Objective Donor-derived carbapenem-resistant Klebsiella pneumoniae(CRKP)infection has recently emerged as a critical early complication after renal transplantation.Although CRKP is usually sensitive to tigecycline,mon...Objective Donor-derived carbapenem-resistant Klebsiella pneumoniae(CRKP)infection has recently emerged as a critical early complication after renal transplantation.Although CRKP is usually sensitive to tigecycline,monotherapy with this drug is often less than effective.We investigated the efficacy of a combined regimen of tigecycline with high-dose,extended-infusion meropenem in the treatment of donor-derived CRKP infection after kidney transplantation.Methods From Jan.2016 to Dec.2017,a total of 12 CRKP isolates were detected from cultures of the organ preservation solution used for soaking the donor kidneys at our institute.Probable or possible donor-derived infection(DDI)was identified in 8 transplant recipients.Clinical data were retrospectively analyzed.Results Klebsiella pneumoniae carbapenemase-2(KPC-2)-producing CRKP was reported to be positive in organ preservation solution cultures at 3.5±0.9 days after transplantation,leading to surgical site(n=3),urinary tract(n=4),and/or bloodstream(n=2)infections in 8 recipients.The drug susceptibility tests showed that CRKP was sensitive to tigecycline,but resistant to meropenem.In 7 patients who received tigecycline combined with high-dose extended-infusion meropenem,DDIs were successfully cured.The length of hospital stay was 31(18–129)days,and the serum creatinine at discharge was 105.8±16.7µmol/L.The one remaining patient who received tigecycline combined with intravenous-drip meropenem died of septic shock.A median follow-up of 43 months(33–55)showed no recurrence of new CRKP infection in the 7 surviving recipients.Conclusion It was suggested that a prompt and appropriate combination therapy using tigecycline with high-dose extended-infusion meropenem is effective in treating donor-derived KPC-2-producing CRKP infection after renal transplantation.展开更多
目的了解人工智能(AI)技术在输血领域的发展现况。方法系统性检索Clarivate Web of Science Database数据库中AI与输血相关的文献,检索日期截止在2024年12月,共检索到4775篇文献,按纳入排除标准,最后以叙述性方法分析了133篇原创性研究...目的了解人工智能(AI)技术在输血领域的发展现况。方法系统性检索Clarivate Web of Science Database数据库中AI与输血相关的文献,检索日期截止在2024年12月,共检索到4775篇文献,按纳入排除标准,最后以叙述性方法分析了133篇原创性研究的结果。结果AI在输血中的研究自2020年开始爆发式增长(占所有发文量的77%),其中我国发文数量位居全球第二;69.2%的研究聚焦个体输血预测,其次是库存管理(8.3%)、输血不良反应诊断与预测(6.0%)、输血结局的影响因素(5.3%)、血型鉴定(5.3%)、血液质量检测(4.5%)和血液精确计量(1.5%)。4.5%的研究发表在影响因子>10分的期刊上;19.5%的研究开发了软件或应用程序;31.5%研究为多中心研究;48.1%的研究使用了决策树的方法,31.5%的研究使用了神经网络的方法;14.2%的研究进行了算法的外部验证。结论AI在输血风险预测、决策支持及血液管理等多方面展现出显著潜力。然而,模型泛化能力和算法可解释性不足及临床转化壁垒是当前面临的主要挑战。AI与输血医学的深度融合将加速精准输血时代到来,以最大化利用血液资源,减少浪费,保证输血安全。展开更多
This paper introduces a sampled-data and intermittent-hold controller for nonlinear feedforward systems.The intermittent hold allows the control signal to be held in a portion of each sampled period,which does not req...This paper introduces a sampled-data and intermittent-hold controller for nonlinear feedforward systems.The intermittent hold allows the control signal to be held in a portion of each sampled period,which does not require the control to be persistently implemented,and thus has less control time.But,less control time degrades the performance of a continuous-time control system or even destabilizes it,especially when the holding portion is sufficiently small.To tackle this obstacle,we first introduce the notion of activating rate to describe the intermittent hold,and give the sampled-data and intermittent-hold controller based on some tuning parameters.Then it is proved that for any activating rate,these parameters can be designed to achieve the stability of the considered systems under appropriately choosing the sampling size.Finally,simulation examples are given to illustrate the effectiveness of the proposed method.展开更多
基金supported by grants from Non-Profit Central Research Institute Fund of Chinese Academy of Medical Science(No.2018PT32018)Hubei Science and Technology Plan(No.2017ACA096).
