1.Mechanism of n-butanol alcohol extract of Baitouweng Decoction in treatment of vulvovaginal candidiasis based on negative regulation of NLRP3 inflammasome via PKCδ/NLRC4/IL-1Ra axis.
Kai-Fan HU ; Ling MO ; Hao ZHANG ; Dan XIA ; Gao-Xiang SHI ; Da-Qiang WU ; Tian-Ming WANG ; Jing SHAO ; Chang-Zhong WANG
China Journal of Chinese Materia Medica 2023;48(6):1578-1588
This study aimed to explore the mechanism of n-butanol alcohol extract of Baitouweng Decoction(BAEB) in the treatment of vulvovaginal candidiasis(VVC) in mice based on the negative regulation of NLRP3 inflammasome via PKCδ/NLRC4/IL-1Ra axis. In the experiment, female C57BL/6 mice were divided randomly into the following six groups: a blank control group, a VVC model group, high-, medium-, and low-dose BAEB groups(80, 40, and 20 mg·kg~(-1)), and a fluconazole group(20 mg·kg~(-1)). The VVC model was induced in mice except for those in the blank control group by the estrogen dependence method. After modeling, no treatment was carried out in the blank control group. The mice in the high-, medium-, and low-dose BAEB groups were treated with BAEB at 80, 40, and 20 mg·kg~(-1), respectively, and those in the fluconazole group were treated with fluconazole at 20 mg·kg~(-1). The mice in the VVC model group received the same volume of normal saline. The general state and body weight of mice in each group were observed every day, and the morphological changes of Candida albicans in the vaginal lavage of mice were examined by Gram staining. The fungal load in the vaginal lavage of mice was detected by microdilution assay. After the mice were killed, the degree of neutrophil infiltration in the vaginal lavage was detected by Papanicolaou staining. The content of inflammatory cytokines interleukin(IL)-1β, IL-18, and lactate dehydrogenase(LDH) in the vaginal lavage was tested by enzyme-linked immunosorbent assay(ELISA), and vaginal histopathology was analyzed by hematoxylin-eosin(HE) staining. The expression and distribution of NLRP3, PKCδ, pNLRC4, and IL-1Ra in vaginal tissues were measured by immunohistochemistry(IHC), and the expression and distribution of pNLRC4 and IL-1Ra in vaginal tissues were detected by immunofluorescence(IF). The protein expression of NLRP3, PKCδ, pNLRC4, and IL-1Ra was detected by Western blot(WB), and the mRNA expression of NLRP3, PKCδ, pNLRC4, and IL-1Ra was detected by qRT-PCR. The results showed that compared with the blank control group, the VVC model group showed redness, edema, and white secretions in the vagina. Compared with the VVC model group, the BAEB groups showed improved general state of VVC mice. As revealed by Gram staining, Papanicolaou staining, microdilution assay, and HE staining, compared with the blank control group, the VVC model group showed a large number of hyphae, neutrophils infiltration, and increased fungal load in the vaginal lavage, destroyed vaginal mucosa, and infiltration of a large number of inflammatory cells. BAEB could reduce the transformation of C. albicans from yeast to hyphae. High-dose BAEB could significantly reduce neutrophil infiltration and fungal load. Low-and medium-dose BAEB could reduce the da-mage to the vaginal tissue, while high-dose BAEB could restore the damaged vaginal tissues to normal levels. ELISA results showed that the content of inflammatory cytokines IL-1β, IL-18, and LDH in the VVC model group significantly increased compared with that in the blank control group, and the content of IL-1β, IL-18 and LDH in the medium-and high-dose BAEB groups was significantly reduced compared with that in the VVC model group. WB and qRT-PCR results showed that compared with the blank control group, the VVC model group showed reduced protein and mRNA expression of PKCδ, pNLRC4, and IL-1Ra in vaginal tissues of mice and increased protein and mRNA expression of NLRP3. Compared with the VVC model group, the medium-and high-dose BAEB groups showed up-regulated protein and mRNA expression of PKCδ, pNLRC4, and IL-1Ra in vaginal tissues and inhibited protein and mRNA expression of NLRP3 in vaginal tissues. This study indicated that the therapeutic effect of BAEB on VVC mice was presumably related to the negative regulation of NLRP3 inflammasome by promoting PKCδ/NLRC4/IL-1Ra axis.
