Molecular adsorbent recycling system in treat-ing patients with acute liver failure: a bridge to liver transplantation

BACKGROUND:Acute liver failure is still a life-threaten- ing disease although it can be treated by liver transplanta- tion. This study was conducted to assess the molecular ad- sorbent recycling system (MARS), which may bridge acute liver failure patients to liver transplantation. METHODS: Biochemical indexes and other clinical data were analyzed of 8 patients with acute liver failure, who had been treated by MARS for 34 times and subsequent Piggyback liver transplantation. RESULTS: After treatment with MARS, the levels of tran- saminase and total bilirubin decreased markedly, but coagu- lation function remained unimproved. All patients survived and discharged from the hospital. CONCLUSION: MARS is effective in bridging patients with acute liver failure to liver transplantation.

The scoring system for patients with severe sepsis after orthotopic liver transplantation

BACKGROUND: Because of the complicated pathological features after liver transplantation, severe sepsis is difficult to treat and often leads to death. This study was undertaken to analyze the role of orthotopic liver transplantation (OLT) in patients with severe sepsis and to evaluate the effect of the scoring system. METHODS: Fifty-six patients conformed to the inclusion criteria. They were divided into two groups: non-OLT group (group A) and OLT group (group B). Besides the general data of the patients, the surveillance of blood lactate, the number of failed organs, acute physiology and chronic health evaluationⅡ(APACHEⅡ) and mutiple organ dysfunction score (MODS) were evaluated at the 1st, 3rd and 7th day after OLT. RESULTS: The mortality during hospitalization was 30% in the non-OLT group and 57.6% in the other group. The level of blood lactate at the 1st day of OLT increased more significantly in the OLT group than in the non-OLT group (P<0.01). It was decreased but higher than that in the non-OLT group in the seven days after OLT. The number of failed organs in the OLT group was greater than that in the non-OLT group (P<0.01). The continuous score of APACHEⅡwas not significantly different in the two groups. But the continuous MODS in the OLT group was higher than that in the non-OLT group (P<0.01), which was consistent with the number of failed organs. CONCLUSIONS: The persistently higher level of blood lactate during 7 days may be a dependent risk factor. Immunosuppression may be another risk factor for OLT patients. The mortality of OLT in patients with severe sepsis in 28 days is almost double that in non-OLT patients. The MODS score is better than the APACHEⅡscore in the assessment of organ failure in OLT patients with severe sepsis. The standard scoring system could be improved or a new scoring system that includes the blood lactate score should be established for liver transplantation.

Artificial liver support molecular adsorbents recirculating system therapy as a bridge to re-transplantation in two cases of long anhepatic duration

BACKGROUND: Molecular adsorbents recirculating sys- tem (MARS) liver support therapy is the development of albumin dialysis. This study was to assess the successful ap- plication of MARS artificial liver support therapy as a bridge to re-transplantation in two cases of long anhepatic duration. METHODS: MARS therapy was given after failure plasma- exchange ( PE) treatment, which resulted in circulatory de- rangement and acute renal dysfunction in a 36-year-old male patient. Finally his uncontrolled anhepatic condition led to a successful re-transplantation. In another 48-year- old man who was diagnosed as having primary nonfunction (PNF) during the liver transplantation, 10-hour MARS treatment contributed to smooth bridging of his anhepatic phase. RESULTS: The two anhepatic patients were bridged for 26 and 17 hours respectively to re-transplantation with MARS therapy. CONCLUSION: Our experience proves that MARS artifi- cial liver can be an effective support for long time bridging PNF until re-transplantation is available.

Posttransplantation lymphoproliferative disorder involving the central nervous system in liver transplant recipients

BACKGROUND: Posttransplantation lymphoproliferative disorder (PTLD) involving the central nervous system (CNS) is a rare and serious complication associated with solid organ transplantation. We treated a case of PTLD with CNS involvement in a liver transplant recipient and reviewed the literature. METHOD: The clinicopathological features of a 53-year-old man were retrospectively analyzed. RESULTS: Metastasis of the hepatoma was preoperatively considered on the basis of clinical findings. Craniotomy was performed and PTLD was diagnosed pathologically. The patient was treated with antiviral agents, radiation therapy, and chemotherapy; the immunosuppressive medication was reduced. The patient is still alive after follow-up for 14 months. CONCLUSIONS: Definitive diagnosis of PTLD is only established on the basis of histopathologic evaluation of the tissue. Although there are several ways to manage PTLD with CNS involvement, the prognosis is still poor.

