Mg-doped SrTaO_(2)N as a visible-light-driven H_(2)-evolution photocatalyst for accelerated Z-scheme overall water splitting

Perovskite SrTaO_(2)N is one of the most promising narrow-bandgap photocatalysts for Z-scheme overall water splitting.However,the formation of defect states during thermal nitridation severely hinders the separation of charges,resulting in poor photocatalytic activity.In the present study,we successfully synthesize SrTaO_(2)N photocatalyst with low density of defect states,uniform morphology and particle size by flux-assisted one-pot nitridation combined with Mg doping.Some important parameters,such as the size of unit cell,the content of nitrogen,and microstructure,prove the successful doping of Mg.The defect-related carrier recombination has been significantly reduced by Mg doping,which effectively promotes the charge separation.Moreover,Mg doping induces a change of the band edge,which makes proton reduction have a stronger driving force.After modifying with the core/shell-structured Pt/Cr_(2)O_(3)cocatalyst,the H_(2)evolution activity of the optimized SrTaO_(2)N:Mg is 10 times that of the undoped SrTaO_(2)N,with an impressive apparent quantum yield of 1.51%at 420 nm.By coupling with Au-FeCoO_(x)modified BiVO_(4)as an O_(2)-evolution photocatalyst and[Fe(CN)_(6)]_(3)−/[Fe(CN)_(6)]_(4)−as the redox couple,a redox-based Z-scheme overall water splitting system is successfully constructed with an apparent quantum yield of 1.36%at 420 nm.This work provides an alternative way to prepare oxynitride semiconductors with reduced defects to promote the conversion of solar energy.

Pharmacological effects of volatile oil from chrysanthemum and its associated mechanisms:a review

Volatile oil(VO)is the main chemical component of common plants in Chrysanthemum genus,and it possesses several beneficial pharmacological properties,including bacteriostatic,antioxidant,anti-tumor,anti-inflammatory,antipyretic,analgesic,antiosteoporotic,antihypertensive,sedative,and hypnotic effects.To date,research on the effective components of Chrysanthemum extract has mainly focused on flavonoids,whereas limited data are available on the chemical constituents and underlying mechanisms of action of the VO components.In this review,the pharmacological activities and mechanisms of VO are comprehensively reviewed with the aim of providing a foundation for further development for medicinal,aromatherapy,and diet therapy applications.

Renewable Biomass as a Platform for Preparing Green Chemistry

1 About the Special Issue Editor Qiaoguang Li is an associate professor and master’s supervisor in the Department of College of Chemistry and Chemical Engineering,Zhongkai University of Agriculture and Engineering.He received his PhD from Institute of Chemical Industry of Forestry Products,Chinese Academy of Forestry in 2018.He has been focusing his research on the chemical basis and application of natural resources.He has published nearly 30 international peer reviewed papers and applied for 10 patents.

上海市宝山区11~18岁青少年血压偏高现状及其与超重肥胖的关系

目的 了解上海市宝山区11~18岁青少年血压偏高现状及其与超重肥胖的关系,为预防青少年高血压提供参考依据。方法 利用2013—2019年上海市宝山区185 980名11~18岁青少年的体检数据,计算不同性别、年龄青少年的血压偏高率、超重率和肥胖率,采用Logistic回归分析血压偏高与超重肥胖的关系。结果 上海市宝山区11~18岁青少年收缩压(systolic blood pressure,SBP)和舒张压(diastolic blood pressure,DBP)均值分别为(112.77±13.86)mmHg与(67.72±9.51)mmHg,血压水平随年龄呈上升趋势;血压偏高检出率为18.49%,随年龄的增长而增长(χ^(2)=150.99,P <0.001)。男、女生血压偏高检出率分别为18.79%与18.16%(χ^(2)=12.05,P <0.01)。体重正常、超重、肥胖青少年血压偏高检出率分别为15.20%、23.45%、37.72%,不同体重指数(body mass index,BMI)组间差异有统计学意义(χ^(2)=5 809.51,P <0.001)。多元线性回归与Logistic回归分析显示,BMI与年龄是血压偏高的危险因素,15~18岁青少年血压偏高的风险是11~14岁青少年的1.13倍;超重和肥胖青少年血压偏高的风险分别为正常体重青少年的1.71倍和3.40倍(P <0.001)。结论 上海市宝山区11~18岁青少年血压偏高检出情况处于较高水平,超重肥胖和年龄是主要危险因素,控制青少年超重和肥胖能有效预防青少年血压偏高,应加强青少年血压监测与诊断。