Female
;
Animals
;
Humans
;
Mice
;
Candidiasis, Vulvovaginal/drug therapy*
;
Inflammasomes/genetics*
;
Interleukin-18
;
NLR Family, Pyrin Domain-Containing 3 Protein/genetics*
;
1-Butanol/pharmacology*
;
Fluconazole/therapeutic use*
;
Interleukin 1 Receptor Antagonist Protein/therapeutic use*
;
Mice, Inbred C57BL
;
Candida albicans
;
Cytokines
;
Drugs, Chinese Herbal/pharmacology*
;
Ethanol
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RNA, Messenger
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Calcium-Binding Proteins/therapeutic use*
2.Casticin Attenuates Stemness in Cervical Cancer Stem-Like Cells by Regulating Activity and Expression of DNMT1.
Xue-Li WANG ; Xiao-Zheng CAO ; Dao-Yuan WANG ; Ye-Bei QIU ; Kai-Yu DENG ; Jian-Guo CAO ; Shao-Qiang LIN ; Yong XU ; Kai-Qun REN
Chinese journal of integrative medicine 2023;29(3):224-232
OBJECTIVE:
To explore whether casticin (CAS) suppresses stemness in cancer stem-like cells (CSLCs) obtained from human cervical cancer (CCSLCs) and the underlying mechanism.
METHODS:
Spheres from HeLa and CaSki cells were used as CCSLCs. DNA methyltransferase 1 (DNMT1) activity and mRNA levels, self-renewal capability (Nanog and Sox2), and cancer stem cell markers (CD133 and CD44), were detected by a colorimetric DNMT activity/inhibition assay kit, quantitative real-time reverse transcription-polymerase chain reaction, sphere and colony formation assays, and immunoblot, respectively. Knockdown and overexpression of DNMT1 by transfection with shRNA and cDNA, respectively, were performed to explore the mechanism for action of CAS (0, 10, 30, and 100 nmol/L).
RESULTS:
DNMT1 activity was increased in CCSLCs compared with HeLa and CaSki cells (P<0.05). In addition, HeLa-derived CCSLCs transfected with DNMT1 shRNA showed reduced sphere and colony formation abilities, and lower CD133, CD44, Nanog and Sox2 protein expressions (P<0.05). Conversely, overexpression of DNMT1 in HeLa cells exhibited the oppositive effects. Furthermore, CAS significantly reduced DNMT1 activity and transcription levels as well as stemness in HeLa-derived CCSLCs (P<0.05). Interestingly, DNMT1 knockdown enhanced the inhibitory effect of CAS on stemness. As expected, DNMT1 overexpression reversed the inhibitory effect of CAS on stemness in HeLa cells.
CONCLUSION
CAS effectively inhibits stemness in CCSLCs through suppression of DNMT1 activation, suggesting that CAS acts as a promising preventive and therapeutic candidate in cervical cancer.
Female
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Humans
;
Cell Line, Tumor
;
HeLa Cells
;
Neoplastic Stem Cells/metabolism*
;
RNA, Small Interfering/metabolism*
;
Uterine Cervical Neoplasms/metabolism*
3.The prognosis and complications differences between MIBC and NMIBC in the orthotopic ileal neobladder
Lingkai CAI ; Xiao YANG ; Qiang CAO ; Pengchao LI ; Juntao ZHUANG ; Kai LI ; Baorui YUAN ; Qikai WU ; Pengfei SHAO ; Jie LI ; Zengjun WANG ; Qiang LYU
Chinese Journal of Urology 2023;44(9):675-681
