Tacrolimus dosage requirements in living donor liver transplant recipients with small-for-size grafts

AIM:To investigate the tacrolimus dosage requirements and blood concentrations in adult-to-adult right lobe living donor liver transplantation (AALDLT) recipients with small-for-size (SFS) grafts.METHODS: During January 2007 and October 2008, a total of 54 cases of AALDLT with an observation period of 6 mo were enrolled in this study. The 54 patients were divided into two groups according to graft-recipient body weight ratio (GRBW): SFS grafts group (Group S, GRBW<0.8%, n=8) and non-SFS grafts group (Group N, GRBW ≥0.8%, n=46). Tacrolimus 12-hour blood levels and doses were recorded during weeks 1,2,3 and 4 and months 2,3,4,5 and 6 in group S and group N. Meanwhile, acute rejection rates, liver and renal function test results, and the number of potentially interacting medications were determined at each interval in the two groups. A comparison of tacrolimus dosage requirements and blood levels were made weekly in the first month post-surgery, and monthly from months 2 to 6.RESULTS: There were no differences in the demo-graphic characteristics, acute rejection rates, liver and renal function test results, or the number of potentially interacting medications administered between the two groups. The tacrolimus dosage requirements in group S were significantly lower than group N at 2 wk (2.8±0.4 mg/d vs 3.6±0.7 mg/d, P=0.006), 3 wk (2.9±0.7 mg/d vs 3.9±0.8 mg/d, P=0.008), 4 wk (2.9±0.8 mg/d vs 3.9±1.0 mg/d, P=0.023) and 2 mo (2.8±0.7 mg/d vs 3.8 ±1.1 mg/d, P=0.033). Tacrolimus 12-h trough concentrations were similar between the two groups at all times except for 2 wk post-transplantation, when the concentrations were signifi cantly greater in group S recipients than in group N recipients (11.3±4.8 ng/mL vs 7.0±3.8 ng/mL, P=0.026).CONCLUSION: SFS grafts recipients have signifi cantly decreased tacrolimus dosage requirements compared with non-SFS grafts recipients in AALDLT during the first 2 mo post-surgery.

Feasibility of using marginal liver grafts in living donor liver transplantation

Liver transplantation(LT) is one of the most effective treatments for end-stage liver disease caused by related risk factors when liver resection is contraindicated. Additionally,despite the decrease in the prevalence of hepatitis B virus(HBV) over the past two decades,the absolute number of HBs Ag-positive people has increased,leading to an increase in HBV-related liver cirrhosis and hepatocellular carcinoma. Consequently,a large demand exists for LT. While the wait time for patients on the donor list is,to some degree,shorter due to the development of living donor liver transplantation(LDLT),there is still a shortage of liver grafts. Furthermore,recipients often suffer from emergent conditions,such as liver dysfunction or even hepatic encephalopathy,which can lead to a limited choice in grafts. To expand the pool of available liver grafts,one option is the use of organs that were previously considered "unusable" by many,which are often labeled "marginal" organs. Many previous studies have reported on the possibilities of using marginal grafts in orthotopic LT; however,there is still a lack of discussion on this topic,especially regarding the feasibility of using marginal grafts in LDLT. Therefore,the present review aimed to summarize the feasibility of using marginal liver grafts for LDLT and discuss the possibility of expanding the application of these grafts.

Impact of human leukocyte antigen mismatching on outcomes of liver transplantation:A meta-analysis

AIM:To assess the effect of human leukocyte antigen(HLA) mismatching on liver graft outcome and acute rejection from a meta-analysis of available cohort studies.METHODS:Articles in PubMed/MEDLINE,EMBASE and the Cochrane database from January 1970 to June 2009,including non-English literature identified in these databases,were searched.Only studies comparing HLA or sub-phenotype matching with mismatching were extracted.The percentage of graft survival was extracted by "Engauge Digitizer" from survival curves if the raw data were not displayed.A meta-analysis was performed when at least 3 studies provided data.RESULTS:Sixteen studies met the inclusion criteria.A lower number of HLA mismatches(0-2 vs 3-6) did reduce the incidence of acute rejection(relative risk:0.77,P = 0.03).The degree of HLA mismatching(0-2 vs 3-6) had no significant effect on 1-year [hazard ratio(HR):1.04,P = 0.68] and 5-year(HR:1.09,P = 0.38) graft survival.In sub-phenotype analysis,the degree of HLA-A,B and DR mismatching(0 vs 1-2) had no significant effect on 1-year and 5-year graft survival,either.The HRs and P-values were 0.95,0.71(HLA-A,1-year);1.06,0.60(HLA-A,5-year);0.77,0.16(HLA-B,1-year);1.07,0.56(HLA-DR,1-year);1.18,0.23(HLADR,5-year),respectively.CONCLUSION:The results of this systematic review imply that good HLA compatibility can reduce the incidence of acute rejection in spite of having no influence on graft outcomes.To obtain a short recovery time and minimize rejection post transplantation,HLA matching studies should be considered before the operation.

