Objective This study aimed to evaluate the clinical benefits of a vancomycin dosage strategy based on a serum trough concentration model in elderly patients.Methods This prospective single-center, open-label, randomiz...Objective This study aimed to evaluate the clinical benefits of a vancomycin dosage strategy based on a serum trough concentration model in elderly patients.Methods This prospective single-center, open-label, randomized controlled trial categorized 66 elderly patients with severe pneumonia into study and control groups. The control group received vancomycin using a regimen decided by the attending physician. Meanwhile, the study group received individualized vancomycin therapy with a dosing strategy based on a serum trough concentration model. The primary endpoint was the proportion of patients with serum trough concentrations reaching the target values.The secondary endpoints were clinical response, vancomycin treatment duration, and vancomycinassociated acute kidney injury(VA-AKI) occurrence.Results All patients were at least 60 years old(median age = 81 years). The proportion of patients with target trough concentration achievement(≥ 15 mg/L) with the initial vancomycin regimen was significantly higher in the study group compared to the control group(75.8% vs. 42.4%, P = 0.006).Forty-five patients(68.2%) achieved clinical success, the median duration of vancomycin therapy was10.0 days, and VA-AKI occurred in eight patients(12.1%). However, there were no significant differences in these parameters between the two groups. The model for predicting vancomycin trough concentrations was upgraded to: serum trough concentration(mg/L) = 17.194-0.104 × creatinine clearance rate(mL/min) + 0.313 × vancomycin daily dose [mg/(kg·d)].Conclusion A vancomycin dosage strategy based on a serum trough concentration model can improve the proportion of patients achieving target trough concentrations in elderly patients with severe pneumonia.展开更多
BACKGROUND Chronic pulmonary aspergillosis(CPA)is a rare syndrome that is often accompanied by gradual lung tissue destruction.Voriconazole is usually employed as the first-line agent for CPA treatment.However,some pa...BACKGROUND Chronic pulmonary aspergillosis(CPA)is a rare syndrome that is often accompanied by gradual lung tissue destruction.Voriconazole is usually employed as the first-line agent for CPA treatment.However,some patients can develop hepatotoxicity and often were forced to stop voriconazole treatment.AIM To record the improving trend of liver function and the therapeutic effects in patients after lowering the trough concentration of voriconazole.METHODS This study retrospectively analyzed 12 adult CPA patients who developed hepatotoxicity during the voriconazole treatment.In these patients,the oral dose was reduced to 3/4 or 1/2 of the standard dose(4 mg/kg,twice daily),and the lower limit of voriconazole trough concentration was maintained more than 0.5μg/m L.The trend of remission of liver toxicity after drug reduction in 12 patients was recorded.During the same period,25 patients who received standard doses served as the control group.Data from the two groups were collected and analyzed for different parameters such as demographic characteristics,underlying pulmonary disorders,laboratory tests,and therapeutic effect.The differences between the two groups were statistically compared.RESULTS Hepatotoxicity occurred in 12 patients within 28-65 d after oral voriconazole treatment.Hepatotoxicity was mainly manifested by the significantly increased level of gamma-glutamyltransferase and a slight increase of alanine aminotransferase and aspartate aminotransferase.The oral dose of voriconazole was reduced to approximately 3 mg/kg in seven patients and approximately 2 mg/kg in five patients.The average trough concentrations for the 12 patients before and after voriconazole oral dose reduction were 3.17±1.47μg/m L(1.5-6.0μg/m L)and 1.70±0.78μg/m L(0.6-3.3μg/m L),respectively(P=0.02).After lowering the trough concentrations,the hepatotoxicity was alleviated in all the patients.However,gamma-glutamyltransferase levels declined slowly.After 4 mo of treatment,7 of the 12 patients were successfully treated in the low trough concentrations group(41.7%).Similarly,8 of the 25 patients in the standard treatment dose group(32.0%)were effectively treated.There was no statistical difference between the groups(P=0.72).CONCLUSION Reducing the lower limit of the voriconazole trough concentration to 0.5μg/m L can alleviate the hepatotoxicity and maintained certain clinical efficacy in CPA patients;however,patients should be closely monitored.展开更多
Based on field investigations, this paper analyzes three types of harbour basinns and navigation channel excavated on seabed in Jiaozhou Bay, get a general rule of deposition for excavated trough, it found that pollut...Based on field investigations, this paper analyzes three types of harbour basinns and navigation channel excavated on seabed in Jiaozhou Bay, get a general rule of deposition for excavated trough, it found that pollution is one of crucial factors resulting in the deposition of the excavated trough in the east shore of Jiaozhou Bay. With these results, it predicted the annual deposition thickness for the excavated trough and disclosed the fact that it can't be deposited deadly during one storm. At the same time, with two-dimensional numerical model, it studied the effects of the excavated trough and the reclamation near shore on tidal cureent and said that the excavated trough can decrease the current velocity passing through the trough about 10- 15%, but only limited inside and near the trough and there are no effect on other regions; reclamation can cut off the pollution sources and no obvious effect on the currents of the Jiaozhou Bay. Connecting the deep trough and Cangkou tidal channel with a new excavated trough can improve the current conditions on the deep trough in some degree, but not great.展开更多