技术逻辑与行为逻辑下的低碳社区设计研究——以奉贤上海之鱼为例

在“双碳”目标和“人民城市”两大战略引领下,低碳导向的美好人居环境建设是城市发展的必由之路。本文聚焦社区这类城市中最贴近人民生活的基本空间单元与日常活动场所,从技术逻辑与行为逻辑双重视角出发,构建“减碳技术—空间场景”的方法框架。以上海之鱼低碳社区为例,通过规划技术的组合干预,实现可感知的低碳生活场景营造,最终引导公众形成绿色低碳的生活方式。由此探索建立适应“双碳”时代人们行为方式和需求转变的低碳社区建设模式。

Development of a model based on the age-adjusted Charlson comorbidity index to predict survival for resected perihilar cholangiocarcinoma

BACKGROUND Perihilar cholangiocarcinoma(pCCA)has a poor prognosis and urgently needs a better predictive method.The predictive value of the age-adjusted Charlson comorbidity index(ACCI)for the long-term prognosis of patients with multiple malignancies was recently reported.However,pCCA is one of the most surgically difficult gastrointestinal tumors with the poorest prognosis,and the value of the ACCI for the prognosis of pCCA patients after curative resection is unclear.AIM To evaluate the prognostic value of the ACCI and to design an online clinical model for pCCA patients.METHODS Consecutive pCCA patients after curative resection between 2010 and 2019 were enrolled from a multicenter database.The patients were randomly assigned 3:1 to training and validation cohorts.In the training and validation cohorts,all patients were divided into low-,moderate-,and high-ACCI groups.Kaplan-Meier curves were used to determine the impact of the ACCI on overall survival(OS)for pCCA patients,and multivariate Cox regression analysis was used to determine the independent risk factors affecting OS.An online clinical model based on the ACCI was developed and validated.The concordance index(C-index),calibration curve,and receiver operating characteristic(ROC)curve were used to evaluate the predictive performance and fit of this model.RESULTS A total of 325 patients were included.There were 244 patients in the training cohort and 81 patients in the validation cohort.In the training cohort,116,91 and 37 patients were classified into the low-,moderate-and high-ACCI groups.The Kaplan-Meier curves showed that patients in the moderate-and high-ACCI groups had worse survival rates than those in the low-ACCI group.Multivariable analysis revealed that moderate and high ACCI scores were independently associated with OS in pCCA patients after curative resection.In addition,an online clinical model was developed that had ideal C-indexes of 0.725 and 0.675 for predicting OS in the training and validation cohorts.The calibration curve and ROC curve indicated that the model had a good fit and prediction performance.CONCLUSION A high ACCI score may predict poor long-term survival in pCCA patients after curative resection.High-risk patients screened by the ACCI-based model should be given more clinical attention in terms of the management of comorbidities and postoperative follow-up.

TMED2 Induces Cisplatin Resistance in Breast Cancer via Targeting the KEAP1-Nrf2 Pathway

Objective Cisplatin is the first-line treatment for breast cancer,but it faces challenges of drug resistance.This study investigated new molecular mechanisms underlying cisplatin resistance in breast cancer.Methods We analyzed sequencing data from the TCGA database to identify potential associations between transmembrane emp24 protein transport domain containing 2(TMED2)and breast cancer.Western blotting,real-time PCR,CCK-8,and TUNEL assays were used to measure the effects and molecular mechanism of TMED2 on cisplatin resistance in MCF-7 and MDA-MB-231 cell lines.Results TMED2 was overexpressed in breast cancer and associated with poor prognosis.TMED2 increased cisplatin resistance in breast cancer cells in vitro via promoting ubiquitination of Kelch-like ECH-associated protein 1(KEAP1),relieving inhibition of KEAP1 on nuclear factor erythroid 2-related factor 2(Nrf2),and increasing expression of downstream drug resistance related genes,such as heme oxygenase 1(HO-1)and NAD(P)H quinone oxidoreductase 1(NQO1).Conclusion We identified a new molecular mechanism by which TMED2 affects cisplatin resistance in breast cancer.Our results provide theoretical guidance for future clinical applications.

