Evaluation of safety and consistency of inhaled allergen extracts in the diagnosis of allergic diseases in children / 中华实用儿科临床杂志

Objective:To investigate the safety and consistency of domestic inhaled allergen extracts in the diagnosis of allergic diseases in children.Methods:Nine thousand five hundred and sixty-three children diagnosed with allergic diseases from September 2018 to June 2020 in Children′s Hospital Affiliated to Capital Institute of Pedia-trics were selected in this study, and all of them were subjected to skin prick test(SPT), and 415 of them were subjected to serum specific IgE (sIgE) test at the same time.The adverse events during SPT were recorded and the consistency of the results between SPT and sIgE test was analyzed.Results:There were 14 cases with adverse events in 9 563 patients, and the overall incidence was 0.15%.The incidence of adverse events was 0.07% (2/2 581 cases) in the 1-5 years old group, 0.19% (12/6 197 cases) in the 6-11 years old and 0 in the 12-17 years old group.The severity of all these events was grade Ⅰ.Out of the 14 cases with adverse events, only 1 case was considered to be related to allergen preparations, with the incidence being 0.01% (1/9 563 cases). The Kappa index showed that the results of dermatophagoides pteronyssinus, dermatophagoides farinae, alternaria and artemisia measured by SPT and sIgE were almost the same.There was high consistency between tree pollens and ragweed ( P<0.01), and moderate consistency between aspergillus fumigatus ( P<0.01). When the results of sIgE were used as the diagnostic criteria, the Youden index for the results of SPT ranged from 0.76 to 0.89, with aspergillus fumigatus (0.76) and tree pollens mixture (0.79) as the lowest.The positive likelihood ratio for most of the inhaled allergens was more than 10 except for tree pollens mixture (7.12) and dermatophagoides farinae (9.10). The negative likelihood ratio for most of the inhaled allergens was less than or equal to 0.1 except for aspergillus fumigatus (0.19). Conclusions:The domestic inhaled allergen extracts had high safety in the clinical application of SPT, and their results of SPT had good consistency with those of serum sIgE, which was conducive to the diagnosis and evaluation of allergic diseases in children.

Analysis of risk factors for patients with liver cancer admitted to the ICU after major hepatectomy / 中华肝胆外科杂志

Objective This study aimed to evaluate the impact of Intensive Care Unit (ICU)admission on patients with malignant liver tumors after elective major hepatectomy,and to analyze the relevant factors relating to ICU admission.Method 1 044 liver cancer patients who underwent elective hepatectomy were included into this study.Using the length of extubation time (＞ 5 h) and/or treatment time (＞ 24 h) in ICU,the patients were divided into the ICU group and the general group.The age,gender,underlying disease and operative time,intraoperative blood loss,blood transfusion,as well as postoperative complications,mortality,hospital stay and hospitalization costs were compared between the two groups.The relative factors of the ICU group were evaluated using univariate and multivariate analysis.Results Compared to the general group,the mean age (57.4 ± 3.7 vs.53.2 ± 3.2),and the proportions of patients with associated lung diseases (33.7％ vs.10.0％),chronic kidney diseases (9.6％ vs 2.0％),anemia (50.6％ vs.5.3％),as well as the amounts of intraoperative blood loss (816 ml vs.635 ml) and blood transfusion (4.3 U vs.1.4 U) in the ICU group were significantly higher.The differences were significant (P ＜0.05).Furthermore,the ICU group of patients had a significantly longer hospital stay (21.6 days vs.10.1 days,P ＜ 0.05) and more hospital costs (76 751 yuan vs.42 069 yuan,P ＜ 0.05).Multivariate analysis showed that age,blood loss and transfusion were associated with ICU admission.Conclusions It is not necessary to admit every patient with malignant liver tumors to ICU after elective major hepatectomy.ICU admission resulted in prolonged hospital stay and elevated hospital costs.Age (OR =1.077,95％ CI:1.030 ～ 1.127),amount of blood loss (OR =3.211,95％ CI:1.038 ～ 9.929) and blood transfusion (OR =1.330,95％ CI:1.113 ～ 1.589) were associated with ICU admission.There are still many potentially influencing factors which need further studies to determine.

