Liver dysfunction was associated with poor outcomes in patients with ST-segment elevation myocardial infarction(STEMI).However,the optimal methods for assessing the liver function was unclear.This study was to compare...Liver dysfunction was associated with poor outcomes in patients with ST-segment elevation myocardial infarction(STEMI).However,the optimal methods for assessing the liver function was unclear.This study was to compare the predictive value of the different liver function assessment tools for in-hospital and oneyear adverse events in STEMI patients undergoing percutaneous coronary intervention(PCI).Methods A total of 1157 patients with STEMI undergoing PCI were enrolled from January 2012 to December 2015.The model for end-stage liver disease excluding international normalized ratio(MELD-XI)and albumin-bilirubin(ALBI)score were calculated at admission.The discrimination and calibration of these two scores for in-hospital and oneyear adverse events were compared.Results The in-hospital mortality was 4.0%.Both MELD-XI[area under the curve(AUC)=0.768,95%confidence interval(CI):0.691-0.845,P<0.001]and ALBI score(AUC=0.682,95%CI:0.602-0.761,P<0.001)had excellent discrimination for in-hospital death.The calibration for in-hospital death was good in MELD-XI(Hosmer-Lemeshow chi-square=7.2,P=0.520),but not good in ALBI score(Hosmer-Lemeshow chi-square=13.8,P=0.087).In addition,the predictive power of MELD-XI for in-hospital death was better than ALBI score(AUC:0.768 vs.0.682,P=0.037).1108(95.8%)patients completed one-year followup.Kaplan-Meier analysis showed that patients with a high MELD-XI score had high-risk of one-year mortality(Log-rank test:54.8,P<0.001).Conclusions As the method for assessing the liver function,MELD-XI was better than ALBI score in predicting the in-hospital and one-year adverse events in STEMI patients,which could be considered as a risk assessment tool.展开更多
Accurately revealing the spatial heterogeneity in the trade-offs and synergies of land use functions(LUFs)and their driving factors is imperative for advancing sustainable land utilization and optimizing land use plan...Accurately revealing the spatial heterogeneity in the trade-offs and synergies of land use functions(LUFs)and their driving factors is imperative for advancing sustainable land utilization and optimizing land use planning.This is especially critical for ecologically vulnerable inland river basins in arid regions.However,existing methods struggle to effectively capture complex nonlinear interactions among environmental factors and their multifaceted relationships with trade-offs and synergies of LUFs,especially for the inland river basins in arid regions.Consequently,this study focused on the middle reaches of the Heihe River Basin(MHRB),an arid inland river basin in northwestern China.Using land use,socioeconomic,meteorological,and hydrological data from 2000 to 2020,we analyzed the spatiotemporal patterns of LUFs and their trade-off and synergy relationships from the perspective of production,living,ecological functions.Additionally,we employed an integrated Extreme Gradient Boosting(XGBoost)-SHapley Additive exPlanations(SHAP)framework to investigate the environmental factors influencing the spatial heterogeneity in the trade-offs and synergies of LUFs.Our findings reveal that from 2000 to 2020,the production,living,and ecological functions of land use within the MHRB exhibited an increasing trend,demonstrating a distinct spatial pattern of''high in the southwest and low in the northeast''.Significant spatial heterogeneity defined the trade-off and synergistic relationships,with trade-offs dominating human activity-intensive oasis areas,while synergies prevailed in other areas.During the study period,synergistic relationships between production and living functions and between production and ecological functions were relatively robust,whereas synergies in living-ecological functions remained weaker.Natural factors(digital elevation model(DEM),annual mean temperature,Normalized Difference Vegetation Index(NDVI),and annual precipitation)emerged as the primary factors driving the trade-offs and synergies of LUFs,followed by socioeconomic factors(population density,Gross Domestic Product(GDP),and land use intensity),while distance factors(distance to water bodies,distance to residential areas,and distance to roads)exerted minimal influence.Notably,the interactions among NDVI,annual mean temperature,DEM,and land use intensity exerted the most substantial impacts on the relationships among LUFs.This study provides novel perspectives and methodologies for unraveling the mechanisms underlying the spatial heterogeneity in the trade-offs and synergies of LUFs,offering scientific insights to inform regional land use planning and sustainable natural resource management in inland river basins in arid regions.展开更多
