Normothermic regional perfusion mobile teams in controlled donation after circulatory death pathway: Evidence and peculiarities

To facilitate the implementation of controlled donation after circulatory death(cDCD)programs even in hospitals not equipped with a local Extracorporeal Membrane Oxygenation(ECMO)team(Spokes),some countries and Italian Regions have launched a local cDCD network with a ECMO mobile team who move from Hub hospitals to Spokes for normothermic regional perfusion(NRP)implantation in the setting of a cDCD pathway.While ECMO teams have been clearly defined by the Extracorporeal Life Support Organization,regarding composition,responsibilities and training programs,no clear,widely accepted indications are to date available for NRP teams.Although existing NRP mobile networks were developed due to the urgent need to increase the number of cDCDs,there is now the necessity for transplantation medicine to identify the peculiarities and responsibility of a NRP team for all those centers launching a cDCD pathway.Thus,in the present manuscript we summarized the character-istics of an ECMO mobile team,highlighting similarities and differences with the NRP mobile team.We also assessed existing evidence on NRP teams with the goal of identifying the characteristic and essential features of an NRP mobile team for a cDCD program,especially for those centers who are starting the program.Differences were identified between the mobile ECMO team and NRP mobile team.The common essential feature for both mobile teams is high skills and experience to reduce complications and,in the case of cDCD,to reduce the total warm ischemic time.Dedicated training programs should be developed for the launch of de novo NRP teams.

Individual alcohol consumption by the population of Russia versus regional living conditions

Background:There are substantial regional differences in drinking alcohol in Russia,both at the population and individual levels.However,the causes of these differences have not been studied yet.Objective:The goal of our study was to examine the effect of regional living conditions on individual alcohol consumption by the population of Russia.Methods:For the analysis,we used data from a cross-sectional epidemiological study conducted in 2013-2014.The final analytical sample included 18,130 people aged 25-64 years.We conducted the interviews face to face,based on which any drinking in the last year,as well as alcohol abuse,were considered as a response.Alcohol abuse was recorded when the respondent consumed 5.75 or more grams of pure ethanol per day(75th percentile of average daily alcohol consumption among alcohol drinkers).The assessment of the regional living conditions was accomplished via integral indexing,which was previously performed based on publicly available data for 2010-2014.Associations were assessed using generalized scoring equations with unchanging standard errors.The associations were expressed by odds ratios(OR)and 95%confidence intervals(C).Results:Deterioration of social conditions and increase in demographic depression in the region of residence increased the odds of any drinking(OR 1.51,95%CI:1.33 to 1.72,P<0.001 and OR 1.22,95%CI:1.05 to 1.41,P=0.oo9,respectively).The odds of alcohol abuse increased with the deterioration of social living conditions and the growth of the industrial development in the region:OR 1.35,95%CI:1.14 to 1.59,P<0.001 and OR 1.16,95%CI:1.05 to 1.28,P=0.002,respectively.Conclusion:Our analysis allowed assessing the impact of the regional living conditions on individual drinking alcohol in the population of Russia.

Delayed hippocampal neuronal death in young gerbil following transient global cerebral ischemia is related to higher and longer-term expression of p63 in the ischemic hippocampus

The tumor suppressor p63 is one of p53 family members and plays a vital role as a regulator of neuronal apoptosis in the development of the nervous system. However, the role of p63 in mature neuronal death has not been addressed yet. In this study, we first compared ischemia-induced effects on p63 expression in the hippocampal regions （CA1-3） between the young and adult gerbils subjected to 5 minutes of transient global cerebral ischemia. Neuronal death in the hippocampal CA1 region of young gerbils was significantly slow compared with that in the adult gerbils after transient global cerebral ischemia, p63 immunoreactivity in the hippocampal CA1 pyramidal neurons in the sham-operated young group was significantly low compared with that in the sham-operated adult group, p63 immunoreactivity was apparently changed in ischemic hippocampal CA1 pyramidal neurons in both ischemia-operated young and adult groups. In the ischemia-operated adult groups, p63 immunoreactivity in the hippocampal CA1 pyramidal neurons was significantly decreased at 4 days post-ischemia; however, p63 immunoreactivity in the ischemia-operated young group was significantly higher than that in the ischemia-operated adult group. At 7 days post-ischemia, p63 immunoreactivity was decreased in the hippocampal CA1 pyramidal neurons in both ischemia-operated young and adult groups. Change patterns of p63 level in the hippocampal CA1 region of adult and young gerbils after ischemic damage were similar to those observed in the immunohistochemical results. These findings indicate that higher and longer-term expression of p63 in the hippocampal CA1 region of the young gerbils after ischemia/reperfusion may be related to more delayed neuronal death compared to that in the adults.

