clock after injection,and no significant difference was found between before and after injection (all at P＞0.05) (Z=-4.124,P＜0.01).There were no statistically significant difference in the changes of blood glucose and blood pressure between before and after injection.The LogMAR visual acuities were 2.14±0.46,1.29±0.57 and 1.17±0.55 before injection and 1 month,3 months after injection,respectively,with a siginificant difference among them (F =22.060,P＜0.001).The retinal reattachment rate was 95.5 ％.Conclusions Subtenon injection of TA seems to be a good option for perisurgical management of RD/CD patients,which can alleviate uvitis,increase intraocular pressure,reduce CD height and CD range.

Objective To investigate the prevalence of diabetes and prediabetes in northeast Sichuan area.Methods A total of 8 053 adult residents(over 18 years old)from the hospital who had underwent physical examination were recruited in the study.The concentrations of Fasting plasma glucose(FPG),glycated hemoglobin A1c(HbA1C)and blood lipids were measured.Diabetes and prediabetes were defined according to the 2013 American Diabetes Association criteria.Results The FPG and HbA1C concentra-tions increased with age.The overall prevalence of diabetes and prediabetes were estimated to be 8.5% and 39.6% in the adult pop-ulation in northeast sichuan area respectively.The prevalence of diabetes and prediabetes in men were significantly higher than those in women(10.7% vs.5.7%,41.5% vs.37.2%,P <0.05,respectively).Furthermore,the prevalence of diabetes increased with age,and the prevalence of prediabetes had a trend of first enhancement followed by a decline.Conclusion The prevalence of diabe-tes and prediabetes are relatively high in northeast Sichuan area.

OBJECTIVE: To determine whether non-linear blending technique for arterial-phase dual-energy abdominal CT angiography (CTA) could improve image quality compared to the linear blending technique and conventional 120 kVp imaging. MATERIALS AND METHODS: This study included 118 patients who had accepted dual-energy abdominal CTA in the arterial phase. They were assigned to Sn140/80 kVp protocol (protocol A, n = 40) if body mass index (BMI) < 25 or Sn140/100 kVp protocol (protocol B, n = 41) if BMI > or = 25. Non-linear blending images and linear blending images with a weighting factor of 0.5 in each protocol were generated and compared with the conventional 120 kVp images (protocol C, n = 37). The abdominal vascular enhancements, image noise, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) and radiation dose were assessed. Statistical analysis was performed using one-way analysis of variance test, independent t test, Mann-Whitney U test, and Kruskal-Wallis test. RESULTS: Mean vascular attenuation, CNR, SNR and subjective image quality score for the non-linear blending images in each protocol were all higher compared to the corresponding linear blending images and 120 kVp images (p values ranging from < 0.001 to 0.007) except for when compared to non-linear blending images for protocol B and 120 kVp images in CNR and SNR. No significant differences were found in image noise among the three kinds of images and the same kind of images in different protocols, but the lowest radiation dose was shown in protocol A. CONCLUSION: Non-linear blending technique of dual-energy CT can improve the image quality of arterial-phase abdominal CTA, especially with the Sn140/80 kVp scanning.
Adult ; Aged ; Angiography/*methods ; Body Mass Index ; Female ; Humans ; Male ; Middle Aged ; Observer Variation ; Radiation Dosage ; Radiographic Image Enhancement/methods ; Radiographic Image Interpretation, Computer-Assisted/*methods ; Radiography, Abdominal/*methods ; Signal-To-Noise Ratio ; Statistics, Nonparametric ; Tomography, X-Ray Computed/*methods

Objective To establish reference interval of hemoglobin A1c(HbA1c) determined in healthy adults in northeast Si-chuan .Methods Venous blood was pumped from 494 individuals without previously diagnosed diabetes and other critical illness . The HbA1c level ,blood routine examination ,blood lipids ,fasting plasma glucose ,liver and kidney function were measured . Reference value of HbA1c was determined by 95% confidence interval through the mean of HbA1c .Results The HbA1c level took on normal distribution in 494 healthy individuals ,and the reference interval was 4 .482% -6 .012% .There was no statistical signifi-cance of HbA1c level between different genders(t= -0 .905 ,P= 0 .366) .The levels of HbA1c in 20 - < 35 years old people , 35- <65 years old people and ≥65 years old people were(5 .109 ± 0 .150)% ,(5 .224 ± 0 .122)% ,(5 .444 ± 0 .125)% ,and the differences were statistically significant among different age group(P<0 .05) .The HbA1c level and age were positively correlated (r=0 .338 ,P<0 .01) .Conclusion It is necessary to establish appropriate reference intervals of HbA1c for different laboratories or areas .

Experimental report is an important segment of the experimental teaching pro-cess.This article analyzes the current status and factors that influence the quality of experimental report,puts foreword some countermeasures on how to enhance the experimental teaching by im-proving the writing of experimental reports,in order to achieve the purpose of improving the quality of clinical experimental teaching of clinical biochemistry and laboratory.