草莓移栽机控制系统设计与试验

针对草莓高起垄定向移栽农艺要求,设计一种机械打穴、人工识别草莓苗弓背方向后定向穴栽的移栽机。基于可编程控制器(PLC)设计整机控制系统,包括移栽机定速行走控制系统、前轮转向控制系统、打穴控制系统等任务模块。整机采用直流无刷电机作为底盘的驱动元件,根据电机自带编码器的输出值进行行走速度、栽植株距和打穴频率的协调控制,采用步进电机作为打穴机构的驱动元件,由接近开关对打穴机构进行定位,通过二者配合完成打穴过程,在人机协同作业下,完成草莓苗移栽。试验结果表明:当单行移栽效率为15株/min,株距为150 mm、200 mm、250 mm时,株距合格率、孔深合格率、孔径合格率均在95%以上,其变异系数均小于5%,打穴成功率均大于95%,符合移栽机行业标准,打穴移栽效果满足农艺要求。

Reconstruction of the adenosine system by bone marrow-derived mesenchymal stem cell transplantation

In the present study, we transplanted bone marrow-derived mesenchymal stem cells into the CA3 area of the hippocampus of chronic epilepsy rats kindled by lithium chloride-pilocarpine, Immunofluorescence and western blotting revealed an increase in adenosine A1 receptor expression and a decrease in adenosine A2a receptor expression in the brain tissues of epileptic rats 3 months after transplantation. Moreover, the imbalance in the A1 adenosine receptor/A2a adenosine receptor ratio was improved. Electroencephalograms showed that frequency and amplitude of spikes in the hippocampus and frontal lobe were reduced. These results suggested that mesenchymal stem cell transplantation can reconstruct the normal function of the adenosine system in the brain and greatly improve epileptiform discharges.

面向对象技术的智能插秧机控制系统设计研究

以插秧机智能控制系统为研究对象,基于面向控制对象技术设计一种无人驾驶插秧机智能控制系统,并在水泥路面和水田两种不同环境中对插秧机进行性能试验测试。试验结果表明:在水泥路面上插秧机行进过程最大横向偏差小于50mm,最大航向偏差小于2°;在水田内插秧机行进过程最大横向偏差小于60mm,最大航向偏差小于3°,表明智能控制系统在使用过程中具有较高的可靠性和稳定性。

Temporal Dynamics of Antioxidant Defence System in Relation to Polyamine Catabolism in Rice under Direct-Seeded and Transplanted Conditions

Six rice cultivars viz. PR120, PR116, Feng Ai Zan, PR115, PAU201 and Punjab Mehak 1 under the direct-seeded and transplanted conditions were used to investigate the involvement of antioxidative defence system in relation to polyamine catabolism in temporal regulation of developing grains. Activities of ascorbate peroxidase （APx）, guaiacol peroxidase （GPx）, catalase （CAT）, superoxide dismutase （SOD）, polyamine oxidases （PAO） and contents of ascorbate, a-tocopherol, proline and polyamines increased gradually until mid-milky stage and then declined towards maturity stage under both planting conditions. The transplanted condition led to higher activities of antioxidative enzymes （APx, GPx and CAT） and contents of ascorbate, a-tocopherol and proline whereas the direct-seeded condition had elevated levels of PAO and SOD activities and contents of polyamines, lipid peroxide and hydrogen peroxide. Cultivars Feng Ai Zan and PR120 exhibited superior tolerance over other cultivars by accumulating higher contents of ascorbate, a-tocopherol and proline with increasing level of PAO and SOD activities under the direct-seeded condition. However, under the transplanted condition PR116 and PAU201 showed higher activities of antioxidative enzymes with decreasing content of lipid peroxide. Therefore, we concluded that under the direct-seeded condition, enhancements of polyamines content and PAO activity enabled rice cultivars more tolerant to oxidative stress, while under the transplanted condition, antioxidative defence with decreasing of lipid peroxide content was closely associated with the protection of grains by maintaining membrane integrity during rice grain filling. The results indicated that temporal dynamics of H2O2 metabolic machinery was strongly up-regulated especially at the mid-milky stage.