Outcomes associated with the intention of loco-regional therapy prior to living donor liver transplantation for hepatocellular carcinoma

BACKGROUND Loco-regional therapy for hepatocellular carcinoma(HCC) during the period awaiting liver transplantation(LT) appears to be a logical approach to reduce the risk of tumor progression and dropout in the waitlist.Living donor LT(LDLT)offers a flexible timing for transplantation providing timeframe for well preparation of transplantation.AIM To investigate outcomes in relation to the intention of pre-transplantation locoregional therapy in LDLT for HCC patients.METHODS A total of 308 consecutive patients undergoing LDLTs for HCC between August2004 and December 2018 were retrospectively analyzed.Patients were grouped according to the intention of loco-regional therapy prior to LT,and outcomes of patients were analyzed and compared between groups.RESULTS Overall,38 patients(12.3%) were detected with HCC recurrence during the follow-up period after LDLT.Patients who were radiologically beyond the University of California at San Francisco criteria and received loco-regional therapy as down-staging therapy had significant inferior outcomes to other groups for both recurrence-free survival(RFS,P < 0.0005) and overall survival(P= 0.046).Moreover,patients with defined profound tumor necrosis(TN) by locoregional therapy had a superior RFS(5-year of 93.8%) as compared with others(P= 0.010).CONCLUSION LDLT features a flexible timely transplantation for patient with HCC.However,the loco-regional therapy prior to LDLT does not seem to provide benefit unless a certain effect in terms of profound TN is noted.

Characteristics of Hypertension Death in Low-income Regions of Inner Mongolia, China

Hypertension has been a major risk factor for cardiovascular disease[1].Hypertension overall prevalence in adults is 30%–45%,becoming>60%in people aged above 60 years[2],with a worldwide agestandardised prevalence of 20 and 24%in women and men,respectively[3].

Machine perfusion and the prevention of ischemic type biliary lesions following liver transplant:What is the evidence?

The widespread uptake of different machine perfusion(MP)strategies for liver transplant has been driven by an effort to minimize graft injury.Damage to the cholangiocytes during the liver donation,preservation,or early posttransplant period may result in stricturing of the biliary tree and inadequate biliary drainage.This problem continues to trouble clinicians,and may have catastrophic consequences for the graft and patient.Ischemic injury,as a result of compromised hepatic artery flow,is a well-known cause of biliary strictures,sepsis,and graft failure.However,very similar lesions can appear with a patent hepatic artery and these are known as ischemic type biliary lesions(ITBL)that are attributed to microcirculatory dysfunction rather than main hepatic arterial compromise.Both the warm and cold ischemic period duration appear to influence the onset of ITBL.All of the commonly used MP techniques deliver oxygen to the graft cells,and therefore may minimize the cholangiocyte injury and subsequently reduce the incidence of ITBL.As clinical experience and published evidence grows for these modalities,the impact they have on ITBL rates is important to consider.In this review,the evidence for the three commonly used MP strategies(abdominal normothermic regional perfusion[A-NRP],hypothermic oxygenated perfusion[HOPE],and normothermic machine perfusion[NMP])for ITBL prevention has been critically reviewed.Inconsistencies with ITBL definitions used in trials,coupled with variations in techniques of MP,make interpretation challenging.Overall,the evidence suggests that both HOPE and A-NRP prevent ITBL in donated after circulatory death grafts compared to cold storage.The evidence for ITBL prevention in donor after brain death grafts with any MP technique is weak.