Objective:To compare the prognosis and complications of muscle-invasive bladder cancer (MIBC) and non-muscle-invasive bladder cancer (NMIBC) patients undergoing radical cystectomy (RC) followed by ileal neobladder.Methods:The clinical data of 103 patients who underwent orthotopic ileal neobladder in Jiangsu Province Hospital from April 2010 to October 2021 were retrospectively analyzed. There were 51 MIBC patients and 52 NMIBC patients. In the MIBC group, there were 49 males and 2 females, aged (58.1 ± 8.9) years, with American Society of Anesthesiologists (ASA) score of 1-2 in 48 cases and 3 in 3 cases. Open radical cystectomy (ORC) was performed in 2 cases, laparoscopic (LRC) in 34 cases and robot-assisted radical cystectomy (RARC) in 15 cases. In the NMIBC group, there were 49 males and 3 females, aged (55.7 ± 9.9) years, ASA score of 1-2 in 51 cases and ASA score of 3 in 1 case. LRC was performed in 41 cases, and RARC in 11 cases. There were no statistically differences between the two groups in above indicators ( P>0.05). The Clavien-Dindo grading system (CCS) was used to assess the complications, defining CCS Ⅰ-Ⅱ as mild complications and CCS Ⅲ-Ⅴ as severe complications. According to their relationship to the neobladder, complications were be classified as neobladder-related and non-neobladder-related complications. The occurrence of complications and the prognosis of neobladder between MIBC and NMIBC were compared. Results:The average operation time of the MIBC group and NMIBC group were (421.2 ± 119.7) min vs. (439.8 ± 106.2) min. The blood loss were 400 (300, 700) ml vs. 400 (300, 625) ml. The frequency of lymph nodes removed were (14.9 ± 8.3) vs. (14.8 ± 8.5). The postoperative defecation time were 5 (4, 6) d vs. 5 (3, 6) d. And the postoperative hospital stay were 20 (15, 28) d vs. 22 (19, 28) d. There were no statistically differences between the two groups in above indicators ( P>0.05). The MIBC group had a significantly lower rate of pelvic lymph node metastasis [17.6% (9/51) vs. 0(0/52), P=0.001] and tumor thrombosis [23.5% (12/51) vs. 5.8% (3/51), P=0.011] than the MIBC group. Moreover, the NMIBC group had a considerably superior 5-year overall survival (OS) (97.6% vs. 70.2%, P=0.035). The proportion of pads needed in the daytime of the MIBC group and NMIBC group were 14.6% (7/46) vs. 6.7% (3/45). The frequency of urination were (2.0 ± 0.7) h vs. (2.4 ± 0.7) h. Furthermore, The proportion of pads needed at night were 47.9% (23/48) vs. 53.3% (24/45). The frequency of nocturnal urination were 3.1±1.5 vs. 2.3 ± 1.7. And the number of pads needed at night were all 1 (0, 1) pad. The daytime and nighttime incontinence rate were 25.0% (12/48) and 62.5% (30/48) respectively in MIBC, compared to 11.1% (5/45) and 62.2% (28/45) respectively in NMIBC. And the proportion of erectile function retention were 15.8% (6/38) vs. 25.0% (10/40). There were no statistically significant differences in the prognosis of neobladder function between the two groups ( P>0.05). Furthermore, the proportions of mild complications in the MIBC group and NMIBC group were [41.2% (21/51) vs. 51.9 (27/52)]. The proportions of severe complications were [21.6% (11/51) vs. 19.2% (27/52)]. The proportions of neobladder-related complications were [27.5% (14/51) vs. 25.0% (13/52)]. And the proportions of non-neobladder-related complications were [39.2% (20/51) vs. 25.0% (13/52)]. There were no statistically significant differences in the complications between the two groups ( P>0.05). Conclusions:There was no statistically significant difference in functional prognosis and complications of neobladder between MIBC group and NMIBC group, and NMIBC had a better oncologic prognosis.
