Evaluation of proactive therapeutic drug monitoring application in infliximab users in ulcerative colitis

Objective: To evaluate the application of proactive pro-drug therapy (TDM) at week six in users of infliximab therapy in ulcerative colitis patients and to analyze the need for further disease optimization. Method: This is a retrospective analysis that will be carried out simultaneously at the Hospital de Clínicas de Passo Fundo and at the Endoclin Diagnostic Center in the city of Passo Fundo, with secondary data collection between January 2020 and May 2022. The sample included patients from both sexes, regardless of age, who are being followed up in the services mentioned above, by signing the informed Free and Clarified Consent Term. Results: 63.2% of patients required optimization of their treatment based on the serum level assessment at week six. Conclusion: Proactive TDM performed at week six benefits patients in order to complete indications for treatment to avoid lack of drug response and complications from the disease. (AU)

The impact of universal induction therapy on early hospital readmission of kidney transplant recipients / O impacto da terapia de indução universal na readmissão hospitalar precoce de receptores de transplante renal

ABSTRACT Background: Early hospital readmission (EHR) is associated with worse outcomes. The use of anti-thymocyte globulin (rATG) induction therapy is associated with increased efficacy in preventing acute rejection, although safety concerns still exist. Methods: This retrospective single-center study compared the incidence, causes of EHR, and one-year clinical outcomes of patients receiving a kidney transplant between August 18, 2011 and December 31, 2012 (old era), in which only high-risk patients received 5 mg/kg rATG, with those transplanted between August 18, 2014 and December 31, 2015 (new era), in which all patients received a single 3 mg/kg dose of rATG. Results: There were 788 patients from the Old Era and 800 from the New Era. The EHR incidence in the old era patients was 26.4% and in the new era patients, 22.5% (p = 0.071). The main cause of EHR in both eras was infection (67% vs. 68%). The incidence of acute rejection episodes was lower (22.7% vs 3.5%, p < 0.001) and the one-year patient survival was higher (95.6% vs. 98.1%, vs. p = 0.004) in new era patients. Conclusion: The universal use of 3 mg/kg rATG single-dose induction therapy in the new era was associated with a trend towards reduced EHR and a reduction in the incidence of acute rejection and mortality.

Resumo Histórico: A Readmissão Hospitalar Precoce (RHP) está associada a piores desfechos. O uso de terapia de indução com globulina antitimócito (rATG, por sua sigla em inglês) está associado ao aumento da eficácia na prevenção de rejeição aguda, embora ainda existam preocupações quanto à segurança. Métodos: Este estudo retrospectivo de centro único comparou a incidência, as causas da RHP e os desfechos clínicos de um ano de pacientes que receberam transplante renal entre 18 de Agosto de 2011 e 31 de Dezembro de 2012 (Antiga Era), em que apenas pacientes de alto risco receberam 5 mg/kg de rATG, com aqueles transplantados entre 18 de Agosto de 2014 e 31 de Dezembro de 2015 (Nova Era), em que todos os pacientes receberam uma única dose de 3 mg/kg de rATG. Resultados: Houve 788 pacientes da Antiga Era e 800 da Nova Era. A incidência de RHP nos pacientes da antiga era foi de 26,4% e nos pacientes da nova era, 22,5% (p = 0,071). A principal causa de RHP em ambas as eras foi infecção (67% vs. 68%). A incidência de episódios de rejeição aguda foi menor (22,7% vs. 3,5%; p < 0,001) e a sobrevida do paciente em um ano foi maior (95,6% vs. 98,1%; vs. p = 0,004) em pacientes da nova era. Conclusão: O uso universal de terapia de indução de 3 mg/kg de rATG em dose única na nova era foi associado a uma tendência à redução da RHP e a uma redução na incidência de rejeição aguda e mortalidade.

Chemical and sensory assessment of extra virgin olive oil blends with omega-3 polyunsaturated fatty acids from plant origin

Extra virgin olive oil (EVOO) is known for its health benefits, although it provides a minimum amount of n-3 polyunsaturated fatty acids (n-3 PUFA), which play an important role in the human organism. In this study, EVOO was blended with vegetable oils which are rich sources of n-3 PUFA alpha-linolenic acid (ALA) and/or stearidonic acid (SDA) (chia, walnut, linseed and viper's bugloss seed oils). Fatty acid profiles, induction time, and organoleptic characteristics of the resulting blends were assessed. The n-3 PUFA enrichment in the blends was proportional to the degree of blending. Sensory analysis carried out by a trained panel showed that it is possible to enrich EVOO with up to 20% chia, linseed and viper's bugloss seed oil without altering the original organoleptic characteristics of EVOO. However, the induction time of the blends was significantly reduced compared with EVOO even after adding n-3 PUFA in small proportions, meaning that shelf-life time of these blends is much lower than that of EVOO, which should be considered when preparing these products for commercial purposes.