Preliminary Research on Biological Characteristics of Scopula subpunctaria in Shandong Tea Region

[Objectives]The paper was to observe the life history and living habits of Scopula subpunctaria in Shandong tea region.[Methods]The occurrence period and duration of each insect state,as well as duration of each instar larvae in various generations were investigated and statistically analyzed.[Results]There were 6 generations of S.subpunctaria per year in Shandong tea region.Different from southern tea region,S.subpunctaria survived the winter as pupae and larvae in tea trees in Shandong,and the duration of overwintering eggs was greatly affected by temperature.The generations of S.subpunctaria overlapped seriously.[Conclusions]The results provide a basis for the comprehensive treatment of S.subpunctaria in Shandong tea region.

The regional design concepts of geographical features based on natural environment

Regional design is the design method based on the geographical characteristics, and the natural environment is basic factors. This paper puts forward to the regional product design thought patterns and makes some brief comments on its value and social significance of the design, in a long run, with exploratory guiding significance.

Research on Landscape System of Traditional Living Environment in Jingzhou

With the aid of the research method of land landscape,on the basis of briefly analyzing the construction process of regional traditional living environment in Jingzhou,a hierarchical analysis of the regional landscape system was carried out from the aspects of natural landscape,water conservancy construction,agricultural production and urban construction,and the overall pattern of traditional living environment landscape system in Jingzhou was summarized to provide new ideas for the exploration of landscape system.In view of the many problems in the current urban development of Jingzhou,the enlightenment of traditional human settlement experience and wisdom in Jingzhou to the current urban construction of Jingzhou was summarized to provide an example reference for building a living environment that integrates mountains,water and a city.

基于AHP的传统村落“活态”评价研究——以中国贵州省铜仁市传统村落为例

可以预见未来中国农村的发展趋势是传统农业农村被现代农业农村取代,演绎传统村落的生态舞台发生了变化。面向未来,传统村落在多大程度上还保持着“活态”,或者说传统村落的“活态”由哪些要素构成是本文的关注点。文章以贵州省铜仁市的传统村落为案例,通过实地调查、文献检索等方法收集第一手数据信息构建评价体系,运用AHP对案例村落进行“活态”评价,寻求和把握使传统村落处于“活态”的要素,为传统村落面向未来发展如何保持活力提供参考依据。

《民法典》第1179条第2句(残疾赔偿、死亡赔偿)评注

《民法典》第1179条第2句第2分句不仅仅是进一步明确法律效果的辅助规范**,也是进一步明确单纯侵害民事利益侵权责任的构成要件的辅助规范。《人身损害赔偿司法解释》对残疾赔偿金、丧葬费、死亡赔偿金、被扶养人生活费的计算进行了定额处理。定额赔偿的本质是不考虑被侵权人本人情况客观计算损害。残疾赔偿金、死亡赔偿金有广狭义之分。广义残疾赔偿金、死亡赔偿金代表了被侵权人的全部收入损失,包含被扶养人生活费,而不能与被扶养人生活费赔偿并存;狭义残疾赔偿金、死亡赔偿金只是被侵权人收入损失的一部分,与被扶养人生活费赔偿并存不会导致重复赔偿。扶养期限既取决于被扶养人需要他人扶养的期限,更取决于扶养人(被侵权人)能够扶养他人的期限。被扶养人生活费是被侵权人的部分收入损失,被侵权人的收入期限直接决定了扶养期限。被侵权人的收入期限应当与残疾赔偿金、死亡赔偿金的赔偿期限一致。

末期病患善终权之真实意思表达及其认定

近年德、日等地善终权研究重点转向病患的意思真实及其表达。意思真实表达需要满足有效告知、具备同意能力、不存在意思瑕疵三个要件。刑法视域下善终权不适用代理规则。死亡直接阶段病患真实意思容易认定;非死亡直接阶段病患处于丧失意识状态,在无生前预嘱的情形下,需特定法益主体进行事前判断,以恢复可能性和存活时间作为实体容许要件,并适用推定同意确定病患真实意思表示。我国在建立生前预嘱制度时,可建构意思真实表达的体系化结构,对于无预立医疗决定+无意思表示病患,允许有限制地适用推定同意规则。

