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 analyze the epidemiological characteristics and pathogen spectrum of hand，foot mouth disease (HFMD) in Anhui province from 2015 to 2022，and to provide scientific evidence for prevention and control measures of HFMD． Methods : The surveillance data of hand，foot and mouth disease in Anhui province from 2015 to 2022 were analyzed by descriptive epidemiology. Real-time PCR was used to detect and classify HFMD samples. Results : A total of 650 590 HFMD cases were reported in Anhui province from 2015 to 2022，including 1 406 se- vere cases and 17 deaths．The annual reported incidence was 131. 45 /100 000．The epidemic features of“low incidence in odd years and high incidence in even years”were presented from 2015 to 2019．The incidence showed a continuous decline from 2020 to 2022．The monthly distribution showed the characteristics of bimodal epidemic，and the main peak was not obvious in 2020．Hefei，Fuyang，Bozhou，Chuzhou and Suzhou ranked the top five cities in terms of cumulative incidence．The age of onset was mainly distributed in children aged 5 years and below，accounting for 89. 26% of the total cases．The male to female ratio was 1. 48 ∶ 1．A total of 28 657 laboratory-confirmed cases had been reported from 2015 to 2022．EV71 cases accounted for 10. 57% ，Cox A16 cases accounted for 24. 90% ，and other enterovirus cases accounted for 64. 53%．The dominant pathogens showed dynamic changes in different years．Since 2018，the proportion of EV71 decreased significantly，and the proportion of other enteroviruses gradually increased to become the dominant pathogens．Among other enteroviruses，Cox A6 strain was dominant (80. 48% ) ． Conclusion This study suggests that the prevention and control of HFMD in Anhui province should be paid more attention from April to July and from October to December．The focus areas are the cities in northern Anhui and Hefei where the floating population is large．The focus of prevention and control is on children aged 5 years and below．Other enteroviruses have become the dominant pathogens of hand-foot-mouth disease in Anhui province，Cox A6 strain is dominant.

Objective To observe the effects of triptolide on drebrin and cofilin expression in the hippocampus of rats with Alzheim-er's disease (AD). Methods Sixty male Sprague-Dawley rats were equally divided into control group, model group and triptolide-treated group with 20 cases in each group. The AD model was established with unilateral injection of beta amyloid 1-40 (Aβ1- 40) into hippocampus in rats. The control group was established with unilateral injection of normal saline with the same volume into hippocampus in rats. The triptolide-treated group was administered triptolide intraperi-toneally, 0.4 mg/kg, once a day, for 15 days after modeling. Spine density of hippocampal neurons was assayed by Golgi staining. Drebrin and cofilin expression of hippocampal neurons was assayed by immunohistochemical staining and reverse transcription polymerase chain reaction (RT-PCR). Results The spine density of hippocampal neurons was higher in the triptolide-treated group than in the model group (P<0.05). The average optical density of drebrin was higher in the triptolide-treated group than in the the model group (P<0.01), while the cell number and average optical density of cofilin were lower (P<0.05). The drebrin mRNA expression was higher in the triptolide-treated group than in the model group (P<0.05), and the cofilin mRNA expression was lower (P<0.01). Conclusion Triptolide may delay the degeneration of dendritic spines in hippocampal neurons of AD rats by regulating the expression of drebrin and cofilin.

Objective To investigate the therapeutic effect of enteral nutrition in patients with severe traumatic brain injury (sTBI) by nasogastric tube and nasointestinal tube.Methods A retrospective case control study was made on 64 patients with sTBI hospitalized from October 2013 to December 2015.The patients were assigned to nasogastric tube group (n=32) and nasointestinal tube group (n=32) according to the random number table, and the same nutrient solution was given to all patients.Eighteen male and 14 female patients aged (37.8±8.7)years were identified in nasogastric tube group, and the Glasgow coma score (GCS) was (4.7±1.3)points.Twenty males and 14 females aged (39.7±6.5)years were identified in nasointestinal tube group, and the GCS was (4.1±1.2)points.Triceps skinfold thickness, body mass index, hemoglobin, level of serum albumin and level of prealbumin were measured and compared between groups before and after operation.Incidence of complications was recorded as well.Results All the above-mentioned indexes of the two groups did not differ significantly before the therapy (P>0.05), but showed significant differences 7 and 15 days after therapy (P<0.05).Incidence of complications in nasointestinal tube group (17 lung infection, nine gastrointestinal bleeding, 11 electrolyte imbalance) was lower than that in nasogastric tube group (seven lung infection, two gastrointestinal bleeding, one reflux esophagitis, four electrolyte imbalance) (P<0.05).Conclusion Nasointestinal tube enteral nutrition is better than nasogastric tube enteral nutrition in improving nutritional status and reducing complications in patients with sTBI.