El aceite de oliva extra virgen (AOEV) es ampliamente conocido por sus beneficios para la salud, aunque apenas aporta ácidos grasos poliinsaturados n-3 (AGPI n-3), los cuales juegan un papel importante en el organismo humano. En este estudio se elaboraron mezclas de AOEV con aceites vegetales ricos en ácido alfa-linolénico (ALA) y/o estearidónico (SDA) (chia, nuez, linaza y viborera). Se evaluaron los perfiles de ácidos grasos, tiempos de inducción y características organolépticas de las mezclas resultantes. El enriquecimiento en AGPI n-3 fue proporcional al grado de mezcla. El análisis sensorial llevado a cabo por un panel entrenado mostró que es posible enriquecer AOEV con hasta un 20% de aceite de chia, linaza o viborera sin alterar las características organolépticas originales del AOEV. Sin embargo, los tiempos de inducción de las mezclas fueron significativamente menores que el del AOEV, incluso tras añadir AGPI n-3 en pequeñas proporciones, lo que significa que el tiempo de vida media de las mezclas es mucho menor que el del AOEV. Este hecho debería tenerse en cuenta al preparar las mezclas con propósitos comerciales.

Randomized and controlled trial to determine safety and efficacy of Foley’s catheter and PGE2 gel for induction of labor

Background: The goal of obstetrics is a pregnancy that results in a healthy infant and a healthy mother. During medical or obstetrics complications of pregnancy, cervical ripening and induction of labor are often required. Different methods are available for that. Aims and Objectives: Randomized and control trial has been conducted to determine safety and efficacy of Foley’s catheter and prostaglandin E2 (PGE2) gel for induction of labor. Materials and Methods: Randomized and controlled trial has been conducted on 200 study participant who fullfield inclusion criteria in Department of Obstetrics and Gynaecology, GMERS Medical College, Sola during the period of July 2017–July 2019. Statistical analysis was done by descriptive statistics and qualitative method. Results: Both groups cerviprim and Foley’s catheter are comparable for cervical ripening for induction of labor in terms of safety and efficacy as there was no statistically significant observation for obstetric and perinatal outcome. Conclusion: Foley’s catheter is equally dependable method for cervical ripening for induction of labor as cerviprim gel as it is cost effective and easily available.

A comparison between propofol and sevoflurane for easy insertion of laryngeal mask airway among adults in minor elective surgeries: An observational study

Background: The laryngeal mask airway (LMA) has reached ample popularity for the management of airway during surgery. Propofol, used as induction agent, causes change in blood pressure and heart rate (HR) while insertion of LMA. Sevoflurane, whereas, has the potential to be a good induction agent as propofol. We have compared propofol and sevoflurane for easy insertion of LMA among adults in minor surgeries. Aim and Objectives: The primary objective of the study was to compare the ease of insertion of LMA and its characteristics related to insertion among adults in minor elective surgeries using intravenous propofol or inhalational sevoflurane. While time taken to set induction and actual event of LMA insertion along with number of attempts, jaw relaxation time, LMA insertion time, apnea time, monitoring hemodynamic changes, and occurrence of complications were taken as secondary objectives. Materials and Methods: It was a prospective and observational study done in Department of Anesthesiology and Operation Theaters of Fortis Hospital, Kolkata, after getting ethical approval. Total 100 patients were recruited by consecutive sampling and divided into two groups - P (propofol) and S (sevoflurane) group. Anesthesia induction time, jaw relaxation time, LMA insertion time, etc. were noted. LMA insertion conditions were assessed by a 3-point scale using six variables, total score was calculated for each group. Hemodynamic parameters and induction complications were also recorded. Results: There was no significant difference in demographic parameters, American Society of Anesthesiologists class, Modified Mallampati Grading, and LMA size, between the groups. LMA insertion time was comparable between the two groups. Regarding complications, there was no incidence of coughing while minor gagging (4%) and laryngospasm (6%) were noted only with sevoflurane. Final summation of scores showed excellent insertion characteristics with propofol (94%) and sevoflurane (84%), respectively, with no significant difference. Conclusion: Inhalational sevoflurane may be regarded as a viable alternative to inj. propofol for insertion of laryngeal mask among adults in minor elective surgeries.

Programmed ventricular stimulation in structural heart disease: Implications of patterns of ventricular arrhythmias induced to long-term outcomes