Assessment of the induced radioactivity in the treatment room of the heavy-ion medical machine in Wuwei using PHITS

Carbon-ion radiotherapy(CIRT)offers unique physical and biological advantages over photon radiotherapy.However,some materials and devices in the CIRT treatment room become radioactive under bombardment by therapeutic carbon-ion beams due to nuclear reactions,thereby leading to possible radiation hazards to medical staff and additional and unwanted doses to patients.This study assessed the level of induced radioactivity in the treatment room of the Heavy-Ion Medical Machine(HIMM)in Wuwei.Monte Carlo simulations using PHITS were performed for a conservative case under the conditions of maximum beam energy and intensity provided by the HIMM facility.The geometry and configuration of Treatment Room 2 of the HIMM facility in Wuwei were adopted.We evaluated the activation of air,the phantom,and the components of the beamline,such as the primary collimator(PC),ridge filter(RF),and multileaf collimator(MLC).For air activation,we calculated the medical staff immersion external exposure and inhalation internal exposure caused by the corresponding radionuclides.For phantom activation,we estimated the additional dose to the patient’s family members owing to secondary photons after treatment.In addition,the exemption or non-exemption of the component material activation was assessed.The results showed that external radiation caused by air activation was the main source of the annual effective dose at approximately 0.5 mSv/y.The induced radioactivity exposure to family members of a patient after CIRT was approximately 40μSv,sufficiently lower than the public dose limit of 1 mSv/a.The induced radioactivity of the PC,RF,and MLC was all above the exempt levels after the devices were retired,whereas the induced radioactivity of the RS and compensator could reach the exempt levels after one patient session.Our study indicated that medical staff engaged in CIRT should stay away from the high-dose-rate area of induced radioactivity along the beam direction,shorten the residence time in the treatment room as much as possible,and store the activated components in isolation after the equipment is out of use.Thus,this study provides guidance for accurately assessing the level of induced radioactivity in the treatment room for CIRT.

Trees species’ dispersal mode and habitat heterogeneity shape negative density dependence in a temperate forest

Conspecific negative density dependence(CNDD)is a potentially important mechanism in maintaining species diversity.While previous evidence showed habitat heterogeneity and species’dispersal modes affect the strength of CNDD at early life stages of trees(e.g.,seedlings),it remains unclear how they affect the strength of CNDD at later life stages.We examined the degree of spatial aggregation between saplings and trees for species dispersed by wind and gravity in four topographic habitats within a 25-ha temperate forest dynamic plot in the Qinling Mountains of central China.We used the replicated spatial point pattern(RSPP)analysis and bivariate paircorrelation function(PCF)to detect the spatial distribution of saplings around trees at two scales,15 and 50 m,respectively.Although the signal was not apparent across the whole study region(or 25-ha),it is distinct on isolated areas with specific characteristics,suggesting that these characteristics could be important factors in CNDD.Further,we found that the gravity-dispersed tree species experienced CNDD across habitats,while for wind-dispersed species CNDD was found in gully,terrace and low-ridge habitats.Our study suggests that neglecting the habitat heterogeneity and dispersal mode can distort the signal of CNDD and community assembly in temperate forests.