温室辣椒自动补苗机构控制系统设计与试验

针对辣椒培育过程中会出现一定量劣苗影响穴盘苗一致性,且目前移栽机械自动化程度低、移栽效果不理想的问题,依照农艺要求规范设计了机-电-气一体的自动补苗机构控制系统。阐述了自动补苗机构工作原理和系统结构,结合传感器和执行器布局和剔补苗运行机制设计了补苗机构控制系统软件和硬件。参照移栽手工作要求,设计气路系统并进行相关计算。对45天辣椒幼苗进行移栽补苗试验,以水平移动速率、取苗深度、含水率为试验因子,剔苗成功率、移栽成功率为衡量指标,设计三因素三水平正交试验,结果表明:水平移栽速率对剔苗成功率和移栽成功率影响较小,移栽手运行平稳,剔苗成功率平均值为94%,移栽成功率为91.1%,表明自动补苗机构性能可靠。

肾移植受者发生肾癌的临床特征和诊治分析

目的:探讨肾移植受者发生肾癌的临床特征和诊疗特点。方法:回顾性分析2011年3月至2023年3月天津市第一中心医院收治的27例肾移植受者发生肾癌患者的临床资料,其中男性25例、女性2例。27例患者中24例行肾癌根治性切除术(包括1例行双侧肾癌根治性切除术、1例行肾输尿管全长切除术),3例行保守治疗。手术方式包括开放、腹腔镜和机器人手术,并对患者的诊疗过程、病理特征和手术预后进行分析。结果:手术中位时间为148(100~210)min,术后中位住院时间为7(4~10)天。24例手术患者为原肾肾癌,肿瘤直径平均为(4.03±2.49)cm,其中6例为肾乳头状细胞癌、1例为肾嫌色细胞癌、17例为肾透明细胞癌。3例行保守治疗中的1例患者发现移植肾肿物,行穿刺活检病理为肾透明细胞癌。27例患者的临床TNM分期分别为T1aN0M0为18例、T1bN0M0为4例、T2aN0M0为2例、T4N1M1为3例。患者首次诊断肿瘤的平均年龄为(51.21±7.60)岁。至移植前中位透析时间为19(1.2~72.0)个月,诊断肿瘤至移植手术的中位时间为95(12~180)个月。27例患者中位随访时间为47(3~147)个月,随访至129个月和95个月后有2例死亡,死亡原因分别为肺炎和脓毒血症。结论:肾移植术后发生肾癌患者的早期诊断较为困难,有多发、囊性变、坏死倾向,重视规范的随访及确定预防性切除术时机尤为重要。

我国高校院系治理的演进、困境与进路探赜

院系治理是大学治理能否实现现代化的关键。在协调党政关系主基调下,我国高校院系治理大致历经了“探索初创期”、“调适定型期”和“提质增效期”等三个演进阶段。当前,我国院系治理面临领导体制不健全、制度体系不完备、运行机制不通畅、治理主体权责失衡、党组织功能“悬浮化”等瓶颈和困境。推动院系治理现代化,应在遮蔽与澄清、守正与创新的动态调适中科学规避“制度移植陷阱”,创造性地推进党委领导下的校长负责制向院系层面的制度移植。在实践中,明晰院系党政共同领导下的分工负责制、完善党政联席会议制度、构建党政学协商共治模式、充分发挥党组织功能作用,是加快推进院系治理现代化的应然路径。