BACKGROUND： Donor shortage is the biggest obstacle in organ transplantation. Living donor liver transplantation（LDLT） has been considered as a valuable approach to shortening waiting time. The objectives of this st...BACKGROUND： Donor shortage is the biggest obstacle in organ transplantation. Living donor liver transplantation（LDLT） has been considered as a valuable approach to shortening waiting time. The objectives of this study were to investigate the feasibility of utilizing donors older than 50 years in LDLT and to evaluate the graft function and recipient survival.METHODS： All LDLT cases（n=159） were divided into the older（donor age ≥50 years, n=10） and younger（donor age 〈50 years,n=149） donor groups. Donor graft and recipient condition pre-,intra- and post-operation were compared between the two groups.In particular, graft functions and recipient survivals were analyzed.RESULTS： The median donor age was 58.5（52.5-60.0） years in the older donor group and 25.0（23.0-32.0） in the younger donor group. There was no significant difference in cold ischemic time, anhepatic phase and operation time between the older and younger donor groups（P〉0.05）. However, the volume of red blood cell transfused in operation was greater in the older donor group than in the younger donor group（1900 vs 1200 m L, P=0.023）. The 1-, 3- and 5-year graft survival rates were 90%, 80% and 80% for the older donor group, and 92%, 87% and 87% for the younger donor group, respectively（P=0.459）.The 1-, 3- and 5-year survival rates were 100%, 90% and 90% for recipients with older grafts, and 93%, 87% and 87% for those with younger grafts, respectively（P=0.811）.CONCLUSION： It is safe for a LDLT recipient to receive liver from donors older than 50 years, and there is no significant adverse effect on graft function and long-term patients’ survival.展开更多
BACKGROUND: Living donor liver transplantation(LDLT)has been widely accepted over the past decade, and hepatic dysfunction often occurs in the donor in the early stage after liver donation. The present study aimed to ...BACKGROUND: Living donor liver transplantation(LDLT)has been widely accepted over the past decade, and hepatic dysfunction often occurs in the donor in the early stage after liver donation. The present study aimed to evaluate the effect of intraoperative cholangiography(IOC) and parenchymal resection on liver function of donors in LDLT, and to assess the role of IOC in influencing the biliary complications and improving the overall outcome.METHODS: Data from 40 patients who had donated their right lobes for LDLT were analyzed. Total bilirubin(TB), alanine aminotransferase(ALT), aspartate aminotransferase(AST),alkaline phosphatase(ALP) and γ-glutamyl transpeptidase(GGT)at different time points were compared, and the follow-up data and the biliary complications were also analyzed.RESULTS: The ALT and AST values were significantly increased after IOC(P<0.001) and parenchymal resection(P<0.001).However, the median values of TB, ALP and GGT were not significantly influenced by IOC(P>0.05) or parenchymal resection(P>0.05). The biochemical changes caused by IOC or parenchymal resection were not correlated with the degree of post-operative liver injury or the recovery of liver function. The liver functions of the donors after operation were stable, and none of the donors suffered from biliary stenosis or leakage during the follow-up.CONCLUSIONS: IOC and parenchymal resection may induce a transient increase in liver enzymes of donors in LDLT, but do not affect the recovery of liver function after operation. Moreover,the routine IOC is helpful to clarify the division line of the hepatic duct, thus reducing the biliary complication rate.展开更多
本文以系统功能语言学为理论根据,以言语功能和互动模式为分析框架,以美国CNN电视访谈节目Larry King Live作为分析语料,考察在电视媒介下会话参与者的交流互动和意义磋商过程,目的是探讨在电视访谈中主持人及嘉宾之间存在的语言互动模...本文以系统功能语言学为理论根据,以言语功能和互动模式为分析框架,以美国CNN电视访谈节目Larry King Live作为分析语料,考察在电视媒介下会话参与者的交流互动和意义磋商过程,目的是探讨在电视访谈中主持人及嘉宾之间存在的语言互动模式。本研究表明:在我们所分析的语料中,存在3种语言互动模式:合作型、挑衅型及回避型。展开更多
目的:通过Meta分析系统性评估间歇性Theta刺激改善脑卒中患者下肢运动功能、平衡功能以及日常活动能力的效果。方法:检索Cochrane Library、Scopus、PubMed、Embase、ProQuest、Web of Science、中国知网、中国生物医学、维普和万方数据...目的:通过Meta分析系统性评估间歇性Theta刺激改善脑卒中患者下肢运动功能、平衡功能以及日常活动能力的效果。方法:检索Cochrane Library、Scopus、PubMed、Embase、ProQuest、Web of Science、中国知网、中国生物医学、维普和万方数据库,选择各数据库建库至2024年11月期间间歇性Theta刺激治疗脑卒中的随机对照试验。其中,试验组接受小脑/M1区间歇性Theta刺激,对照组进行常规康复治疗。采用RevMan 5.3和Stata 16.0进行Meta分析。结果:共纳入12篇文献,444例患者。Meta分析表明,间歇性Theta刺激有助于提高脑卒中患者下肢Fugl-Meyer量表评分[WMD=2.87,95%CI(1.77,3.98),P<0.00001]、Berg平衡量表评分[WMD=5.79,95%CI(3.80,7.79),P<0.00001]以及改良Barthel指数[WMD=6.32,95%CI(4.02,8.44),P<0.00001]。亚组分析结果显示,相较于600脉冲刺激,1200脉冲刺激更有利于改善下肢Fugl-Meyer量表评分[WMD=4.31,95%CI(2.91,5.71),P<0.00001]、Berg平衡量表评分[WMD=8.12,95%CI(5.27,10.98),P<0.00001]和改良Barthel指数[WMD=8.50,95%CI(6.55,10.45),P<0.00001]。结论:间歇性Theta刺激能够提高脑卒中患者的下肢运动能力、平衡功能及日常生活能力评分。其中,1200脉冲间歇性Theta刺激在改善下肢运动能力、平衡功能和日常生活能力方面,可能具有更大益处。展开更多