Combining local regional therapy and systemic therapy:Expected changes in the treatment landscape of recurrent hepatocellular carcinoma

Improvements in early screening,new diagnostic techniques,and surgical treatment have led to continuous downward trends in hepatocellular carcinoma(HCC)morbidity and mortality rates.However,high recurrence and refractory cancer after hepatectomy remain important factors affecting the long-term prognosis of HCC.The clinical characteristics and prognosis of recurrent HCC are heterogeneous,and guidelines on treatment strategies for recurrent HCC are lacking.Therapies such as surgical resection,radiofrequency ablation,and transhepatic arterial chemoembolization are effective for tumors confined to the liver,and targeted therapy is a very important treatment for unresectable recurrent HCC with systemic metastasis.With the deepening of the understanding of the immune microenvironment of HCC,blocking immune checkpoints to enhance the antitumor immune response has become a new direction for the treatment of HCC.In addition,improvements in the tumor immune microenvironment caused by local treatment may provide an opportunity to improve the therapeutic effect of HCC treatment.Ongoing and future clinical trial data of combined therapy may develop the new treatment scheme for recurrent HCC.This paper reviews the pattern of recurrent HCC and the characteristics of the immune microenvironment,demonstrates the basis for combining local treatment and systemic treatment,and reports current evidence to better understand current progress and future approaches in the treatment of recurrent HCC.

Transcutaneous electrical acupoint stimulation in adult patients receiving gastrectomy/colorectal resection:A randomized controlled trial

BACKGROUND Acupuncture promotes the recovery of gastrointestinal function and provides analgesia after major abdominal surgery.The effects of transcutaneous electrical acupoint stimulation(TEAS)remain unclear.AIM To explore the potential effects of TEAS on the recovery of gastrointestinal function after gastrectomy and colorectal resection.METHODS Patients scheduled for gastrectomy or colorectal resection were randomized at a 2:3:3:2 ratio to receive:(1)TEAS at maximum tolerable current for 30 min immediately prior to anesthesia induction and for the entire duration of surgery,plus two 30-min daily sessions for 3 consecutive days after surgery(perioperative TEAS group);(2)Preoperative and intraoperative TEAS only;(3)Preoperative and postoperative TEAS only;or(4)Sham stimulation.The primary outcome was the time from the end of surgery to the first bowel sound.RESULTS In total,441 patients were randomized;405 patients(58.4±10.2 years of age;247 males)received the planned surgery.The time to the first bowel sounds did not differ among the four groups(P=0.90;log-rank test).On postoperative day 1,the rest pain scores differed significantly among the four groups(P=0.04;Kruskal–Wallis test).Post hoc comparison using the Bonferroni test showed lower pain scores in the perioperative TEAS group(1.4±1.2)than in the sham sti-mulation group(1.7±1.1;P=0.04).Surgical complications did not differ among the four groups.CONCLUSION TEAS provided analgesic effects in adult patients undergoing major abdominal surgery,and it can be added to clinical practice as a means of accelerating postoperative rehabilitation of these patients.

不同程度精索静脉曲张不育患者精索静脉高位结扎术后精子DNA碎片分析

目的分析不同程度精索静脉曲张(VC)不育患者行精索静脉高位结扎术后精子DNA碎片的情况。方法不同程度VC不育患者57例。其中,诊断为2级患者27例,3级患者30例。所有患者行精索静脉高位结扎术前1个月及术后3个月检测并计算精子DNA碎片指数(DFI)。结果 57例VC不育患者均行腹腔镜双侧精索静脉高位结扎术。VC 2级和3级患者行手术治疗后精子DFI与术前比较均值降低,差异有统计学意义(P<0.05)。治疗前VC 2级和3级不育患者精子DFI比较差异无统计学意义(P>0.05);治疗后2级患者精子DFI低于3级患者(P<0.05),DFI改善情况优于3级患者(P<0.05)。结论腹腔镜精索静脉高位结扎术能够改善VC不育患者精子DNA碎片情况,对于2级患者效果更佳。

基于“功能-能力”框架的中国多维福祉测评及区域均衡分析

基于“功能-能力”框架构建中国多维福祉测评指标体系,对1995~2014年中国省级区域多维福祉水平、空间差异以及功能与能力福祉的区域均衡类型进行研究发现:①中国功能福祉与能力福祉水平均有明显提升。四大区域功能福祉水平由高到低依次为东部、东北、中部和西部地区,能力福祉水平东部最高、中部最低,西部与东北较为接近。②整体来看,中国功能福祉的省际差异缩小,能力福祉的省际差异有所扩大。③中国各省份功能福祉与能力福祉的发展大致经历了“功能福祉主导→能力福祉主导→较高水平协调”的不断优化演进过程,提高能力福祉向功能福祉的转换效率是促进中国综合福祉提升及其协调发展的关键。