Introduction: Currently available data gives some credence to utility of VT induction studies in patients with stable ischemic cardiomyopathy, there are some unresolved questions as to define sensitive threshold for low-risk and the prognostic relevance of ill sustained or non-specific tachycardia on induction study. We evaluated potential ability of VT inducibility to predict likelihood of SHD (Structural heart disease) patients for subsequent arrhythmic or adverse cardiac events. Material and Methods: All consecutive patients with syncope/documented arrhythmia who had VT induction done were included and patients with VT storm, ACS,uncontrolled HF were excluded. We studied in 4 groups-monomorphic VT, sustained polymorphicVT, ill sustainedVT/VF and no VT/VF induced. The primary-endpoints were e Sudden death, all-cause mortality and secondary-endpoints were e MACE (AICD shock, death,HF, recurrence of VT). We screened 411 patients and included 169 within inducible (n ¼ 79) and non-inducible group (n ¼ 90). Results: There were a higher number of patients with coronary artery disease, LV dysfunction, patients on amiodarone in inducible group and no difference in usage of beta-blockers. Recurrence of VT, composite of MACE was significantly higher in inducible group (p < 0.05). Mortality was not different in 3 groups compared with no VT/VF group. We found that monomorphic VT group had significantly higher MACE as compared to others and also predicted recurrence of VT and AICD shock and showed a trend towards significance for prediction of mortality. Inducible patients on AICD had mortality similar to noninducible group. Conclusion: Induction of monomorphicVT/polymorphicVT with 3extrastimuli is associated with a higher number of MACE events on follow up. Induction of monomorphicVT predicts recurrence of VT/ICD shock.

Establishment and Evaluation of Animal Models of Chronic Fatigue Syndrome / 中国实验方剂学杂志

Chronic fatigue syndrome （CFS） is a heterogeneous disease with dysfunction in multiple systems and multiple organs. Its etiology and pathogenesis have not been fully clarified， and its treatment also lacks specificity. The key to studying CFS is developing animal models that reflect the underlying mechanisms and etiology of CFS. The existing CFS modeling methods are complicated and not unified. By sorting out relevant literature，the present study evaluated the modeling methods，modeling standards，mechanisms， and clinical coincidence of the immune model，the stress model， and the disease-syndrome combination model in traditional Chinese medicine （TCM）. The immune model is mainly constructed from the perspective of pathophysiology， with easy operation and wide investigation， which can simulate the pathological characteristics of CFS to ensure pathogenesis research，but the experimental repeatability is general. Stress modeling is a common method for a variety of neuropsychiatric diseases，including CFS. Many different stressors can be employed to investigate the etiology of CFS， but their effects are unpredictable. Compared with the two western medicine models mentioned above，the TCM disease-syndrome combination model integrates modern medicine with TCM theory，with high clinical coincidence and great practical value. However，the TCM disease-syndrome combination model of CFS is still in the exploratory stage with a few types of models，which needs to be further improved， aiming to establish scientific，reasonable，simple， and efficient animal models to provide support for exploring the etiology，pathogenesis， and new treatment ideas of CFS.

Safety of levofloxacin as an antibiotic prophylaxis in the induction phase of children newly diagnosed with acute lymphoblastic leukemia: an interim analysis of a randomized, open-label trial in Brazil

ABSTRACT Background: Despite high cure rates, treatment-related mortality in children with acute lymphoblastic leukemia (ALL) remains significant. About 4% of patients die during remission induction therapy and approximately two-thirds of treatment-related deaths are due to infectious complications. Methods: From May 2021 to June 2022, children aged one through 18 years, with a recent diagnosis of ALL, admitted to three pediatric oncology centers in Brazil, were enrolled in this multicenter, open-label, randomized, phase 3 clinical trial. Eligible patients were randomly divided into two groups, based on a 1:1 allocation ratio, to receive, or not, levofloxacin as a prophylactic agent during the induction phase. All patients were treated according to the IC-BFM 2009 chemotherapy protocol. Primary endpoints were carbapenemase-producing Enterobacteriaceae (CPE) colonization, Clostridioides difficile diarrhea, and other adverse events related to the use of levofloxacin. The secondary endpoint was febrile neutropenia during induction. The median follow-up was 289 days. Results: Twenty patients were included in this trial, 10 in each group (control and levofloxacin). Mild adverse reactions related to levofloxacin were observed in three patients (30%). Three patients had Clostridioides difficile diarrhea, two in the levofloxacin group and one in the control group (p > 0.99). Only one patient presented colonization by CPE. This patient belonged to the levofloxacin group (p > 0.99). Nine patients presented febrile neutropenia, five in the control group and four in the levofloxacin intervention group (p > 0.99), one patient died due to febrile neutropenia. Conclusion: The use of levofloxacin was shown to be safe in the induction phase in children with de novo ALL. The use of this medication did not increase the rate of colonization by CPE nor the rate of diarrhea by C. difficile. All adverse reactions were mild and remitted either spontaneously or after switching medicine administration from oral to intravenous route.

Corifollitropin Alfa for Controlled Ovarian Stimulation in Assisted Reproductive Technologies: State of the Art / Alfacorifolitropina para estimulação ovariana controlada em tecnologias de reprodução assistida: Estado da arte

Abstract Physical and emotional burdens during the journey of infertile people through assisted reproductive technologies are sufficient to justify the efforts in developing patient-friendly treatment strategies. Thus, shorter duration of ovarian stimulation protocols and the need for less injections may improve adherence, prevent mistakes, and reduce financial costs. Therefore, the sustained follicle-stimulating action of corifollitropin alfa may be the most differentiating pharmacokinetic characteristic among available gonadotropins. In this paper, we gather the evidence on its use, aiming to provide the information needed for considering it as a first choice when a patient-friendly strategy is desired.