基金supported by grants from Science and Technology Projects of Guangzhou(No.201903010097)。
文摘Liver dysfunction was associated with poor outcomes in patients with ST-segment elevation myocardial infarction(STEMI).However,the optimal methods for assessing the liver function was unclear.This study was to compare the predictive value of the different liver function assessment tools for in-hospital and oneyear adverse events in STEMI patients undergoing percutaneous coronary intervention(PCI).Methods A total of 1157 patients with STEMI undergoing PCI were enrolled from January 2012 to December 2015.The model for end-stage liver disease excluding international normalized ratio(MELD-XI)and albumin-bilirubin(ALBI)score were calculated at admission.The discrimination and calibration of these two scores for in-hospital and oneyear adverse events were compared.Results The in-hospital mortality was 4.0%.Both MELD-XI[area under the curve(AUC)=0.768,95%confidence interval(CI):0.691-0.845,P<0.001]and ALBI score(AUC=0.682,95%CI:0.602-0.761,P<0.001)had excellent discrimination for in-hospital death.The calibration for in-hospital death was good in MELD-XI(Hosmer-Lemeshow chi-square=7.2,P=0.520),but not good in ALBI score(Hosmer-Lemeshow chi-square=13.8,P=0.087).In addition,the predictive power of MELD-XI for in-hospital death was better than ALBI score(AUC:0.768 vs.0.682,P=0.037).1108(95.8%)patients completed one-year followup.Kaplan-Meier analysis showed that patients with a high MELD-XI score had high-risk of one-year mortality(Log-rank test:54.8,P<0.001).Conclusions As the method for assessing the liver function,MELD-XI was better than ALBI score in predicting the in-hospital and one-year adverse events in STEMI patients,which could be considered as a risk assessment tool.
基金funded by the University Teachers Innovation Fund Project of Gansu Province(2025A-001)the Northwest Normal University Young Teachers'Scientific Research Ability Improvement Plan(NWNULKQN2024-20).
文摘Accurately revealing the spatial heterogeneity in the trade-offs and synergies of land use functions(LUFs)and their driving factors is imperative for advancing sustainable land utilization and optimizing land use planning.This is especially critical for ecologically vulnerable inland river basins in arid regions.However,existing methods struggle to effectively capture complex nonlinear interactions among environmental factors and their multifaceted relationships with trade-offs and synergies of LUFs,especially for the inland river basins in arid regions.Consequently,this study focused on the middle reaches of the Heihe River Basin(MHRB),an arid inland river basin in northwestern China.Using land use,socioeconomic,meteorological,and hydrological data from 2000 to 2020,we analyzed the spatiotemporal patterns of LUFs and their trade-off and synergy relationships from the perspective of production,living,ecological functions.Additionally,we employed an integrated Extreme Gradient Boosting(XGBoost)-SHapley Additive exPlanations(SHAP)framework to investigate the environmental factors influencing the spatial heterogeneity in the trade-offs and synergies of LUFs.Our findings reveal that from 2000 to 2020,the production,living,and ecological functions of land use within the MHRB exhibited an increasing trend,demonstrating a distinct spatial pattern of''high in the southwest and low in the northeast''.Significant spatial heterogeneity defined the trade-off and synergistic relationships,with trade-offs dominating human activity-intensive oasis areas,while synergies prevailed in other areas.During the study period,synergistic relationships between production and living functions and between production and ecological functions were relatively robust,whereas synergies in living-ecological functions remained weaker.Natural factors(digital elevation model(DEM),annual mean temperature,Normalized Difference Vegetation Index(NDVI),and annual precipitation)emerged as the primary factors driving the trade-offs and synergies of LUFs,followed by socioeconomic factors(population density,Gross Domestic Product(GDP),and land use intensity),while distance factors(distance to water bodies,distance to residential areas,and distance to roads)exerted minimal influence.Notably,the interactions among NDVI,annual mean temperature,DEM,and land use intensity exerted the most substantial impacts on the relationships among LUFs.This study provides novel perspectives and methodologies for unraveling the mechanisms underlying the spatial heterogeneity in the trade-offs and synergies of LUFs,offering scientific insights to inform regional land use planning and sustainable natural resource management in inland river basins in arid regions.