Poor prognosis for hepatocellular carcinoma with transarterial chemoembolization pre-transplantation:Retrospective analysis

AIM: To investigate whether transarterial chemoembolization(TACE) before liver transplantation(LT) improves long-term survival in hepatocellular carcinoma(HCC) patients.METHODS: A retrospective study was conducted among 204 patients with HCC who received LT from January 2002 to December 2010 in PLA General Hospital. Among them, 88 patients received TACE before LT. Prognostic factors of serum α-fetoprotein(AFP), intraoperative blood loss, intraoperative blood transfusion, disease-free survival time, survival time with tumor, number of tumor nodules, tumor size, tumor number, presence of blood vessels and bile duct invasion, lymph node metastasis, degree of tumor differentiation, and preoperative liver function were determined in accordance with the Child-TurcottePugh(Child) classification and model for end-stage liver disease. We also determined time of TACE before transplant surgery and tumor recurrence and metastasis according to different organs. Cumulative survival rate and disease-free survival rate curves were prepared using the Kaplan-Meier method, and the logrank and χ2 tests were used for comparisons.RESULTS: In patients with and without TACE before LT, the 1, 3 and 5-year cumulative survival rate was 70.5% ± 4.9% vs 91.4% ± 2.6%, 53.3% ± 6.0% vs 83.1% ± 3.9%, and 46.2% ± 7.0% vs 80.8% ± 4.5%, respectively. The median survival time of patients with and without TACE was 51.857 ± 5.042 mo vs 80.930 ± 3.308 mo(χ2 = 22.547, P < 0.001, P < 0.05). The 1, 3 and 5-year disease-free survival rates for patients with and without TACE before LT were 62.3% ± 5.2% vs98.9% ± 3.0%, 48.7% ± 6.7% vs 82.1% ± 4.1%, and 48.7% ± 6.7% vs 82.1% ± 4.1%, respectively. The median survival time of patients with and without TACE before LT was 50.386 ± 4.901 mo vs 80.281 ± 3.216 mo(χ2 = 22.063, P < 0.001, P < 0.05). TACE before LT can easily lead to pulmonary or distant metastasis of the primary tumor. Although there was no significant difference between the two groups, the chance of metastasis of the primary tumor in the group with TACE was significantly higher than that of the group without TACE.CONCLUSION: TACE pre-LT for HCC patients increased the chances of pulmonary or distant metastasis of the primary tumor, thus reducing the long-term survival rate.

Traditional surgical planning of liver surgery is modified by 3D interactive quantitative surgical planning approach： a single-center experience with 305 patients

BACKGROUND： Decision making and surgical planning are to achieve the precise balance of maximal removal of target lesion, maximal sparing of functional liver remnant volume, and minimal surgical invasiveness and therefore, crucial in liver surgery. The aim of this prospective study was to validate the accuracy and predictability of 3D interactive quantitative surgical planning approach （IQSP）, and to evaluate the impact of IQSP on traditional surgical plans based on 2D images. METHODS： A total of 305 consecutive patients undergoing hepatectomy were included in this study. Surgical plans were created by traditional 2D approach using picture archiving and communication system （PACS） and 3D approach using IQSP respectively by two groups of physicians who did not know the surgical plans of the other group. The two surgical plans were submitted to the chief surgeon for selection before operation. The specimens were weighed. The two surgical plans were compared and analyzed retrospectively based on the operation results. RESULTS： The two surgical plans were successfully developed in all 305 patients and all the 3D IQSP surgical plans were selected as the final decision. Total 278 patients successfully underwent surgery, including 147 uncomplex hepatectomy and 131 complex hepatectomy. Twenty-seven patients were withdrawn from hepatectomy. In the uncomplex group, the two surgical plans were the same in all 147 patients and no statistically significant difference was found among 2D calcu- lated resection volume （2D-RV）, 3D IQSP calculated resection volume （IQSP-RV） and the specimen volume. In the complex group, the two surgical plans were different in 49 patients （49/131, 37.4%）. According to the significance of differences, the 49 different patients were classified into three grades. No statistically significant difference was found between IQSP-RV and specimen volume. The coincidence rate of territory analy- sis of IQSP with operation was 92.1% （93/101） for 101 patients of anatomic hepatectomy. CONCLUSIONS： The accuracy and predictability of 3D IQSP were validated. Compared with traditional surgical planning, 3D IQSP can provide more quantitative information of anatomic structure. With the assistance of 3D IQSP, traditional surgical plans were modified to be more radical and safe.