Resumo O desgaste físico e emocional durante a jornada de pessoas inférteis pelas tecnologias de reprodução assistida é suficiente para justificar esforços no desenvolvimento de estratégias de tratamento compassivas. Desta forma, a menor duração dos protocolos de estimulação ovariana e a necessidade de menos injeções podem melhorar a adesão, prevenir erros e reduzir custos financeiros. Portanto, a estimulação folicular sustentada da alfacorifolitropina parece ser a característica farmacocinética que melhor a diferencia das gonadotrofinas atualmente disponíveis no mercado. No presente artigo, reunimos evidências sobre seu uso, com o objetivo de fornecer as informações necessárias para considerá-la como primeira escolha quando se deseja uma estratégia amigável ao paciente.

Determinants of successful labor induction in a teaching hospital in Nigeria: a 10-year review / Determinantes da indução do trabalho de parto bem sucedida em hospital-escola na Nigéria: uma revisão de 10 anos

Abstract Objectives: to evaluate the success rate of labor induction and determinants of successful outcome. Methods: retrospective cohort study of parturients that undergone labor induction between 2006 and 2015. Data was retrieved from the medical records and multivariate logistic regression was used to evaluate the determinants of successful labor induction. Results: the rate of labor induction was 10.9%. Out of the 940 women analysed, six hundred and fifty-six women (69.8%) had successful vaginal delivery. Labor induction at 39-40 weeks (OR=2.70; CI95%=1.17-6.36), 41 weeks (OR=2.44; CI95%=1.14-5.28), estimated fetal weight between 2.5 and 3.4kg (OR=4.27, CI95%=1.96-5.59) and estimated fetal weight of 3.5-3.9kg (OR=5.45; CI95%=2.81-10.60) increased the odds of achieving vaginal delivery. Conclusions: our findings suggest that 39, 40 and 41 weeks are optimal gestational ages for labor induction with respect to successful vaginal delivery. Also, estimated fetal weight between 2.5kg and 3.9kg favours successful vaginal delivery.

Resumo Objetivos: avaliar a taxa de sucesso da indução do trabalho de parto e determinantes de um resultado bem sucedido. Métodos: estudo de coorte retrospectivo de parturientes que submeteram a indução de trabalho de parto entre 2006 e 2015. Os dados foram recuperados dos registros médicos e a regressão logística multivariada foi utilizada para avaliar os determinantes da indução de trabalho de parto bem sucedida. Resultados: a taxa de indução de trabalho de parto foi de 10,9%. Das 940 mulheres analisadas, seiscentas e cinquenta e seis mulheres (69,8%) tiveram um parto vaginal bem sucedido. A indução de trabalho de parto nas 39-40 semanas (OR=2,70; IC95%=1,17-6,36), 41 semanas (OR=2,44; IC95%=1,14-5,28), peso fetal estimado entre 2,5 e 3,4kg OR=4,27; IC95%=1,96-5,59) e peso fetal estimado entre 3,5-3,9kg (OR=5,45; IC95%=2,81-10,60) aumentou as probabilidades de conseguir um parto vaginal. Conclusões: as nossas conclusões sugerem que as 39, 40 e 41 semanas são idades gestacionais ideais para a indução do trabalho de parto no que diz respeito ao sucesso do parto vaginal. Além disso, o peso fetal estimado entre 2,5kg e 3,9kg favorece o parto vaginal bem sucedido.

Effects of Compound troxerutin and poreine cerebroside injection on cytochrome P450 enzyme in vivo and in vitro / 中国药房