The traditional methods of surface movement and deformation prediction seldom take account of the effects of small structures. However, because of the effects of small structures, the buildings located at the bottom o...The traditional methods of surface movement and deformation prediction seldom take account of the effects of small structures. However, because of the effects of small structures, the buildings located at the bottom of subsidence trough for full-extraction can not be protected by the flat bottom, but destroyed severely by concentrated strains in the fault-half-trough. Under this coudition, if tbere is an important building at the bottom of subsidence trough, it is significant to accurately determinate the directions and values of concentrated strains and the location of concentrated strain zone. The mechanical method can calculate the maximum principal strain, including bi-directional horizontal deformation, shearing strain and their directions, which are necessary to reinforce the buildings. The mechanical method has more advantages than the method of scalar quantity horizontal deformation. This paper dwells on the effects of small structures on surface movement and deformation using the mechanical method in Pingdingshan mining area.展开更多
During the calendar year of 2012 the University of Louisiana at Lafayette in conjunction with CLECO Power LLC (CLECO) has constructed and commissioned a pilot scale parabolic trough solar thermal power plant for the f...During the calendar year of 2012 the University of Louisiana at Lafayette in conjunction with CLECO Power LLC (CLECO) has constructed and commissioned a pilot scale parabolic trough solar thermal power plant for the first time in Louisiana. The large aperture trough (LAT) solar collectors were provided by Gossamer Space Frames and are coupled with an organic Rankine cycle (ORC) power block provided by ElectraTherm, Inc. for study of the feasibility of cost-effective commercial scale solar thermal power production in Louisiana. Supported by CLECO and providing power to the existing CLECO grid, the implementation of state-of-the-industry collector frames, mirrors, trackers, and ORC power block is studied under various local weather conditions which present varied operating regimes from existing solar thermal installations. The solar collectors provide a design output of 650 kWth and preliminary actual performance data from the system level is presented. The optimal size, configuration and location for such a plant in the given solar resource region are being studied in conjunction with CLECO’s search for optimal renewable energy solutions for the region. The pilot scale size of the facility and implementation of the simpler ORC allow remote operation of the facility and flexibility in operating parameters for optimization studies. The construction of the facility was supported by the Louisiana Department of Natural Resources, the U.S. Department of Energy, and CLECO. The continued operation of the plant is supported by CLECO Power LLC and the University of Louisiana at Lafayette.展开更多
基金funded as a key clinical project of Peking University Third Hospital [No. BYSY2018021]funded by Beijing Natural Science Foundation [7212128]。
文摘Objective This study aimed to evaluate the clinical benefits of a vancomycin dosage strategy based on a serum trough concentration model in elderly patients.Methods This prospective single-center, open-label, randomized controlled trial categorized 66 elderly patients with severe pneumonia into study and control groups. The control group received vancomycin using a regimen decided by the attending physician. Meanwhile, the study group received individualized vancomycin therapy with a dosing strategy based on a serum trough concentration model. The primary endpoint was the proportion of patients with serum trough concentrations reaching the target values.The secondary endpoints were clinical response, vancomycin treatment duration, and vancomycinassociated acute kidney injury(VA-AKI) occurrence.Results All patients were at least 60 years old(median age = 81 years). The proportion of patients with target trough concentration achievement(≥ 15 mg/L) with the initial vancomycin regimen was significantly higher in the study group compared to the control group(75.8% vs. 42.4%, P = 0.006).Forty-five patients(68.2%) achieved clinical success, the median duration of vancomycin therapy was10.0 days, and VA-AKI occurred in eight patients(12.1%). However, there were no significant differences in these parameters between the two groups. The model for predicting vancomycin trough concentrations was upgraded to: serum trough concentration(mg/L) = 17.194-0.104 × creatinine clearance rate(mL/min) + 0.313 × vancomycin daily dose [mg/(kg·d)].Conclusion A vancomycin dosage strategy based on a serum trough concentration model can improve the proportion of patients achieving target trough concentrations in elderly patients with severe pneumonia.