Seasonal variations in the energy budget of Elliot's pheasant (Syrmaticus ellioti) in cage

This study aimed to discuss the energy budget of Elliot's pheasant Syrmaticus ellioti in different seasons, with life and health, good growth and normal digestion of Elliot's pheasant as the tested objects, The energy budget of Elliot's pheasant was measured by daily collection of the trial pheasants' excrement in the biological garden of Guangxi Normal University from March 2011 to February 2012. The results showed that the gross energy consumption, metabolic energy and excrement energy varied by season, increasing as temperature decreased. There was significant difference in gross energy consumption, metabolic energy, excrement energy between adults and nonages. There was also a trend that food digestibility of pheasants increases as temperature increases. In the same season, the food digestibility of adults was better than that of nonages. Throughout spring, summer, autumn and winter, the metabolic energy of 4-year adults were 305.77±13.40 kJ/d, 263.67±11.89 kJ/d, 357.23±25.49 kJ/d and 403.12±24.91 kJ/d, respectively, and the nonages were 284.86±17.22 kJ/d, 284. 66±15.16 kJ/d, 402. 26±31.46 kJ/d and 420. 30±31.98 kJ/d, respectively. The minimum metabolic energies were 247.65±21.81 g, 265.86±26.53 g, respectively for each group, detected between 4-year adults and 1-year nonages. Further study is needed to determine whether 29.6 C is the optimal temperature for the Elliot's pheasant.

Safety validation of decision trees for hepatocellular carcinoma

AIM: To evaluate a different decision tree for safe liver resection and verify its efficiency.METHODS: A total of 2457 patients underwent hepatic resection between January 2004 and December 2010 at the Chinese PLA General Hospital,and 634 hepatocellular carcinoma(HCC) patients were eligible for the final analyses. Post-hepatectomy liver failure(PHLF) was identified by the association of prothrombin time < 50% and serum bilirubin > 50 μmol/L(the "50-50" criteria),which were assessed at day 5 postoperatively or later. The Swiss-Clavien decision tree,Tokyo University-Makuuchi decision tree,and Chinese consensus decision tree were adopted to divide patients into two groups based on those decision trees in sequence,and the PHLF rates were recorded.RESULTS: The overall mortality and PHLF rate were 0.16% and 3.0%. A total of 19 patients experienced PHLF. The numbers of patients to whom the SwissClavien,Tokyo University-Makuuchi,and Chinese consensus decision trees were applied were 581,573,and 622,and the PHLF rates were 2.75%,2.62%,and 2.73%,respectively. Significantly more cases satisfied the Chinese consensus decision tree than the Swiss-Clavien decision tree and Tokyo University-Makuuchi decision tree(P < 0.01,P < 0.01); nevertheless,the latter two shared no difference(P = 0.147). The PHLF rate exhibited no significant difference with respect to the three decision trees.CONCLUSION: The Chinese consensus decision tree expands the indications for hepatic resection for HCC patients and does not increase the PHLF rate compared to the Swiss-Clavien and Tokyo UniversityMakuuchi decision trees. It would be a safe and effective algorithm for hepatectomy in patients with hepatocellular carcinoma.