OBJECTIVE To investigate the effects of Compound troxerutin and poreine cerebroside injection on the activity of cytochrome P450 （CYP450） enzyme in vivo and in vitro. METHODS Human liver microsomes were incubated with Compound troxerutin and poreine cerebroside injection （volume fraction 0.05%-10%） and the specific probe substrates of CYP1A2， CYP2B6， CYP2C8， CYP2C9， CYP2C19， CYP2D6 and CYP3A4 for 30 min. The production of corresponding metabolites was detected by ultra-high performance liquid chromatography-tandem mass spectrometry （UPLC-MS/MS）， and the half inhibitory concentration （IC50） was calculated. The relative mRNA expression （i.e. induction multiple） of CYP450 enzyme was determined by real-time fluorescence quantitative PCR after human primary hepatocytes were incubated with Compound troxerutin and poreine cerebroside injection （volume fraction 0.05%-10%） or 3 positive inducers of CYP1A2， CYP2B6， CYP3A4 for 48 hours. Male SD rats were randomly divided into control group （normal saline+probe substrates of CYP1A2， CYP2B6， CYP2C8， CYP2C9， CYP2C19， CYP2D6， CYP3A4 8， 2， 1， 1， 10， 10， 8 mg/kg） and experimental group （Compound troxerutin and poreine cerebroside injection 0.9 mL/kg+probe substrates of CYP1A2， CYP2B6， CYP2C8， CYP2C9， CYP2C19， CYP2D6， CYP3A4 8， 2， 1， 1， 10，10， 8 mg/kg）， with 6 rats in each group. The pharmacokinetic parameters of probe substrates were detected by UPLC-MS/MS and Cocktail probe drug method. RESULTS After the lzqpharm@126.com treatment of 0.05%-10% Compound troxerutin and poreine cerebroside injection， the activities of CYP2B6， CYP2C8 and CYP2C19 in human liver microsomes had no significant change， and IC50 could not be fitted； IC50 of CYP1A2， CYP2C9， CYP2D6 and CYP3A4 were 419.90%， 97.78%， 176.00%， 19.42%， respectively. After the treatment of 0.05%-10% Compound troxerutin and poreine cerebroside injection， the average induction multiple of CYP3A4 mRNA in human primary hepatocytes （No. MHK） was 4.88 （and the average induction multiples of 2 concentration points were higher than 2）. After the treatment of Compound troxerutin and poreine cerebroside injection， AUC0－t and AUC0－∞ of CYP2C8， CYP2C9 and CYP2C19 substrates were increased significantly， CL of CYP2C8 and CYP2C19 substrates were decreased significantly， while t1/2 of CYP2C9 substrate was prolonged significantly （P＜0.05）. CONCLUSIONS Compound troxerutin and poreine cerebroside injection has no obvious inhibitory effect on CYP1A2， CYP2B6， CYP2C8， CYP2C9， CYP2C19， CYP2D6 and CYP3A4 in human liver microsomes in vitro， but can induce the mRNA expression of CYP3A4 in human primary hepatocytes in vitro， and can inhibit the activities of CYP2C8， CYP2C9 and CYP2C19 in rats in vivo.

Effect evaluation of reference-induced blended teaching method in medical statistics / 上海预防医学

ObjectiveTo explore the effects and satisfaction of reference-induced blended teaching method in medical statistics teaching for undergraduate students in clinical medicine. MethodA total of 83 clinical medical undergraduate students from the class of 2018 at the Tongji University School of Medicine were enrolled into the study. The effect evaluation of blended teaching based on reference-induced self education （RISE） in the course of medical statistics was conducted. A self-designed questionnaire was used to assess student satisfaction. ResultsCompared with the traditional teaching method group， students’ distinguished achievement rate and pass rate in total score from RISE blended teaching group were 53.7% and 96.3%， respectively， and 83.3% students were satisfied with the overall effect. The RISE blended teaching method had higher satisfaction in stimulating learning interest （90.7% satisfaction rate， P=0.034） and cultivating scientific research ability （96.3% satisfaction rate， P=0.048）. ConclusionThe RISE blended teaching method， which integrates literature guidance with online and offline approaches， organically combines statistical knowledge with clinical research problems. It yields positive results in medical statistics education， stimulating learning interest， and fostering innovative scientific research abilities.

Effect of Mingjing Granules on Fibrovascular Membrane of Wet Age-related Macular Degeneration Based on Macrophages and Glial Cells / 中国实验方剂学杂志

ObjectiveTo investigate the effects of Mingjing granules （MJKL） on the fibrovascular membrane of experimental wet age-related macular degeneration （nAMD） based on macrophages and glial cells and further explain the mechanism of MJKL in the treatment of nAMD. MethodThe experimental nAMD fibrovascular membrane model was established by two-stage laser photocoagulation. BN rats were randomly divided into three groups： model group， anti-vascular endothelial growth factor （VEGF） group， and MJKL + anti-VEGF group. The model group was given distilled water for intragastric administration. Anti-VEGF group was injected with leizumab injection in the vitreous cavity. MJKL + anti-VEGF group was injected with leizumab injection in the vitreous cavity， and MJKL was intragastrically administered. Ten normal BN rats were not modeled and fed as controls. After 40 days of model making， fundus lesion morphology， lesion exudation area， and MD value were observed by fundus photography （FP）， fundus angiography （FFA）， optical coherence tomography （OCT）， and retinal pigment epithelium （RPE）-choroid-sclera film. The changes in retinal structure were observed by histopathology， and the expression and distribution of F4/80， Iba-1， and GFAP were detected by immunofluorescence. The relative expression levels of F4/80， Iba-1， and GFAP mRNA were detected by real-time fluorescence quantitative polymerase chain reaction （Real-time PCR）. ResultThe fibrovascular membrane model was established 40d after two-stage laser modeling. The lesion exudation area， MD value， lesion height， and lesion area in the anti-VEGF group were significantly lower than those in the model group （P<0.05）， and the retinal structural damage degree was significantly improved. Compared with the anti-VEGF group， the MJKL + anti-VEGF group significantly decreased the MD value， lesion height， and lesion area （P<0.05）， and lesion area and retinal structural damage degree were significantly improved. The fluorescence intensity of F4/80 and Iba-1 in the model group was significantly higher than that in the normal group （P<0.05）， and that in the anti-VEGF group was significantly lower than that in the model group （P<0.05）. The fluorescence intensity in the MJKL + anti-VEGF group was significantly lower than that in the anti-VEGF group （P<0.05）. The fluorescence intensity of GFAP in the model group was significantly higher than that in the normal group （P<0.05）， and that in the anti-VEGF group was significantly lower than that in the model group （P<0.05）. The relative expression levels of F4/80， Iba-1， and GFAP mRNA in the model group were significantly increased compared with the normal group （P<0.05）， and the anti-VEGF group was significantly decreased compared with the model group （P<0.05）. The relative expression levels of F4/80， Iba-1， and GFAP mRNA in the MJKL + anti-VEGF group were significantly decreased compared with those in the anti-VEGF group （P<0.05）. ConclusionMJKL combined with anti-VEGF drugs can inhibit the growth of experimental nAMD fibrovascular membrane better than anti-VEGF drugs alone， and the mechanism may be related to inhibiting the participation of macrophages and glial cells in the formation of fibrovascular membrane.