A field follow_up study of six years′outcome of children with asthma / 中华实用儿科临床杂志

Objective To investigate six yearsˊ outcome of children with asthma. Methods Children with asthma diagnosed in the epidemiological survey of childhood asthma in urban area of Beijing in 2010 were selected in this study. The field follow-up was conducted in 2016(6 years later)to obtain information about asthma attack,di-sease control,medication usage,and comorbidities of allergic diseases. The skin prick test,lung function and exhaled ni-tric oxide were performed during field follow - up stage. Results Sixty - four children,aged 7 - 19 years old [(13. 59 ± 3. 48)years old],completed the field follow-up survey. Among 35. 9%(23/64 cases)children,the asth-ma symptoms still persisted within 2 years(without remission),while 64. 1%(41/64 cases)children had no symp-toms within 2 years and above(remission). The course of children without remission(9. 0 years)was significantly lon-ger than that of children with remission(5. 5 years),and there was statistical significance(z＝ -3. 775,P<0. 001). Among the children without remission,the number of uncontrolled children in the last month accounted for 13. 0%(3/23 cases),partially controlled for 17. 4%(4/23 cases),and under controlled for 69. 6%(16/23 cases). The majority of unrelieved children were treated with intermittent control drug[43. 5%(10/23 cases)υs. 12. 2%(5/41 cases), χ2 ＝8. 036,P<0. 01]. A total of 47. 8%(11/23 cases)of children without remission were completely unaffected by physical activity,while 92. 7%(38/41 cases)of children with clinical remission were completely unaffected by physi-cal activity(χ2 ＝14. 117,P<0. 001). The proportion of children without remission with eczema and atopic dermatitis lasting longer than 6 years old was 56. 5%(13/23 cases),which was significantly higher than that of children with re-mission[29. 3%(12/41 cases),χ2 ＝4. 598,P<0. 05]. In 2010 and 2016,there were 46 children with allergen re-sults. Compared with 2010,the proportion of animal fur and pollen allergy increased in 2016[19. 6%(9/46 cases)υs. 52. 2%(24/46 cases),36. 9%(17/46 cases)υs. 67. 4%(31/46 cases)],and there were statistical significances (χ2 ＝10. 632,8. 538,all P<0. 01). In 2016,the number and degree of total allergens in the clinical unrelieved chil-dren were higher than that in the relieved children. Further analysis showed that the unrelieved children had higher cigarette allergy positivity(21. 7% υs. 2. 5%,χ2 ＝4. 239,P<0. 05). There was no significant difference in lung func-tion and exhaling nitric oxide between the clinical unrelieved children and the relieved children. Conclusions Six years later,the proportion of animal fur and pollen allergy increased in children with asthma. Compared with children with remission,the children without remission had more treatment with intermittent control drug,with higher proportion of eczema and atopic dermatitis over six years old,and higher percentage of cigarette allergy positivity.

Conditioned Medium Enhances Osteogenic Differentiation of Induced Pluripotent Stem Cell-Derived Mesenchymal Stem Cells

BACKGROUND: Recent studies have shown that induced pluripotent stem cells (iPSCs) could be differentiated into mesenchymal stem cells (MSCs) with notable advantages over iPSCs per se. In order to promote the application of iPSC-MSCs for osteoregenerative medicine, the present study aimed to assess the ability of murine iPSC-MSCs to differentiate into osteoblast phenotype. METHODS: Osteogenic differentiation medium, blending mouse osteoblast-conditioned medium (CM) with basic medium (BM) at ratio 3:7, 5:5 and 7:3, were administered to iPSC-MSCs, respectively. After 14 days, differentiation was evaluated by lineage-specific morphology, histological stain, quantitative reverse transcription-polymerase chain reaction and immunostaining. RESULTS: The osteogenesis-related genes, alp, runx2, col1 and ocn expressions suggest that culture medium consisting of CM:BM at the ratio of 3:7 enhanced the osteogenic differentiation more than other concentrations that were tested. In addition, the alkaline phosphatase activity and osteogenic marker Runx2 expression demonstrate that the combination of CM and BM significantly enhanced the osteogenic differentiation of iPSC-MSCs. CONCLUSION: In summary, this study has shown that osteoblast-derived CM can dramatically enhance osteogenic differentiation of iPSC-MSCs toward osteoblasts. Results from this work will contribute to optimize the osteogenic induction conditions of iPSC-MSCs and will assist in the potential application of iPSC-MSCs for bone tissue engineering.