Monte Carlo study of the neutron ambient dose equivalent at the heavy ion medical machine in Wuwei

The use of carbon-ion radiotherapy(CIRT)is gradually increasing.Owing to the generation of high-energy secondary neutrons during CIRT,its use presents new challenges in radiation protection.Thus,secondary neutron dose distributions must be explored and evaluated under clinical scenarios based on different treatment configurations.However,neutron dose and energy spectrum measurements are often difficult.This can be primarily attributed to the inherent limitations of most neutron detectors,such as their unsuitability for spectral measurements and inaccurate responses to neutrons with energies above 20 MeV.Numerical calculation methods based on probabilistic statistical theory are fast and convenient for neutron dose evaluation.In this study,external secondary neutron doses at the heavy ion medical machine in Wuwei,which is equipped with a passive beam delivery system,were calculated using the Monte Carlo method.The dependence of neutron doses on various treatment parameters(incident carbon-ion beam energy,spatial location,field size,and spread-out Bragg peak(SOBP)width)was investigated.Furthermore,the feasibility of applying an analytical model to predict the ambient dose equivalent was verified.For the combination involving an energy of 400 MeV=u and SOBP width of 6 cm,the ambient dose equivalent per therapeutic dose(H=D)at the isocenter was 79.87 mSv=Gy:The H=D value decreased rapidly with increasing spatial distance and slightly with increasing aperture size and SOBP width.The H=D values derived from the Monte Carlo simulations were in good agreement with the results reported in the literature.The analytical model could be used to quickly predict the H=D value along the incidence direction of the beam with an error of less than 20%.Thus,our study contributes to the understanding of the relationship between neutron radiation and treatment configuration parameters,which establishes a basis for predicting non-therapeutic radiation doses in CIRT.

Delayed introduction of immunosuppressive regimens in critically ill patients after liver transplantation

BACKGROUND: The manipulation of immunosuppression therapy remains challenging in patients who develop infectious diseases or multiple organ dysfunction after liver transplantation. We evaluated the outcomes of delayed introduction of immunosuppression in the patients after liver transplantation under immune monitoring with ImmuKnow assay. METHODS: From March 2009 to February 2014, 225 consecutive liver recipients in our institute were included. The delayed administration of immunosuppressive regimens was attempted in 11 liver recipients with multiple severe comorbidities. RESULTS: The median duration of non-immunosuppression was 12 days (range 5-58). Due to the infectious complications, the serial ImmuKnow assay showed a significantly low ATP level of 64 +/- 35 ng/mL in the early period after transplantation. With the development of comorbidities, the ImmuKnow value significantly increased. However, the acute allograft rejection developed when a continuous distinct elevation of both ATP and glutamyltranspeptidase levels was detected. The average ATP level measured just before the development of acute rejection was 271 +/- 115 ng/mL. CONCLUSIONS: The delayed introduction of immunosuppressive regimens is safe and effective in management of critically ill patients after liver transplantation. The serial ImmuKnow assay could provide a reliable depiction of the dynamics of functional immunity throughout the clinical course of a given patient.

Graft cholangiopathy: etiology, diagnosis, and therapeutic strategies

BACKGROUND: Graft cholangiopathy has been recognized as a significant cause of morbidity, graft loss, and even mortality in patients after orthotopic liver transplantation. The aim of this review is to analyze the etiology, pathogenesis, diagnosis and therapeutic strategies of graft cholangiopathy after liver transplantation. DATA SOURCE: A PubMed database search was performed to identify articles relevant to liver transplantation, biliary complications and cholangiopathy. RESULTS: Several risk factors for graft cholangiopathy after liver transplantation have been identified, including ischemia/ reperfusion injury, cytomegalovirus infection, immunological injury and bile salt toxicity. A number of strategies have been attempted to prevent the development of graft cholangiopathy, but their efficacy needs to be evaluated in large clinical studies. Non-surgical approaches may offer good results in patients with extrahepatic lesions. For most patients with complex hilar and intrahepatic biliary abnormalities, however, surgical repair or re-transplantation may be required. CONCLUSIONS: The pathogenesis of graft cholangiopathy after liver transplantation is multifactorial. In the future, more efforts should be devoted to the development of more effective preventative and therapeutic strategies against graft cholangiopathy.