Efficacy of immunosuppression monotherapy after liver transplantation:A meta-analysis

AIM:To assess the advantages and disadvantages of immunosuppression monotherapy after transplantation and the impact of monotherapy on hepatitis C virus(HCV)recurrence.METHODS:Articles from Cochrane Hepato-Biliary Group Controlled Trials Register,the Cochrane Central Register of Controlled Trials in The Cochrane Library,MEDLINE,EMBASE,and Science Citation Index Expanded,including non-English literature identified in these databases,were searched up to January 2013.We included randomized clinical trials comparing various immunosuppression monotherapy and prednisone-based immunosuppression combinations for liver transplantation.The modified Jadad scale score or the Oxford quality scoring system was used.Meta-analyses were performed with weighted random-effects models.RESULTS:A total of 14 randomized articles including 1814 patients were identified.Eight trials including1214 patients compared tacrolimus monotherapy(n=610)vs tacrolimus plus steroids or triple therapy regarding acute rejection and adverse events(n=604).Five trials,including 285 patients,compared tacrolimus monotherapy(n=143)vs tacrolimus plus steroids or triple therapy regarding hepatitis C recurrence(n=142).Four trials including 273 patients compared cyclosporine monotherapy(n=148)vs cyclosporine and steroids regarding acute rejection and adverse events(n=125).Two trials including 170 patients compared mycophenolate mofetil monotherapy(n=86)vs combinations regarding acute rejection(n=84).There were no significant differences in the acute rejection rates between tacrolimus monotherapy(RR=1.04,P=0.620),and cyclosporine monotherapy(RR=0.89,P=0.770).Mycophenolate mofetil monotherapy had a significant increase in the acute rejection rate(RR=4.50,P=0.027).Tacrolimus monotherapy had no significant effects on the recurrence of hepatitis C(RR=1.03,P=0.752).More cytomegalovirus infection(RR=0.48,P=0.000)and drug-related diabetes mellitus(RR=0.54,P=0.000)were observed in the immunosuppression combination therapy groups.CONCLUSION:Tacrolimus and cyclosporine monotherapy may be as effective as immunosuppression combination therapy.Mycophenolate mofetil monotherapy was not considerable.Tacrolimus monotherapy does not increase recurrence of HCV.

QBFO-BOMP Based Channel Estimation Algorithm for mmWave Massive MIMO Systems

At present,the traditional channel estimation algorithms have the disadvantages of over-reliance on initial conditions and high complexity.The bacterial foraging optimization(BFO)-based algorithm has been applied in wireless communication and signal processing because of its simple operation and strong self-organization ability.But the BFO-based algorithm is easy to fall into local optimum.Therefore,this paper proposes the quantum bacterial foraging optimization(QBFO)-binary orthogonal matching pursuit(BOMP)channel estimation algorithm to the problem of local optimization.Firstly,the binary matrix is constructed according to whether atoms are selected or not.And the support set of the sparse signal is recovered according to the BOMP-based algorithm.Then,the QBFO-based algorithm is used to obtain the estimated channel matrix.The optimization function of the least squares method is taken as the fitness function.Based on the communication between the quantum bacteria and the fitness function value,chemotaxis,reproduction and dispersion operations are carried out to update the bacteria position.Simulation results showthat compared with other algorithms,the estimationmechanism based onQBFOBOMP algorithm can effectively improve the channel estimation performance of millimeter wave(mmWave)massive multiple input multiple output(MIMO)systems.Meanwhile,the analysis of the time ratio shows that the quantization of the bacteria does not significantly increase the complexity.

文化遗产网络舆情大数据的监测系统设计

文章设计了文化遗产网络舆情大数据的监测系统,系统功能为:(1)能够实时的爬取海量网络媒体内容中的文化遗产舆情信息;(2)建立核心舆情数据库存储核心舆情信息;(3)能对隐含在核心舆情信息中的价值信息进行挖掘和展示;(4)能自动给相关人员发送文化遗产舆情的监测和预警信息。该系统的设计能为相关各方获得文化遗产的信息与动态提供一种新的方式与渠道。