五酯胶囊联合他克莫司在肾移植患者中的疗效及安全性研究

目的 通过分析五酯胶囊联合他克莫司治疗肾移植患者的疗效及安全性,为临床安全合理用药提供依据。方法 回顾性研究2020年1月至2021年2月在中南大学湘雅医院行同种异体肾移植术的患者,分析联用五酯胶囊对他克莫司浓度、肾移植术后常见并发症以及全身免疫炎症指数(SII)的影响,探讨联用五酯胶囊对肾移植患者疗效及安全性的影响。结果 共纳入87例患者,31例(35.63%)患者术后规律使用五酯胶囊,联用达稳态后他克莫司谷浓度较前升高且服药日剂量较前显著下降(P <0.001)。五酯胶囊联用组在术后1个月时血红蛋白为(105.06±15.93)g·L^(-1),显著低于他克莫司单用组(114.58±17.71)g·L^(-1)(P=0.015),在术后3个月时逐渐升高且两组间差异消失。五酯胶囊联用组全身免疫炎症指数在术后1个月无明显变化,术后3个月显著下降(P=0.006)。结论 五酯胶囊联合他克莫司可显著提高肾移植患者他克莫司的血药浓度且减少用药剂量,联合用药初期应关注患者贫血情况。五酯胶囊对肾移植患者全身免疫炎症状态的影响仍需进一步研究。

改良预警评分对预防干细胞移植术后环孢素相关脑病的影响

目的:分析改良预警评分对预防干细胞移植术后环孢素相关脑病的影响。方法:选取2021年1月-2022年1月我院干细胞移植术后使用环孢素治疗的80例病人为研究对象,通过早期预警评分(MEWS)和改良早期预警评分工具找出截断点;对80例移植术后采用环孢素治疗的病人运用改良早期预警评分工具评分,并就改良早期预警评分工具评分截断点进行预警干预,统计分析环孢素相关脑病病人的发生率,同时对病人的预后情况进行研究分析。结果:本组病人中共计发生14例环孢素相关脑病,环孢素相关脑病发生率为17.5%;改良早期预警评分分值与病人预后呈正相关,分值越高其预后情况越差,两者相关系数为0.41(P<0.05);早期预警评分≥4分者收入重症监护室和自动出院/死亡占比高于早期预警评分0~<4分者,改良早期预警评分≥3分者收入重症监护室和自动出院/死亡占比高于改良早期预警评分0~<3分者;3分为改良早期预警评分的最佳截断点,敏感度为98.02%,特异度降为92.85%;环孢素相关脑病发生率由20.0%降至2.5%。结论:与早期预警评分相比,改良早期预警评分对使用环孢素的病人发生环孢素相关脑病风险的判定准确度更高,临床医师可以更加明确是否需要将病人的监护级别提高,以保障医疗资源合理使用的同时最大限度地提高病人的预后。

器官捐献移植伦理审查信息系统开发的必要性与方案设计研究

目前国内医院器官捐献与移植伦理审查模式普遍存在突发性、无计划性,且时间紧、召集会议难、委员培训难、伦理审查质量及效率普遍不高等现状,无法满足临床需求和造成一些紧缺资源的浪费。昆明市第一人民医院人体器官移植技术临床应用与伦理委员会团队结合10多年审查实践经验,不断探索优化器官捐献与移植伦理审查流程与操作规程,专项申请获批,并与苏州大学、福建省医学伦理委员会共同研发构建器官捐献与移植伦理审查全流程信息软件系统管理平台,充分发挥审查信息系统具有的提升工作效率、提高审查质量、方便全流程信息管理及开展委员线上培训学习等优势功能,以期为解决人体器官捐献与移植伦理审查工作有关困难与难题做出专项实操性范本。

数学建模应用的水稻插秧机控制系统优化分析

以水稻插秧机仿形机构作业升降和保持过程为研究对象,采用力反馈和位移反馈相互切换的控制方式构建作业过程控制系统,并利用数学建模的方式搭建仿形机构作业过程控制模型,在MatLab/Simulink环境中建立控制系统模型。采用模糊PID算法对控制系统仿真模型进行优化,仿真结果表明:模糊PID控制算法能够显著提升插秧机控制系统在不同控制阶段的工作性能。

激励制度在公民逝世后器官捐献中的伦理分析

器官移植在重建健康、挽救生命的卓越成效表明了其重大价值所在,其中器官捐献是促进我国器官移植事业发展的重要组成部分。近年来,我国器官移植取得了重大进展,器官捐献率也逐年上升。尽管如此,我国依然面临捐献器官数量不足的严峻事实,破解这个难题需要医学科学技术和公共卫生政策进一步完善。根据国际经验,实施一定的激励制度可以有效地提高捐献率,但是激励制度本身隐藏的伦理特性似乎与器官捐献事业中的利他精神有着根本性的冲突。因此,本文从激励的性质、器官捐献与激励制度以及激励制度的伦理论证进行综述,以期为我国官捐献和移植事业的进一步发展提供参考。