文摘BACKGROUND Chronic pulmonary aspergillosis(CPA)is a rare syndrome that is often accompanied by gradual lung tissue destruction.Voriconazole is usually employed as the first-line agent for CPA treatment.However,some patients can develop hepatotoxicity and often were forced to stop voriconazole treatment.AIM To record the improving trend of liver function and the therapeutic effects in patients after lowering the trough concentration of voriconazole.METHODS This study retrospectively analyzed 12 adult CPA patients who developed hepatotoxicity during the voriconazole treatment.In these patients,the oral dose was reduced to 3/4 or 1/2 of the standard dose(4 mg/kg,twice daily),and the lower limit of voriconazole trough concentration was maintained more than 0.5μg/m L.The trend of remission of liver toxicity after drug reduction in 12 patients was recorded.During the same period,25 patients who received standard doses served as the control group.Data from the two groups were collected and analyzed for different parameters such as demographic characteristics,underlying pulmonary disorders,laboratory tests,and therapeutic effect.The differences between the two groups were statistically compared.RESULTS Hepatotoxicity occurred in 12 patients within 28-65 d after oral voriconazole treatment.Hepatotoxicity was mainly manifested by the significantly increased level of gamma-glutamyltransferase and a slight increase of alanine aminotransferase and aspartate aminotransferase.The oral dose of voriconazole was reduced to approximately 3 mg/kg in seven patients and approximately 2 mg/kg in five patients.The average trough concentrations for the 12 patients before and after voriconazole oral dose reduction were 3.17±1.47μg/m L(1.5-6.0μg/m L)and 1.70±0.78μg/m L(0.6-3.3μg/m L),respectively(P=0.02).After lowering the trough concentrations,the hepatotoxicity was alleviated in all the patients.However,gamma-glutamyltransferase levels declined slowly.After 4 mo of treatment,7 of the 12 patients were successfully treated in the low trough concentrations group(41.7%).Similarly,8 of the 25 patients in the standard treatment dose group(32.0%)were effectively treated.There was no statistical difference between the groups(P=0.72).CONCLUSION Reducing the lower limit of the voriconazole trough concentration to 0.5μg/m L can alleviate the hepatotoxicity and maintained certain clinical efficacy in CPA patients;however,patients should be closely monitored.
文摘Based on field investigations, this paper analyzes three types of harbour basinns and navigation channel excavated on seabed in Jiaozhou Bay, get a general rule of deposition for excavated trough, it found that pollution is one of crucial factors resulting in the deposition of the excavated trough in the east shore of Jiaozhou Bay. With these results, it predicted the annual deposition thickness for the excavated trough and disclosed the fact that it can't be deposited deadly during one storm. At the same time, with two-dimensional numerical model, it studied the effects of the excavated trough and the reclamation near shore on tidal cureent and said that the excavated trough can decrease the current velocity passing through the trough about 10- 15%, but only limited inside and near the trough and there are no effect on other regions; reclamation can cut off the pollution sources and no obvious effect on the currents of the Jiaozhou Bay. Connecting the deep trough and Cangkou tidal channel with a new excavated trough can improve the current conditions on the deep trough in some degree, but not great.
文摘The traditional methods of surface movement and deformation prediction seldom take account of the effects of small structures. However, because of the effects of small structures, the buildings located at the bottom of subsidence trough for full-extraction can not be protected by the flat bottom, but destroyed severely by concentrated strains in the fault-half-trough. Under this coudition, if tbere is an important building at the bottom of subsidence trough, it is significant to accurately determinate the directions and values of concentrated strains and the location of concentrated strain zone. The mechanical method can calculate the maximum principal strain, including bi-directional horizontal deformation, shearing strain and their directions, which are necessary to reinforce the buildings. The mechanical method has more advantages than the method of scalar quantity horizontal deformation. This paper dwells on the effects of small structures on surface movement and deformation using the mechanical method in Pingdingshan mining area.
文摘During the calendar year of 2012 the University of Louisiana at Lafayette in conjunction with CLECO Power LLC (CLECO) has constructed and commissioned a pilot scale parabolic trough solar thermal power plant for the first time in Louisiana. The large aperture trough (LAT) solar collectors were provided by Gossamer Space Frames and are coupled with an organic Rankine cycle (ORC) power block provided by ElectraTherm, Inc. for study of the feasibility of cost-effective commercial scale solar thermal power production in Louisiana. Supported by CLECO and providing power to the existing CLECO grid, the implementation of state-of-the-industry collector frames, mirrors, trackers, and ORC power block is studied under various local weather conditions which present varied operating regimes from existing solar thermal installations. The solar collectors provide a design output of 650 kWth and preliminary actual performance data from the system level is presented. The optimal size, configuration and location for such a plant in the given solar resource region are being studied in conjunction with CLECO’s search for optimal renewable energy solutions for the region. The pilot scale size of the facility and implementation of the simpler ORC allow remote operation of the facility and flexibility in operating parameters for optimization studies. The construction of the facility was supported by the Louisiana Department of Natural Resources, the U.S. Department of Energy, and CLECO. The continued operation of the plant is supported by CLECO Power LLC and the University of Louisiana at Lafayette.