药学综合实验形成性评价体系的设计和应用

课程质量是高校生存和发展的生命线,课程建设是强院兴校的重要举措,是高校实现人才培养目标的途径和手段。形成性评价在课程建设和质量提升中发挥着重要作用,通过对药学综合实验课程进行形成性评价体系的设计和应用以及课程反思,旨在发现课程的多维价值、存在问题及解决策略,为提升课程质量、促进学生能力跨越式发展奠定基础。

大数据、物联网技术在智慧城市中的应用

为实现智慧城市建设,使政府运行管理更加高效,人们生活品质进一步提升,分析了大数据与物联网技术在智慧城市中电子商务、养老服务、智慧家居等方面的应用,提高了大数据城市应用能力和管理能力,解决了我国公共交通问题。智能家居、智能设备的出现,极大地便利了人们的衣食住行,解决了城市管理工作在时间和空间上的局限,实现了互通发展,使城市更加智能化。未来,要加快智慧城市建设脚步,有效提高智慧城市建设速度与质量,促进城市更好地实现可持续发展。

“新文科”建设背景下艺术院校大学英语教学再思考

“新文科”建设赋予了艺术院校的大学英语教学新内涵。艺术院校的大学英语教学一方面要以育人为中心,结合学科特点和优势,将思政教育的理念应用于英语课程;另一方面要研究英语与艺术学科的交叉融合,使大学英语在教学内容和模式上由通用英语向专门用途英语(ESP)转型,走具有专业属性的艺术院校大学英语教学发展之路,培养“一专多能”的创新型人才,提高艺术类学生运用专业英语进行沟通交流的能力。

微课在艺术院校大学英语教学中的有效性调查

微课短而精,是适合教育资源碎片化、知识传授多样化、学习个性化的一种教学模式。本文探讨了微课的内涵,结合教学有效性的理论研究,构建以微课为主要载体的艺术院校大学英语教学有效性研究。作者从微课选题、有效设计、效果、满意度四个维度设计问卷,采用问卷调查法,以艺术院校的学生为研究对象进行调查、数据分析,以此探讨微课在艺术院校大学英语教学中的效果及有效性。

宁波市城区两级区域医疗联合体现状调查及对策分析

以宁波市某三甲综合医院及其下属5家社区卫生服务中心的医务人员和患者为调查对象,了解宁波市三甲综合医院和社区卫生服务中心形成的医联体运行情况,发现医联体在运行过程中存在的问题,提出运用多元治理理论,完善医联体运行的对策和建议。

基于银纳米线电极-rGO敏感材料的柔性NO2气体传感器

使用银纳米线作为材料制备柔性叉指电极,用还原氧化石墨烯(reduced graphene oxide, rGO)作为气体敏感材料制备出柔性气体传感器,并研究其对二氧化氮气体的响应特性以及柔韧性能.实验结果表明,制备的以银纳米线作为电极的r GO气体传感器可以实现室温下对浓度为5-50 ppm (1 ppm=10^–6)的NO2气体的检测,对50 ppm的NO2的响应能够达到1.19,传感器的重复性较好,恢复率能够保持在76%以上,传感器的灵敏度是0.00281 ppm^-1,对浓度为5 ppm的NO2气体的响应时间是990 s,恢复时间是1566 s.此外,传感器在0°-45°的弯曲角度下仍表现出优异的电学特性与气体传感性能,所制备的器件具有相对稳定的导电性和较好的弯曲耐受性.

水合肼还原的氧化石墨烯吸附NO2的实验研究

还原氧化石墨烯由于独特的原子结构,作为气体检测领域有潜力的候选者引起了研究者们的广泛兴趣.本文采用水合肼作为还原剂来制备还原氧化石墨烯,并以此作为叉指电极的气体敏感层,研究了其对NO2气体的响应特性.结果表明,水合肼还原的氧化石墨烯可以实现在室温下对浓度为1—40 ppm (1 ppm=10–6)的NO2气体的检测,具有较好的响应性和重复性,恢复率可以达到71%以上,但是灵敏度只有0.00201 ppm–1,还有较大的提升空间.此外,对浓度5 ppm的NO2的响应和恢复时间分别是319 s和776 s.水合肼还原的氧化石墨烯气体传感器的传感机制可归因于NO2分子和传感材料之间的电荷转移.还原氧化石墨烯的突出电学特性促进了电子转移过程,这使得传感器在室温下表现出优异的气体传感性能.本实验研究可为石墨烯基传感器件的应用奠定一定的基础.