Objective To explore the relationship between plasma protein Z level and severity of coronary atherosclerosis in patients with coronary heart disease,and analyze the clinical value of plasma protein Z detection.Methods Eighty-five patients who undertaken coronary arteriography were selected,and the patients were divided into coronary heart disease group (63 patients) and control group (22 patients)according to coronary arteriography results.The patients in coronary heart disease group were divided into three groups according to the Gensini score:A group (≤30 scores),B group (31-60 scores) and C group (＞ 60 scores).All patients' plasma was collected and stored at-80 ℃ until examined,and the plasma PZ level was detected by enzyme-linked immunosorbent assay method.Results The plasma protein Z level in coronary heart disease group was significantly lower than that in control group [(721.82 ± 289.53) μ g/L vs.(1 077.80 ± 338.12) μ g/L],and there was statistical difference (P＜ 0.05).The plasma protein Z level in A group,B group and C group was (856.09 ± 312.53),(665.27 ± 267.15) and (643.04 ±248.39) μg/L,respectively.The plasma protein Z level in B group and C group was significantly lower than that in A group,and there was statistical difference (P ＜ 0.05),but there was not statistical difference between C group and B group (P ＞ 0.05).There was negative correlation between the plasma Z level and Gensini score (r =-0.300,P =0.017).In coronary heart disease group,the plasma Z level in patients with smoking was significantly lower than that in patients without smoking [(687.83 ± 249.94) μ g/L vs.(844.29 ± 454.71) μ g/L,and there was statistical difference (P ＜ 0.05).There was negative correlation between the plasma Z level,age and hypersensitive C reactive protein (r =-0.349,-0.339,P ＜ 0.05).Conclusions Plasma protein Z level in patients with coronary heart disease is significantly decreased,and the plasma protein Z level has negative correlation with the severity of coronary atherosclerosis.Smoking can induce the decrease of plasma protein Z level,and the decrease of protein Z level maybe a predictor for coronary heart disease.

Objective To investigate the role of liver X receptors (LXRs) on endothelin-1 ( ET-1 )induced murine HL-1 cardiomyocytes hypertrophy.Methods Cutured murine HL-1 cardiomyocytes were divided into four experiment groups:①Control group:treated with DMSO ; ②T0901317 group:treated with LXRs agonist T0901317( 1 μmol/L) ; ③ET-1 group:treated with ET-1 ( 1 nmoL/L) ; ④T0901317 + ET-1 group:treated with T0901317 ( 1 μmol/L) for 8 hours,then treated with ET-1 ( 1 nmol/L).Twenty-four hours later,immunofluorescent staining was performed on HL-1 cells,the surface area of HL-1 cells was analyzed with NIH Image J software,and the synthetic rate of protein in HL-1 cells was detected by 3 H-leucine incorporation.The mRNA level of atrial natriuretic peptide (ANP) and β-myosin heavy chain (β-MyHC ) was measured by quantitative realtime PCR.The effect of T0901317 on mRNA expression of ANP was also detected after LXRs gene silencing.Results The surface area of HL-1 cells,mRNA expression of ANP and β-MyHC,and 3H-leucine incorporation in ET-1 group were 2.00 ± 0.29,1.98 ± 0.47,2.13 ±0.39 and 1.79 ±0.17,respectively,which were singnficantly higher than those of control group ( 1.00 ±0.26,1.00 ±0.21,1.00 ±0.31 and 1.00 ±0.03,respectively,all P ＜0.05).Compared with ET-1 group,the surface area of HL-1 cells,mRNA expression of ANP and β-MyHC,and 3H-leucine incorporation were significantly decreased in T0901317 + ET-1 group ( 1.24 ± 0.25,1.19 ± 0.21,1.48 ± 0.27 and 1.15 ±0.11,respectively,all P ＜ 0.05 ).After inhibition of LXRo/β expression in HL-1 cardiomyocytes using the specific siRNAs,the mRNA expression of ANP in T0901317 + ET-1 group was 1.78 ± 0.05,which was similar as that in ET-1 group ( 1.94 ± 0.17,P ＞ 0.05).Conclusion T0901317,an agonist of LXRs,could inhibit ET-1 induced cardiac hypertrophy in vitro,and LXR Iigand-mediated inhibition on ANP mRNA expression by T0901317 is receptor dependent.

Objective To develop a simple, fast and accurate preoperative planning method for endoscopic surgery of patients with hypertensive intracerebral hemorrhage (HICH).Methods Eighteen patients with HICH, admitted to our hospital from June 2008 to August 2010, were performed endoscopic minimally invasive surgery; CT three-dimensional reconstruction was employed to locate the intracerebral hematoma and select the appropriate endoscopic approach before the endoscopic surgery.The clinical data and treatmem efficacy were analyzed.Results According to the results of CT three-dimensional reconstruction, our neurosurgeons could design the best endoscopic approach; the three-dimensional relationship between intracerebral hematoma and scalp markers was shown directly and accurate positioning of the location of drilling was achieved; therefore, the time for preoperative preparation, anesthesia and operation was shortened. The mean operating time of these 18 patients was about 1.5 h; the volume of blood loss was only 30-40 mL; and the evacuation ratio was about 89.2%.After the elimination of hematoma, the brain tissues were flabby, so decompressive craniectomy was not needed. Conclusion CT three-dimensional reconstruction is a simple, fast and accurate preoperative planning method for endoscopic surgery of patients with HICH.