4.Application value of endoscopic retrograde biliary drainage for acute obstructive suppurative cholangitis in the elderly
Qiang GUO ; Kai ZHONG ; Tiemin JIANG ; Bo RAN ; Ruiqing ZHANG ; Yingmei SHAO ; Tuerganaili AJI
Chinese Journal of Digestive Endoscopy 2022;39(8):645-649
Objective:To evaluate the safety and efficacy of endoscopic retrograde biliary drainage (ERBD) for acute obstructive suppurative cholangitis (AOSC) in the elderly.Methods:A retrospective analysis was performed on the clinical data of AOSC patients admitted to the First Affiliated Hospital of Xinjiang Medical University from January 2018 to January 2020. Patients aged 75 years and over ( n=49) were assigned to the elderly group and patients under 75 years old were assigned to the control group ( n=63). General data, American Society of Anesthesiologists (ASA) grading, procedure-related indicators, incidence of postoperative complications and mortality were compared. Results:There were significant differences in age (82.6±5.1 years VS 64.6±4.5 years, t=19.98, P<0.001), albumin levels (29.1±5.9 g/L VS 34.6±8.8 g/L, t=-3.94, P<0.001) and ASA grade ( χ2=8.37, P=0.015) in the elderly group and the control group . The elderly group were accompanied by more basic diseases, i.e. hypertension [57.14% (28/49) VS 34.9% (22/63), χ2=5.51, P=0.019], coronary heart disease [55.1% (27/49) VS 27.0% (17/63), χ2=9.14, P=0.003], chronic obstructive pulmonary diseases/asthma [24.5% (12/49) VS 6.3% (4/63), χ2=7.41, P=0.006]. There were no significant differences in the operation time (31.4±8.1 min VS 30.4±8.0 min, t=-0.61, P=0.543) or hospital stay (6.1±1.7 days VS 5.7±1.4 days, t=1.35, P=0.182). The incidences of postoperative complications were 14.3% (7/49) in the elderly group and 12.7% (8/63) in the control group, showing no significant difference ( χ2=0.06, P=0.807). No ERBD-related death was observed in either group during hospital stay. Conclusion:For elderly patients with AOSC over 75 years old, emergency ERBD, which can quickly relieve the disease, is safe and effective. Advanced age is not an absolute contraindication for emergency ERBD.
5.Malnutrition in Relation with Dietary, Geographical, and Socioeconomic Factors among Older Chinese.
Jian ZHANG ; Peng Kun SONG ; Li Yun ZHAO ; Ye SUN ; Kai YU ; Jing YIN ; Shao Jie PANG ; Zhen LIU ; Qing Qing MAN ; Li HE ; Cheng LI ; Fabrizio ARIGONI ; Nabil BOSCO ; Gang Qiang DING ; Wen Hua ZHAO
Biomedical and Environmental Sciences 2021;34(5):337-347
Objective:
Nutrition is closely related to the health of the elderly population. This study aimed to provide a comprehensive picture of the nutrition status of elderly Chinese and its related dietary, geographical, and socioeconomic factors.
Methods:
A total of 13,987 ≥ 60-year-old persons from the 2010-2013 Chinese National Nutrition and Health Survey were included to evaluate various aspects of malnutrition, including underweight, overweight or obesity, and micronutrient inadequacy.
Results:
Overall, the prevalence of obesity, overweight, and underweight was 12.4%, 34.8%, and 5.7%, respectively, with disparities both geographically and socioeconomically. The prevalence of underweight was higher among the older old (≥ 75 years), rural residents and those with low income, with low education status, and residing in undeveloped West areas. More than 75% of the elderly do not meet the Dietary Reference Intakes for vitamins A, B
Conclusions
Obesity epidemic, inadequacy of micronutrient intake, and high prevalence of underweight and anemia in susceptible older people are the major nutrition challenges for the rapidly aging population in China.
Age Factors
;
Aged
;
Aged, 80 and over
;
China/epidemiology*
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Cross-Sectional Studies
;
Diet/statistics & numerical data*
;
Female
;
Health Surveys
;
Humans
;
Male
;
Malnutrition/etiology*
;
Micronutrients/deficiency*
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Middle Aged
;
Nutritional Status
;
Overweight/etiology*
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Risk Factors
;
Socioeconomic Factors
;
Thinness/etiology*
6.Immunogenicity and safety of a recombinant fusion protein vaccine (V-01) against coronavirus disease 2019 in healthy adults: a randomized, double-blind, placebo-controlled, phase II trial.
Ya-Jun SHU ; Jian-Feng HE ; Rong-Juan PEI ; Peng HE ; Zhu-Hang HUANG ; Shao-Min CHEN ; Zhi-Qiang OU ; Jing-Long DENG ; Pei-Yu ZENG ; Jian ZHOU ; Yuan-Qin MIN ; Fei DENG ; Hua PENG ; Zheng ZHANG ; Bo WANG ; Zhong-Hui XU ; Wu-Xiang GUAN ; Zhong-Yu HU ; Ji-Kai ZHANG
Chinese Medical Journal 2021;134(16):1967-1976
BACKGROUND:
Innovative coronavirus disease 2019 (COVID-19) vaccines, with elevated global manufacturing capacity, enhanced safety and efficacy, simplified dosing regimens, and distribution that is less cold chain-dependent, are still global imperatives for tackling the ongoing pandemic. A previous phase I trial indicated that the recombinant COVID-19 vaccine (V-01), which contains a fusion protein (IFN-PADRE-RBD-Fc dimer) as its antigen, is safe and well tolerated, capable of inducing rapid and robust immune responses, and warranted further testing in additional clinical trials. Herein, we aimed to assess the immunogenicity and safety of V-01, providing rationales of appropriate dose regimen for further efficacy study.