区域医联体全处方点评实践分析

目的探讨区域医联体内全处方点评实践对提高区域合理用药水平的影响,促进“药学信息”向“信息药学”发展。方法根据已上市药品的药品说明书、临床指南、《中华人民共和国药品管理法》等有关法律规范,于2019年1月起建立合理用药知识规则库。于2019年5月起运用处方点评软件与人工点评相结合的模式对区域医联体内上海市静安区闸北中心医院等五家单位——进行全处方点评分析、干预、反馈。通过各家医疗机构的HIS系统提取2019年5—7月每月月初10日内门诊全部处方作为对照组,提取2019年10—12月每月同期的门诊全部处方作为观察组,比较两组处方合格率变化。结果通过医联体内全处方点评、干预和反馈,区域医联体处方合格率由点评干预前的89.08%上升至点评干预后的93.65%(χ^(2)=48.939,P<0.001)。结论区域医联体全处方点评干预模式不仅提高了处方质量和处方合理率,也保障了医疗安全,为各医院间知识库信息资源共享、区域同质化管理提供了参考价值。

课程思政在高职护理少数民族学生基本护理技术课程中的应用

目的探索课程思政在高职护理少数民族学生基本护理技术课程中的应用。方法随机选取2个班学生分为对照组和实验组,实验组在教学过程中采取课程思政,对照组采用传统教学模式,观察两组护生的专业认可度、自我效能感。结果实验组在专业认可度、自我效能感优于对照组,差异有统计学意义。结论课程思政可以增强学生的专业认可度、自我效能感,值得进一步研究。

Is total laparoscopic pancreaticoduodenectomy superior to open procedure? A meta-analysis

BACKGROUND Laparoscopy has been widely used in general surgical procedures,but total laparoscopic pancreaticoduodenectomy(TLPD)is still a complex and challenging surgery that is only performed in a small number of patients at a few large academic medical centers.Although the safety and feasibility of TLPD have been established,few studies have compared it with open pancreaticoduodenectomy(OPD)with regard to perioperative and oncological outcomes.Therefore,we carried out a meta-analysis to evaluate whether TLPD is superior to OPD.AIM To compare the treatment outcomes of TLPD and OPD in order to assess the safety and feasibility of TLPD.METHODS We conducted a systematic search of studies comparing TLPD with OPD that were published in the PubMed,EMBASE,and Cochrane Library databases through December 31,2018.The studies comparing TLPD and OPD with at least one of the outcomes we were interested in and with more than 10 cases in each group were included in this analysis.The Newcastle-Ottawa scale was used to assess the quality of the nonrandomized controlled trials and the Jadad scale was used to assess the randomized controlled trials.Intraoperative data,postoperative complications,and oncologic outcomes were evaluated.The metaanalysis was performed using Review Manager Software version 5.3.Random or fixed-effects meta-analyses were undertaken to measure the pooled estimates.RESULTS A total of 4790 articles were initially identified for our study.After screening,4762 articles were excluded and 28 studies representing 39771 patients(3543 undergoing TLPD and 36228 undergoing OPD)were eventually included.Patients who underwent TLPD had less intraoperative blood loss[weighted mean difference(WMD)=-260.08 mL,95%confidence interval(CI):(-336.02,-184.14)mL,P<0.00001],a lower blood transfusion rate[odds ratio(OR)=0.51,95%CI:0.36-0.72,P=0.0001],a lower perioperative overall morbidity(OR=0.82,95%CI:0.73-0.92,P=0.0008),a lower wound infection rate(OR=0.48,95%CI:0.34-0.67,P<0.0001),a lower pneumonia rate(OR=0.72,95%CI:0.60-0.85,P=0.0002),a shorter duration of intensive care unit(ICU)stay[WMD=-0.28 d,95%CI(-2.88,-1.29)d,P<0.00001]and a shorter length of hospital stay[WMD=-3.05 d,95%CI(-3.93,-2.17),P<0.00001],a lower rate of discharge to a new facility(OR=0.55,95%CI:0.39-0.78,P=0.0008),and a lower 30-d readmission rate(OR=0.81,95%CI:0.68-0.95,P=0.10)than those who underwent OPD.In addition,the TLPD group had a higher R0 rate(OR=1.28,95%CI:1.13-1.44,P=0.0001)and more lymph nodes harvested(WMD=1.32,95%CI:0.57-2.06,P=0.0005)than the OPD group.However,the patients who underwent TLPD experienced a significantly longer operative time(WMD=77.92 min,95%CI:40.89-114.95,P<0.0001)and had a smaller tumor size than those who underwent OPD[WMD=-0.32 cm,95%CI:(-0.58,-0.07)cm,P=0.01].There were no significant differences between the two groups in the major morbidity,postoperative pancreatic fistula,delayed gastric emptying,postpancreatectomy hemorrhage,bile leak,gastroenteric anastomosis fistula,intra-abdominal abscess,bowel obstruction,fluid collection,reoperation,ICU admission,or 30-d and 90-d mortality rates.For malignant tumors,the 1-,2-,3-,4-and 5-year overall survival rates were not significantly different between the two groups.CONCLUSION This meta-analysis indicates that TLPD is safe and feasible,and may be a desirable alternative to OPD,although a longer operative time is needed and only smaller tumors can be treated.