Effect of spontaneous breathing on atelectasis during induction of general anesthesia in patients undergoing laparoscopic resection of gastrointestinal tumors / 肿瘤研究与临床

Objective:To explore the effect of spontaneous breathing during induction of general anesthesia on atelectasis in patients undergoing laparoscopic resection of gastrointestinal tumors.Methods:A total of 60 patients aged 18-60 years scheduled for laparoscopic resection of gastrointestinal tumors under general anesthesia in the First Hospital of Shanxi Medical University from October 2021 to August 2022 were selected. The body mass index was 18.5-28.0 kg/m 2 and the American Society of Anesthesiology grade wasⅠ-Ⅱ. All patients were divided into the spontaneous breathing group (group S, 30 cases) and the controlled breathing group (group C, 30 cases) according to the random number table method. Patients in group S received 0.2-0.3 mg/kg etomidate (pumping at the speed of 200 ml/h) and 2 μg/kg remifentanil (slowly injected more than 30 s) for anesthesia induction; patients in group C received 0.2-0.3 mg/kg etomidate and 2 μg/kg remifentanil (slowly injected more than 30 s) and 0.2 mg/kg cisatracurium. After bispectral index (BIS) decreased to 80, the patients had no response to the language stimulation; and then the mask was used to closely fit the face and maintain spontaneous breathing in group S; patients in group C received manual positive pressure ventilation. Atelectasis scores were collected immediately after endotracheal intubation (T 1) and 15 min after transferring to the recovery room (T 3), and oxygenation index (OI) was collected 5 min after endotracheal intubation (T 2) and at T 3. The postoperative pulmonary complication (PPC) on the 3rd day after the operation was recorded. Results:A total of 56 patients were finally enrolled, 27 cases in group S and 29 cases in groups C. Compared with group C, the atelectasis score of group S at T 1 and T 3 decreased [T 1: (2.4±0.8) scores vs. (4.2±0.7) scores, t = -9.12, P < 0.001; T 3: (8.2±1.8) scores vs. (10.5±1.6) scores, t = -4.96, P < 0.001]. The OI increased at T 2 and T 3 in group S [T 2: (334±11) mmHg (1 mmHg = 0.133 kPa) vs. (323±13) mmHg, t = 3.45, P = 0.001; T 3: (362±23) mmHg vs. (347±25) mmHg, t = 2.31, P = 0.025]. The incidence of PPC was 20.7% (6/29) and 18.5% (5/27), respectively in group C and group S on the 3rd day after the operation, and the difference was statistically significant ( χ2 = 0.04, P = 0.838). Conclusions:Maintaining spontaneous breathing during induction of general anesthesia can reduce atelectasis caused by general anesthesia and improve oxygenation for patients undergoing laparoscopic resection of gastrointestinal tumors.

Clinical trial of low-dose rabbit anti-human thymocyte globulin for induction therapy of kidney transplantation in children / 中华器官移植杂志

Objective:To explore the efficacy and safety of low-dose rabbit anti-human thymocyte globulin (rATG) for induction therapy of kidney transplantation (KT) in children.Methods:From October 2018 to May 2021, clinical data were reviewed retrospectively for 77 pediatric KT recipients on a low-dose rATG induction protocol.Recipient/graft survival rate, renal function recovery, acute rejection (AR) and adverse reactions were observed at 1 year post-operation.The postoperative changes of renal function were examined by Friedman’s test; According to the preoperative baseline data, Pearson’s Chi-square or Fisher's exact test was utilized for examining the influencing factors of postoperative AR.Results:A total of 16(20.78%) recipients had AR within the first 6 months post-operation.The incidence of delayed graft function (DGF) was 14.29%(11/77); The incidence of severe infection post-transplantation 18.18%(14/77), the infection rate of BK virus 25.97%(20/77) and the incidence of neutropenia 32.47%(25/77).The recipient/graft survival rate at 1 year post-operation was 97.40%(75/77) and 94.81%(73/77) respectively.Chi-square test indicated that the incidence of postoperative infection in children with body weight ≤30 kg and height ≤138 cm was 28.95%(11/38) and 27.50%(11/40) respectively, Both were higher than 7.69%(3/39) and 8.11%(3/37) of children with body weight >30 kg and height>138 cm.The difference between groups was statistically significant ( P=0.016 and 0.028). Conclusions:Low-dose rATG is generally excellent in preventing AR in pediatric KT recipients.And the risk of related AR may be lower.The infection rate of recipients with decent preoperative development is low.