广西体育非物质文化遗产活态传承与区域旅游融合研究

该文运用文献资料法、实地调查法等方法,分析广西体育非物质文化遗产活态传承与区域旅游的意义、瓶颈及其路径,认为广西体育非物质文化遗产活态传承与区域旅游有助于传承民族文化,促进区域旅游业发展;扩大区域乡村旅游对体育非物质文化遗产的保护和扩散效用。瓶颈体现在广西体育非遗市场化有待开发,应拓宽消费者的消费视野;提高相关部门对非遗文化完善保障力度,加大对非遗活态传承与旅游市场的融合力度。相应对策为:紧密结合当下广西节庆体育,推动区域体育非遗走向旅游产业化;创新体育非遗与旅游的营销方式,推广区域体育非遗文化旅游;加大对体育非遗传承人的扶持力度,提高体育非遗传承人的业务素养。

地域文化传承下的综合康养社区规划与适老居住建筑设计教学探讨

建筑学住宅设计及住区规划课程以“适老与更新——既有建筑改造前提下的综合康养社区规划与适老居住建筑设计”为主题,赛教结合,通过实地调研、定性、定量分析等环节,尝试引导学生关注社会、人文、环境。课程强化问题导向,并将社区规划与居住建筑设计与所属地域文化相融合,以培养学生规划与建筑设计中的适老化设计能力。该探索可以为建筑设计教学改革尝试提供借鉴。

SOX7靶向ERK1/2/PD-L1通路抑制结直肠癌血管生成

目的探讨性别决定区Y框蛋白7(SOX7)对结直肠癌血管生成的影响及潜在作用机制。方法应用免疫荧光检测结直肠癌患者组织样本中SOX7表达水平,之后通过裸鼠、转染SOX7 mimic的人结直肠癌细胞系SW480细胞和人脐静脉内皮细胞(HUVEC)共培养进一步研究。用Western-blot验证SOX7与ERK1/2/PD-L1对结直肠癌细胞的相关蛋白表达的影响。用CCK8检测SOX7与ERK1/2/PD-L1对HUVEC增殖的影响。通过体外内皮细胞成管实验测定SOX7与ERK1/2/PD-L1对肿瘤血管生成的影响。结果SOX7在人结直肠癌组织中表达被抑制(P<0.01),同时SOX7的过表达抑制了小鼠体内肿瘤生长(P<0.01)。SW480细胞中SOX7的过表达抑制了ERK1/2、c-Jun的表达,并在ERK1/2的激动剂Senkyunolide I的作用下上调了SW480细胞的ERK1/2、c-Jun蛋白表达(P<0.01),逆转了SOX7对SW480细胞中ERK1/2、c-Jun蛋白表达的影响(P<0.01)。HUVEC中SOX7抑制了PD-L1、V-EGFR2、p-PI3K、HIF-1α的蛋白表达,Senkyunolide I上调了HUVEC的PD-L1、V-EGFR2、p-PI3K、HIF-1α的蛋白表达,并逆转了SOX7对HUVEC中上述相关蛋白表达的影响(P<0.01)。PD-1/PD-L1 Inhibitor 3抑制了PD-L1、V-EGFR2、p-PI3K、HIF-1α的蛋白表达,SOX7过表达在PD-1/PD-L1 Inhibitor 3的影响下并没有表现出抑制作用。CCK8实验结果显示SOX7过表达显著抑制了HUVEC的增殖能力,Senkyunolide I作用下的两组HUVEC增殖能力较SOX7 NC组与SOX7 mimic组明显上升,PD-1/PD-L1 Inhibitor 3作用下的两组HUVEC增殖能力较SOX7 NC组与SOX7 mimic组明显下降,以上均有明显统计学差异(P<0.01)。成管实验结果显示SOX7过表达抑制了HUVEC的血管生成,Senkyunolide I强烈加速了血管生成,而PD-1/PD-L1 Inhibitor 3血管生成则被显著抑制,以上均有明显统计学差异(P<0.01)。结论SOX7通过ERK1/2/PD-L1通路抑制结直肠肿瘤的增殖和血管生成,SOX7可能是晚期CRC患者临床治疗中潜在的抗血管生成靶点。