METHODS:
A randomized, double-blind, placebo-controlled phase II clinical trial was initiated at the Gaozhou Municipal Centre for Disease Control and Prevention (Guangdong, China) in March 2021. Both younger (n = 440; 18-59 years of age) and older (n = 440; ≥60 years of age) adult participants in this trial were sequentially recruited into two distinct groups: two-dose regimen group in which participants were randomized either to follow a 10 or 25 μg of V-01 or placebo given intramuscularly 21 days apart (allocation ratio, 3:3:1, n = 120, 120, 40 for each regimen, respectively), or one-dose regimen groups in which participants were randomized either to receive a single injection of 50 μg of V-01 or placebo (allocation ratio, 3:1, n = 120, 40, respectively). The primary immunogenicity endpoints were the geometric mean titers of neutralizing antibodies against live severe acute respiratory syndrome coronavirus 2, and specific binding antibodies to the receptor binding domain (RBD). The primary safety endpoint evaluation was the frequencies and percentages of overall adverse events (AEs) within 30 days after full immunization.
RESULTS:
V-01 provoked substantial immune responses in the two-dose group, achieving encouragingly high titers of neutralizing antibody and anti-RBD immunoglobulin, which peaked at day 35 (161.9 [95% confidence interval [CI]: 133.3-196.7] and 149.3 [95%CI: 123.9-179.9] in 10 and 25 μg V-01 group of younger adults, respectively; 111.6 [95%CI: 89.6-139.1] and 111.1 [95%CI: 89.2-138.4] in 10 and 25 μg V-01 group of older adults, respectively), and remained high at day 49 after a day-21 second dose; these levels significantly exceed those in convalescent serum from symptomatic COVID-19 patients (53.6, 95%CI: 31.3-91.7). Our preliminary data show that V-01 is safe and well tolerated, with reactogenicity predominantly being absent or mild in severity and only one vaccine-related grade 3 or worse AE being observed within 30 days. The older adult participants demonstrated a more favorable safety profile compared with those in the younger adult group: with AEs percentages of 19.2%, 25.8%, 17.5% in older adults vs. 34.2%, 23.3%, 26.7% in younger adults at the 10, 25 μg V-01 two-dose group, and 50 μg V-01 one-dose group, respectively.
CONCLUSIONS:
The vaccine candidate V-01 appears to be safe and immunogenic. The preliminary findings support the advancement of the two-dose, 10 μg V-01 regimen to a phase III trial for a large-scale population-based evaluation of safety and efficacy.
TRIAL REGISTRATION
http://www.chictr.org.cn/index.aspx (No. ChiCTR2100045107, http://www.chictr.org.cn/showproj.aspx?proj=124702).
Aged
;
Antibodies, Viral
;
COVID-19/therapy*
;
COVID-19 Vaccines
;
Double-Blind Method
;
Humans
;
Immunization, Passive
;
Recombinant Fusion Proteins
;
SARS-CoV-2
7.Clinical efficacy of laparoscopic surgery for hepatic cystic echinococcosis: a meta-analysis
Kai ZHONG ; Fashun LU ; Mutalifu MUREAIHEMAITIJIANG ; Xiaojie ZHENG ; Tiemin JIANG ; Bo RAN ; Qiang GUO ; Ruiqing ZHANG ; Aji TUERGANAILI ; Yingmei SHAO
Chinese Journal of Hepatobiliary Surgery 2021;27(1):55-60
Objective:To explore the curative effect of laparoscopic surgery for hepatic cysticercosis.Methods:Search the literature from February 2010 to February 2020 on literature platforms such as Wanfang Data, VIP, CNKI, Pubmed, ScienceDirect, Web of Science, etc. the key words were "肝囊型包虫病" , "细粒棘球蚴" , "手术" , "开腹手术" , "腹腔镜" , "微创手术" , " echinococcosis " , " liver or hepatic " , " laparoscopic or minimal invasive " . Data on intraoperative indicators (e.g., operation time, bleeding volume), postoperative complications, hospital stay, recurrence rate, etc. in the literature included in the study were extracted and meta-analyzed.Results:A total of 9 articles were included, including 2 prospective studies and 7 retrospective case-control studies. A total of 1031 patients were enrolled, including 272 in the laparoscopic group and 759 in the laparotomy group. The results of the meta-analysis showed that the total postoperative complication rate in the laparoscopic group was lower than that in the laparotomy group ( OR=1.64, 95% CI: 1.10-2.45, P<0.05). Incision-related complications in the laparoscopy group and laparotomy group the difference was statistically significant ( OR=2.81, 95% CI: 1.03-7.70, P<0.05), and the hospital stay in the laparoscopic group was shorter ( SMD=1.21, 95% CI: 0.47-1.96, P<0.05). There was no significant difference between the two groups in operation time, postoperative bile leakage, residual cavity infection and effusion, and postoperative recurrence rate ( P>0.05). Conclusions:Under the premise of strictly grasping the indication of laparoscopic surgery, the incidence of complications after laparoscopic surgery is low, the hospitalization time is short.