Factors associated with acute rejection after pediatric kidney transplantation: a single-center cohort study / 中华器官移植杂志

Objective:To summarize the incidence of acute rejection (AR) after pediatric kidney transplantation (KT) at a single center and examine its impact on graft/patient survival and risk factors for AR.Methods:This is a retrospective cohort study including pediatric recipients who underwent kidney transplantation in past 8 years.After excluding recipients of graft thrombosis within a week post-transplant and lost to follow-ups, a total of 143 cases were ultimately recruited and assigned into two groups of AR (n=29) and non-AR (n=114).Basic profiles of both donors and recipients and graft/patient survival rate were compared between two groups.Relative risk factors for AR episodes were also examined by Logistic regression.Results:Renal grafts for 130/143 cases (90.9%) were harvested from deceased donors and 120(83.9%) cases from children.Twenty-seven transplants (18.9%) were performed in infants and young recipients aged < 3 years.During a median follow-up of 33 months, 34 AR episodes occurred in 29(20.3%) patients.Rate of re-transplantation (27.6% vs. 7.9%), pediatric donor (96.5% vs. 80.7%) and rabbit anti-human thymocyte globulin (rATG) induction (79.3% vs. 36%) were significantly higher in AR group than non-AR group ( P=0.007, P=0.046, P<0.001).Multivariate regression analysis indicated that basiliximab induction caused a significant reduction in the risk of AR incidence as compared with rATG induction (odds ratio 0.13, 95% confidence interval 0.04-0.43, P<0.001).The median time of AR incidence was 1.3 months post-transplantation and 23 episodes (67.6%) were confirmed by biopsy.After anti-rejection treatment, 52.9%(n=18) of the cases achieved a full recovery and 38.3% (n=13) had improved graft function.However, 3 cases (8.8%) developed irreversible graft failure.The 1/3-year graft survival rates were significantly lower in AR group than those in non-AR group (75.3% vs. 95.2%, 68.4% vs. 90.4%, P=0.01), and there was no significant difference in 1-and 3-year patient survival rates between two groups. Conclusions:The incidence of AR is relatively high in pediatric renal transplantation, which has an impact on graft survival.Basiliximab induction can effectively reduce the risk of AR.

Characteristics and thinking of acute rejection after pediatric kidney transplantation / 中华器官移植杂志

Because of the current national organ allocation policy of "pediatric donor kidneys are given priority to pediatric recipients", Chinese pediatric kidney transplantation has achieved rapid development, but the outcomes of pediatric kidney transplantation need to be further systematically summarized.In this paper, by summarizing the characteristics of children's immune system and related research progress, the incidence and influencing factors of acute rejection after pediatric kidney transplantation, the prevention effects of rabbit anti-human thymocyte immunoglobulin (rATG) and anti-CD25 monoclonal antibody induction therapy on acute rejection after pediatric kidney transplantation were compared, and suggestions were put forward for their future application.

Effects of remazolam vs propofol on hemodynamics during induction of anaesthesia in elderly patients: area under curve method / 中华麻醉学杂志

Objective:To evaluate the effects of remazolam and propofol on the hemodynamics during induction of anaesthesia in elderly patients using the area under curve (AUC) method.Methods:Eighty elderly patients of either sex, aged 65-75 yr, with body mass index of 20-28 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ, scheduled for elective non-cardiac surgery, were divided into 2 groups ( n=40 each) by using a random number table method: remazolam group (R group) and propofol group (P group). Remazolam 1 mg/ml or propofol 10 mg/ml was slowly and intravenously injected through titration to achieve loss of responsiveness to verbal command. The accumulative areas under the curve below (AUC MAP-) or above (AUC MAP+ ) baseline mean arterial pressure and under the curve below or above 10% of baseline heart rate at the same time (AUC HR-, AUC HR+ ) were calculated within the first 10 min after administration of propofol or remazolam. The use of vasoactive drugs and injection pain were recorded during this period. The intraoperative awareness during the 24-h follow-up after surgery and development of cardiovascular complications, cerebral infarction and oliguria or anuria within 30 days after surgery were recorded. Results:Compared with R group, AUC MAP- was significantly enlarged (the mean difference 59.375 mmHg·min, 95% confidence interval 26.763-91.987 mmHg·min), AUC HR- was enlarged ( P<0.05), and no significant change was found in AUC MAP+, AUC HR+, requirement for vasoactive drugs, frequency of vasoactive drugs, and postoperative complications in P group ( P>0.05). No injection pain or intraoperative awareness was found in two groups. Conclusions:Remazolam is superior to propofol in maintaining hemodynamic stability during anesthesia induction in elderly patients.