Objective To develop a minimally invasive operating technique for the treatment of hypertensive thalamic hemorrhage. Methods The clinical data of 15 patients with hypertensive thalamic hemorrhage performed neuroendoscope-assisted micro-invasive surgical treatment in our hospitals from July 2007 to June 2010 were retrospectively analyzed; their treatment efficacy were also concluded. Results The mean operation time of these patients was (1.5±0.4) h and the amount of blood loss was 30-40 mL; the mean clearance rate of hematoma in the thalamus was (86.2 ±7.9)percentage. Patients were followed up and evaluated by Glasgow outcome scale for at least 3 months.Three patients (21.4%) showed good recovery, 4 (28.6%) moderate disability, 4(28.6%) severe disability and 2 (14.3%) vegetative survival; 1 patient (7.1%) died. Conclusion Neuroendoscope-assisted micro-invasive surgical treatment is a fast and minimally invasive operating technique with little blood loss in the treatment of hypertensive thalamic hemorrhage.

OBJECTIVETo explore the relationship of apolipoprotein E (ApoE) genotype with hypertriglyceridemia-associated recurrent acute pancreatitis.

METHODSTaking the fasting serum triglyceride (TG) level > or = 2.3 mmol/L as hypertriglyceridemia, ApoE genotypes in 115 patients with hypertriglyceridemia-associated recurrent acute pancreatitis were assessed by polymerase chain reaction. According to the fasting serum TG level, all patients were divided into 3 groups: TG mild elevation group (2.3 mmol/L < or = TG < 5.5 mmol/L, Group A), TG moderate elevation group (5.5 mmol/L < or = TG < 11.3 mmol/L, Group B), and TG severe elevation group (TG > or = 11.3 mmol/L, Group C).

RESULTSGroup C had significantly fewer patients with biliary tract disease, improper diet and heavy alcohol consumption, and significantly more patients with passed history of moderate-severe hypertriglyceridemia than Group A and B (P < 0.05). The proportion of patients with E3/4, E3/2, E2/4 and E2/2 genotypes and gene frequency for epsilon 2 and epsilon 4 alleles are significantly higher in Group C than in Group A and B(P < 0.05). Group B had significantly more patients with E3/2 genotype and higher gene frequency for epsilon 2 allele than Group A (P < 0.05).

CONCLUSIONSApo epsilon 2 and epsilon 4 alleles are closely related to moderate-severe hypertriglyceridemia-associated recurrent acute pancreatitis.

Acute Disease ; Adolescent ; Adult ; Alleles ; Apolipoproteins E ; genetics ; Female ; Gene Frequency ; Genotype ; Humans ; Hypertriglyceridemia ; complications ; Male ; Middle Aged ; Pancreatitis ; complications ; genetics ; Recurrence

Objective To investigate the relationship between the Apolipoprotein(Apo)A5-1131T>C polymorphism and strokes.Methods Polymerase chain reaction-restriction fragment length polymorphism(PCR-RFLP)and polyacrylamide gel eletrophoresis(PAGE)wefe used to analyze the genotypic polymorphism in 327 patients with stroke(including 194 cerebral infarction patients and 133 cerebral hemorrhage patients)and 311 healthy controls.The levels of serum lipids profiles were also measuredby enzymatic methods. Results The frequency of the-1131C allele in cerebral infarction patients was significantly higher than that of the control group(44.1% vs 32.3%,P<0.05),but there was not statisticai difference between cerebral hemorrhage patients and controls on the-1131C allele frequeney(35.4%vs 32.3%,P>0.05).Compared with the noncamers,the C carriers also had a higher triglyceride(TG)levels in stroke group[(1.45±0.77)vs(1.69±1.06)mmol/L,P<0.05],but the total cholesterol(TC),high density lipoprotein cholesterol(HDL-C)and low density lipoprotein cholesterol (LDL-C)levels did not show statistical differences in various genotypes(P>0.05).Unadjusted Logistic regression analysis indicated that TC+CC genotype of A5-1131T>C was significantly associated with the presence of cerebral infarction,but not with hemorrhage stroke.Logistic regression analysis adjustedfor BMI,presence of hypertension or diabetes and HDL-C levels revealed that TC+CC genotype was an independent risk factor for cerebralinfarction(OR=1.932,95%CI:1.057-3.532,P=0.032). Conclusion The ApoA5-1131C allele frequency of the patients with cerebral infarction is significantly higher than controls.ApoA5-1131T>C polymorphism has a significant influence on serum TG levels.The ApoA5-1131T>C variant is associated with an increased susceptibility for ischemic stroke.