文摘Objective Donor-derived carbapenem-resistant Klebsiella pneumoniae(CRKP)infection has recently emerged as a critical early complication after renal transplantation.Although CRKP is usually sensitive to tigecycline,monotherapy with this drug is often less than effective.We investigated the efficacy of a combined regimen of tigecycline with high-dose,extended-infusion meropenem in the treatment of donor-derived CRKP infection after kidney transplantation.Methods From Jan.2016 to Dec.2017,a total of 12 CRKP isolates were detected from cultures of the organ preservation solution used for soaking the donor kidneys at our institute.Probable or possible donor-derived infection(DDI)was identified in 8 transplant recipients.Clinical data were retrospectively analyzed.Results Klebsiella pneumoniae carbapenemase-2(KPC-2)-producing CRKP was reported to be positive in organ preservation solution cultures at 3.5±0.9 days after transplantation,leading to surgical site(n=3),urinary tract(n=4),and/or bloodstream(n=2)infections in 8 recipients.The drug susceptibility tests showed that CRKP was sensitive to tigecycline,but resistant to meropenem.In 7 patients who received tigecycline combined with high-dose extended-infusion meropenem,DDIs were successfully cured.The length of hospital stay was 31(18–129)days,and the serum creatinine at discharge was 105.8±16.7µmol/L.The one remaining patient who received tigecycline combined with intravenous-drip meropenem died of septic shock.A median follow-up of 43 months(33–55)showed no recurrence of new CRKP infection in the 7 surviving recipients.Conclusion It was suggested that a prompt and appropriate combination therapy using tigecycline with high-dose extended-infusion meropenem is effective in treating donor-derived KPC-2-producing CRKP infection after renal transplantation.
文摘目的了解人工智能(AI)技术在输血领域的发展现况。方法系统性检索Clarivate Web of Science Database数据库中AI与输血相关的文献,检索日期截止在2024年12月,共检索到4775篇文献,按纳入排除标准,最后以叙述性方法分析了133篇原创性研究的结果。结果AI在输血中的研究自2020年开始爆发式增长(占所有发文量的77%),其中我国发文数量位居全球第二;69.2%的研究聚焦个体输血预测,其次是库存管理(8.3%)、输血不良反应诊断与预测(6.0%)、输血结局的影响因素(5.3%)、血型鉴定(5.3%)、血液质量检测(4.5%)和血液精确计量(1.5%)。4.5%的研究发表在影响因子>10分的期刊上;19.5%的研究开发了软件或应用程序;31.5%研究为多中心研究;48.1%的研究使用了决策树的方法,31.5%的研究使用了神经网络的方法;14.2%的研究进行了算法的外部验证。结论AI在输血风险预测、决策支持及血液管理等多方面展现出显著潜力。然而,模型泛化能力和算法可解释性不足及临床转化壁垒是当前面临的主要挑战。AI与输血医学的深度融合将加速精准输血时代到来,以最大化利用血液资源,减少浪费,保证输血安全。
文摘目的通过比较不同血小板输注策略的输注疗效,探讨血小板抗体筛查及交叉配型对于免疫性血小板输注无效(platelet transfusion refractoriness,PTR)患者的应用价值。方法采用固相凝集法对临床送检血小板抗体筛查的患者进行血小板抗体检测,提取患者的临床资料如性别、年龄、疾病种类、输血记录等,计算血小板抗体筛查阳性率并分析其分布特点。以血小板输注后增量(the post-transfusion platelet increment,PPI)和血小板校正后增值(the corrected count increment,CCI)为衡量指标,分析比较血小板抗体阳性以及不同输血策略(随机输注、交叉相合、交叉不相合)对患者血小板输注疗效的影响。结果血小板抗体筛查阳性患者61例(23.55%),且多为血液系统疾病患者;其中,抗体筛查阳性组的PPI(U=18851,P=0.0720)、CCI(U=14585,P=0.0183)、血小板输注有效率(χ^(2)=5.691,P=0.017)均低于抗体筛查阴性组。61例抗体阳性患者先后共输注122次血小板,其中,交叉相合73次,交叉不相合6次,随机输注43次;交叉相合组的PPI(11 vs 4,P<0.001)、CCI(6.7 vs 0,P=0.001)中位数均明显高于随机输注组(P<0.001),且血小板输注有效率高于随机输注组(58.6%vs 24.4%,χ^(2)=12.163,P=0.001)。对于血小板抗体阳性的血液病患者,交叉相合组的PPI(13.5 vs 0,P=0.025)、CCI(9.0 vs 0,P=0.001)中位数高于随机输注组,且血小板输注有效率高于随机输注组(60.7%vs 29.2%,χ^(2)=5.175,P=0.023)。交叉不相合组与其余两组之间的差异无统计学意义。结论临床有必要常规检测血小板抗体,且为患者提供交叉配血相合的血小板可以显著提高其血小板的输注疗效。
基金supported in part by research grants from the National Natural Science Foundation of China(12201365)the Natural Science Foundation of Shandong Province(ZR2021QF106).
文摘This paper introduces a sampled-data and intermittent-hold controller for nonlinear feedforward systems.The intermittent hold allows the control signal to be held in a portion of each sampled period,which does not require the control to be persistently implemented,and thus has less control time.But,less control time degrades the performance of a continuous-time control system or even destabilizes it,especially when the holding portion is sufficiently small.To tackle this obstacle,we first introduce the notion of activating rate to describe the intermittent hold,and give the sampled-data and intermittent-hold controller based on some tuning parameters.Then it is proved that for any activating rate,these parameters can be designed to achieve the stability of the considered systems under appropriately choosing the sampling size.Finally,simulation examples are given to illustrate the effectiveness of the proposed method.