40例肾移植受者感染新型冠状病毒的治疗药物分析

目的为肾移植受者感染新型冠状病毒制订治疗方案提供参考。方法回顾性分析安徽省某三甲医院肾移植病区2022年12月6日至2023年1月5日入院且已符合出院标准的40例患者的用药情况,统计药品金额、用药剂量,计算用药频度(DDDs)和药物利用指数(DUI),分析其用药特点。结果40例患者的药费共244.29万元,约占总住院费用的63.71%,其中抗菌药物费用共142.09万元,约占总药费的58.16%。DDDs排前10位的药品为糖皮质激素、质子泵抑制剂和抗菌药物,100.00%的患者联用2种及以上抗菌药物,最多共使用6种。服用奈玛特韦利托那韦(Paxlovid)或阿兹夫定的患者39例(97.50%),其中两药联用16例(40.00%)。22例(55.00%)患者发生药品不良反应,以腹泻(42.50%)、头晕(37.50%)、转氨酶升高(32.50%)为主。结论肾移植受者感染新型冠状病毒住院期间用药复杂,联用药物较多,应加强病原学送检及培养,根据病原学检测结果进行抗感染治疗。注意药物的相互作用和药品不良反应,实现个体化用药治疗。

水稻插秧机调平装置电气控制系统设计

为了保证秧苗入土深度一致,提升秧苗成活率,对水稻插秧机的调平装置及电气控制系统进行了设计。水稻插秧机的主要组成包括机架、电气控制系统、调平装置、秧箱、取秧和插秧部件、动力系统及传动系统。为了提升调平装置的性能,对液压装置的参数包括最大功率和作业效率进行了设计,并对横向自适应调平装置的电气控制系统进行了设计。为了验证水稻插秧机调平装置的性能,对插秧机进行了液压装置仿真试验和调平装置性能试验。试验结果表明:液压装置的参数可以满足设计要求,调平装置可以满足插秧机的作业要求。

数学建模在水稻插秧机作业优化中的应用

为了降低插秧机的作业故障次数、提升插秧效率和插秧质量,对数学建模在水稻插秧机作业优化中的应用进行了研究。为了有效提升作业效率和作业质量,分插机构的传动部件改进为非圆齿轮行星系,并针对传动装置建立数学模型并分析。为了验证水稻插秧机的结构是否合理,对其进行了仿真试验,结果表明:水稻插秧机的结构合理,可将其应用于实际生产。

甘薯脱毒及种薯(苗)繁育技术研究

中国是世界上最大的甘薯生产国,然而由于病毒病的存在,严重制约了甘薯产业的发展,建立通用的脱毒组培体系、高灵敏度的检测体系及高效的种薯(苗)繁育体系对甘薯产业发展具有重要意义。对12个主栽品种进行茎尖脱毒处理,建立了通用的脱毒组培体系MS+2 mg/L NAA+1.0 mg/L 6-BA,大多数品种的再生率在58%以上;获得SPFMV、SPCSV、SPLV、SPCFV和SPVG这5种病毒的特异性引物,该引物对病毒检测极限依次为10^(-6)、10^(-1)、10^(-4)、10^(-3)和10^(-3),具有较高的灵敏性;对脱毒品系进行筛选,获得优良脱毒株系甘12和粉薯2-2;建立脱毒种薯(苗)的三级繁育体系,即组培苗(一级)扩繁,温网室基质苗(二级)扦插扩繁和网棚大田苗(三级)繁育生产用种;进行洗苗速率(带根和不带根)对比试验,移栽方式(带根和不带根)与每孔移栽棵数(1~3棵)的双因素试验,结果表明不带根处理可显著提升洗苗速率,育苗前期每孔移栽棵数(1~3棵)在株高、茎粗、节间数方面无显著差异,带根处理前期生长具有优势,但二者成活率无显著差异,并不影响育苗结果。因此,该研究有利于甘薯病毒病防治、脱毒种薯(苗)推广和育苗成本的降低。