Influence of CYP3A5 genotype of donor and recipient on tacrolimus concentration/dose ratio in early postoperative period of children living related liver transplantation / 中华器官移植杂志

Objective To provide a reference for the individualized medication of tacrolimus in children after living related liver transplantation,according to the effect of CYP3A5 genotyping on the concentration/dose ratio of tacrolimus in children with living related liver transplantation.Methods Peripheral blood samples were collected from children with living related liver transplantation in the transplant center.The CYP3A5 genotype was determined by polymerase chain reaction (PCR)pyrosequencing.Related indicators such as tacrolimus dose and concentration in children with living related liver transplantation were collected within 3 months after operation.According to the donor/receptor genotype,the donor/receptor expression group,the donor/receptor single expression group,and the donor/receptor non-expression group were set up.Tacrolimus concentration/dose (C0/D) ratio was statistically analyzed at 5th day,7th day,14th day,28th day,2nd month and 3rd month after administration.Results Among the 76 patients,there were 21 patients (27.63％) in CYP3A5 donor/receptor non-expression group,27 patients (35.53％) in donor/receptor single expression group,and 28 patients (36.84％) in the donor/receptor expression group.The time to the target concentration range (C0＞8 ng/mL) in CYP3A5 donor/receptor expression group was longer than in donor/receptor single expression group and donor/receptor non-expression group.Except for the individual time points,there were significant differences between CYP3A5 donor/receptor expression group and donor/receptor non expression group,or between donor/receptor non-expression group and donor/receptor single expression group,or between donor/receptor expression group and donor/receptor single expression group at rest time points (P＜0.05 for all).Conclusion In the CYP3A5 donor/receptor gene expression group,the higher dose was needed to reach the target concentration range than the gene single expression group and the donor/receptor non-expression group.Except for individual time points,there were significant differences in C0/D at rest different time points.Regardless of whether the donor or recipient contained the CYP3A5* 1 allele,C0/D was lower than the non-expressed type of the gene.Considering the polymorphism of the donor/receptor CYP3A5 gene,it was worthful for children with living related liver transplantation to allow the drug concentration to reach the therapeutic window as soon as possible and reduce organ rejection and adverse reactions.

The influence of tacrolimus concentration/dose ratio and curative effect in early postoperative period of children living donor liver transplantation based on the CYP3A5 genotype / 中华器官移植杂志

Objective To investigate the relationship between CYP3A5 gene polymorphism and tacrolimus concentration/dose ratio in children living donor liver transplantation and the correlation with clinical efficacy,for the relatives living donor liver transplantation in children tacrolimus individualized medication providing reference indicators.Methods Peripheral blood samples were collected from children with relatives living donor liver transplantation in the center of liver transplantation,the genotype of CYP3A5 was determined by polymerase chain reaction (PCR)/pyrophosphate sequencing,The dosage of tacrolimus and blood concentration,liver and kidney function and other related indicators were measured within 3 months after operation According to genotypes,the children can be divided into gene expression group (CYP3A5 *1/*1 and CYP3A5 *1/*3) and non-expression group (CYP3A5*3/*3).The drug concentration (C0),tacrolimus dose / body weight (D/W) ratio,drug concentration/dose (C0/D) ratio of each genotype at 1 day,3 d,5 d,7 d,14 d,28 d,2 months and 3 months after administration and the genotype at the time point on liver and kidney function was carried out statistics.Results Among the 80 cases,36 cases (45.0％) were CYP3A5*3/*3,37 cases (46.2％) were CYP3A5*1/*3,7 cases (8.8％) were CYP3A5*1/*1.CYP3A5 gene expression group reached a therapeutic concentration range (C0 ＞ 8 μg/L) than the gene non-expression group takes longer time.There was no significant difference in CYP3A5 gene expression group between the non-expression group on the initial dose (P＞ 0.05);CYP3A5 gene expression group than the non-expression group,tacrolimus C0 within 1 month after operation were statistically significant.CYP3A5 gene expression group than the non-expression group,tacrolimus D/ W in addition to the first day after surgery,other time points were statistically significant (P＜0.05).CYP3A5 gene expression group than the non-expression group,C0/D at the above time points were statistically significant (P＜0.05);There were no significant differences in liver and kidney function between the two genotypes (P ＞ 0.05),but there was significant difference in the alkaline phosphatase.Conclusion CYP3A5 gene expression in children than non-expression group of children need higher doses to reach the therapeutic drug concentration;CYP3A5 gene polymorphism had significant effects on early tacrolimus C0,D/W and C0/D values;CYP3A5 gene polymorphism is instructive for the administration of tacrolimus in children with living donor liver transplantation,CYP3A5 gene type tests should be regular,improve efficacy and reduce the incidence of adverse reactions.