异构网络环境中基于能量时间竞争机制的网络分簇算法研究

无线传感器网络的使用寿命主要是由能量来决定的,节点能量消耗可以通过节点分簇算法来进一步降低。针对无线传感器网络分簇中存在的"能量空洞"问题,本文提出一种新的降低节点能量损耗的节点分簇算法——LVUC算法。该算法综合考虑了网络中节点的能量消耗的异构性以及各个节点计算能力的异构性,依据节点的剩余能量和预测的成簇节点的能量损耗,选取剩余能量相对较高的节点为簇头节点。仿真实验结果表明,该算法能有效地均衡节点的能量消耗,从而延长网络的生命周期。

艺术院校大学生英语写作句法复杂度现状

英语写作句法复杂度是衡量英语学习者写作水平的重要指标之一。以艺术院校大学生为研究对象,通过对不同专业学生的英语写作文本进行分析,试图从句法复杂度的三个方面,即T单位长度、子句长度和T单位复杂性比率探究艺术院校大学生英语写作句法复杂度现状,为学习者的英语写作水平的提升和日后的英语教学改革提供借鉴。

改良盆底重建术和腹腔镜下阴道骶骨固定术治疗Ⅲ度~Ⅳ度盆腔器官脱垂的双盲随机研究

目的探究改良盆底重建术与腹腔镜更下阴道骶骨固定术治疗重度(Ⅲ度~Ⅳ度)盆腔器官脱垂的临床价值。方法选取安徽医科大学附属妇幼保健院(安徽省妇幼保健院)2015年1月至2018年10月诊治的86例Ⅲ度~Ⅳ度盆腔器官脱垂患者作为研究对象。依据手术方式不同分为两组,观察组(58例)采用经阴道改良盆底重建术(协和术式)治疗,对照组(28例)采用腹腔镜下阴道骶骨固定术。于手术前后分别使用盆腔器官脱垂定量分度法(POP-Q)、盆底功能障碍疾病相关问卷-简要版(PFDI-20)、盆底器官脱垂/尿失禁对性功能影响影响调查问卷(PISQ-12)以及国际尿失禁调查问卷(ICIQ-SF)对手术效果进行评估;比较两组患者手术情况以及并发症发生率情况。结果术后两组患者POP-Q各指示点解剖位置均明显改善,观察组Aa、Ba、C、Ap、Bp点恢复效果优于对照组,差异具有统计学意义(P<0.05);术前两组患者PFDI-20、PISQ-12和ICIQ-SF评分差异无统计学意义(P>0.05),术后观察组PFDI-20、ICIQ-SF评分降幅均优于对照组,PISQ-12评分增幅低于对照组,差异具有统计学意义(P<0.05);观察组手术用时短于对照组,对照组术中出血量、术后住院时间由于观察组,差异具有统计学意义(P<0.05);术后观察组并发症发生率为13.79%,对照组为17.86%,差异无统计学意义(P>0.05)。结论改良盆底重建术术式治疗Ⅲ度~Ⅳ度盆腔器官脱垂更好的修复盆底功能,缓解患者症状表现,安全性满足要求,但患者术后性生活质量略差。

杵针联合隔药灸对社区高血压阴虚火旺型患者睡眠质量和生活质量的影响

目的杵针联合隔药灸对社区高血压阴虚火旺型患者睡眠质量和生活质量的影响。方法在2018年4月至2019年8月期间以雅安职业技术学院为中心辐射周边多个社区收集高血压伴失眠患者64例,随机分成两组。对照组单纯采用隔药灸治疗,治疗组在对照组的基础上采用杵针治疗,每日1次,1周治疗5次,持续治疗3个疗程。观察2组的生活质量评分和3个疗程的疗效。结果连续治疗3疗程,除第一疗程无差异外,第二、第三疗程治疗组均优于对照组,差异有统计学意义(P<0.05);而在SF-36生活质量比较,治疗组在躯体疼痛、精神健康、生理功能、活力、生理职能各项分数高于对照组,差异有统计学意义(P<0.05),而在社会功能、情感职能两项,差异无统计学意义。结论杵针联合隔药灸对社区高血压阴虚火旺型患者,能有效改善患者的睡眠质量,提高患者的生活质量,标本兼治,效果显著,治疗方便实用,值得在社区进一步推广。