机器人辅助肾移植术单中心初步经验

目的 探索机器人辅助肾移植(RAKT)的安全性、有效性及可行性。方法 收集行肾移植术的16例患者资料,其中8例采用RAKT(RAKT组),接受同一供者对侧肾脏的8例患者采用开放肾移植术(OKT组)。对比两组受者围手术期结果及移植肾功能恢复情况。结果 所有患者均成功完成手术,RAKT组无患者在术中转开放手术。RAKT组手术时间长于OKT组(P=0.015)。两组受者术前血清肌酐及出院时血清肌酐差异无统计学意义(均为P>0.05)。OKT组1例受者出现移植物功能延迟恢复(DGF),其余患者均未出现围手术期并发症。两组术后短期肾功能恢复差异无统计学意义(P>0.05)。结论 RAKT术后恢复与OKT相当,对于肾移植手术经验丰富的团队而言,RAKT是一种安全有效的手术方式,可以尝试开展。

清水江河谷南寨梯田“三生”空间时空演变及格局分析

快速城镇化背景下,山区传统梯田农业文化景观面临严重退化与可持续发展问题,厘清梯田片区“三生”空间时空格局特征及演变规律,对山区农业景观保护与开发具有现实意义。以清水江河谷南寨梯田片区为例,基于地理信息系统(GIS)空间数据,采用参与式农村评估、地形位分析和土地利用转移矩阵等方法,分析2000—2020年“三生”空间演变规律与格局特征,研究结果如下:①从数量变化来看,生产空间面积萎缩,生活与生态空间面积均扩张。②从格局演变规律来看,生产空间呈大聚集、小分散的阶梯式分布格局,且在研究区南部与东部收缩态势明显;生活空间由聚集中心向外围分散扩张;生态空间自清水江向两岸蔓延,与生产、生活空间毗邻时,呈现被生产和生活空间割裂的细碎化分布特征。③从地形分布看,生产空间分布向中高地形梯度转移,在低地形梯度上呈收缩趋势;生活空间分布向中低地形梯度转移;生态空间分布则呈现向低地形梯度集中的趋势。④从面积转移行为来看,“三生”空间之间发生了复杂的转换行为,以生产空间流出、生活空间和生态空间流入行为为主要特征。

西部地区乡村人居环境与经济协调发展时空演变及其驱动力--以广西为例

以2005年、2010年、2015年、2020年为研究时间节点,运用熵权TOPSIS模型测算广西14个地级市乡村人居环境质量与区域经济发展水平,采用耦合协调度模型测算二者耦合协调度,并利用最优参数地理探测器模型探讨乡村人居环境质量驱动因子。结果表明,2005-2020年广西乡村人居环境质量与区域经济发展水平整体上呈逐步上升的趋势,乡村人居环境高值区主要分布在桂北和桂西地区,低值区分布在桂南和桂中地区,区域经济发展水平高值区分布在桂北地区,低值区分布在桂西地区;二者耦合协调度稳步提升,但协调水平不高,协调变化呈现由单一的核心区逐步向四周辐射扩散特征;乡村人居环境的驱动力主要与农村通讯设施水平、农村人均住房面积、农田有效灌溉效率、农民人均消费水平等因素有关。

论我国生前预嘱制度构建的可行性

生前预嘱制度的推广和应用具有必要性与可行性。生前预嘱制度的构建尚需要解决订立主体的范围、订立的形式、适用对象、适用的限制等问题。首先,生前预嘱的主体应当为完全民事行为能力人,从年龄和精神两个层次判断。其次,生前预嘱的形式应当为要式,且应当为书面形式。再次,生前预嘱的适用对象应当包括永久性植物状态患者和阿尔茨海默症患者。最后,生前预嘱的适用还应当有一定的限制,其适用范围不宜过宽并且不能危害到他人合法利益或者是社会公共利益。

生前预嘱制度的适用与完善构想

2022年,深圳市出台的《深圳经济特区医疗条例》引发了关于生前预嘱的广泛讨论。生前预嘱制度作为引入概念经常与其他概念相混淆,很有必要对其进行区分和界定。目前,我国生前预嘱制度尚不完善,由于生前预嘱制度能够从伦理和法理上保障临终患者的意思自主和死亡尊严,提高处于终末期生命状态患者的生命质量。因此,我们应在借鉴国外经验的基础上对我国生前预嘱制度进行完善性的构想,推动健康中国战略的实施。