Monitoring and regularity of tacrolimus in patients subject to cadaveric liver transplantation and living-donor partial liver transplantation / 中华器官移植杂志

Objective To analyze and compare the therapeutic drug monitoring (TDM) and regularity of tacrolimus in deceased donor liver transplantation (DDLT) and living-donor partial liver transplantation (LDLT) the therapeutic drug monitoring (TDM) and regularity of tacrolimus.Method The clinical data of 68 patients undergoing liver transplantation from January 2010 to October 2011 were analyzed retrospectively.Thirty cases underwent LDLT as group A,and the remaining 37 underwent DDLT as group B.Result The time to reach therapeutic window was shorter in group A(3.9 ± 0.7 days) than in group B (6.5 ± 1.0 days,P＜0.01).The tacrolimus dosage in group A was significantly less than that in group B during the first 28 days post-transplantation.However,the tacrolimus dosage approached gradually and tended to be consistent after 28 days.On the postoperative day 7,14,21 and 28,the Tacrolimus dosage in group A was 72.37％,79.31％,90.11％ and 95.45％ of that in group B respectively.Concentration-dose ratio in group B was in a steady state (80-90 g/L).Concentration-dose ratio in group A was decreased with time,culminating at 28th day and close to that in group B.Correlation analysis revealed that graft recipient weight ratio(GRWR) had a significantly positive correlation with the tacrolimus dosage on the first 7 days (r =0.557) and a significantly negative correlation with the tacrolimus concentration/dose ratio (r =-0.578).Conclusion The early tacrolimus dosages in patients subject to LDLT were correlated significantly with the GRWR.The early tacrolimus dosages in patients undergoing LDLT were about 70％ of those in patients undergoing LDLT.However,with the regeneration of the liver,they tended to be consistent after 28 days.

Comparison of the effect of citalopram and fluoxetine in the treatment of depression / 中国基层医药

ObjectiveTo compare the effect and side effects of citalopram and fluoxetine in the treatment of depression.Methods46 cases meet the diagnostic criteria of CCMD-3 in patients with depression were randomly divided into citalopram group and fluoxetine group,treatment for 6 weeks,with Hamilton Depression Rating Scale (HAMD) and Emergent Symptom Scale(TESS) assessed the efficacy and adverse reactions.Results The efficiercy in citalopram group was 75.4％,74.8％ for the fluoxetine group,the difference between the two groups was not significant ( P＞0.05).Affter 2weeks treatment HAMD score between the two groups was significantly different (P ＜ 0.05),TESS score in Citalopram group was lower than the fluoxetine group,the differences were significant ( P ＜ 0.05 ).ConclusionCitalopram and fluoxetine have good antidepressant effects.Citalopram has the advanteges of early onset,cess adverse reactions.

Fenofibrate Improved Acute Insulin Response in Subjects with Impaired Glucose Metabolism and Hypertriglyceridemia / 中山大学学报(医学科学版)