基金supported by a grant from the 863 National High-Tech Research and Development Program of China:Establishing Integrated Organ Preserving and Recovering System In Vitro as well as Evaluating and Screening Criteria of DCD donors(2012AA021001)
文摘BACKGROUND： Donor shortage is the biggest obstacle in organ transplantation. Living donor liver transplantation（LDLT） has been considered as a valuable approach to shortening waiting time. The objectives of this study were to investigate the feasibility of utilizing donors older than 50 years in LDLT and to evaluate the graft function and recipient survival.METHODS： All LDLT cases（n=159） were divided into the older（donor age ≥50 years, n=10） and younger（donor age 〈50 years,n=149） donor groups. Donor graft and recipient condition pre-,intra- and post-operation were compared between the two groups.In particular, graft functions and recipient survivals were analyzed.RESULTS： The median donor age was 58.5（52.5-60.0） years in the older donor group and 25.0（23.0-32.0） in the younger donor group. There was no significant difference in cold ischemic time, anhepatic phase and operation time between the older and younger donor groups（P〉0.05）. However, the volume of red blood cell transfused in operation was greater in the older donor group than in the younger donor group（1900 vs 1200 m L, P=0.023）. The 1-, 3- and 5-year graft survival rates were 90%, 80% and 80% for the older donor group, and 92%, 87% and 87% for the younger donor group, respectively（P=0.459）.The 1-, 3- and 5-year survival rates were 100%, 90% and 90% for recipients with older grafts, and 93%, 87% and 87% for those with younger grafts, respectively（P=0.811）.CONCLUSION： It is safe for a LDLT recipient to receive liver from donors older than 50 years, and there is no significant adverse effect on graft function and long-term patients’ survival.
基金supported by grants from the Foundation for Innovative Research Groups of the National Natural Science Foundation of China(81121002)Zhejiang Provincial Program for the Cultivation of High-Level Innovative Health Talents(2012-236)+1 种基金Zhejiang Provincial Education Department Project(Y201018972)Zhejiang Provincial Natural Science Foundation of China(LQ12H03002)
文摘BACKGROUND: Living donor liver transplantation(LDLT)has been widely accepted over the past decade, and hepatic dysfunction often occurs in the donor in the early stage after liver donation. The present study aimed to evaluate the effect of intraoperative cholangiography(IOC) and parenchymal resection on liver function of donors in LDLT, and to assess the role of IOC in influencing the biliary complications and improving the overall outcome.METHODS: Data from 40 patients who had donated their right lobes for LDLT were analyzed. Total bilirubin(TB), alanine aminotransferase(ALT), aspartate aminotransferase(AST),alkaline phosphatase(ALP) and γ-glutamyl transpeptidase(GGT)at different time points were compared, and the follow-up data and the biliary complications were also analyzed.RESULTS: The ALT and AST values were significantly increased after IOC(P<0.001) and parenchymal resection(P<0.001).However, the median values of TB, ALP and GGT were not significantly influenced by IOC(P>0.05) or parenchymal resection(P>0.05). The biochemical changes caused by IOC or parenchymal resection were not correlated with the degree of post-operative liver injury or the recovery of liver function. The liver functions of the donors after operation were stable, and none of the donors suffered from biliary stenosis or leakage during the follow-up.CONCLUSIONS: IOC and parenchymal resection may induce a transient increase in liver enzymes of donors in LDLT, but do not affect the recovery of liver function after operation. Moreover,the routine IOC is helpful to clarify the division line of the hepatic duct, thus reducing the biliary complication rate.
文摘本文以系统功能语言学为理论根据,以言语功能和互动模式为分析框架,以美国CNN电视访谈节目Larry King Live作为分析语料,考察在电视媒介下会话参与者的交流互动和意义磋商过程,目的是探讨在电视访谈中主持人及嘉宾之间存在的语言互动模式。本研究表明:在我们所分析的语料中,存在3种语言互动模式:合作型、挑衅型及回避型。