Short-term efficacy of camrelizumab combined with induction chemotherapy followed by concurrent chemoradiotherapy for patients with locally advanced nasopharyngeal carcinoma / 中华放射医学与防护杂志

Objective:To investigate the clinical effect and safety of camrelizumab combined with induction chemotherapy followed by concurrent chemoradiotherapy for patients with locally advanced nasopharyngeal carcinoma (NPC).Methods:A total of 24 patients with stage Ⅲ-IV A NPC were recruited prospectively to receive two cycles of camrelizumab combined with induction chemotherapy (docetaxel 75 mg/m 2+ cisplatin 25 mg/m 2 for three consecutive days) followed by concurrent chemoradiotherapy (prescription doses: 6 996 cGy in 33 fractions for PGTV and PGTV nd, 6 006 cGy in 33 fractions for PTV 1, 5 096 cGy in 28 fractions for PTV 2, and concurrent cisplatin chemotherapy with a dose of 75 mg/m 2). The short-term efficacy and adverse reactions were evaluated. Results:After induction therapy, nasopharyngeal lesions showed an objective response rate (ORR) of 91.6%, including 45.8% of complete response (CR) and 45.8% of partial response (PR); cervical lymph nodes showed an ORR of 95.8% (CR: 4.2%; PR: 91.6%). Seventeen patients accepted a reexamination under a nasopharyngoscope, and the biting biopsy result indicated that 13 patients among them had complete pathologic response. After concurrent chemoradiotherapy, nasopharyngeal lesions and cervical lymph nodes showed CR rates of 83.3% and 91.7% and PR rates of 16.7% and 8.3%, respectively. After the induction therapy, 13 patients with stage IV A NPC had ORR (PR) rates of 92.4% and 92.4%, respectively, at nasopharyngeal lesions and cervical lymph nodes. After concurrent chemoradiotherapy, the patients with stage IV A NPC had CR rates of 84.6% and 92.3% and PR rates of 15.4% and 7.7%, respectively, at nasopharyngeal lesions and cervical lymph nodes. Major adverse reactions include leukopenia, granulopenia, anemia, radioactive acute oropharyngeal mucositis and dermatitis, digestive tract reaction, fatigue, hypothyroidism, aminotransferase elevation, and reactive capillary hyperplasia. Conclusions:Camrelizumab combined with induction chemotherapy followed by concurrent chemoradiotherapy can achieve high short-term efficacy for patients with locally advanced nasopharyngeal carcinoma, without increasing the incidence of adverse reactions. Its long-term efficacy deserves further research.

Effect of follicular size on clinical outcomes of frozen-thawed embryo transfer induced by hCG on ovulation in natural cycles / 中华妇产科杂志

Objective:To investigate the effect of follicular size on the clinical outcomes of frozen-thawed embryo transfer induced by human chorionic gonadotropin (hCG) of natural cycles on ovulation.Methods:Clinical data of 427 cycles of frozen-thawed single blastocyst transfer in Nanjing Drum Tower Hospital from January 2016 to December 2019 were retrospectively analyzed. The patients were divided into 15-16 mm group (15≤diameter≤16 mm, n=66), 16-17 mm group (16<diameter≤17 mm, n=101), 17-18 mm group (17<diameter≤18 mm, n=125), 18-20 mm group (18<diameter≤20 mm, n=109),>20 mm group (diameter>20 mm, n=26), according to the maximum follicle diameter on the induction day of hCG ovulation induction. The estradiol and luteinizing hormone (LH) levels, and clinical pregnancy rate, abortion rate and live birth rate were compared in five groups. Results:There were statistically significant differences in estradiol and LH levels among the five groups on the day of hCG induction (all P<0.05). Estradiol levels in 15-16 mm group to >20 mm group gradually increased on the day of hCG induction, and estradiol level in 15-16 mm group was significantly lower than those in 17-18 mm group, 18-20 mm group and >20 mm group (median: 1 002.3 vs 1 103.3 vs 1 171.2 vs 1 539.0 pmol/L), with statistical significances ( P=0.034, P<0.001, P=0.002). On the day of hCG induction, LH levels in 15-16 mm group to >20 mm group showed a decreasing trend, and LH level in 15-16 mm group was significantly higher than those in 17-18 mm group and >20 mm group (median: 37.73 vs 28.24 vs 24.11 U/L), with statistically significant differences ( P=0.007, P=0.006). There were no significant differences in clinical pregnancy rate, abortion rate and live birth rate in 15-16 mm group to >20 mm group (all P>0.05). Conclusion:In the natural cycle protocol of hCG induced ovulation, the small follicle group could achieve similar clinical outcomes compared with normal sized follicles in the single blastocyst transfer of frozen-thawed embryos.