[Objective] The study was conducted to investigate the effect of micronized fenofibrate on acute insulin response in the subjects with impaired glucose metabolism and hypertriglyceridemia. [Methods] Fifty-three subjects were randomly (2:1 ratio) allocated to fenofibrate group (n=36, including IFG 3 cases, IGT 19 cases, IFG/IGT 6 cases, T2DM 8 cases) or control group (n = 17, including IFG 1 case, IGT 9 cases, IFG/IGT 4 cases, T2DM 3 cases) without any intervention for 3 months. Fasting blood samples were collected for measuring fasting plasma glucose (FPG), free fatty acids (FFA), and lipid profile. IVGTTs were carried out with measurement of plasma insulin before and after treatment. Acute insulin response (AIR), the maximum insulin concentrations (C_(INS,MAX)) to fasting insulin (FINS) ratio (C_(INS,MAX)/FINS) and values of the maximum insulin concentrations increment (△C_(INS)) during IVGTT were calculated as indexes of first-phase insulin secretion. HOMA insulin resistance index (HOMA IR) was used for assessing insulin resistance. [Results] After 3-month treatment, the lipid profile was evidently improved in fenofibrate group. Levels of trigiyceridemia (TG), low-density lipoprotein cholesterol and FFA were significantly reduced and high-density lipoprotein cholesterol increased significantly. Waist circumference was also significantly declined. No change of above indicators was found in control group. In fenofibrate group, C_(INS,MAX)/FINS and △C_(INS) were significantly increased (median 8.4 pmol/L vs. 5.3 pmol/L, 808±473 pmol/L vs. 660±472 pmol/L, both P<0.0001), along with great improvement of AIR (5 585±3 441 pmol·L~(-1)·min~(-1) vs. 4 444±3 642 pmol·L~(-1)·min~(-1), P<0.0001). The level of FINS and HOMA IR was also markedly reduced (108±65 pmol/L vs. 166±115 pmol/L, P = 0.002; 3.8±2.3 vs. 6.0±4.2, P = 0.001). In contrast, there were modest declining in acute insulin response (AIR: 4 313～1 943 pmol·L~(-1)·min~(-1) vs. 5 362±2 861 pmol·L~(-1).min~(-1); C_(INS,MAX)/FINS: median 4.6 vs. 7.0, P= 0.01; △C_(INS): 641±286 pmol/L, vs. 720±321 pmol/L, P= 0.003 9) and increasing HOMA IR (7.8±4.2 vs. 5.6±3.2, P<0.000 1) in control group after 3-month follow-up. The improvement of AIR was correlated with the decreasing of plasma FFA and TG (r=0.41, 0.36, P = 0.002, 0.014), but no correlation with the changing of FPG and HOMA IR. [Conclusions] These results indicated that sbort-term lipid-lowering treatment with fenofibrate evidently improved acute insulin response and alleviated insulin resistance in subjects with impaired glucose metabolism and hypertriglyceridemia. Moreover, the improvement of insulin secretion capacity may be mainly due to the relieving of iipotoxity resulting from finofibrate.

Effect of micronized fenofibrate on beta-cell function and insulin resistance in type 2 diabetic patients with hypertriglyceridemia / 中华全科医师杂志

Thirty six patients with hypertriglyceridemia and impaired glucose regulation or newly diagnosed type 2 diabetes, whose fasting plasma glucose was ≤8.0 mmol/L, were treated by fenofibrate for 3 months. Lipid profile, insulin during intravenous glucose tolerance test and oral glucose tolerance test ( including glucose) were measured before and after treatment After treatment, lipid profile was significantly improved. Insulinogenic index (△I30/△G30) and acute insulin response were significantly increased (98. 9vs. 129. 2, 3558.9 vs. 4783. 3 pmol · L - 1 · min - 1, respectively, P ＜ 0. 05 ). Fasting insulin and insulin resistant index in homeostasis model assessment ( HOMA IR) decreased ( 128. 6 vs. 84. 8 pmol/L, 4. 8 vs.3.0, respectively, P ＜0. 05 ). The improvement of insulin secretory function was more significant in patients with higher triglyceride (TG ＞ 3. 3 mmol/L). These results indicate that short-term lipid-lowering treatment with fenofibrate can improve β-cell function and insulin resistance. Patients with higher triglyceride are likely to achieve more benefit from lipid-lowering treatment.

Effect of risperidone and clozapine on the treatment of schizophrenia / 中国基层医药

Objective To comparie effect of risperidone and clozapine on the treatment of schizophrenia and adverse reactions. Methods 40 cases were randomly divided into two groups of patients with schizophrenia, risperi-done and clozapine group 20 cases, pre-treatment and treatment in the first weekend 2,4,6 Symptom Rating Scale (PANSS) and the reaction volume Table (TESS) were used to assess the efficacy and adverse reactions. Results Comparison of reduction rate PANSS, there was no significant difference(P > 0. 05), compared with clozapine group, risperidone group had less adverse reactions. Conclusion Risperidone and clozapine group had considerable effect in the treatment of schizophrenia, but risperidone had fewer adverse reactions.

Analysis of Narcotics Used in Our Hospital During the Period 2000～2002 / 中国药房

OBJECTIVE:To investigate the situation and developing trend of the use of narcotics METHODS:The data of narcotics used in our hospital in 2000～2002 were collected from HIS System and analyzed RESULTS:The sum of money of narcotics was increasing year by year,especially for morphine preparation;The use of Durogesic and MS Contin for the pain control of cancer occupied the first and second places in frequency,but the amount of use of pethidine injection was constantly high CONCLUSION:Irrational drug-use for the pain control of cancer still existed