8.Molecular Cloning and Sequence Analysis of GgUGE Gene in Glycyrrhiza glabra
Jia-ming HOU ; Shao-kai TIAN ; Lin YANG ; Zhi-xin ZHANG ; Zhi-qiang GAO ; Han-qing WANG ; Ying LIU
Chinese Journal of Experimental Traditional Medical Formulae 2020;26(6):163-167
Objective::To clone the cDNA sequence of UDP-glucose 4-epimerase (UGE) in
9.Cloning and Bioinformatic Analysis of ARPI Gene from Glycyrrhiza glabra
Shao-kai TIAN ; Jia-ming HOU ; Zhi-qiang GAO ; Lin YANG ; Zhi-xin ZHANG ; Ying LIU
Chinese Journal of Experimental Traditional Medical Formulae 2020;26(4):185-190
Objective::To clone the complementary deoxyribonucleic acid (cDNA) of auxin/indole acetic acid protein (Aux/IAA) from
10.Application of enhanced recovery after surgery in ambulatory laparoscopic appendectomy
Qiang GUO ; Tuerganaili AJI ; Kai ZHONG ; Bo RAN ; Tiemin JIANG ; Ruiqing ZHANG ; Yingmei SHAO
Chinese Journal of General Practitioners 2019;18(8):760-764
Objective To assess the safety and feasibility of ambulatory laparoscopic appendectomy (ALA) with the concept of enhanced recovery after surgery (ERAS).Methods The clinical data of patients with appendicitis undergoing surgical treatment in the First Affiliated Hospital of Xinjiang Medical University from August 2017 to August 2018 were retrospectively analyzed.Among 196 patients,100 cases received ambulatory laparoscopic appendectomy with ERAS (ERAS group) and 96 cases received conventional laparoscopic appendectomy (control group).The average length of hospital stay,hospitalization expenses,NRS pain score at 6 h,12 h,24 h after surgery,patient satisfaction,time of postoperative off-bed activity,time of gastrointestinal function recovery,and postoperative complications were compared between two groups.Results There were significant differences in average length of hospital stay [(36.5± 1.3) h vs.(74.5±4.4) h,t=80.986),hospitalization expenses[(9 617.5±637.5) Yuan vs.(13 740.1±640.6) Yuan,t=45.150],6 h NRS pain score[(3.4± 1.4) vs.(4.1±1.3),t=3.360],12 h NRS pain score(2.0±1.3 vs.2.5±1.1,t=-2.929),time of postoperative off-bed activity[(5.7 ± 0.9) h vs.(11.5 ± 2.0) h,t=26.237],time of gastrointestinal function recovery(6.8± 1.1) h vs.(12.2±2.3) h,t=20.341]and patient satisfaction [(95.6±3.0) vs.(90.5±4.9),t=-8.644]between ERAS group and control group (all P<0.05).There was no significant difference in the NRS pain score at 24 h(1.0±0.7 vs.1.0±0.8,t=0.287)and postoperative complications (x2=0.025)between the two groups (P>0.05).Conclusion The ambulatory laparoscopic appendectomy with enhanced recovery after surgery is safe and feasible,with the advantages of low hospitalization cost,short hospitalization time,and high patient satisfaction.

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